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| Pulmonary Valve and Pulmonary Artery Views |
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Standard views of the PV and pulmonary artery have been described by the American Society of Echocardiography (ASE) and should be included in every exam . Standard views for visualizing the PV are the midesophageal RVIO, midesophageal ascending aorta short axis, and upper esophageal aortic arch short axis. The midesophageal AV short axis is a standard ASE/SCA view but the pulmonary valve is not always visualized in this view. Non standard views of the pulmonary artery and PV may not be obtainable in every patient, but, in certain situations, may yield additional information about the PV or pulmonary artery. The non standard views of the pulmonary artery and PV are the transgastric RV outflow view, deep transgastric RV Outflow view and the midesophageal pulmonary artery long axis view.
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Midesophageal RVIO View
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By rotating the angle to 60 degrees from the midesophageal 4 chamber view, the midesophageal RV inflow-outflow (RVIO) view is obtained. The long axis of the PV is visualized. The right posterior PV leaflet is in a posteromedial location while the anterior PV leaflet is in a lateral location. The proximal portion of the long axis of the pulmonary artery is usually visualized, although, in some cases almost the entire main pulmonary artery may be present. A true or foreshortened short axis of the aortic valve may also be present.
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| ME RVIO Image |
ME RVIO Video |
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| Midesophageal Aortic Valve Short Axis View |
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| Rotating the multiplane angle to 30-60 degrees from the midesophageal 3 chamber view, the aortic valve short axis is visualized. From this view, the pulmonary artery, PV, and the RVOT may be visible for analysis. The right PV leaflet is posteromedial and the left PV leaflet is more lateral in this view. The mid portion of the main pulmonary artery long axis is present. Sometimes the entire main pulmonary artery long axis or just the proximal or distal portion of the main pulmonary artery may be visualized. |
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| ME AV SAX Image |
ME AV SAX Video |
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| Midesophageal Ascending Aorta Short Axis View |
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| Withdrawing the transesophageal probe from the RVIO view and rotating the multiplane to zero degrees, the short axis of the ascending aorta and the short axis of the main pulmonary artery can be visualized in some patients. The left atrium and the superior vena cava is also present. The short axis of the pulmonary artery is frequently off-axis but can be, in some cases a true axis. This view is a nonstandard view for the pulmonary artery and is usually not included in pulmonary artery evaluation. |
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| ME AscAo SAX Image |
ME AscAo SAX Video |
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Further withdrawing the probe into the upper mid-esophagus at a 0 degree multiplane allows viewing of the distal portion of the long axis of the main pulmonary artery, right and left pulmonary arteries. A pulmonary artery catheter can be visualized going into the right pulmonary artery or left pulmonary artery. The very proximal section of the left pulmonary artery can be visualized, but distal portions of the left pulmonary artery are usually not visible because the air-filled left bronchus attenuates the echocardiographic signal. The right pulmonary artery can usually be visualized for a significant portion of its course. This view is the standard midesophageal ascending aorta short axis view.
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| ME AscAo SAX Image |
ME AscAo SAX Video |
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| Upper Esophageal Aortic Arch Short Axis View |
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| From the long axis of the aortic arch view, rotating the electronic plane to 70-90 degrees produces the upper esophageal aortic arch short axis view. This is often the best view to assess the main pulmonary artery, PV and in some patients, the RVOT. The PV can be best assessed for regurgitation and stenosis in this view because of the parallel angle to the Doppler beam. It is also useful to assess the diameter of the main pulmonary artery in long axis for a dilated or compressed pulmonary artery . To improve the view the probe may have to be retroflexed and/or turned counter clockwise. |
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| UE ArchAo SAX Image |
UE ArchAo SAX Video |
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