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Non-invasive imaging
Transoesophageal echocardiography: what the general cardiologist needs to know
  1. Malgorzata Wamil1,
  2. James D Newton1,
  3. Bushra S Rana2,
  4. Sacha Bull3
  1. 1Oxford Heart Centre, Oxford Universities NHS Foundation Trust, Oxford, UK
  2. 2Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK
  3. 3Department of Cardiology, Royal Berkshire Hospitals NHS Foundation Trust, Reading, UK
  1. Correspondence to Dr Sacha Bull, Department of Cardiology, Royal Berkshire Hospitals NHS Foundation Trust, Craven Road, Reading RG1 5AN, UK; sacha.bull{at}

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Learning objectives

  • To understand the indications for transoesophageal echocardiography (TOE) in clinical practice

  • To appreciate the risks and diagnostic pitfalls of TOE in clinical practice

  • To appreciate when three-dimensional TOE provides added diagnostic value in clinical practice.


Transoesophageal echocardiography (TOE) is an invaluable technique in clinical practice providing immediate, accurate and cost-effective cardiac diagnostics at the bedside at low risk.1 Recent advances have been driven primarily by improvements in TOE transducer technology. An important innovation, the ‘game changer’, has been the introduction of three-dimensional (3D) TOE transducers that are increasingly used in clinical practice. The last decade has seen the rapid expansion of non-coronary structural interventions and has changed the TOE case load of the general cardiologist. Familiarity with percutaneous structural procedures and potential complications is now essential. In this article, we aim to provide a brief overview for the general cardiologist of the main uses of TOE in the clinical routine, emergency, intensive care and interventional setting and to outline future developments in the field.

TOE probe technology

Frazin published the first case report using a primitive TOE probe (single M-mode crystal probe attached to a rigid endoscope) in 1976.2 Introduction of a flexible endoscope, reduction in transducer size, development of multiplane probes enabling two-dimensional (2D), colour, spectral and tissue Doppler acquisition led to the birth of the present day 5–7.5 MHz TOE probe with excellent spatial and temporal resolution. Current technology allows 3D imaging, both real-time 3D (RT3D) and multiple-beat 3D (MB3D) imaging. RT3D acquires data continuously; with MB3D, several data sets over many heartbeats are acquired offering higher temporal and spatial resolution than RT3D. Stitch artefact may arise to due movement and irregular heartbeat with MB3D.3

TOE standards, indications, patient preparation and image acquisition

The European Association of Echocardiography (EAE) and the British Society of Echocardiography (BSE) set standards for the quality of echocardiography service provided by the …

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  • Contributors MW contributed substantially to the conception of the paper structure and writing the main first draft. SB revised the initial draft substantially for intellectual content. JDN assisted with revisions of the subsequent draft and contributed the figures for the paper. BSR contributed by revising the drafts critically for important intellectual content, and she contributed some figures.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.