New Guidelines from ASE Set Standards to Perform Transesophageal Echocardiographic Screening for Structural Heart Interventions

New guidelines published this year by the American Society of Echocardiography (ASE), Standards for the Performance of Transesophageal Echocardiographic Screening for Structural Heart Intervention, provide a unique teaching resource for interventional cardiologists, a growing group of heart specialists who perform echocardiography.  

As cardiologists provide an increasing number of structural heart interventions, imaging guidance obtained before and during procedures becomes of utmost importance. Accordingly, interventional echocardiography is being recognized as a subspecialty requiring advanced training for guidance during various procedures.

The new Guidelines elucidate and standardize how to acquire essential pre-interventional transesophageal echocardiographic images to help accurately identify the mechanisms of structural/valvular dysfunction, the hemodynamic as well as anatomic severity of the disease, and specific anatomic features to inform decision-making about appropriate device selection or exclusion. 

These peer-reviewed Guidelines, created by 14 international echocardiographers who are experts in this emerging field, have been endorsed by 25 American Society of Echocardiography International Alliance Partners and were published in the January 2022 issue of the Journal of the American Society of Echocardiography

“The Guidelines were written specifically for cardiologists who perform pre-procedural TEE imaging and this imaging serves as the foundation of structural heart disease procedural planning,” said co-author of the guidelines Lucy Safi, D.O., FACC, FASE, director of Interventional Echocardiography, Hackensack Meridian Hackensack University Medical Center.

“The structured imaging protocols and extensive figures and tables in the new Guidelines show concrete and practical examples of the protocols used in transesophageal echocardiography screening, and they should benefit all echocardiographers involved in the care of structural heart disease patients,” said David B. Landers, M.D., FACC, FSCAI, interim director, Heart and Vascular Hospital; executive director, Cardiovascular Partners, Hackensack University Medical Center and assistant professor of Cardiology, Hackensack Meridian Health School of Medicine.

A transesophageal echocardiogram (TEE) uses echocardiography to assess the heart’s structure and function. A TEE is done by inserting a probe with a transducer at its tip down the esophagus and behind the heart.  This provides clear images of the heart because the sound waves do not have to pass through skin, muscle, or bone tissue. During the procedure, the transducer sends out ultrasound waves.   These ultrasound waves travel through the body, reflect off the heart tissues,  then back to the transducer which acts as a computer that processes the information and displays the images of the heart walls and valves.   

“The American Society of Echocardiography (ASE) has been an early adopter of the concept that Interventional Echocardiography is a new subspecialty in the field of cardiology.  As with other developing clinical imaging needs, ASE has taken the lead on defining the training and competencies required for Interventional Echocardiography. The new Guidelines are the first step to standardizing the education around this exciting new field,” added Dr. Landers.

The new Guideline and all ASE Guideline documents are also available online at  For more information:

In its 2022-23 Best Hospitals Report, U.S. News & World Report ranked Hackensack University as #43 in the nation in Cardiology & Heart Surgery, the highest ranking medical center in the state in these specialties.  For information about Hackensack Meridian Health’s cardiovascular services, visit  For information about Hackensack Meridian School of Medicine, visit