Abstract
This chapter describes all the standard echocardiographic views and windows.
Keywords
Echocardiographic examination views, echocardiographic windows
Introduction
In the adult two-dimensional (2D) transthoracic echocardiographic (TTE) examination, a standard series of cross-sectional anatomical views are recommended by the American Society of Echocardiography (ASE). Each echocardiographic view is described using three aspects of the examination, namely (1) the transducer positioned at a specified anatomical “window” on or near the thorax, (2) the cardiac scan plane transected by the transducer beam, and (3) the anatomical structure or region of interest ( Fig. 8.1 ). The 2D TTE examination is the basis for the comprehensive assessment of cardiac structure and function ( Figs. 8.2–8.21 ; see also Fig. 8.1 ).
Graphical summary of the standard examination protocol and nomenclature of the two-dimensional (2D) transthoracic echocardiographic views (American Society of Echocardiography [1980]). Note the transducer scan planes and cross-sectional anatomical planes.
Modified from Bulwer BE, Shernan SK, Thomas JD. Physics of echocardiography. In: Savage RM, Aronson S, Shernan SK, eds. Comprehensive textbook of perioperative transesophageal echocardiography. Philadelphia: Lippincott, Williams & Wilkins; 2009:1–41.
The standard recommended transducer positions in transthoracic echocardiography. PLAX, Parastemal long-axis; PSAX, Parastemal short-axis.
Courtesy of Bernard E. Bulwer, MD, FASE.
The orthogonal anatomical imaging planes and the echocardiographic imaging planes compared.
Courtesy of Bernard E. Bulwer, MD, FASE.
The standard orthogonal cardiac imaging planes and cross-sectional projections.
Courtesy of Bernard E. Bulwer, MD, FASE.
The orthogonal echocardiographic imaging planes and their corresponding anatomical projections.
Courtesy of Bernard E. Bulwer, MD, FASE.
Graphical summary of the three components used to describe the standard transthoracic echocardiographic (TTE) views in the adult: (1) transducer position or “window,” (2) cardiac imaging plane, and (3) the cardiac region or structure of interest.
Courtesy of Bernard E. Bulwer, MD, FASE.
Primary cardiac structures and the standard transthoracic echocardiographic views used in their assessment.
Courtesy of Bernard E. Bulwer, MD, FASE.
Image display convention recommended by the American Society of Echocardiography (1980). The index mark located on the transducer indicates the part of the echocardiographic imaging plane that appears on the right-hand side of the image display.
Courtesy of Bernard E. Bulwer, MD, FASE.
Panorama of the standard left parasternal long-axis (PLAX) views showing their anatomical orientation (above) , their corresponding cross-sectional anatomy (below right) , and image displays (below left) . The PLAX view (scan plane 1)—typically the first to be obtained in the two-dimensional transthoracic echocardiography examination (see Fig. 8.1 )—is aligned along the long-axis of the left ventricular (LV), aortic root (Ao), and left atrium (LA), and transects both the mitral and aortic valves. The RV inflow view (scan plane 2) transects the right atrium (RA), right ventricle (RV), and the tricuspid valve. The RV outflow view (scan plane 3) transects the RV outflow tract and pulmonary valve. Note that when the transducer is positioned at the left parasternal window, the first cardiac chamber transected is the RV—which appears in the near field of the image display.
Courtesy of Bernard E. Bulwer, MD, FASE.
Orientation of the parasternal long-axis views of the left ventricular inflow-outflow (PLAX) and the right ventricular (RV) inflow, showing their anatomical orientation (left-hand column) , cross-sectional anatomy (central column), and corresponding image displays (right-hand column) . Note the orientation of the index mark in the anatomical position—directed toward the right shoulder (∼10 o’clock position), compared with the corresponding image display.
Courtesy of Bernard E. Bulwer, MD, FASE.
Panorama of the standard left parasternal short-axis (PSAX) views showing their anatomical orientation (top panel) , the corresponding cross-sectional anatomy (midpanel), and image displays (below). Note that the PSAX views are oriented orthogonal to the long-axis (LAX) views (see Figs. 8.1 and 8.9 ). The PSAX family of views are acquired following the examination of the parasternal long-axis family of views (see Fig. 8.1 ). The PSAX view at the aortic valve level (AVL, scan plane 1) is typically the first PSAX view to acquire (since it is reliably obtained by rotating the transducer scan plane 90 degrees clockwise, starting from the PLAX view). The PSAX-AVL serves as the reference plane for the scan planes labeled 2–5.
Courtesy of Bernard E. Bulwer, MD, FASE.
Panorama of the standard apical views with the transducer positioned at the apical (A) window, transecting the left ventricular (LV) apex and the four-chamber (4C) plane. Note their anatomical orientation (top left) , corresponding cross-sectional anatomy viewed from the left lateral supine perspective (bottom panel) , and the corresponding image displays (top right). The A4C view transects the LV apex and all four cardiac chambers (LA, LV, RA, and RV) and septae, with their junction (internal cardiac crux) clearly visible. When the A4C scan plane is superiorly directed, it transects the LV outflow tract and the aortic root (Ao) or “fifth” chamber; hence the term apical five-chamber or A5C view . Optimally acquired apical views should transect the true anatomical apex of the LV. The apical views are acquired following examination of the left parasternal views (see Fig. 8.1 ).
Courtesy of Bernard E. Bulwer, MD, FASE.
Anatomical orientation and scan plane projections of the apical four-chamber (A4C) view. Two image display options are recommended. Most laboratories use the apex-up projection to display the A4C view, as this is consistent with other imaging protocols such as cardiac computed tomography and cardiac magnetic resonance imaging. The apex-down projection is preferred in pediatric echocardiography.
Courtesy of Bernard E. Bulwer, MD, FASE.
