Parasternal long axis:
place the transducer on the 3rd intercostal space left parasternal. The trans- ducer's index mark
is directed towards the patient's right shoulder. The right (RV) and the left ventricle (LV),
as well as the aortic bulb (Ao) and the left atrium (LA) can be displayed.
Parasternal short axis (papil- lary muscle level):
turn the transducer 90° clockwise from the previous position. The left ventri- cle (LV)
at the level of the papil- lary muscles and the right ventricle (RV) can be displayed.
Parasternal short axis (mitral valve level):
tilt transducer a little from the same position down to the right.
A cross section of the left ventricle (LV) at the level of the mitral valve and
the right ventricle (RV) can be displayed.
Parasternal short axis (aortic valve level):
tilt transducer a little more from the same position down to the right.
The aortic valve (AV), the pulmonary valve (PV), the left atrium (LA) and the right
atrium (RA), as well as the tricuspid valve (TV) and the right ventricular outflow
track (RVOT) can be displayed.
Apical four-chamber view:
place transducer on the 5th inter- costal space, aprox. left midclavi- cular.
The transducer's index mark is directed towards the patient's left side.
The left (LV) and the right ventricle (RV), as well as the left (LA) and
the right atrium (RA) can be displayed.
Apical two-chamber view:
turn the transducer aprox. 60° counter- clockwise from the previous position.
The left ventricle (LV) and the left atrium (LA) can be displayed.
Apical three-chamber view:
turn the transducer further, aprox. 60° counter-clockwise from the previous position
and side tilt slightly. The left ventricle (LV), the left atrium (LA) and the aortic bulb (Ao)
can be displayed.
Apical five-chamber view:
show a four-chamber view and then tilt the transducer slightly down. The
aortic valve (AV) can be seen in the middle, between chambers. Tilting the
transducer to the opposite direction, the coronary sinus can be displayed.
Subcostal view:
place the transducer on the subxyphoid region. The transducer's index mark is directed towards
the patient's head. The inferior vena cava (VCI) can be displayed. Turn the transducer clockwise
slightly to diplay the right and left ventricle, as well as the right (RA) and left atrium.
Suprasternal view:
place the transducer on the suprasternal region. The transducer's index mark is directed towards
the patient's head and turned aprox. 45° to the right. The aortic arch (*), the neck arteries
(TB, CL, SL) and the right pulmonary artery (RPA) as well as the left atrium (LA) can be displayed.
Measurements must always be done perpendicular to the main axis of a vessel, a chamber or
atria. The aortic bulb should be measured at the beginning, the left atrium at the end
of the ventricular systole. Perpendicular "cuts" from the parasternal view in adults are
often not possible, short axis can be taken instead for a better orientation. A global impression
from all views is necessary in order to avoid under- or overestimation of dimensions.
Therefore, traditional measurements with M-Mode from parasternal can not be recommended anymore.
Aortic bulb
< 40 mm
Ascending aorta
< 40 mm
Aortic arch
< 30 mm
Descending aorta
< 20 mm
Left atrium
< 40 mm
Right atrium
< 35 mm
Right ventricle
< 30 mm
Inferior vena cava
< 20 mm
Interventricular septum
6-10 mm
Posterior wall
6-10 mm
Lelft ventricle - end diastolic
40-55 mm
Left ventricle - end systolic
variable
Doppler velocities
Aortic valve
1.35 (1.0 - 1.7) m/s
Mitral valve
0.90 (0.6 - 1.3) m/s
Pulmonary valve
0.75 (0.6 - 0.9) m/s
Tricuspid valve
0.50 (0.3 - 0.7) m/s
The American Society of Echocardiography has published new recommendations
for chamber quantification. This document can be downloaded directly from
the ASE: Recommendations for
Chamber Quantification, 2005.
Prosthetic valves - normal values
Velocities depend not only from the diameter and type of the prosthesis, but also from the degree
of hyperdynamia (pregnant women, hyperthyoidism, anemia), significant prosthetic valve regurgitation, and
the "too-small-to-fit" phenomenon, caused by too small prosthetic valves for the native anatomic architecture.
Maximal velocity (Vmax) in m/s, peak pressure gradient (PPG) and
mean pressure gradient (MPG) in mmHg.
AVP = prosthetic aortic valve, MVP = prosthetic mitral valve.
Overview
