Multiplane Transesophageal Echocardiography: Image Orientation, Examination Technique, Anatomic Correlations, and Clinical Applications

Multiplane transesophageal echocardiography (TEE) consists of a single ultrasound array or imaging sector that can be rotated around the long axis of the ultrasound beam typically in a 180° arc. This capability produces a circular (conical) continuum of tomographic two-dimensional images. The principal advantage of multiplane TEE is that the transducer can be rotated to an image-specific orientation and critically optimized. Thus, manipulation of the transducer is less complex than with the biplane technique, and user adaptation is considerably enhanced. The logical image notation (that is, degrees of rotation) and orientation are described in this report. A step-by-step approach to the multiplane TEE examination, which evolved from our initial experience with 400 consecutive patients, is correlated with accompanying tomographic anatomic corroboration. The unique clinical applications are discussed and related to the amplification of diagnostic information. Although the multiplanar TEE transducer is relatively large, all adult patients who weigh 40 kg or more can be examined. No major complications occurred in our initial experience with this promising new technology.