The 11 TEE views
Why examiners ask this
Every echo clip in the monitors station starts with the same unspoken question: do you know where the probe is? If I cannot name the view, I cannot name the finding with any authority, and the grader marks the orientation step before the diagnosis. The outline limits the station to 11 transesophageal views,1 so this is a finite list I can own completely. It tests application of knowledge and organization.
The 60-second answer
When a TEE loop starts, I orient in three passes. First, depth: is the probe in the mid-esophagus with the left atrium at the top of the sector, in the stomach with liver or gastric wall at the apex, or looking at a circle of aorta with nothing else? Second, the multiplane angle printed on the screen, which narrows the mid-esophageal views to two or three candidates. Third, the anchor structure: two atria and two ventricles, the aortic valve cusps, the cavae, or the papillary muscles. I say the view aloud, name the chambers I can see, then describe the abnormality in that view. If the angle icon is hidden, I name the view from the anatomy alone, because the anatomy is what the grader is checking.
Decision points and the "why"
The 11 outline views, with the features that identify each and what I use it for.
| View | Angle, depth | Identifying features | Main use |
|---|---|---|---|
| ME four-chamber | ~10–20°, ~30–35 cm2 | LA at apex, all four chambers, mitral and tricuspid valves | Global function, septal and lateral walls, MR, TR, ASD |
| ME two-chamber | 80–100°3 | LA and LV only, left atrial appendage, no right heart | Anterior and inferior walls, appendage thrombus |
| ME long-axis | 120–140°3 | LVOT, aortic valve and root, mitral valve | Anteroseptal and inferolateral walls, AR, SAM |
| ME ascending aortic long-axis | 90–110°, withdrawn | Tubular ascending aorta, right pulmonary artery in cross-section beneath | Dissection flap, aortic dilation |
| ME ascending aortic short-axis | 0–30°, withdrawn | Circular ascending aorta, main PA and its bifurcation, SVC | Proximal PE, PA catheter position |
| ME aortic valve short-axis | 25–45°3 | Three cusps in a "Mercedes" sign, interatrial septum, RVOT | AS planimetry, AR origin, ASD |
| ME RV inflow-outflow | ~50–90°2 | RA, tricuspid valve, RV wrapping around a central aortic valve to the pulmonary valve | RV function, TR, PA catheter course |
| ME bicaval | 90–110°, turned right3 | LA top, RA below, SVC on the right of the screen, IVC on the left | PFO, sinus venosus ASD, air, catheter tips |
| TG mid-papillary short-axis | 0–20°, advanced into the stomach, anteflexed3 | LV "doughnut" with both papillary muscles, RV crescent | Volume, global and regional function in all three coronary territories |
| Descending aortic short-axis | 0–10°, turned left | Single circle with no cardiac structure | Dissection, atheroma, left pleural effusion |
| Descending aortic long-axis | ~90–100°, turned left3 | Tubular aorta across the screen | Extent of a flap, IABP position |
- TG mid-papillary first when the pressure falls — it is the only single view that shows all three coronary territories and the filling of the LV, so it answers hypovolemia, failure and ischemia at once.2
- ME four-chamber versus ME two-chamber — the right heart is the discriminator. If I see the RV, I am in the four-chamber; if I see the appendage and no RV, I am at roughly 90°.
- ME long-axis versus ascending aortic long-axis — both show a tube of aorta. The long-axis keeps the LVOT and mitral valve; the ascending view loses the LV and shows the right PA beneath the aorta.
- Bicaval is the venous-air and PFO view — air collects in the RA and the septum is perpendicular to the beam, so it is my answer to "where do you look for paradoxical embolism?"
The complication they will inject
The second clip is a mid-esophageal view with no angle icon and a dark, foreshortened sector. The facilitator asks which view it is and what is abnormal. I state what I can identify: "Left atrium at the apex, so mid-esophageal; a single valve with three cusps in cross-section, so this is the aortic valve short-axis." I then describe the abnormality in that frame, such as heavily calcified, restricted cusps. If I cannot name the view with confidence, I name the structures, give my best view, and say which view I would rotate to next to confirm. A wrong view called confidently loses more than a partial answer stated plainly.
Pitfalls that cost points
- Naming the diagnosis before the view.
- Confusing ME long-axis with ME ascending aortic long-axis because both show aorta.
- Calling the descending aorta short-axis a pericardial effusion or a cyst.
- Reading wall motion in a foreshortened four-chamber view and calling the apex akinetic.
Rapid-why
Q: Why is the left atrium at the top of the sector in mid-esophageal views? A: The esophagus lies directly behind the left atrium, so it is the structure closest to the transducer.
Q: Which view shows all three coronary territories? A: The transgastric mid-papillary short-axis: anterior and anteroseptal LAD, lateral circumflex, inferior and inferoseptal right coronary.3
Q: Where do I look for a sinus venosus ASD? A: The ME bicaval view, where the defect sits at the SVC–right atrial junction outside the fossa ovalis; PFO and secundum ASD are also seen here.2
Q: Why can I not see the distal ascending aorta? A: The air-filled left main bronchus crosses between the esophagus and the aorta, hiding the distal ascending aorta and proximal arch, the TEE blind spot.3
Numbers to know
| Item | Value |
|---|---|
| Views in the outline | 11 TEE |
| Probe depth, mid-esophageal | ~30–35 cm from incisors |
| Probe depth, transgastric | Advance until papillary muscles appear2 |
| ME four-chamber angle | ~10–20°3 |
| ME two-chamber angle | 80–100° |
| ME long-axis angle | 120–140° |
| Doppler in the exam | Color only; no PW or CW1 |
Links
- The monitors and echo station: format and timing, Ventricular function and wall motion, Basic valvular lesions on 2D and color, Atrial septal defect and aortic dissection (coming), Pulmonary embolism and air embolism (coming)
- Atlas: The 5 POCUS cardiac views
- ASE/SCA Guidelines for Performing a Comprehensive TEE Examination (2013); ASE/SCA Basic Perioperative TEE Examination consensus statement
Sources
- 1.APPLIED Exam Objective Structured Clinical Examination (OSCE) Content Outline · ABA · theaba.org
- 2.Basic Perioperative Transesophageal Echocardiography Examination: A Consensus Statement · ASE/SCA, 2013 · asecho.orgLists RV inflow-outflow at 60-90 degrees; the comprehensive guideline lists 50-70 degrees.
- 3.Guidelines for Performing a Comprehensive Transesophageal Echocardiography Examination · ASE/SCA, 2013 · asecho.orgTable 10 (28 views): multiplane angles and maneuvers.
Facts on this page were checked against these sources on Oct 14, 2026. Guidelines change; confirm doses against current institutional protocols.