Use of a mini 3D transesophageal echocardiogram (TEE) probe in adult patients for outpatient TEE: initial experience in a national tertiary hospital
Authors: Ramirez B P , Obillos-Laforteza S M , Magno J D , Ramirez-Ragasa R , Uy C C 
Published: January 2025

Abstract

Background
The mini 3D TEE probe, initially developed for pediatric patients, is now being utilized for adult patients due to its smaller size and clear 2D & 3-dimensional imaging and Doppler studies, potentially limiting anesthesia use and procedural complications.

Purpose
This study aimed to analyze the clinical profiles and outcomes of adult patients who underwent an outpatient TEE using a mini 3D TEE probe, including image quality and ease of use. Proper evaluation is vital for patient safety, and this initial study aims to determine the mini 3D TEE probe's applicability and safety in adults, potentially guiding future clinical practice.

Methods
This was a retrospective cross-sectional, and observational study. Medical records were reviewed, including demographic and clinical profiles, echocardiographic data, and procedural and safety outcomes. For each patient, two operators rated ease of use and all imaging modalities on a 5-point scale, from 1 (very difficult/poor) to 5 (very easy/good).

Results
Eight adult patients were included in the study to undergo a comprehensive TEE using a mini 3D TEE probe. Most patients were female (63%) with a median age of 28.5 years (IQR 5.13), with valvular heart diseases (38%), congenital heart diseases (38%), and heart failure (50%). Most patients had an ASA Physical Classification of Class II (38%) or III (38%). Indications for TEE were primarily suspected congenital heart disease with inadequate transthoracic echo (63%) and pre-intervention evaluation of valvular structures (63%). The probe insertion was rated very easy (100%), and handling was mostly very easy (87.5%). 2D, 3D, 2D color, continuous, and pulsed wave Dopplers were rated very good (100%), with 87.5% rating 3D color flow Doppler as very good. All patients received local pharyngeal anesthesia, with only half of the patients given low-dose intravenous midazolam. The median procedure time for a full study was 40 minutes (IQR 17). After the procedure, all patients were fully awake and recovered (median recovery time 4.5 minutes, IQR 1.88), with only minor post-TEE complications like pharyngeal irritation (13%) and hoarseness (13%). No major morbidities, GI bleeding, esophageal perforation, arrhythmia, respiratory compromise, or mortality occurred. All patients were discharged after recovery with a median outpatient length of stay of 47 minutes (IQR 15.25).

Conclusion
The mini 3D TEE probe demonstrates ease of use and excellent imaging quality for adult patients across all imaging modalities. It is safe to use and can be performed with local pharyngeal anesthesia alone or with mild intravenous sedation, with no significant post-procedural complications. This study supports the mini 3D TEE probe's applicability and safety in adult patients, suggesting its potential for broader clinical application in cardiovascular diagnostics. A larger scale prospective study is recommended to further confirm these preliminary findings.