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function.",{"id":215,"name":216},1,"Course previews",[218,229,234],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},298,{"platform":223,"name":224,"url":225,"size":226},"YouTube","How to use TEE to obain mid-esophageal four-chamber views.","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=TCmVNTkkBVc",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},17.066666666666666,"\u003Cp>In this video by \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fteacher\u002Fandrew-r-houghton-md\">Andrew Houghton\u003C\u002Fa>, MD, you will learn how to use TEE to obtain the mid-esophageal four-chamber view to assess regional and global right ventricular function, measure RV size and tricuspid annulus diameter, and assess the tricuspid valve leaflets.\u003C\u002Fp>\u003Cp>Want to stand out among your peers? Learning TEE will help you do that!\u003C\u002Fp>\u003Cp>This video was taken from our \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Ftransesophageal-echocardiography-essentials\">TEE Essentials course\u003C\u002Fa>. Register for a free trial and \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Ftransesophageal-echocardiography-essentials\">check it out!\u003C\u002Fa>\u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},139.46666666666667,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-e198d952-7fff-7064-c1ec-d33d64d12672\">[00:00:00] \u003C\u002Fb>In this lesson, we're going to learn how to obtain the mid-esophageal four-chamber view of the right heart, which shows us the right atrium, the tricuspid valve, and the right ventricle. This view is obtained with the transesophageal echo probe in the mid-esophageal position, pointing anteriorly, so we obtain the cut through the right heart. I'd suggest starting with a transducer imaging plane angle of 0 \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-e198d952-7fff-7064-c1ec-d33d64d12672\">[00:00:30] \u003C\u002Fb>degrees, however, a little bit of optimization may be necessary to avoid any foreshortening of the chambers. Normally, an optimal view will be obtained somewhere between 0 and 20 degrees. To begin with, the mid-esophageal four-chamber view will look something like this. We have an imaging plane angle of 0 degrees and we are seeing the left atrium, mitral valve, and left ventricle. And then we have the right atrium, tricuspid valve, and right ventricle. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-e198d952-7fff-7064-c1ec-d33d64d12672\">[00:01:00] \u003C\u002Fb>And ideally, we would like to center the right heart a little more towards the middle of the image sector. So, what we do is we turn the TEE probe towards the patient's right and this sweeps across the heart and helps to center the right heart in the middle of the sector. And so, this is the view that we end up with. We can see now that the right heart is a little more centered in the middle of the sector. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-e198d952-7fff-7064-c1ec-d33d64d12672\">[00:01:30] \u003C\u002Fb>And in this view, we can look at the size and anatomy of the right atrium. We can look for any right atrial masses. We can also look at the size of the right ventricle. We can look at this visually in comparison to the left ventricle, and normally, the right ventricle is no more than two-thirds of the size of the left ventricle. We can also quantify the right ventricular dimensions and we'll show you where to take these linear measurements, in just a moment. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-e198d952-7fff-7064-c1ec-d33d64d12672\">[00:02:00] \u003C\u002Fb>In addition, we can look at the tricuspid valve. And then before chamber view, we can see two of the three tricuspid leaflets. This is the septal leaflet, here and then over here, we have either the anterior or posterior tricuspid valve leaflets, depending upon how deeply down the esophagus we have advanced the probe. In order to quantify the size of the right ventricle, we should measure its internal diameter \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-e198d952-7fff-7064-c1ec-d33d64d12672\">[00:02:30] \u003C\u002Fb>at the base point of the right ventricle and also at its midpoint and we should make this measurement in end-diastole. So, this is where the measurements are made, at the base of the right ventricle and also at the midpoint of the right ventricle and we should time these measurements in the cardiac cycle, using the ECG trace so that they are made at the end of diastole. If the diastolic diameter at the base is greater than 42 mm or \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-e198d952-7fff-7064-c1ec-d33d64d12672\">[00:03:00] \u003C\u002Fb>a mid-level is greater than 35 mm, then this indicates right ventricular dilatation. We should also measure the tricuspid annulus, between the hinge points of its leaflets, at both end-systole and end-diastole. This is a useful measurement for cardiothoracic surgeons, in planning tricuspid valve repair. And this is where we make that measurement, this is the tricuspid annulus diameter, \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-e198d952-7fff-7064-c1ec-d33d64d12672\">[00:03:30] \u003C\u002Fb>measured between the hinge points, of the leaflets at end-diastole. Again, we use the ECG trace to time that. And here's the same measurement, between the hinge points, made at end-systole. Finally, we should undertake a Doppler assessment flow, through the tricuspid valve, in the mid-esophageal four-chamber view. We should begin by applying color Doppler to have a look at flow patterns \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-e198d952-7fff-7064-c1ec-d33d64d12672\">[00:04:00] \u003C\u002Fb>and here we can see this yellowy red jet of tricuspid regurgitation through the valve. This is a relatively small and mild jet of regurgitation. And if the alignment is appropriate, we can perform continuous wave Doppler of flow, through the tricuspid valve, to obtain a spectral Doppler trace, like this. And we can measure the peak velocity of a tricuspid regurgitant jet, \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-e198d952-7fff-7064-c1ec-d33d64d12672\">[00:04:30] \u003C\u002Fb>to assist in the estimation of pulmonary artery systolic pressure.\u003C\u002Fp>",{"courses":240,"showAwardsBelow":48},[241],{"id":242,"isFreeCmeCourse":243,"title":244,"type":245,"specialization":246,"teachers":248,"cmeCredits":250,"teacherIllustration":251,"backgroundImage":252,"relativeUrl":253,"lastChanged":254,"created":255,"description":256,"relativeURL":253,"meta":257},2718,false,"Transesophageal Echocardiography Essentials","course",[247],"Ultrasound",[249],"Andrew R. Houghton, MD FRCP",6,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ea9-9720-419f-ac2a-594a1d7b4d51","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55eaa-a071-40d0-8222-24710a5316b0","\u002Fcourses\u002Ftransesophageal-echocardiography-essentials","1763556396","1462447422","Targeted towards cardiologists in training, internists, anesthesiologists, emergency physicians, cardiac physiologists, and cardiac sonographers this course teaches you everything you need to know about performing a standard TEE exam. You’ll learn when a TEE should be ordered and what needs to be done to ensure the safety of your patient during the process. You’ll also learn how to obtain the standard views and how the standard views can be modified to obtain some of the more atypical views.",{"duration":258,"quizzes":259,"lessons":260},14769,10,65,{"id":262,"name":249,"image":263,"profession":264,"relativeUrl":267,"specializations":268},1590,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef8-716d-4d30-99af-035d10a4581d",{"name":265,"description":266},"Cardiologist","Cardiologist and cardiac imaging specialist at the United Lincolnshire Teaching Hospitals NHS Trust in the UK.","\u002Fteachers\u002Fandrew-r-houghton-md-frcp",[269,247,270,271],"Imaging","Cardiology","Infectious diseases",164,"3m",[275,303,321],{"id":276,"title":277,"text":278,"image":279,"author":287,"path":296,"readDuration":297,"readDurationFormatted":298,"internal":299},1351,"Starting statins as first-line therapy for hyperlipidemia","Starting statins: how to choose the right agent for your patient, match statin intensity to cardiovascular risk, and monitor effectively after initiation.",{"alt":280,"title":281,"size":282,"location":284},"Healthcare provider discussing starting statins with a patient and reviewing a medication bottle","",{"width":283,"height":283},660,{"bucket":285,"key":286},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC121(2)_magazine image.png",{"id":288,"title":289,"relativeURL":290,"image":291,"professionLong":292,"profession":293,"weight":295},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":294},"Internist",4,"\u002Fmagazine\u002Fstarting-statins-first-line-therapy",238,"4m",{"created":300,"updated":301,"published":302},1778960150,1779196374,1778961827,{"id":304,"title":305,"text":306,"image":307,"author":313,"path":315,"readDuration":316,"readDurationFormatted":273,"internal":317},1350,"How to recognize INOCA (ANOCA) on an exercise stress test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":308,"title":281,"size":309,"location":311},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).",{"width":310,"height":310},1200,{"bucket":285,"key":312},"\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":288,"title":289,"relativeURL":290,"image":291,"professionLong":292,"profession":314,"weight":295},{"name":294},"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,{"created":318,"updated":319,"published":320},1778115738,1778799792,1778118255,{"id":322,"title":323,"text":324,"image":325,"author":331,"path":333,"readDuration":334,"readDurationFormatted":335,"internal":336},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":326,"title":281,"size":327,"location":329},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":328,"height":328},600,{"bucket":285,"key":330},"\u002F2026-04\u002FC121_magazine image.png",{"id":288,"title":289,"relativeURL":290,"image":291,"professionLong":292,"profession":332,"weight":295},{"name":294},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":337,"updated":338,"published":339},1777403036,1777572381,1777412421,{"seo":341,"og":343},{"title":342,"description":213},"Using TEE to get the mid-esophageal four-chamber views  | Medmastery",{"title":342,"description":213,"image":344},{"alt":281,"title":281,"size":345,"location":348},{"width":346,"height":347},799,448,{"bucket":285,"key":349},"\u002Fmigrated-images\u002FScreen Shot 2017-10-24 at 12.36.22 PM.png",{"id":351,"created":352,"updated":353,"published":352},154,1508844007,1753108855]