Normal Values of TEE

Reference values for normal adult TEE measurements

Reference values for normal adult TEE measurements

Parameter		Mean ± SD (mm)	Range (mm)
	Right pulmonary artery diametera	17 ± 3	12-22
	Left upper pulmonary vein diameter	11 ± 2	7-16
Left atrial appendage	Length	28 ± 5	15-43
	Diameter	16 ± 5	10-28
	Superior vena cava diameter	15 ± 3	8-20
	Right ventricular outflow tract diameterb	27 ± 4	16-36
Left atriumc	Anteroposterior diameter	38 ± 6	20-52
	Medial-lateral diameter	39 ± 7	24-52
Right atriumc	Anteroposterior diameter	38 ± 5	28-52
	Medial-lateral diameter	38 ± 6	29-53
	Tricuspid annular diameterc	28 ± 5	20-40
	Mitral annular diameterc	29 ± 4	20-38
	Coronary sinus diameter	6.6 ± 1.5	4-10
Left ventricled	Anteroposterior diameter (diastole)	43 ± 7	33-55
	Medial-lateral diameter (diastole)	42 ± 7	23-54
	Anteroposterior diameter (systole)	28 ± 6	18-40
	Medial-lateral diameter (systole)	27 ± 6	18-42
	Aortic root diameterb	28 ± 3	21-34
Descending thoracic aorta diameter	Proximal	21 ± 4	14-30
	Distal	20 ± 4	13-28
aRight pulmonary artery diameter measured in midesophageal ascending aorta short-axis view. bAortic root and right ventricular outflow tract diameters measured in the midesophageal right ventricular inflow/outflow tract view. cAtrial (end-systole) and both mitral and tricuspid annular (mid-diastole) diameters measured in the midesophageal four-chamber view. dLeft ventricular dimensions measured in transgastric mid short-axis view. SD, standard deviation. Adapted from Cohen G, White M, Sochowski R, et al. Reference values for normal transesophageal measurements. J Am Soc Echocardiogr 1995;8:221-230.

Transesophageal Echocardiographic Anatomy

Transesophageal Echocardiographic Anatomy

ME two-chamber	Probe adjustment: neutral	Sector depth: ~14 cm
image	Primary diagnostic issues LA appendage Mass/thrombus LV apex pathology LV systolic dysfunction (apical segments)	Required structures LA appendage Mitral valve LV apex (i.e., maximal LV length)
ME LAX	Probe adjustment: neutral	Sector depth: ~12 cm
image	Primary diagnostic issues Mitral valve pathology LVOT pathology	Required structures LV Mitral valve LVOT
ME mitral commissural	Probe adjustment: neutral	Sector depth: ~12 cm
image	Primary diagnostic issues Localization of mitral valve pathology	Required structures Mitral valve (P1, P3 and A2 scallops) Papillary muscles/chordae tendineae LA LV
TG mid-SAX	Probe adjustment: neutral	Sector depth: ~12 cm
image	Primary diagnostic issues Hemodynamic instability LV enlargement LV hypertrophy LV systolic dysfunction (global and regional)	Required structures LV cavity LV walls (at least 50% of circumference with visible endocardium) Papillary muscles (approximately equal in size and distinct from ventricular wall)
TG two-chamber	Probe adjustment: neutral	Sector depth: ~12 cm
image	Primary diagnostic issues LV systolic dysfunction (anterior and inferior basal segments)	Required structures Mitral leaflets Mitral subvalvular apparatus LV (anterior and inferior: basal plus mild segments)
TG RV inflow	Probe adjustment: neutral-rightward	Sector depth: ~12 cm
image	Primary diagnostic issues RV systolic dysfunction Tricuspid valve pathology	Required structures Tricuspid leaflets Tricuspid subvalvular apparatus
TG RV inflow-outflow	Probe adjustment: neutral-rightward	Sector depth: ~14 cm
image	Primary diagnostic issues RV systolic dysfunction RVOT pathology Pulmonary artery pathology Pulmonic valve evaluation	Required structures RA RV Main pulmonary artery Pulmonic valve
TG basal SAX	Probe adjustment: neutral	Sector depth: ~12 cm
image	Primary diagnostic issues LV systolic dysfunction (basal segments) Mitral valve pathology	Required structures Mitral leaflets Mitral subvalvular apparatus LV (basal segments)
TG LAX	Probe adjustment: neutral-leftward	Sector depth: ~12 cm
image	Primary diagnostic issues LV systolic dysfunction (anteroseptal and posterior: basal segments) Doppler evaluation of aortic valve	Required structures Mitral leaflets Mitral subvalvular apparatus LV (anteroseptal and posterior: basal plus midsegments) Aortic valve
Deep TG LAX	Probe adjustment: neutral	Sector depth: ~16 cm
image	Primary diagnostic issues Aortic valve pathology LVOT pathology Doppler evaluation of aortic valve	Required structures LV Aortic valve Aorta
ME, midesophageal; Asc, ascending; SAX, short axis; LAX, long axis; UE, upper esophageal; Desc, descending; AV, aortic valve; RV, right ventricular; LVOT, left ventricular outflow tract; RA, right atrium; LA, left atrium; LV, left ventricular; RVOT, right ventricular outflow tract; TG, transgastric. Modified from Miller JP, Lambert SA, Shapiro WA, et al. The adequacy of basic intraoperative transesophageal echocardiography performed by experienced anesthesiologist. Anesth Analg 2001;92:1103–1110, with permission.

Positions of measurements

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