DK2985_C000 1..28 - AlSharqia Echo Club

72 Transesophageal Echocardiography(A)(B)RUPVLARASVC(C)PVFSD(D)RAARRUPVRLPVFigure 4.22 (A, B) Mid-esophageal view of the right upper pulmonary vein (RUPV) positioned behind the right atrium (RA) and closeto the superior vena cava (SVC). (C) Pulsed-wave Doppler interrogation. The systolic (or S), diastolic (or D), and atrial reversal (AR)waves are shown. (D) Intraoperative view (LA, left atrium; PVF, pulmonary venous flow; RLPV, right lower pulmonary vein).(Photo D courtesy of Dr. Nancy Poirier.)of the IVC can be assessed by advancing the probe totransgastric views, where its diameter can be assessed inresponse to respiratory variations. This view also providesan excellent Doppler interrogation angle of the hepaticveins as they merge with the IVC (Figs. 4.25 and 5.18).Coronary SinusThe coronary sinus runs in the posterior atrioventriculargroove and empties into the RA at the inferoposterior aspectof the interatrial septum (IAS) near the attachment of the tricuspidseptal leaflet (Fig. 4.18). The longitudinal image ofthe coronary sinus running lateral to medial behind theinferior aspect of the LA is obtained from the midesophagealfour-chamber view with slight retroflexion ofthe probe tip (Fig. 4.26). A cross-sectional view of the coronarysinus appears in the lateral atrioventricular groove inthe mid-esophageal two-chamber view at 908 (Fig. 4.26).5. ArteriesCoronary ArteriesThe coronary ostia and proximal coronary arteries canbe seen from the mid-esophageal short-axis 458 view ofthe aortic annulus and aortic root. The left main coronaryartery originates from the aortic root above the left coronarycusp and runs laterally toward the right side of theimage sector (Fig. 4.27). Slight adjustment of probe tipdepth and flexion together with color flow Dopplerimaging is often needed to optimize its visualization.The left main bifurcation and proximal portions of the circumflexand left anterior descending (LAD) coronaryartery can be seen in many patients. The left circumflexcan sometimes be followed in the left atrioventriculargroove with the coronary sinus. The right coronaryartery (RCA) is more difficult to image with TEE. TheRCA originates from the right coronary sinus and runs