2017-11-26 KSE

Normal echocardiographic
view & anatomy

Hyemoon Chung

Kyung Hee University Medical Center

Department of Internal Medicine
Cardiology Division
 Aorta
Pulmonary
artery
SVC Aorta
SVC
LA Pulmonary
artery
RA Pulmonary
vein LA
RA
RV LV
LV
IVC
RV
Standard image planes and acoustic windows

Long axis 2 chamber

plane plane
Suprasternal
Suprasternal

Parasternal Parasternal

Apical

Subcostal 4 chamber
Short axis
plane plane

Apical
Subcostal
 Parasternal view Suprasternal view

Suprasternal view

Apical view Subcostal view

 Echocardiographic views
• Parasternal long axis view
• RV inflow view
• Parasternal short axis view
• Apical view
• Subcostal view
• Suprasternal view
Parasternal view
Parasternal long axis view
• The 2~4th intercostal space
• Just lateral to the sternal border
• Indicator pointing toward the right
shoulder

RV

LV
LA
 Parasternal long axis view

Proper alignment is essential to obtain accurate measurements

of the LVOT, aorta, LA, LV wall thickness, and LV systolic and
diastolic diameters.
Parasternal long axis view
RVOT prox

LV
dimension

LVOT
LA AP dimension

2015 ASE Guideline

Parasternal long axis view
-Aortic root
Parasternal long axis view
Parasternal long axis view

Proper alignment is essential.

The true LV apex is not visualized.
Parasternal long axis view
Systolic murmur

VSD
Parasternal long axis view
RV inflow view
 Parasternal short axis view

PSAX-AV level PSAX-MV level

PSAX-mid-LV level PSAX apex level

Parasternal short axis view
-Aortic valve level
• The second intercostal space
• Just lateral to the sternal border
• Indicator pointing toward the left
shoulder

RV

RA
LA
 Parasternal short axis view
-Aortic valve level

Tricuspid AV RVOT size

 Parasternal short axis view
-Aortic valve level

Left atrial appendage

Parasternal short axis view
-Aortic valve level

Pulmonary artery
Parasternal short axis view
-Aortic valve level

Continuous murmur
Parasternal short axis view
-Mitral valve (base) level
Parasternal short axis view
-Mitral valve (base) level

D-shaped LV
 Parasternal short axis view
-Papillary muscle (mid-LV) level
M-mode at mid-LV level

2015 ASE Guideline

Parasternal short axis view
-Apex level
Parasternal short axis view
-Apex level

Apical hypertrophy
Apical view

2015 ASE Guideline

Apical 4 chamber view
Apical 4 chamber view
 Apical 4 chamber view

TV is slightly more apical than MV Ebstein anomaly

Apical 4 chamber view

Atrial septal defect

Apical 4 chamber view for RV

2015 ASE Guideline

Apical 3 chamber view
Apical 2 chamber view
Apical 2 chamber view
 Apical 2 chamber view

contrast

LV apical thrombus
Optimal apical view is important
Subcostal view

• RV diastolic wall thickness

• Interatrial communication
• Pericardial effusion
 Subcostal view

Subcostal view- PLAX Subcostal view - PSAX

Subcostal view

Atrial septal defect

 Subcostal view

Pericardial effusion RV wall thickness

2015 ASE Guideline

 Estimation of RA pressure

Change with RA pr
IVC
respiration (mmHg)
< 21 mm Decrease by >50% 5

< 21 mm Decrease by < 50% 10

> 21 mm Decrease by <50% 15

> 21 mm Decrease <50% 20

+ HV >1 cm

Kircher BJ. Am J Cardiol. 1990

 Subcostal view
Hepatic vein
- Expiratory diastolic flow reversal

Welch et al. Circulation 2014

Suprasternal view
SVC
Ao

RPA

LA
AV
 Suprasternal view

Dissection flap Holodiastolic flow reversal

(Aortic dissection) (severe AR)
Suprasternal view

Coarctation of aorta

Torok et al. World J Cardiol 2015

 Summary
• Basic echocardiographic view
 Parasternal long axis view
 Parasternal short axis view
 Apical view
 Subcostal view
 Suprasternal view
• 정확한 측정 및 평가를 위해서 optimal image를 획득하
는 것이 중요하다.
• 때로는 off-axis view도 중요하다.
Thank You For Your Attention