For those starting out with TOE, The Alfred ICU has produced a document outlining each of the standard views for a complete TOE exam in the critically ill patient (TOE Standard views 2014). Emphasis is always on systematically examining each element of the cardiac structure and function where possible.

This strategy incorporates:

If the patient is unstable, the scan should “go for the money”, with the examination order focused on identifying key pathologies quickly. An initial overview in the midoesophageal 4 chamber view is handy to quickly focus on gross pathology. The busy intensive care environment also provides frequent distractions which can potentially limit the completeness of the study, so following a structured exam sequence is important. This is just one example of such.

When distractions have been frequent, a simple approach to ensure a complete study is to confirm prior to removing the probe that each of the following have been adequately assessed:

  • Valves – all four
  • Biatrial and biventricular size and function
  • Great vessels
    • Inflow (IVC, SVC and pulmonary veins)
    • outflow (pulmonary artery and Aorta)
  • Surrounds (pericardium and pleura)


See more after the jump..


This guide uses stills taken from the 3D Heartworks simulator model used by The Alfred ICU and on the Transoesophageal Echocardiography (TOE) Course. You can access a limited online version at: Heartworks: Introduction to Transesophageal Echocardiography ($$ for their online course but signup for a free 72 hour trial – set aside a weekend and learn in depth)

Another excellent free online resource to check out is the outstanding Virtual Transesophageal Echocardiography simulator from the Toronto General Hospital Department of Anesthesia and Pain Management.

The Alfred Transoesophageal Echocardiography (TOE) Course returns in less than a month. If you weren’t one of the lucky few to get in, don’t worry. The next course is early next year (26 March 2015) and you can make your booking now.

First Published on INTENSIVE 9/11/14 by Tom Rozen


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