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Echo views
1. A comprehensive transthoracic echocardiographic examination will
include two-dimensional imaging, Doppler imaging, and Mmode
imaging.
With increasing frequency, three-dimensional imaging is
considered a component of a comprehensive examination,
supplementing the two-dimensional study in a similar fashion to
Doppler.
7. The right ventricular outflow view records the right ventricular
outflow tract and the main pulmonary artery (PA). Trivial
pulmonary valve regurgitation (arrow) is illustrated.
B: The bifurcation of the main pulmonary artery is seen from the
basal short-axis view.
8. Doppler evaluation of the parasternal long-axis view is useful to record
blood flow through the mitral and aortic valves .
Because the flow of blood is not parallel to the ultrasound beam,
quantitation of flow velocities is generally not possible.
However, color flow Doppler from this view is routinely used to detect
aortic or mitral regurgitation.
9. Two short-axis views are provided. A: The short-axis view at the level
of the mitral valve (MV).
B: A basal short-axis projection at the level of the aortic valve.
10. Allows optimal recording of mitral leaflet excursion, mid left ventricular wall
motion, and visualization of a portion of the
right ventricle.
The normal interventricular septal curvature can be appreciated and any
abnormalities of septal position, shape, or motion can be assessed.
Minor base-to-apex angulation is useful to record the orifice of the mitral
valve, the coaptation of the leaflets, and the mitral chordae and their
insertion into the anterolateral and posteromedial papillary muscles.
In addition to the annulus, the aortic valve, coronary ostia, left atrium,
interatrial septum, right atrium, tricuspid valve, right ventricular outflow
tract, pulmonary valve, and proximal pulmonary artery can also be
recorded.
11. From the basal short-axis view just above the aortic valve,
the origins of the left coronary artery (LCA) and right
coronary artery (RCA) can be recorded
12. By moving the transducer to a lower interspace and angling the scan
plane more apically, the image will sweep through the papillary
muscle level and then the left ventricular apex .
This series of views is ideal for assessing the contractile pattern of
the left ventricle at the midventricular and apical levels.
14. The Doppler evaluation of the various parasternal short-axis views
serves several purposes.
At the base of the heart, the scan plane can be adjusted so that blood
flow is oriented nearly parallel to the ultrasound beam through both
the tricuspid and pulmonary valves.
Both tricuspid inflow and tricuspid regurgitation can be
recorded from this position. Slight angulation permits a similar
assessment of the pulmonary valve from the
same basal view.
Conversely, aortic flow is nearly perpendicular to the scan plane;
therefore, quantitative Doppler assessment of aortic flow is not
possible.
19. From the apical five-chamber view, simultaneous recording of
aortic outflow and mitral inflow can be performed.
This permits isovolumic relaxation time (IVRT) to be measured.
25. A subcostal short-axis view at the level of the papillary muscles.
B: A short-axis view at the base. This view provides a clear
recording of the interatrial septum and the right ventricular
outflow tract, pulmonary valve, and main pulmonary artery
26. A: The subcostal view is adjusted to demonstrate the long-axis of the
inferior vena cava joining the right atrium.
B: Color flow imaging of hepatic vein flow.
27. From the suprasternal notch, the imaging plane is aligned parallel to
the aortic arch (AA).
The relationship among the arch, right pulmonary artery (RPA), and
left atrium is demonstrated.
28. The suprasternal notch also permits the aortic arch (AA) to be
recorded in cross section.
Allows visualization of the superior vena cava and demonstrates the
right pulmonary artery (RPA)
coursing below the arch and above the left atrium.
30. Less commonly used windows include the right parasternal location.
This position is useful to examine the aorta or interatrial septum and is
also useful in patients with congenital malposition of the heart, such
as dextrocardia.
It plays a major role in the assessment of aortic stenosis. This
approach usually requires positioning the patient in the right lateral
decubitus position.
The right apical, right supraclavicular fossa, and even the back are
potential acoustic windows that must occasionally be used.
For example, the right supraclavicular examination often provides the
best opportunity to visualize the superior vena cava.
31. It should be emphasized that the standard patient positions and
transducer locations serve only as a general guide, applicable to most
patients.
In patients with chest deformities, such as pectus excavatum, or those
with
chronic obstructive lung disease, these standard approaches may be
inadequate.
Likewise, some anomalies within the thorax, including dextrocardia,
pleural effusion, and pneumothorax may also render the standard
approaches ineffective.
