TEE Screening for Structural Heart Intervention

In the ASE guidelines for performing a comprehensive transesophageal echocardiographic (TEE) examination, a standard 28-view (Table 1) imaging protocol as well as specific structural imaging assessments were introduced.1 Interventional echocardiography is increasingly recognized as a subspecialty requiring advanced training for intraprocedural guidance. However, acquisition of preinterventional TEE images by a level II–trained echocardiographer is accepted standard practice. The purpose of the present document is to provide a reference guideline focused on the acquisition of essential preinterventional TEE images that would help identify (1) the mechanism of structural or valvular dysfunction, (2) the hemodynamic and anatomic severity of the disease, and (3) the specific anatomic features that allow appropriate device selection or exclusion. Intraprocedural imaging, whether by transesophageal or intracardiac echocardiography, is not covered, but rather a general approach to TEE screening of the structural target (e.g., aortic valve [AV], mitral valve [MV], or tricuspid valve [TV]; left atrial appendage [LAA]; septal defect) is described. It is not our intent to suggest that complete imaging protocols specific to each structure should be performed in all patients. Rather, protocols should be tailored to be comprehensive but focused on the abnormal structure identified and/or transcatheter intervention under consideration, thus facilitating assessment of device candidacy, procedural planning, and intraprocedural imaging guidance. NOTE: This guideline had a correction published 4/1/22 – Erratum https://doi.org/10.1016/j.echo.2022.01.011