In transesophageal echocardiography (TEE), the mitral valve is examined from multiple angles to assess its structure.
1. Mid-Esophageal (ME) Four-Chamber View (0-10°)
Description: This view provides a cross-section of the heart chambers, including the left atrium (LA), left ventricle (LV), right atrium (RA), and right ventricle (RV).
Mitral Valve View: The anterior and posterior mitral valve leaflets are visualized between the LA and LV. This view is particularly useful for assessing mitral leaflet motion, regurgitation, and annular function.
2. Mid-Esophageal (ME) Two-Chamber View (90°)
Description: This view focuses on the LA and LV without including the RV.
Mitral Valve View: The leaflets are seen in a perpendicular orientation compared to the four-chamber view, offering additional details of the leaflet edges and commissures. Ideal for assessing mitral valve prolapse and leaflet thickening.
3. Mid-Esophageal Long-Axis View (120-140°)
Description: Provides an oblique view that includes the LA, LV, mitral valve, and part of the aortic valve.
Mitral Valve View: Shows a clear view of the anterior and posterior leaflets in profile, allowing for evaluation of leaflet mobility and prolapse. It’s useful for diagnosing conditions like mitral stenosis and assessing the subvalvular apparatus.
4. Mid-Esophageal Commissural View (50-70°)
Description: Displays the mitral valve in a unique orientation that highlights both the anterior and posterior leaflets from the commissures.
Mitral Valve View: Offers a side-by-side view of the leaflets and a full view of the mitral annulus. This view is important for evaluating leaflet coaptation and identifying regurgitant jets at the commissures.
5. Transgastric Short-Axis View (0-30°)
Description: A view from the stomach, directed upward toward the heart.
Mitral Valve View: Provides an en-face (cross-sectional) view of the mitral valve leaflets. Both leaflets and the mitral annulus are seen circularly. This view is crucial for assessing mitral valve leaflet morphology, prolapse, and regurgitation jets.
6. Transgastric Long-Axis View (90°)
Description: Similar to the transgastric short-axis view but with the probe rotated to 90°, offering a sagittal view of the mitral and aortic valves in alignment.
Mitral Valve View: Visualizes the anterior and posterior leaflets in a similar manner to the mid-esophageal long-axis view but from a different angle. Useful for evaluating the anterior leaflet length and subvalvular apparatus.
7. Deep Transgastric View (0-30°)
Description: Provides a unique perspective from deep within the stomach, aimed at the LV outflow tract.
Mitral Valve View: This view is not typically centered on the mitral valve but can sometimes be useful in assessing the LV inflow and mitral valve function in conjunction with LV outflow.