Abstract
This chapter describes the standard echocardiographic views for a transthoracic examination.
Keywords
Echocardiographic views, echocardiographic windows examination
Introduction
This chapter presents the views acquired during the normal two-dimensional (2D) adult comprehensive transthoracic echocardiography (TTE) examination. These views are based on the standards recommended by the American Society of Echocardiography (see Chapter 8 ). Optimal image acquisition is a prerequisite for optimal interpretation and reporting of the adult transthoracic echocardiogram by the echocardiographer/cardiologist expert. This involves competency in cardiac sonographer skills and training, as well as optimizing patient and instrument settings (see Chapter 11 ).
The comprehensive adult 2D TTE examination (TTE) begins at the left parasternal window, followed by the apical, subcostal, and suprasternal notch windows ( Tables 9.1–9.6 ). Each standard echocardiographic view is described using three components (see Table 9.1 ; see also Chapter 8 ): (1) transducer position or window, namely the parasternal (P), apical (A), subcostal (SC), and suprasternal notch (SSN) windows; (2) echocardiographic imaging plane, namely long-axis (LAX), short-axis (SAX), or four-chamber (4C) planes; and (3) cardiac structures or regions of interest.
| Window | Cardiac imaging plane | Region-Structures of Interest |
|---|---|---|
| Parasternal Views (see Figs. 9.1–9.4 ) | ||
| Parasternal (P) | Long-axis (LAX) | LV inflow-outflow, LA, MV, LV, LVOT, RVOT, IVS, Aortic root, descending thoracic aorta |
| P | LAX | RV inflow, TV, RV, coronary sinus, IVC |
| P | LAX | RV outflow: RVOT, PV, PA |
| P | Short-axis (SAX) | Aortic valve level: AV, TV, PV, IAS, LA, IAS, coronary arteries; IVC |
| P | SAX | PA bifurcation: main PA, PV, RPA, LPA, coronary arteries |
| P | SAX | Mitral valve level: MV, basal LV walls, LVOT, IAS |
| P | SAX | Papillary muscle level: LV walls, papillary muscles; IAS |
| P | SAX | Apical level: apical LV walls; LV apex (apical tip) |
| Apical Views (see Figs. 9.5–9.8 ) | ||
| Apical (A) | Four-chamber (4C) | LV, RV, LA, RA, MV, TV, pulmonary veins |
| A | Five-chamber (5C) | AV, LV, LVOT |
| A | Two-chamber (2C) | LV walls, LV, LA, LAA, MV |
| A | Three-chamber (3C); or long-axis (LAX) | LV walls, LV inflow-outflow, LA, MV, LV, LVOT, RVOT, IVS |
| Subcostal Views (see Fig. 9.9 ) | ||
| Subcostal (SC) | Four-chamber | IAS, LV, RV, LA, RA, MV, TV |
| SC | Long-axis (LAX) | Inferior vena cava (IVC), hepatic veins |
| SC | LAX | Abdominal aorta (AA) |
| SC | Optional views | Family of SAX and LAX views of the heart when transthoracic windows unavailable, or in the pediatric examination SAX views of IVC and AA |
| Suprasternal Notch Views (see Fig. 9.10 ) | ||
| Suprasternal notch | Long-axis | Aortic arch and branches, distal ascending aorta, proximal descending thoracic aorta |
| Suprasternal notch | Optional views | Short-axis views of the aortic arch with “crab” view of the LA and pulmonary veins, frontal view of the ascending aorta |
| Transducer Position (Window) | 2D ± M-MODE ± 3D | CFD | Spectral Doppler (PW, CW) |
|---|---|---|---|
| Parasternal long-axis (PLAX): LV inflow-outflow | PLAX 2D
| CD to AV/MV, Zoom (on/off) | CW if VSD |
| RV inflow | 2D depth 20 cm, then 15–16 cm Zoom on the TV | Color Doppler TV for TR | CW Doppler for Max; TR velocity |
| RV outflow (optional) | 2D Zoom on the PV | Color Doppler PV for PR | — |
| Transducer Position (Window) | 2D ± M-MODE ± 3D | CFD | Spectral Doppler PW, CW |
|---|---|---|---|
| Parasternal short-axis (PSAX): aortic valve level (AVL) | 2D to AV
2D to PV M-mode (optional) 3D full-volume (optional) | CFD to AV CFD to TV for TR CFD to PV for PR | CW to TR max velocity |
| PSAX: pulmonary artery bifurcation (PAB) | 2D image of PAB | CFD for PR and PDA | PW-CW of PV |
| PSAX: Mitral valve level (MVL) | 2D image at the MV and basal LV walls | CFD to MV | — |
| PSAX: papillary muscle level (PML) | 2D image at PML, mild LV walls | — | — |
| PSAX: apical level | 2D image at LV apical walls and LV apical segment | — | — |
| Transducer Position (Window) | 2d ± M-Mode ± 3d | CFD | Spectral Doppler Pw, Cw | Tissue Doppler Imaging (Tdi) |
|---|---|---|---|---|
| Apical four-chamber (A4C) | 2D image; depth 15–16 cm. LV and LV walls
2D Measurement of LA volume- measure LA volume at the end of systole and the shorter length of the LA 3D full-volume (optional) Evaluate RV function on 2D focus RV image. TAPSE (tricuspid annular plane systolic excursion) | CFD to MV for MR, MS CFD the Pulmonary veins, PW of right upper or lower pulmonary vein Color M-Mode flow propagation velocity CFD to TV and CW for TR max velocity. | PW Doppler at the tips of the mitral leaflets for MV inflow CW Doppler of the MV | TDI (PW) of MV annulus (lateral and septal) Color TDI to LV walls TDI of TV annulus |
| Apical five-chamber view (A5C) | 2D visualization of the AV-Zoom on the valve | CFD to the AV | PW Doppler of the LVOT (1–2 cm) from the valve leaflets, closing AV click CW for transaortic velocities | |
| Apical two-chamber view (A2C) | 2D image LV and LV walls
| CFD to MV | TDI (PW) of MV annulus (anterior and inferior) Color TDI to LV walls | |
| Apical three-chamber view (A3C) or apical long-axis (ALAX) view | 2D image for wall motion evaluation | CFD to AV and MV | — | — |
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
