Learning intra-operative transesophageal echo can be a daunting task. Luckily, there are great online resources to help visualize the anatomy and learn the views really well. Below are three of best resources out there at this time--a website with multiple animations you can get lost in for hours, a quick 1/2 hour video, and a simple website summarizing most of the key facts you need to know for intra-op TEE.


1. Toronto General Hospital Department of Anesthesia and Pain Management Virtual Transesophageal Echocardiography website

 

What: Comprehensive website of basic views, pathology, a virtual TEE simulator, study notes, and quizzes.

Rating: 5 out of 5 stars

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This website has almost everything you need to learn intra-operative TEE. The “TEE 20 Standard Views” application allows you to manipulate a 3D heart to understand each view.  This application also lists the structures seen and the pathologies that can be assessed  in each view.  The “Alternative TEE Views” application goes one step further and includes non-standard, but often used views.

This website has an incredible amount of information to really learn the details of TEE and correlate images with physiology and pathology. The “Assessment of Cardiac Valves” is just one example of how this website does an excellent job linking together the pathophysiology with the information obtained from TEE images.  There is a TEE simulator, quizzes, and study notes on the website as well.


Pros:

  • Can manipulate images yourself: On the 3D heart, you can twist it around and can even see a cross sectional view correlating to the TEE view.  In the TEE simulator, you virtually control the TEE probe to obtain images.
  • List of views: The apps have a pulldown menu listing views, so you can jump to the one of interest.
  • Apps in Apple store: Some of the applications are available for the iPad, so you can learn on the go.
  • Reviews pathology: This website has video loops and explanations of many different pathologies.
  • Supplemental study materials: There are study notes and quizzes to help you retain key facts and concepts.

Cons:

  •  No labels: As great as the applications are, the structures in the echo images are not labeled.  If you don’t already have a good understanding of cardiac anatomy in echo images, a supplemental resource (such as #3 below) could be helpful.


2.  TEE Imaging Planes and Orientation

 

What: YouTube video reviewing many of the views obtained during an intra-operative TEE exam

Length: 35 minutes, 51 seconds

Rating: 4 out of 5 stars



This video starts off with a review of imaging planes, position of TEE probe relative to the heart, and orientation of images before diving into an explanation of each view obtained during a comprehensive intra-operative exam.



Pros:

  • Very clear TEE views: These are not video clips of non-ideal exams obtained in real patients.  The images are crisp and the anatomy is easy to identify.  There is no need to squint to decipher cardiac structures. This is great for a beginner.

  • Spinning 3D heart: For each of the views, there is a spinning 3D heart cut where the TEE imaging plane is in the heart.  Conceptually, this is super helpful.

Cons:

  • No labels: The images are super crisp, but lack any labels.  The narrative does some explaining, but unless you already know the anatomy, you probably need a supplemental source.  Good thing the perfect supplement exists (see #3 below).

  • Longer than your average lunch break: This may or may not be a con for you.  The intro is good, but if you are looking to get right into the TEE views, start watching at 9:15.



3. Basic TEE Examination and Views

 

What: A website with illustrations and descriptions of the views obtained during an intra-operative TEE exam.

Rating: 5 out of 5 stars



This website is structured as a course.  However, the link above is the most useful page.  This one page has explanations of each view, including how to obtain the view, imaged structures, and diagnoses that can be made in each view.  For each view, there are three accompanying illustrations: an echo, a cartoon, and the imaging plane going through a 3D heart.


Pros:

  • Excellent illustrations:  The combinations of a 3D image of the heart  showing the imaged plane and an actual echo image and a cartoon rendering of the image are incredibly useful.  And the echo images are labeled, making it a good supplement for the above two resources.

  • Useful lists: The lists accompanying each view (“Images Structures” and “Diagnostic Issues) are a succinct reminder of how useful each view can be.

  • Helpful hints: Each view has a description of how to obtain said view.

  • Anatomical Pitfalls: At the bottom of the page are a few examples of how normal anatomy can be mistaken for pathology.   

Cons:

  • Scrolling:  If you want to go to a particular view, there is no link to take you directly to it.  You’ll have to scroll down the page or use the “find” function.