Transesophageal echocardiography in the evaluation of aortic valve disease
- Elyse Foster, MD
Elyse Foster, MD
- Professor of Clinical Medicine
- University of California, San Francisco
Echocardiography is the procedure of choice for the evaluation of valvular heart disease. Because of enhanced resolution and unobstructed visualization, transesophageal echocardiography (TEE) may provide further detail not obvious on transthoracic echocardiography (TTE). TEE also has a growing role in transcatheter aortic valve implantation (TAVI).
This topic will discuss TEE evaluation of the aortic valve. Transthoracic echocardiographic (TTE) evaluation of the aortic valve is discussed separately. (See "Echocardiographic evaluation of the aortic valve".)
To characterize the aortic valve using TEE, the valve should be imaged in short- and long-axis views.
Short-axis view — The short-axis of the aortic valve can generally be visualized in a plane between 30 to 60˚ from the transverse (0˚) using a multiplane transducer . In the short axis view, inspection should include identification of the number of aortic cusps, the presence and extent of calcification, fusion, leaflet perforation, malcoaptation, or vegetation. Adjustment of the imaging plane to a view that clearly demonstrates the coaptation of the leaflets provides another view for regurgitant jet assessment. Direct planimetry of the stenotic systolic orifice from this view is accurate to a level that equals, and may exceed, that of the standard continuity equation as applied to Doppler TTE. (See 'Aortic stenosis' below.)
Long-axis view — In the long axis view, typically at 110 to 140˚ from transverse (0˚) , the right and non-coronary cusps are visualized and the presence of any vegetations or leaflet prolapse is usually evident and regurgitant jet width can be ascertained. In the long axis, the ascending aorta should be viewed from the valve to the right pulmonary artery. This view of the left ventricular outflow tract is usually optimal for excluding subvalvular lesions (eg, subvalvular membrane), measuring regurgitant jet width and for examining associated pathology of the aortic valve, aortic root, and ascending aorta (eg, aorto-annular ectasia, type I aortic dissection, and Marfan's syndrome).
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