A transthoracic echocardiogram (TTE) is the most common type of echocardiogram, which is a still or moving image of the internal parts of the heart using ultrasound. In this case, the probe (or ultrasonic transducer) is placed on the chest or abdomen of the subject to get various views of the heart. It is used as a non-invasive assessment of the overall health of the heart, including a patient's heart valves and degree of heart muscle contraction (an indicator of the ejection fraction). The images are displayed on a monitor for real-time viewing and then recorded. Often abbreviated "TTE", it can be easily confused with transesophageal echocardiography which is abbreviated "TEE". Pronunciation of "TTE" and "TEE" are similar, and full use of "transthoracic" or "transesophageal" can minimize any verbal miscommunication. Details A TTE is a clinical tool to evaluate the structure and function of the heart. All four chambers and all four valves can be assessed by TTE, but the quality and visibility of these structures varies from person to person. Other structures visible on TTE include the aorta, the pericardium, pleural effusions, ascites, and inferior vena cava. It can be used to diagnose a heart attack, enlargement/hypertrophy of the heart, infiltration of the heart from an abnormal substance (e.g. amyloidosis). Weakness of the heart, and cardiac tumors. With advanced measurements of the movement of the tissue with time (Tissue Doppler), it can measure diastolic function, fluid status, and ventricular dyssynchrony. TTE in adults is also of limited use for the structures at the back of the heart, such as the left atrial appendage. Transesophageal echocardiography may be more accurate than TTE because it excludes the variables previously mentioned and allows closer visualization of common sites for vegetations and other abnormalities. Transesophageal Echocardiography also affords better visualization of prosthetic heart valves and clots within the four chambers of the heart. This type of Echocardiogram may be a better option for patients with thick chests, abnormal chest walls, chronic obstructive pulmonary disease and the obese. However, transthoracic is often superior to transesophageal for visualization of the apex of the left ventricle (e.g., left ventricular thrombus) and for visualization of the ventricular size of mechanical valves. "Bubble contrast TTE" involves the injection of agitated saline into a vein, followed by an Echocardiographic study. The bubbles are initially detected in the right atrium and right ventricle. If bubbles appear in the left heart,