DK2985_C000 1..28 - AlSharqia Echo Club

264 Transesophageal EchocardiographyFigure 12.4 Echocardiographic examination of the aorta. Right-sided structures are represented on the left side of the image display.The descending aorta is initially anterior, left and then becomes posterior in the distal portion. Consequently the anatomical orientation ofthe descending aorta varies according to the position of the transesophageal echocardiographic probe and the aorta (E, esophagus).[Adapted from Freeman et al. (6).]is advanced into a deep gastric view to follow the descendingAo down to the upper abdominal Ao. Likewise, theproximal descending Ao is assessed by withdrawing theprobe to the upper esophageal (UE) level, up to the junctionwith the distal transverse Ao at 20–25 cm from the incisors.C. Aortic ArchIn a transverse view at 08, once in the UE level, thedistal transverse arch is revealed at the left of theimage (Fig. 12.10) as the probe is rotated anteriorlytowards the right. As the imaging plane is rotated to908, a vertical SAX view of the mid-portion of the archis obtained. As the probe shaft is gradually rotatedtowards the right, the origins of the arch vessels are successivelyvisualized (left subclavian, left commoncarotid, and right brachiocephalic arteries). More rotationof the probe shaft towards the right will bring into viewthe distal ascending Ao and the adjacent main pulmonaryartery trunk.(A)(B)LALVAoRVFigure 12.5Mid-esophageal long-axis view of the ascending aorta (Ao) (LA, left atrium; LV, left ventricle; RV, right ventricle).