DK2985_C000 1..28 - AlSharqia Echo Club

Normal Anatomy and Flow 81(A)(B)RVLV(C)AMLLAAPMLFigure 4.35 (A, B) Basal transgastric view of the mitral valve. (C) Anatomical correlation (AML, anterior mitral leaflet; LAA, leftatrial appendage; LV, left ventricle; PML, posterior mitral leaflet; RV, right ventricle).the ultrasound beam intersects these structures perpendicularly(see Fig. 12.1).Parallel views of the aortic root in the far field of thedisplay may sometimes be obtained from the transgastricprobe position. Two options include further angle rotationto 90–1208 from the transgastric two-chamber view as previouslydescribed or a deeper transgastric view obtainedwith further probe tip advancement and maximal anteflexionat an angle of 08 (Fig. 4.36). Color flow imaging is frequentlyuseful to optimize pulsed- and continuous-waveDoppler alignment with aortic outflow in these positionswhere the distal aortic root location does not generallyallow optimal 2D structure visualization.A similar view from a different imaging point can beobtained from a transgastric probe position at 908 with rightwardrotation from the two-chamber view (Fig. 4.10). Sometimes,slight readjustment of the angle from 608 to 908 maybe required to display at once the RA, TV, RV, and PV.The PV, main pulmonary artery, and bifurcation in theproximal right and left pulmonary arteries are best visualizedat 08 in the proximal esophageal probe position withmore anteflexion (Fig. 4.14). While rightward rotation ofthe probe often enables visualization of the right pulmonaryartery (RPA) up to its first bifurcation in the near fieldof the display, only the first 1–2 cm of the left PA can bevisualized most of the time.Tricuspid Valve and Pulmonic ValveThe TV and pulmonic valve (PV) are anterior structuresthat are more difficult to visualize with TEE. Bothvalves are seen in the far field in the mid-esophagealshort-axis 458 view (Fig. 4.13). In this position, the TV,RV, PV, and pulmonary trunk appear to wrap around theaortic root from left to right across the bottom of thedisplay.II. DOPPLER FLOW PROFILES FOR NORMALAND ABNORMAL PHYSIOLOGYA. Phases of the Cardiac Cycle(Systole vs Diastole/Four Phases)The cardiac cycle consists of two phases: systole and diastole.Systole is defined as the period between MV closureand aortic valve closure. It consists of an isovolumic