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Transesophageal echocardiography (TEE) is a relatively recent development in imaging. In 1997 the American College of Cardiology (ACC) and the American Heart Association (AHA) published guidelines for the clinical application of echocardiography. Routine intraoperative use of TEE has been shown to lead to an improvement in both surgical and anesthetic management, which presumably is translated into better and more consistent outcomes for patients. The use of TEE as a diagnostic tool in the echo lab, and as a diagnostic and monitoring tool during and after cardiac or other major operations, has increased significantly. In Europe, the problem of training and accreditation in perioperative TEE has been addressed, during the last decade, by the European Association of Echocardiography (EAE), which is a formal association of the European Society of Cardiology (ESC), and the European Association of Cardiothoracic Anaesthesiologists (EACTA).
The tricuspid valve (TV) apparatus consists of three leaflets: a large anterior leaflet, a septal leaflet, and a smaller posterior leaflet. Tricuspid stenosis (TS) is a relatively uncommon valvular lesion in North America and Western Europe. Unlike TS, tricuspid regurgitation (TR) is common and can be primary or secondary to annular dilation. Right-sided valvular heart disease occurs frequently in patients with carcinoid syndrome, but left-sided involvement, pericardial effusion, and myocardial metastases may also occur. The pulmonary valve (PV) is a trileaflet semilunar valve with an anterior, a left, and a right leaflet, and is similar to the aortic valve in basic structure and function. The pulmonary artery (PA) trunk is approximatively 4-5 cm long and 2-3 cm wide in normal adults. Severe pulmonary regurgitation (PR) is usually caused by dilation of the PA and PV annulus, for example as a result of acute or chronic pulmonary hypertension.
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