| Aortic Valve Views |
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| Because the aortic valve lies close to the esophagus, high quality scans of the aortic valve are possible. The aortic valve lies in an oblique plane from the esophageal plane so longitudinal plane rotation is required to view the valve's long or short axis. The ASC/SCA standard views of the aortic valve are the midesophageal aortic valve short axis (ME AVSAX), the midesophageal aortic valve long axis (ME AVLAX), the transgastric aortic valve long axis (TG AVLAX), and the deep transgastric aortic valve long axis (DT AVLAX). These views allow for the 2D, Color Doppler, M Mode, Pulse Doppler, and Continuous Doppler interrogation of the aortic valve. |
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| Midesophageal Aortic Valve Short Axis (ME AVSAX) View |
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| To obtain the midesophageal aortic valve long axis view, insert the transesophageal probe to 20-30 cm and rotate the electronic plane to 30-60 degrees. Minor manipulation should being into view the classic short axis of the aortic valve which contains the "Mercedes Benz" or inverted "Y" structure. In this view the three aortic valve cusps are seen in their short axis. The right, left, and non-coronary cusps are thin, mobile, and completely open during the ejection phase. Minor manipulation of the probe can reveal the right coronary artery and the left main coronary artery. The sinuses of valsalva are similar in size and shape and a small gap occurs between the aortic valve cusps and the wall of the sinuses of valsalva during the ejection phase. During diastole, the cusps contact and overlap their edges from the 12 o'clock, 4 o'clock, and 8 o'clock bases to the center of the valve. At the center of each leaflet edge, a small node, the Nodule of Arantii, can be seen, especially if it is calcified. |
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| TEE Scan Plane
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| Occasionally the anatomical structures of the midesophageal aortic valve short axis view and the midesophageal right ventricular inflow-outflow view are present in the same view. When the two different views occur in the same plane, the left atrium, right atrium, tricuspid valve long axis, right ventricular free wall, pulmonary valve long axis, and pulmonary artery long axis are present. Usually the two views occur in slightly different planes and the corresponding anatomical structures may be missing or displayed with an oblique cut. |
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| ME AVSAX (Normal) Image |
ME AVSAX (normal) VIdeo |
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| Midesophageal Aortic Valve Long Axis (ME AVLAX) View |
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| The midesophageal aortic valve long axis view is found at the 120-160 degree longitudinal plane in the midesophageal acoustic window. The midesophageal aortic valve long axis view contains the left ventricular outflow tract, aortic valve, sinuses of valsalva, sinotubular junction, and an initial portion of the ascending aorta. Also present is the right ventricle and the left atrium. The transverse sinus is sometimes easily visualized. The right and left coronary cusps are present in this view. The sinuses of valsalva are similar in size. The 2D measurements of the LVOT, aortic annulus, sinotubular junction, sinus of valsalva diameter, and sinus of valsalva height can be performed during mid systole. Color flow Doppler can be used to indicate the presence or absence of aortic regurgitation or aortic/sub-aortic stenosis. The anterior leaflet of the mitral valve (A1,A2,A3 scallops) can be seen to contact or nearly contact the anteroseptal wall of the left ventricle. |
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| TEE Scan Plane |
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| Transgastric Aortic Valve Long Axis (TG AVLAX) View |
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| The transgastric aortic long axis view is obtained by inserting the probe to 40-50 cm and changing the longitudinal plane to 110-130 degrees from a standard middle transgastric left ventricular short axis view. The transgastric long axis view contains the long axis of the aortic valve, left ventricular outflow tract, and the aortic root that is parallel to the ultrasound beam. The transgastric aortic valve long axis view contains the left atrium, left ventricle, anterior mitral valve leaflet, left ventricular outflow tract, aortic valve, sinuses of valsalva and, sometimes, the sinotubular junction. Since the aortic valve is in the ultrasound scan's far field, resolution is degraded. This view is usually used for color, pulse, and continuous wave doppler interrogation of the aortic valve. This view is usually, but not always, obtainable for an acceptable Doppler profile. Air in the stomach may make visualization of this view difficult. Evacuation of the gastric air with a gastric tube may improve visualization. |
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| TEE Scan Plane |
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| TG AVLAX (Normal) Image |
TG AVLAX (normal) VIdeo |
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Deep Transgastric Aortic Valve Long Axis (DTG AVLAX) View |
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| The deep transgastric aortic valve long axis view is obtained by inserting the transesophageal probe to 50-60 cm into the distal stomach and the probe is anteflexed about 30 degrees. Anteflexing the probe can be quite uncomfortable in an awake patient. The longitudinal plane should remain at 0 to 30 degrees. The deep transgastric aortic valve long axis view contains the aortic root, aortic valve, left ventricular outflow tract, left ventricle, right ventricle, left atrium, mitral valve, and the right atrium. Sometimes, the membranous interventricular septum is visible. This view is ideal for Doppler interrogation of the aortic valve because of the parallel alignment to the ultrasound beam. This view is usually obtainable. The ability to obtain this view improves with practice.
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| TEE Scan Plane |
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| DTG AVLAX (Normal) Image |
DTG AVLAX (normal) VIdeo |
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