**8.1. Two-dimensional echocardiography**

Image optimization is particularly important in IE to ensure early diagnosis and accurate identification of complications. Despite advances in TTE imaging quality, TEE still provides superior diagnostic capability. A TEE probe is in close proximity to the heart, with minimal intervening tissues and therefore less attenuation of the ultrasound waves. This allows the use of a higher frequency (5–7.5 MHz) transducer and provides superior spatial resolution.

The same principles of image optimization apply to both TTE and TEE. To obtain superior spatial resolution, select the highest frequency transducer that will maintain adequate depth penetration. Position the focal zone adjacent to the region of interest and adjust depth and sector width to optimize spatial and temporal resolution [47, 121]. Gain, time gain compensation (TGC), and dynamic compression of the gray scale are adjusted to optimize image contrast, while zoom function in real time improves spatial and temporal resolution [122].
