From the Guidelines
The best views in Transesophageal Echocardiography (TEE) to assess valvular deformity include the mid-esophageal short-axis view and mid-esophageal long-axis view for the aortic valve, mid-esophageal views for the mitral valve, and mid-esophageal 4-chamber view for the tricuspid valve, as recommended by the 2012 European Heart Journal study 1.
Valvular Deformity Assessment Views
To assess valvular deformity, the following TEE views are recommended:
- For the aortic valve: 60° mid-esophageal short-axis view with and without color, and 120° mid-esophageal long-axis view with and without color 1.
- For the mitral valve: 0° to 120° mid-esophageal views with and without color 1.
- For the tricuspid valve: 0° to 30° mid-esophageal 4-chamber view with and without color 1.
- For the pulmonic valve, although not explicitly mentioned in the provided study, deep transgastric views and upper esophageal views are generally considered helpful.
Importance of Multiple Views
These specific views are crucial because they provide perpendicular imaging planes to the valvular structures, allowing accurate assessment of leaflet morphology, calcification, vegetations, and other structural abnormalities. Comprehensive valve assessment requires multiple views at different angles to overcome limitations of any single view and to fully characterize the three-dimensional nature of valvular pathology. The 2012 study 1 emphasizes the importance of standardized protocols for image acquisition and display using three-dimensional echocardiography, which includes the use of these recommended views for valvular assessment.
From the Research
Best Views in Transesophageal Echo for Valvular Deformity
To assess valvular deformity using Transesophageal Echocardiography (TEE), several views can be utilized, each providing unique insights into the heart's structure and function. The choice of view depends on the specific valve being examined and the nature of the suspected deformity.
- Low Transesophageal View: This view is obtained by advancing the probe approximately 30 cm from the teeth. It is useful for visualizing the left ventricle, left atrium, and the mitral valve 2.
- Mid Transesophageal View: Similar to the low transesophageal view, the probe is advanced about 30 cm from the teeth. This view is also beneficial for examining the mitral valve and the left heart chambers 2.
- High Transesophageal View: The probe is advanced approximately 25-30 cm from the teeth. This view is particularly useful for visualizing the aortic valve, the aortic arch, and the pulmonary valve 2, 3.
- Transgastric Subcardiac View: By advancing the probe approximately 35-40 cm from the teeth, this view provides an excellent perspective on the left ventricle and the mitral valve from below 2.
- Transgastric Five-Chamber View: This view is achieved by advancing the probe deeper than in the subcardiac view and with a stronger anterior flexion. It offers a comprehensive view of the left ventricle, left atrium, right ventricle, right atrium, and the aortic root 2.
- Upper Esophageal Aortic Arch Short Axis (UE AA SAX) View: This view is particularly useful for imaging the right ventricular assist devices and can provide valuable information on the aortic arch and its branches 4.
Considerations for Valvular Deformity Assessment
When assessing valvular deformity, it's crucial to consider the patient's overall cardiac anatomy and the specific characteristics of the valve in question. The use of TEE allows for high-resolution imaging of the heart valves from multiple angles, which can be critical in diagnosing and planning the treatment of valvular diseases.
- Aortic Valve: The high transesophageal view and the UE AA SAX view can be particularly useful for assessing the aortic valve 2, 4.
- Mitral Valve: The low, mid transesophageal, and transgastric subcardiac views are beneficial for examining the mitral valve 2.
- Pulmonary Valve: The feasibility of imaging the pulmonary valve using the transesophageal echocardiographic upper esophageal view has been demonstrated, with better visualization in patients with thicker pulmonary valves 3.
These views and considerations highlight the versatility and diagnostic capability of TEE in evaluating valvular deformities, making it a valuable tool in cardiac assessment 2, 4, 3.