Table 7. Recommendations for transesophageal echocardiography as a diagnostic tool^9,45 .

Recommendations	Recommendation class	Evidence level
Confirmation or exclusion of a relevant clinical diagnostic suspicion not observable using TTE	I	A
Insufficient anatomic and hemodynamic information using TEE, primarily in children with chest deformities or obesity and in adults with congenital heart disease	I	A
Assessment of PFO as a possible etiology of central or peripheral embolic events in young patients (< 60 years), with agitated saline contrast to determine the possibility of right-left flow. To assess PFO risk factors for stroke/TIA: interatrial septum aneurysm, passage of > 30 microbubbles from right atrium to left atrium, PFO tunnel > 10 mm, and prominent Eustachian valve	I	A
Assessment of PFO before placement of a transvenous pacemaker	I	A
Classification, dimensions, and location of atrial septal defect, primarily in adult patients and those with poor transthoracic definition for selection of possible candidates for percutaneous occlusion and choice of occlusion device.	I	A
Assessment of aortic dissection in Marfan, Ehlers-Danlos, and Turner syndromes and in aortic coarctation	I	A
Assessment of the aorta in the Takayasu's Arteritis	I	A
Assessment of the intra or extra-cardiac tubes during the postoperative period after Senning, Mustard, or Fontan procedures	I	A
Assessment of thrombi, masses, vegetations, abscesses, and prostheses	I	A
For determination of the degree and mechanisms of mitral valve reflux to aid in surgical or percutaneous repair (Mitraclip)	I	B

PFO: patent foramen ovale; TEE: transesophageal echocardiogram; TIA: transient ischemic attack; TTE: transthoracic echocardiogram.