Transesophageal echocardiography

Morphological and/or Doppler symptoms of prosthetic stenosis (reduced opening/mobility of cusps/discs and increased flow velocity)

Morphological and Doppler symptoms of prosthetic regurgitation with the mapping of the regurgitation site (transvalvular, para-ring); prosthetic instability

Morphological changes in the prosthesis: calcifications, immobilization, rupture or perforation of biological prosthesis cusps; absence of mechanical valve occluder

The presence of additional structures (vegetations, thrombi, pannus, sutures, fibrin threads, abscesses, pseudoaneurysm, fistula)

Mitral valve morphology (short-axis transgastric view, mid transesophageal views); regurgitation mechanism; location of regurgitation orifice; cusp/cusp segment prolapse; morphology/function of papillary muscles and heart strings; vegetations, paravalvular leak

Color Doppler mapping of the regurgitation jet (width, inflow convergence area)

Reverse flow in the left or right upper pulmonary vein (eccentric regurgitation jet)

Cardiac apex, aneurysm (transgastric views, mid transesophageal two-chamber view)

Aortic and mitral valve (vegetations, degenerative lesions, tumors, e.g. fibroelastoma)

Ascending and descending aorta, aortic arch

Left atrial appendage (flow and spontaneous contrast-enhancement)

Left atrium (spontaneous contrast-enhancement)

Atrial septum (the foramen ovale, persistent foramen ovale, septal aneurysm; contrast-enhanced echo, Valsalva maneuver)

Short-axis ascending aorta in different views (maximum width, dissected membrane, hematoma, periaortic fluid)

Long- and short-axis descending aorta in different views (maximum width, dissected membrane, hematoma, periaortic fluid)

Aortic arch (maximum width, dissected membrane, hematoma, periaortic fluid)

Aortic regurgitation (mechanism, the size of aortic ring and aorta; the number of cusps)

Location of the dissected membrane relative to coronary artery orifices

Pericardial sac and pleural fluid

The site of dissection inlet and outlet

Spontaneous contrast-enhancement, clots in the pseudo-canal (differentiation between pseudo-canal and a real canal)

Mitral valve in multiple views

Aortic valve in long- and short-axis-view, perivalvular tissue (short axis; search for abscesses)

Tricuspid valve (transgastric views; low transesophageal view; right-ventricular inflow-outflow view – high transesophageal view)

Electrodes, catheters, prosthetic vessels, Eustachian valve, the Chiari network, pulmonary valve