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TEE views
In this chapter we will review the 11 views you will be expected to recognize for the OSCEs. To fully understand the cuts made by the planes generated by the probe we encourage you to use the 3D heart companion to this page that you can access here. Explore the companion TEE views with pathology in this link.
Mid Esophageal 4 Chamber View
To obtain this view the TEE probe is advanced to the
mid-esophagus behind the LA.
The sector depth should be 14cm and omniplane of 0-10°. The omniplane on this view is at 38 degrees
RA LA
TV AMVL PMVL
IS AL
RV LV
Here we visualize: Left Atrium (LA), Right Atrium (RA), Left Ventricle (LV) [inferoseptal (IS) + anterolateral (AL) walls], Right Ventricle (RV), Mitral Valve [anterior(AMVL), posterior (PMVL) leaflets], Tricuspid Valve [Septal (STVL), Anterior (ATVL) leaflets]
Mid Esophageal 2 Chamber View
To obtain this view, from ME 4 chamber omniplane to 90°
LA
PMVL AMVL
Inferior Anterior
LV
Here we visualize: Left Atrium (LA), Left Ventricle (LV) [Anterior and Inferior walls], Mitral Valve [anterior(AMVL), posterior (PMVL) leaflets], coronary sinus (CS).
Mid Esophageal Long Axis
To obtain this view, from ME 4 chamber omniplane to
120-130°
LA
PMVL AMVL
LVOT AV
Inferolat
Antero sept
LV
Here we visualize: Left Atrium (LA), Left Ventricle (LV)[anteroseptal and inferolateral walls], Mitral Valve [anterior (AMVL), posterior (PMVL) leaflets], Aortic Valve (AV), Left Ventricular outflow tract (LVOT).
Mid Esophageal Ascending Aorta Short Axis
To obtain this view from the ME Ascending Aorta Long axis omniplane to 0 degrees.
RPA
SVC
Ao
MPA
Here we visualize: Main Pulmonary Artery (PA), Right Pulmonary Artery (RPA), Ascending Aorta in short axis (Ao) and Superior Vena Cava (SVC).
Trans Gastric Mid Pappillary Short Axis
To obtain this view, from the ME 4c view advance the probe to the stomach then anteflex to contact stomach wall and inferior wall of heart.
Inf
Inf sept Inf lat
Ant sept Ant Lat
Ant
Here we visualize: LV [ Mid anterior, mid inferior, mid anteroseptal, mid inferoseptal, mid anterolateral, mid inferolateral walls], anterolateral and posteromedial papillary muscles, Right Ventricle.
Mid Esophageal RV inflow outflow
To obtain this view from the ME 4c omniplane to 60 to 70 degrees.
On the first clip we see a stuck left coronary cusp.
Here we visualize: Aortic Valve (AV), Tricuspid Valve (anterior/septal and posterior leaflet ), Left Atrium (LA), Right Atrium (RA), Pulmonic Valve (PV), Right ventricular outflow tract (RVOT).
LA
IAS
RA
TV PV
Mid Esophageal Aortic Valve Short Axis
To obtain this view, from the ME RV inflow outflow view, center on the Aortic Valve.
We see limited excursion of the aortic valve cusps suggestive of aortic stenosis on this clip.
Here we visualize: Aortic Valve (AV)[Non coronary cusp NCC, Left coronary cusp LCC and Right coronary cusp, RCC], Tricuspid Valve (anterior/septal and posterior leaflet ), Left Atrium (LA), Right Atrium (RA), Pulmonic Valve (PV), Right ventricular outflow tract (RVOT).
LCC
NCC
RCC
Mid Esophageal Bicaval
To obtain this view from the ME 2 chamber view rotate the probe right until the IVC and SVC can be seen.
LA
IAS
IVC
SVC
CT
Here we visualize: Left Atrium (LA), Right Atrium (RA), Inferior Vena Cava (IVC), Superior Vena Cava (SVC), Inter-atrial septum (IAS), Crista Terminalis (CT).
Mid Esophageal Descending Aorta Long and Short Axis
To obtain this view from the ME 2 chamber view rotate the left to find the aorta. The long axis view will be seen orthogonal to this.
Here we can appreciate the short axis of the descending aorta (clip 1) while clip 2 is its long axis appearance. They display high degree of calcification within the lumen.
1
2
References
1. Hahn R and all. Guidelines for Performing a Comprehensive Transesophageal Echocardiographic Examination: Recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 2013;26:921-64