albeit that flexibility is reduced for changing the plane of imaging when the probe is in the stomach The transgastric images are oriented so that, when seen on the screen, the apex is down, the outflow tracts are up, and the left ventricle is on the right side of the screen, thus retaining consistency with the orientation of subcostal images Depending on the degree of flexion, more anteriorly or posteriorly directed images are obtained The short-axis view is usually the first one obtained when the probe is advanced into the stomach and anteflexed to image the heart The right and left ventricles and the intervening ventricular septum are shown, with various shortaxis planes permitting analysis of the atrioventricular valves, the position of the papillary muscles, the pattern of the apical trabeculations, and the ventricular relationships (Fig 19.37) These views are also used for studying global and regional left ventricular function immediately after discontinuation of cardiopulmonary bypass Angulating the probe in a long-axis dimension, with different degree of flexion, shows the right and left ventricular outflow tracts (Figs 19.38 and 19.39) From the transgastric views, it is often possible to align a pulsed wave or continuous wave Doppler cursor to quantify the degree of obstruction in the outflow tracts, if present Lack of good alignment between the signal and the flow can be an important limitation for transesophageal echocardiography FIG 19.37 Transgastric short-axis view cutting through both the left (LV) and the right ventricle (RV) This view is used for assessing biventricular function FIG 19.38 Transgastric view providing a more longitudinal image of the right ventricular outflow tract From this window, it is often possible to obtain good Doppler alignment to assess any obstruction within the outflow tract LV, Left ventricle; PA, pulmonary trunk; RV, right ventricle; RVOT, right ventricular outflow tract FIG 19.39 From transgastric position, it is also possible to cut longitudinally along the left ventricular outflow tract From this window, it is often possible to obtain good Doppler interrogation of obstructions within the outflow tract Ao, Aorta; LV, left ventricle; RV, right ventricle