ANAESTH, PAIN & INTENSIVE CARE; VOL 20(SUPPLEMENT) OCTOBER 2016 S91 SPECIAL ARTICLE Introduction to basic transesophageal echocardiography (TEE) and standard views Mohammad Hamid, MBBS, Diplomate American Board 1 and Mohammad Irfan Akhtar, MBBS, FCPS 2 1 Associate Professor; 2 Assistant Professor Department of Anesthesia, Aga Khan University, Karachi (Pakistan) Correspondence: Dr Mohammad Hamid, Associate Professor, Department of Anesthesia, Aga Khan University, PW II, Stadium Road, Karachi, 74800 (Pakistan); Tel: +92 21 3486 4639; Cell: +92 300 241 2205; E-mail: mohammad. hamid@aku.edu ABSTRACT Intraoperative use of transesophageal echocardiography (TEE) for monitoring and diagnostic purposes has increased over the years in cardiac surgical patients and anaesthesiologists have taken a lead to develop expertise in performing this examination. TEE has proved to be helpful in the management of non-cardiac surgical and Intensive care unit patients particularly those patients who are haemodynamically unstable. It provides important information about ventricular and valvular anatomy and its function. Certain structures which are difficult to visualize by transthoracic echocardiography can be demonstrated easily by TEE. Several guidelines have been established for performing comprehensive TEE examination and cardiologists and anaesthesiologists follow these guidelines to identify any cardiovascular abnormality. TEE use is limited to very few centres in Pakistan, mainly due to the equipment cost and lack of expertise. In addition, there are no established TEE training institutes. The main purpose of this article is to provide basic information about transesophageal echocardiography machine, TEE probe and how to obtain standard images by probe manipulation. Key words: Transesophageal Echocardiography; Intraoperative; Guidelines; Ultrasound; Echocardiography, Doppler; Doppler; Ultrasonography; Diagnosis; Diagnostic Techniques and Procedures Citation: Hamid M, Akhtar MI. Introduction to basic transesophageal echocardiography (TEE) and standard views. Anaesth Pain & Intensive Care. 2016;20 Suppl 1:S91-S96 Received: 23 May 2016; Reviewed: 30 May 2016; Corrected: 28 June 2016; Accepted: 10 July 2016 INTRODUCTION Transesophageal echocardiography (TEE) has become an essential component of cardiac anaesthesia and its value in cardiac surgery(1) is well established. In addition, it is increasingly being used for cardiac assessment and monitoring in intensive care(2) and non-cardiac surgeries(3, 4). TEE has been used to optimize perioperative care in patients with high risk for cardiac event and for quick assessment of cardiac function and fluid status in haemodynamically unstable patients. Intraoperative use of TEE was introduced in 1980 and comprehensive guidelines for intraoperative examination were published in 1999 by American Society of Echocardiography and Society of Cardiovascular Anesthesiologists(5) (ASE/SCA). A 2-D echocardiography is the most common mode used for examination along with Doppler assessment. A 3-D examination is also evolving and gaining popularity particularly during valvular repairs(6). Guidelines for 3-D echocardiography examination have also been developed(7). ACC/ AHA guidelines discourage the routine use of TEE but recommended that it can be used in emergency situations where corrective therapy for haemodynamic instability failed in non-cardiac surgery patients (Class IIa recommendation)(8). TEE provides important information about ventricular and valvular anatomy and function. Certain structures which are difficult to visualize by transthoracic echocardiography can be demonstrated easily by TEE. Main advantage of TEE is that it can be introduced even during