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transesophageal echocardiography (TEE)

Indications: 1) visualization of heart valves* a) rule out endocarditis - 1st line test in patient with high likelihood of endocarditis b) prosthetic valve dysfunction 2) aortic disease 3) left atrial thrombus [3] * sensitivity of TEE is far greater than transthoracic echocardiography (TTE) for visualizing heart valves - TEE can detect vegetations as small as 1.0-1.5 mm - TTE can detect vegetations as small as 2-3 mm [2] Advantages: 1) high-quality images, especially of posterior cardiac structures 2) most accurate test for evaluation of: a) endocarditis b) prosthetic heart valves c) left atrial thrombus [3] 3) excellent imaging of aorta from aortic root to descending thoracic aorta Disadvantages: - requires esophageal intubation, typically with conscious sedation [3]

General

echocardiography endoscopic ultrasound; endosonography (EUS)

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 128
  2. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  3. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2016