Using TEE to get mid-esophageal long-axis aortic root views

This video, taken from our TEE Essentials course, will show you how to obtain a mid-esophageal long-axis view of the aortic root using TEE, how to take measurements, and relevant normal ranges.

Taught by Andrew Houghton, MD, head of cardiac imaging at Grantham & District Hospital, this course will give you an enormous career boost.

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[00:00:00] In this lesson, we're going to learn how to assess the aorta in the mid-esophageal long-axis aortic root view. In this view, we can see the aortic root towards the right-hand side of the screen. We can see the aortic valve, and the aortic root at the level of the aortic cannulas, sinus of Valsalva, sinotubular junction, and the proximal tubular ascending aorta. Other nearby structures include

[00:00:30] the left atrium, the mitral valve, anterior leaflet, and posterior leaflet for left ventricle and a portion of the right ventricle. This view is obtained in the mid-esophageal probe position with the probe facing anteriorly to cut through the aortic valve and aortic root. I'd suggest starting with transducer imaging plane angle of 140 degrees. As always, some fine-tuning of the angle might be necessary to optimize

[00:01:00] the image and avoid foreshortening. The optimal long-axis aortic root view is usually found somewhere between 120 and 140 degrees. And this is the view that we're looking for. This has been obtained with transducer imaging plane angle of 136 degrees. We can see the aortic valve very clearly, in the middle of the image. We have the non-coronary cusp in the near field and the right coronary cusp in the far field,

[00:01:30] and we can see the aortic root. We should inspect the anatomy of the root carefully to look for any evidence of atheroma, any dilatation, and we'll show you in a moment, how to quantify that. We should also look for any absence of dissection flaps, and also any evidence of supravalvular aortic stenosis. In this view, it might also be possible, sometimes, to see the ostium of the right coronary artery as it arises

[00:02:00] from the sinus of Valsalva. As well as describing the appearance of the aortic root, we should also quantitate its dimensions by measuring its internal diameter in mid-diastole, and we do so at several levels. And the first diameter measurement that we make is at the aortic valve annulus level, where the normal diameter is between 2.0 and 3.1 cm. Next, we should measure the diameter at the level of the sinuses of Valsalva. The normal range here is between 2.4 and 4.0 cm.

[00:02:30] Next, we should measure the sinotubular junction diameter. The normal range being 2.2 to 3.6 cm. We also need to describe the appearance of the sinotubular junction and whether it looks normal or whether there is effacement of the junction, which is what we see in patients with

[00:03:00] Marfan syndrome. And finally, we should measure the tubular ascending aorta. The normal diameter here is 2.2 to 3.6 cm. Aortic diameters do vary according to the patient's body size and so it's recommended that the aortic diameter at the sinuses of Valsalva should be indexed for body surface area. And the normal range for the index measurement is 1.8 plus or minus [00:03:30] 0.2 cm / m2.