Distal esophageal views for tricuspid valve (Figure 7)
At the mid-esophageal level, septal leaflet is prone to be attenuated by the acoustic shadowing from interatrial septum; however, such attenuation can be avoided at the distal esophageal level, and 3D en face views reconstructed at this level can be used for delicate investigation in the etiology of tricuspid regurgitation. Although aortic valve disappears sometimes, the anatomical landmarks such as ostium of coronary sinus, Eustachian valve, and rough part of right atrium, can still help determine the orientation in TEE views at the distal esophageal level. On CT simulation, we firstly move the MPR crosshairs into the distal esophageal level, near the EGJ and then rotate the axial MPR line clockwise toward the aortic valve. Next, we simulate “turn to the right” by rotating the sagittal MPR line clockwise on the axial MPR plane to cross the tricuspid valve. Finally, we rotate the axial MPR line on the coronal MPR plane to evaluate the relationship between leaflets.