TEE High Esophageal Views
The high esophageal views are used to image the aorta for pathology, such as dissections, aneurysm and atheromas as well as the pulmonary artery bifurcation and pulmonic valve. Most of the aortic images are obtained by locating the aorta first by rotating the probe around to the aorta (see images below). By withdrawing the probe one can sweep the aorta and when coming out scan parts of the arch by changing the omniplane angle
Pulmonary Artery Bifurcation
From the mid esophageal aortic valve short axis view, withdrawing further the ascending aorta can be visualized in short axis and the pulmonary artery can be followed in long axis to the PA bifurcation.
The descending aorta and distal arch can be seen in short axis at 0 degrees, by rotating toward the aorta from the mid esophageal position and slowly withdrawing the probe. In TEE systems with 3-D capabilities, x-plane is often used to view the aorta in both short axis (left) and long axis (right) to ensure that dissection and atherosclerotic plaque are not missed.
The proximal ascending aorta is best visualized from the long axis, roughly 100-110 degrees and with gentle anteflexion, withdraw the probe to see the ascending aorta until contact is lost. This is an excellent view for the assessment of Type A aortic dissection.
Arch and Pulmonic Valve
Withdrawing the probe further, the aortic arch and in some instances the head and neck vessels can be visualized. Again, it is often useful to use biplane to see the arch in long axis (left) and short axis (right). This view is helpful to evaluate the aortic arch in patients with cryptogenic strokes or suspected systemic emboli to exclude aortic arch atheroma. On the right image you can also see the pulmonic valve in the lower corner.