Deep transgastric views are often the best TEE views for assessing aortic stenosis and regurgitation, because in general, the TEE probe can be oriented parallel to the direction of the LVOT and aortic valve. The deep transgastric views are obtained by advancing the TEE probe deep into the stomach (roughly 50-60 cm in most patients) and gently anteflexing. They can be challenging to obtain in some patients.
By omniplane scanning to 90 degrees, one can see the anterior and inferior wall of the left
ventricle as well as the LV apex to evaluate for left ventricular thrombus.
The deep transgastric view is similar to the apical 5 chamber view obtained in transthoracic imaging. Note that the continuous wave cursor can be oriented essentially parallel to the aortic valve from this view (left panel) to allow accurate measurement of gradients across the aortic valve to assess degree of AS/AR.