Imaging the ascending aorta and aortic arch using transesophageal echocardiography: the expanded aortic view

Transesophageal echocardiography (TEE) imaging of the aorta requires multiple views and is limited by its inability to visualize the distal ascending aorta and proximal aortic arch ("blind spot"). Recent advances in ultrasound technology allow improved imaging of cardiac structures. In this study we describe the ability to image the aortic valve, entire ascending aorta, and aortic arch in one view, the "expanded aortic view" obtained from a novel proximal transgastric window. In 22 patients, an expanded aortic view was acquired with the transducer positioned in a proximal transgastric position using new generation ultrasound system with a TEE probe that incorporates increased range of mobility. Fluoroscopy imaging was performed to confirm the position of transducer in relation to the cardiac anatomy. In 7 of 22 patients, the ability to achieve this view was also tested using an older echocardiography system. The novel proximal transgastric plane allowed reliable images of the aortic valve, ascending aorta including the "blind spot," and aortic arch in a single view-the expanded aortic view.