By Catherine M. Otto MD
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Additional resources for Practice of Clinical Echocardiography, Third Edition
Other structures seen well in this view are the left atrial appendage and the left pulmonary veins. The partition between these structures can be quite bulbous and should not be confused LA Ao 9 with an abnormal intracardiac mass16 (see Fig. 1–5). Rotating the probe to the right should reveal the right pulmonary veins. The horizontal plane is useful in imaging the four pulmonary veins. The left and right pulmonary veins are imaged separately. 17 When one pulmonary vein is identiﬁed, a slight translational movement of the probe should bring out the other because the oriﬁces of the upper and lower pulmonary veins are in close proximity.
Extreme anterior ﬂexion with further advancement of the probe can sometimes produce images similar to the ﬁve-chamber views obtained from the subxiphoid surface approach. Figure 1–9. Transgastric transesophageal echocardiography approach to assess the severity of aortic stenosis using continuous wave Doppler echocardiography. Left Ventricle Multiple cross sections of the left ventricle can usually be obtained using the transgastric approach (see Figs. 1–1C and 1–8). 24 Optimization of the short-axis views of the left ventricle can be achieved with leftward rotation accompanied by leftward ﬂexion.
79 TTE can adequately visualize most aortic valve abnormalities, and only rarely is TEE required. 80 The severity of AS is best quantiﬁed using transvalvular pressure gradients or valve area derived by TTE (see Chapter 23). Continuous wave Doppler interrogation of the aortic valve is possible by TEE using the transgastric long-axis view (100 to 135 degrees) or deep transgastric long-axis view (0 degrees) (see Fig. 1–13). 27 Anatomic aortic valve area can be measured on TEE by planimetry of the maximum systolic oriﬁce area in the esophageal short-axis (30 to 60 degree) view.
Practice of Clinical Echocardiography, Third Edition by Catherine M. Otto MD