Transesophageal echocardiographic views

Transesophageal echocardiographic views

Transesophageal echocardiographic views: American society of echocardiography has described several standard views for transesophageal echocardiography. The views are obtained from the upper and mid esophagus as well as from the stomach (transgastric views).

Upper esophageal views

These views are obtained with the probe about 20-25 cm from the incisors.
Aortic arch long axis view is obtained with the probe in short axis plane (0°).  Even though the probe is in 0°, the arch is visualised as an oblong structure, which is the long axis of the arch. Left brachiocephalic vein can also be seen in this view. As the probe is withdrawn proximally, trachea comes in between and the view of the arch vessels is lost.
Aortic arch short axis is obtained with the probe imaging plane at 90°. Aortic arch, pulmonary artery, pulmonary valve and the left brachiocephalic vein are the structures which may be imaged in this view.

Mid esophageal views

Mid esophageal views are obtained at 30-40 cm from the incisors.
Four-chamber view is obtained with the probe at 0°-20°. The structures visualised are the left ventricle, left atrium, right ventricle, right atrium, mitral valve, tricuspid valve and the interatrial and interventricular septa.
Mitral commissural view is obtained with the probe at 60°-70°. Mitral valve, left ventricle and left atrium can be imaged in this view.
Two-chamber view has the probe angle at 80°-100°.  The short form for the view is ‘ME 2 Chamber’. Left ventricle, left atrium, left atrial appendage, mitral valve and coronary sinus can be seen in this view.
Long axis view is imaged at 120°-160° and the short form is ‘ME LAX’. Left ventricle, left atrium, aortic valve, left ventricular outflow tract, mitral valve and ascending aortic can be visualized in this view. This is a suboptimal view as the ventricle is obliquely seen and the aortic valve is not seen well.
RV inflow-outflow view is imaged at 60°-90°, which shows the right ventricle, right atrium, tricuspid valve, right ventricular outflow tract, pulmonary valve and pulmonary artery.
AV short axis view is obtained with the probe angle at 30°-60°.  The short form for this view is ‘ME AV SAX’. It can visualise the aortic valve, interatrial septum, coronary ostia, left ventricular outflow tract and the pulmonary valve. The unmistakable landmark in this view is the aortic valve seen in cross section like a ‘Mercedes-Benz’ sign.
AV long axis view has the probe angle at 120°-160°. The view is known in short form as ‘ME AV LAX’. Aortic valve, left ventricular outflow tract, proximal ascending aorta and right pulmonary artery are seen in this view.
Bicaval view is obtained with the probe angle at 80°-110°. This is a long axis view of the atrial septum and superior vena cava. In addition, the right atrium, left atrium, inferior vena cava and a section of the right pulmonary artery can be visualised.
Ascending aortic short axis view has the probe angle at 0°-60°. Short form of the view is ‘ME Asc Aortic SAX’. It can image the superior vena cava, main pulmonary artery and right pulmonary artery in addition. The left main bronchus interferes with the imaging of the left pulmonary artery, which cannot be visualised.
Ascending aortic long axis view is obtained with the probe angle at 100°-150°. The view is known in short as ‘ME Asc Aortic LAX’. This view also visualised the the right pulmonary artery.
Descending aorta short axis view has the probe angle at 0°. The short form of the view is ‘DESC Aorta SAX’. The view images the descending thoracic aorta.
Descending aorta long axis view is seen with probe angle at 90°-110°. The view is known in short as ‘DESC Aorta LAX’ and visualises the descending thoracic aorta.

Transgastric views

These views are obtained with probe at 40-45 cm from the incisors.
Basal short axis view imaged at 0°-20° probe angle is also known as ‘TG Basal SAX’. The view images the left ventricle, mitral valve, right ventricle and the tricuspid valve. The anterior mitral leaflet, left ventricular outflow tract and the mitral orifice are seen in this view.
Mid short axis view obtained with probe angle of 0°-20° is known in short as ‘TG Mid SAX’. The left ventricle is seen in cross section along with the interventricular septum, right ventricle and the papillary muscles. The inferior, posterior and anterior walls of the left ventricle are seen in this view. To obtain this view, after the probe is passed beyond the gastroesophageal junction, slight anteflexion of the probe is needed to get mucosal contact.
Two-chamber view is imaged with 80°-100° probe angle. The view is also known as ‘TG 2 Chamber’. The anterior mitral leaflet is seen well in this view also. Other structures imaged are the left ventricle, chordae tendineae, papillary muscles, coronary sinus and the left atrium.
Long axis view has the probe angle at 90°-120°. It is also termed the ‘TG LAX’ view. It visualises the anterior mitral leaflet with the adjacent left ventricular outflow tract and the aortic valve.
RV inflow view is obtained with a probe angle of  100°-120° and images the right ventricle, tricuspid valve, right atrium, chordae and papillary muscles of the tricuspid valve.

Deep transgastric views

These views are obtained with probe at 45-50 cm from the incisor teeth.
Long axis view is image with the probe angle at 0°-20° with anteflexion. This view images the left ventricular outflow tract, aortic valve, ascending aorta and the arch. Obtaining the view is a little uncomfortable for the awake patient. The view is known is short as ‘Deep TG LAX’.