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.