Imaging the aortic valve is best accomplished in the mid-esophageal short and long axis views. The ME AV SAX demonstrates the noncoronary cusp superiorly, the right coronary cusp inferiorly, and the left coronary cusp to the right. As the probe is withdrawn cephalad from this view one can evaluate the sinus of Valsalva and by applying color Doppler, the right and left coronary arteries may be visualized. Imaging the aortic valve in the mid-esophageal long axis view will allow visualization of the LVOT, AV annulus, sinus of Valsalva, and sinotubular junction, as well as proximal ascending aorta. Deeper transgastric views, which allow for parallel beam alignment, are more useful for quantifying hemodynamics such a flow velocities through the LVOT and pressure gradients across the valve.
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