DK2985_C000 1..28 - AlSharqia Echo Club

64 Transesophageal Echocardiography(A)(B)RVRARVOTMPAAoV(C)462851716 121331411 15 10719Figure 4.10 (A, B) Transgastric view at 1108 of the right ventricle (RV). (C) Anatomical correlation (AoV, aortic valve; MPA, mainpulmonary artery; RA, right atrium; RVOT, right ventricular outflow tract) (1, pulmonary annulus; 2, right ventricular anterior wall; 3,tricuspid valve; 4, epicardial fat with vessels; 5, interventricular sulcus or anterior interventricular groove; 6, trabecular zone; 7, anteriorlimb of trabecula septomarginalis (TSM); 8, left ventricle; 9, pulmonic valve; 10, crista supraventricularis; 11, outlet component or infundibulum;12, inlet component; 13, posterior limb of TSM; 14, body of TSM; 15, medial papillary muscle;16, moderator band; 17, anteriorpapillary muscle).(Fig. 4.3t) further rotation reveals the distal ascendingaorta.Tip: During imaging of the aorta, the operator shouldoptimize depth and gain settings to allow the aorta to fillabout two-thirds of the imaging sector. Sometimes, allthe walls of the aorta may not be viewed at the sametime on the sector scan, and therefore some left and rightrotation may be necessary during the pullback to completelyassess all the walls of the aorta.B. Anatomy and Physiology1. Cardiac ChambersLeft VentricleIt is important to describe size, wall thickness, globaland segmental systolic function. The maximal normalinternal diameter is ,60 mm in all views although no standardizedmeasurements are used (unlike for TTE).Transesophageal echocardiography allows analysis ofcontractility of all 16 segments of the LV in five views:three views from the mid-esophageal probe position (fourchamber,two-chamber, and long-axis views) and twoviews from the transgastric position (mid and basal shortaxisviews) (see Chapter 8). It is also important to keep inmind that the apical segments are frequently difficult toevaluate because of the foreshortening of the LV.A visual assessment of global systolic function and ejectionfraction should be possible from the different views ofthe LV used for segmental wall motion assessment.Diastolic left ventricular function can be assessed fromDoppler mitral inflow, mitral annulus tissue Doppler, leftventricular inflow color M-mode and pulmonary venousflow patterns (see Chapter 9).Left Ventricular Outflow TractThe LVOT is imaged from mid-esophageal position at08 (Fig. 4.2[A]) and at 1358 (Figs. 4.3i and 4.11), as well asfrom the deep transgastric view at 1108 (Fig. 4.3j) that alsoallows the optimal ultrasound beam alignment for Dopplerflow velocity measurement.Right Ventricle (Inflow Chamber, Outflow Tract)The RV has an inflow chamber and a right ventricularoutflow tract (RVOT). The RVOT inflow chamber is