Cardiac Anatomy

Christopher J. Gallagher and John C. Sciarra

Time to go back to the model and the pie-shaped slice of imaging that comes out of the echo probe.

And time to take another good look at a plastic model of a heart.

These imaging planes tie in with the BIG 20 views of the heart. These are the 20 views detailed in THE ARTICLE by Shanewise et al on echo.¹ The 20 views are also detailed a million times over on different internet sites. Google “University of Toronto: TEE” for a great tutorial. This article and the 20 views detailed therein are the absolute crux of the TEE experience. Photocopy those 20 views and tape them to your TEE machine. Every time you examine a patient, try to get all the 20 views. Get in the habit of “examining everything every time”. If not, you’ll just look at the “thing of interest” and you’ll miss something else.

Also, getting all 20 views will sharpen your TEE probe-wiggling skills. Shanewise gives the lecture on the “standard exam”—meaning the 20 views—and he says he can do it in 7 minutes, before the patient is even draped!

Shanewise has thrown down the gauntlet. Can you do it that fast?

Here is our version of the 20 views. Notice it is not labeled. That is your job. As you read through this book label every structure on these 20 images. Yes, you can write on the book. You did buy your own, didn’t you?

In each view, note the approximate omniplane angle!

The imaging planes for these views are divided into distinct “layers,” though, in reality, you slide gradually from one view to another rather than making jerky quantum leaps.

The planes are upper esophageal, midesophageal, transgastric, and deep transgastric. Each plane takes in a few views, except for the pesky deep transgastric, which takes in just one view.

Here’s your new alphabet:

Go over these views in detail. Know how to express your findings as related to the views, for example:

That’s how you want to work with the “TEE Alphabet”.

The four-chamber view gives you your best “initial impression” and a good look at most of the major stuff in the heart. It’s what you first see when you’re just starting TEEology.

When you show this view, most medical people can immediately grasp what’s going on because it looks like a drawing of the heart. If you have a med student, ICU nurse, surgeon, or someone else looking on, this view shows you all four chambers of the heart (hence the name), the lateral and septal walls, and the mitral and tricuspid valves. What a deal!