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2011-09-07 12:56:06

TEE views
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  1. 1
    Deep TG Long axis view - 'Deep TG LAX'

    • This view provides an excellent four chamber perspective, and good
    • views of the aortic valve. It is tricky to obtain but may provide valuable
    • information.
  2. 2
    You can view the aorta in long axis by rotating the biplane or multiplane probe through ninety degrees - 'DESC Aorta LAX'
  3. 3
    Descending Aorta

    • It is easy to imagine the circular image of the descending aorta seen in short axis view when the TEE probe is inserted to about 40cm and turned slightly left.
    • Here it is - 'DESC Aorta SAX':
    • Two chamber view (LA, LV, MV) - 'ME 2 Chamber'
    • The left ventricular cavity and mitral valve are well seen. "Fine tuning" by careful probe movement can be used to demonstrate the papillary muscles and details of the mitral valve leaflets. (Inferior papillary muscle on your left, anterior on the right).
  4. Four chamber view (ME 4 Chamber)

    You can see all four chambers clearly! Three of the chambers are labelled (RA, LA, RV) - but the left ventricle is also clearly identifiable. You can also clearly delineate the mitral valve (mv), tricuspid (tv) and lateral wall of the left ventricle (lw).

    Obtaining the view

    • This view is usually obtained with the probe 35-37 cm from the incisor teeth. Note that good views of the mitral valve are obtained, and the interatrial septum is also well seen, but the apex of the left ventricle
    • is usually not well seen, precluding assessment of ventricular function.
  5. 'ME Asc Aortic LAX':
  6. Main pulmonary artery (with RPA) - 'ME Asc Aortic SAX'

    These views are of the main pulmonary artery at the level of its bifurcation. See how the origin of the right pulmonary artery is visible (rpa), but note the position of the left main bronchus (lmb) in the image - even if you move cephalad and rotate the probe, to try and visualise the left pulmonary artery, it will be obscured by this bronchus!
  7. Long axis ascending aorta - 'ME AV LAX'

    The aortic root is seen in long axis. Gentle repositioning of theprobe will also demonstrate the aortic leaflets in profile.
  8. Short axis basal (Aortic Valve, RVOT, atrial septum) 'ME AV SAX'

    • The following view is really rather important, mainly because it contains an unmistakable landmark - the 'Mercedes-Benz sign'of the aortic valve in cross section (av). Posterior to this valve (and close to the probe) you can see the left atrium, to the
    • patient's right (your left) is the right atrium, and ventrally is the right ventricular outflow tract.
  9. SVC, atrial septal long axis - 'ME bicaval'

    In these images, the superior vena cava (svc) is on the right and inferior vena cava on your left as you view them. This is the so-called "bicaval view"! At the top of the screen near the probe is the left atrium. Adjacent to the left atrium (on your right) you can see the right pulmonary artery.
  10. ME Long axis - 'ME LAX'

    The following view is sub-optimal, as the view of the ventricle is somewhat oblique, and the aortic valve isn't well seen
  11. ME Mitral Commissural
  12. Right-ventricular inflow/outflow (ME RV Inflow/Outflow)

    In the following image, the RV inflow and outflow can be seen
  13. Two chamber view (LA, LV, MV) - 'TG 2 Chamber'

    The anterior mitral leaflet (aml) is well seen, as well as the left ventricular and atrial chambers. The inferobasal portion of the left ventricle is particularly well seen in this view - perhaps the major justification for this particular part of the TEE examination! (The inferobasal part is that part of the LV in the upper portion of the image, close to the probe).
  14. The LV short axis mitral view (TG Basal SAX)

    The anterior leaflet of the mitral valve (aml) is clearly seen between the left ventricular outflow tract (lvot) and the mitral valve orifice (mvo).
  15. Long axis view (LA, LV, MV, Ao) - 'TG LAX'

    The anatomical section shows the LV cavity, left ventricular outflow tract (lvot), and anterior leaflet of the mitral valve (aml) rather well.
  16. The LV short axis view at the level of the papillary muscles (TG Mid SAX)
  17. TG RV Inflow
  18. UE Aortic arch LAX

    • It's easy to see that despite the plane of the probe being 0o, we will visualise the arch as an oblong structure
    • - we are effectively visualising the "long axis" of the arch - 'Aortic Arch LAX'.
    • Note that as we move more proximally, the trachea becomes interposed, and we lose the arch and vessels coming off it.
  19. UE Aortic arch SAX

    • rotate the probe to 90o to obtain another view
    • of the arch
  20. 2 chamber heart view vascular
  21. 4 chamber view vascular
  22. Long Axis view vasculature
  23. Mid short axis view vasc
    • 2 basal anterior
    • 6 basal septal
    • 8 Mid anterior
    • 11 mid infer
    • 13 apical anterior
    • 15 apical infer
    • 3 bas lat
    • 6 bas sept
    • 9 mid lat
    • 12 mid sept
    • 14 apic later
    • 16 apical sept
    • all basal
    • 1 ant sept
    • 2 ant
    • 3 lat
    • 4 post
    • 5 inf
    • 6 sept
    • 1 basal anteroseptal
    • 4 basal post
    • 7 mid anteroseptal
    • 10 mid post
    • all mid
    • 7 ant sept
    • 8 ant
    • 9 lat
    • 10 post
    • 11 inf
    • 12 sept