Transoesophageal echocardiogram note template
The study reported structure by structure.
- Indication
- Endocarditis workup, left atrial appendage assessment before cardioversion, or structural assessment before a procedure.
- Procedure
- Probe insertion and the sedation used.
- Findings
- Left ventricle, right ventricle, atria and appendages, mitral valve, aortic valve, tricuspid and pulmonary valves, aorta, pericardium.
- Complications
- Oesophageal or pharyngeal injury, sedation or airway events, and arrhythmia, each with its management.
- Impression
- The findings that matter, with severity.
- Plan
- Surgical or medical management, further imaging, anticoagulation and follow-up.
Worked examples
TOE · before cardioversion Hill, Barbara · 70F · Synthetic patient
Indication Atrial fibrillation of uncertain duration, appendage assessment before direct current cardioversion. Procedure Probe passed without difficulty under midazolam and fentanyl sedation. Findings Left ventricle normal in size with preserved systolic function. Right ventricle normal. No thrombus in the left atrial appendage, appendage emptying velocity 45 cm/s. Mild mitral regurgitation. Aortic valve trileaflet and normal. Tricuspid and pulmonary valves normal. Aorta with mild atheroma. No pericardial effusion. Complications Nil. Impression No intracardiac thrombus. Low-risk appendage velocities. Plan Proceed to cardioversion today. Continue anticoagulation for at least 4 weeks after cardioversion.
TOE · endocarditis workup Young, Nathan · 39M · Synthetic patient
Indication Three positive blood cultures for viridans streptococci, transthoracic study inconclusive. Procedure Probe passed on the second attempt. Propofol sedation, anaesthetist present. Tolerated well. Findings LV normal size, LVEF 55%. RV normal. Atria normal, no appendage thrombus. Mitral valve normal. Aortic valve with a 9 mm mobile vegetation on the non-coronary cusp and moderate regurgitation. Tricuspid and pulmonary valves normal. Aorta normal. Trace pericardial effusion. Complications Transient desaturation to 88% during sedation, corrected with jaw thrust and supplemental O2. No oesophageal injury. Impression Aortic valve endocarditis with a mobile vegetation and moderate regurgitation. Plan IV benzylpenicillin; duration per ID once the MIC is back. Cardiothoracic surgical review today. Repeat TOE in 1 week, sooner if haemodynamics change.
TOE · structural assessment before intervention Clarke, Shirley · 78F · Synthetic patient
Indication Severe mitral regurgitation, anatomical assessment before transcatheter edge-to-edge repair. Procedure Probe passed without difficulty under general anaesthesia in the catheter laboratory. Three-dimensional acquisition of the mitral valve. Findings LV dilated, LVEF 40%. RV normal. Left atrium severely dilated, no appendage thrombus. Mitral valve with a flail posterior leaflet segment and severe eccentric regurgitation, flail gap 6 mm, flail width 9 mm, MVA 4.6 cm², mean gradient 2 mmHg. Aortic valve normal. Tricuspid regurgitation moderate. Aorta normal. No pericardial effusion. Complications Nil. Impression Severe degenerative mitral regurgitation with anatomy suitable for edge-to-edge repair. Plan Proceed at the same sitting. Repeat study after device deployment to confirm gradient and residual regurgitation.
