1. ‘The 20 Views’ Annual Comprehensive Review & Update of Perioperative Echo

2. LV axis model

3. 17 segment model of the Left ventricle

4. ME four chamber LV walls: 6 Basal Inferoseptal 12 Mid Inferoseptal
16 Apical Septal
3 Basal Anterolateral
9 Mid Anterolateral
14 Apical Lateral
17 Apical Cap
Valve leaflets:
Mitral- Anterior(A1, A2) and Posterior(P1)
Tricuspid- Septal(S) Anterior (A), Posterior (P) RA LA A2 P1 S A1 TV 3 6 MV 12 9 RV LV 16 14 17
A or P
(depending upon probe flexion)
RV free wall

5. ME two chamber Valve leaflets: Carpentier Classification
Mitral- Anterior(A1, A2, A3)
Posterior(P3)
LV walls:
5 Basal Inferior
11 Mid Inferior
15 Apical Inferior
2 Basal Anterior
8 Mid Anterior
13 Apical Anterior
17 Apical Cap LA
LAA A1 A2 P3 5 A3 2 11 8 LV 15 13
Left Atrial
Appendage (LAA) 17

6. ME LAX LV walls: 4 Basal Inferolateral Valve leaflets:
10 Mid Inferolateral
1 Basal Anteroseptal
7 Mid Anteroseptal
15 Apical Inferior
13 Apical Anterior
14 Apical Lateral
16 Apical Septal
17 Apical Cap
Valve leaflets:
Carpentier Classification
Mitral- Anterior(A2)
Posterior(P2) LA AV A2 P2 4 1 10 7 RV LV
14 or 15
13 or 16 17

7. TG mid SAX LV walls: 8 Mid Anterior 7 Mid Anteroseptal
12 Mid Inferoseptal
11 Mid Inferior
10 Mid Inferolateral
9 Mid Anterolateral
PM pap 11 12 10 RV
AL pap 7 9 8 LV
Papillary Muscles:
Anterolateral papillary muscle (AL pap)
Posteromedial papillary muscle (PM pap)

8. TG basal SAX LV walls: 2 Basal Anterior 1 Basal Anteroseptal
6 Basal Inferoseptal
5 Basal Inferior
4 Basal Inferolateral
3 Basal Anterolateral
Valve leaflets:
Carpentier Classification
Mitral- Anterior
A1, A2, A3
and Posterior
P1, P2, P3 5 P3 6 4 A3 P2 A2 P1 1 A1 3 RV 2 LV

9. TG Apical SAX (Not part of original 20 views)
13 Apical Anterior
14 Apical Lateral
15 Apical Inferior
16 Apical Septal 15 16 14 LV 13 RV

11. 16 segment LV model Older LV model nomenclature
Replaced by 17 segment model

12. Regional Wall Model
Transthoracic imaging planes

13. Mitral valve axis model

14. Mitral Valve Anatomy
Carpentier
Classification

15. ME mitral commissural Valve leaflets: Mitral- Anterior Scallops (A2)
and Posterior Scallops
(P1, P3) LA P3 P1 A2
PM pap
AL pap LV
Papillary Muscles:
Anterolateral papillary muscle (AL pap)
Posteromedial papillary muscle (PM pap)

16. TG two chamber Valve leaflets: Mitral- Anterior(AL) and Posterior(PL)
LAA
Left Atrium (LA)
Left Atrial Appendage (LAA)
Left Ventricle (LV)

17. ME AV SAX Aortic Valve Non coronary cusp (NCC) IAS
Left coronary cusp (LCC)
Right coronary cusp (RCC)
IAS LA PV
NCC
LCC RA
RCC
RVOT
Left Atrium (LA)
Right Atrium (RA)
Intra atrial septum (IAS)
Pulmonic valve (PV)
Right ventricular outflow tract (RVOT)

18. ME AV LAX Aortic Valve (AV) Valve leaflets: Mitral- Anterior(AL)
Right Coronary Cusp (RCC)
Non Coronary Cusp
(NCC)
Left Coronary Cusp
(LCC)
Valve leaflets:
Mitral- Anterior(AL)
and Posterior(PL) LA PL AL
NCC or LCC
RCC
Asc Ao LV RV AV
Ascending Aorta (Asc Ao)

19. TG LAX Valve leaflets: Mitral- Anterior(AL) and Posterior(PL) AV LV
Asc Ao RV
Right Ventricle (RV)
Aortic Valve (AV)
Ascending Aorta (Asc Ao)

20. deep TG LAX Valve leaflets: Mitral- Anterior(AL) Left Ventricle (LV)
and Posterior(PL
Left Ventricle (LV)
Right Ventricle (RV)
Left Atrium (LA) LV RV AL PL LA AV Ao
Aortic Valve (AV)
Aorta (Ao)

21. ME bicaval IAS LA IVC SVC Left Atrium (LA) Right Atrium (RA)
Eustachian valve
Left Atrium (LA)
Right Atrium (RA)
Inferior Vena Cava (IVC)
Superior Vena Cava (SVC)
Intra atrial septum (IAS)
Right Atrial
Appendage
Fossa Ovalis RA

22. ME RV inflow-outflow Valve leaflets: Tricuspid- Anterior(AL) LA
and Posterior(PL) LA RA AV
TCV PL AL PV RV
RVOT
Left Atrium (LA)
Right Atrium (RA)
Tricuspid Valve (TCV)
Pulmonic Valve (PV)
Aortic Valve (AV)
Right Ventricular Outflow Tract (RVOT)
Inferior RV free wall

23. TG RV inflow TCV Valve leaflets: Tricuspid- Anterior(AL)
and Posterior(PL) RA RV PL AL
Right Atrium (RA)
Right Ventricle (RV)
Tricuspid Valve (TCV)

24. ME asc aortic SAX Rt PA SVC PA Asc Pulmonary Artery (PA)
Right Pulmonary Artery (Rt PA)
Superior Vena Cava (SVC)
Ascending Aorta (Asc)

25. ME asc aortic LAX Orientation: Ascending Aorta (Asc)
Right Pulmonary Artery
(Rt PA)
Rt PA
Asc
Proximal
Distal

26. Aorta-esophageal position
As probe withdrawn from patient, TURN probe to the LEFT to keep
aorta image in the center of the video screen

27. desc aortic SAX Ao
Orientation
Aorta (Ao)

28. desc aortic LAX Ao
Caudad
Cephalad
Aorta (Ao)
Orientation

29. UE aortic arch LAX
Distal
Aortic Arch
Proximal
Orientation

30. UE aortic arch SAX Aortic arch PA L Subclavian artery PV Orientation
RVOT
Left brachiocephalic vein
Pulmonary artery (PA)
Pulmonic valve (PV)
Right ventricular outflow tract (RVOT)

31. References:
Shanewise JS, Cheung AT, Aronson S, et al. ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. Anesth Analg 1999;89: