Biplane and multiplane transesophageal echocardiography: methodology and echo-anatomic correlations

Transesophageal echocardiography (TEE) is one of the most significant developments in cardiology and cardiac imaging in the last decade. While monoplane TEE clearly showed the advantages of imaging from the esophagus, biplane TEE was the next important step forward. The combination of transverse and longitudinal axis images served to provide incremental information about various cardiac pathologies. Multiplane TEE is a further advancement that allows continuous visualization of cardiac anatomy by electronic or manual steering of the ultrasound beam through 180 degrees. The intermediate views obtained by beam steering provides an unlimited perspective of normal and abnormal cardiac anatomy. This ability to view cardiac structures in multiple planes aids the understanding of the spatial arrangement of normal cardiac structures and complex disorders of cardiac anatomy. Multiplane TEE technology also eases the examination by reducing the need for probe manipulation. The ability to obtain multiplane images in a sequential manner lays the foundation for three-dimensional imaging of the heart. Ongoing developments in transducer technology should further strengthen the clinical role of TEE.