Total Heart SimWhat you see
A small clockwise rotation from the home view swings the plane off the tricuspid valve onto the aortic root. Depending on the angle and tilt you see the root in long axis, or the valve in short axis with its three cusps: the non-coronary cusp lies against the interatrial septum and right atrium, the right coronary cusp anteriorly and the left coronary cusp to the left.
Why it matters
The non-coronary cusp sits right next to the region of the His bundle on the right atrial side, and the aortic cusps are a site of origin for some outflow tract arrhythmias. Seeing the cusps, the left main ostium and the catheter tip together helps keep ablation away from the coronary arteries. Structural interventions use the same view for the aortic root.
How to get there
About 12 o'clock (10° clockwise)
From the home view, a small clockwise rotation brings in the aortic root; adding posterior or rightward tilt turns it into a short-axis view of the three cusps.
In the simulator:
- Start from the home view (mid right atrium, neutral).
- Advance the catheter about 1.3 cm.
- Rotate clockwise about 10°, to about 12 o'clock.
- Tilt right (about 40° on the R/L dial).
Clinical uses
- Aortic cusp arrhythmia ablation: catheter position relative to the cusps and coronary ostia.
- Orientation for the His region near the non-coronary cusp.
- Aortic root assessment in structural procedures.
Frequently asked questions
How do you get the aortic valve view on ICE?
From the home view, a small clockwise rotation brings in the aortic root; adding posterior or rightward tilt turns it into a short-axis view of the three cusps. In the Total Heart Sim model heart: Advance the catheter about 1.3 cm. Rotate clockwise about 10°, to about 12 o'clock. Tilt right (about 40° on the R/L dial). Small adjustments either way are normal: anatomy and catheters vary.
References
- Enriquez A, Saenz LC, Rosso R, et al. Use of intracardiac echocardiography in interventional cardiology: working with the anatomy rather than fighting it. Circulation. 2018;137:2278–2294.
- Haloot J, Schurmann P. Electrophysiology laboratory survival guide part 2: introduction to intracardiac echocardiography in the electrophysiology laboratory. US Cardiology Review. 2026;20:e16.
- Alkhouli M, Hijazi ZM, Holmes DR Jr, Rihal CS, Wiegers SE. Intracardiac echocardiography in structural heart disease interventions. JACC Cardiovasc Interv. 2018;11(21):2133–2147.
Educational content; not medical advice. Rotation and deflection values are typical teaching values in the simulator's model heart; real anatomy and catheters vary.
