The foundational TEE view. Provides simultaneous assessment of all four cardiac chambers, both AV valves, and the interatrial septum. Equivalent to the TTE apical 4-chamber but with superior resolution.
Angle
0°
Depth
30–35 cm
Flexion
Neutral to slight anteflexion
Patient Position
Supine; bite block in place; head in neutral position
1Advance probe to mid-esophagus (30–35 cm from incisors)
2Set multiplane angle to 0°
3Apply gentle anteflexion to bring all four chambers into view
4Optimize depth to include the apex — avoid foreshortening
5Rotate slightly left/right to center the IVS vertically
LV (all walls, apex)
RV
LA
RA
Mitral valve (A2/P2 segments)
Tricuspid valve
Interatrial septum
Moderator band (RV)
Critical Findings — Do Not Miss
New LV wall motion abnormality (ischaemia)
Severe MR or TR
Large pericardial effusion
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TEE ScanCoach™
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