Echo windows: basic concepts and some points
- 1. Echo windows
- 3. STANDARD ECHO WINDOWS • Standard locations on the anterior chest wall that are used to place the transducer are called echo windows.
- 4. IMPORTANCE OF ECHO WINDOWS • Standard echo windows are important for two reasons: 1) Penetration of ultrasound waves from windows is good without much masking and absorption of ultrasound by ribs and lungs 2) Standardized echo images can be compared
- 5. DIFFICULTY IN PERFORMING TRANSTHORACIC ECHO • Transthoracic echo may be technically difficult to perform in following conditions: • Severe morbid obesity • Chest wall deformity • Pulmonary emphysema
- 8. Transthoracic Echocardiography Windows Left parasternal window • Long axis view • Short axis view Apical window • 4 chamber view • 5 chamber view • 2chamber view • 3 chamber view Subcostal window Suprasternal window Right parasternal window
- 10. Parasternal long axis view (PLAX) Transducer position: left sternal edge; 2nd to 4th intercostal space. • Marker dot direction: points towards right shoulder
- 11. • Structures seen LA LV MV AO AV RV IVS LV posterior wall M-mode measurements of LA/Ao and LV.
- 12. • Best view to see • MR • VSD • LVOT obstruction
- 14. Parasternal short axis view (PSAX) Transducer position: left sternal edge; 2nd to 4th intercostal spaces • Marker dot direction: points towards left shoulder (90 degrees clockwise from PLAX view)
- 15. Short axis level • Pulmonary artery level • Aortic valve level • Mitral valve level • Papillary muscle level • Ventricular level
- 18. • Structures seen • Ao valve cusps • RA • LA • IAS • TV • RV outflow tract
- 19. Aortic valve short axis
- 20. Mitral valve level Mitral valve orifice Mitral valve leaflet IVS
- 21. Papillary muscle level • Structures seen: • Anterolateral PM • Posteromedial PM • LV wall thickness • Regional wall motion • Ant wall • Lateral wall • Inf wall • IVS
- 22. Short axis view at the level of the papillary muscles
- 23. Apical 4 chamber view (AP4C) • Transducer position: apex of the heart • Marker dot direction: points towards left shoulder
- 24. Structures seen LA,LV RA,RV IAS IVS MV TV LV lat wall LV apex
- 26. Apical 5 chamber view • Transducer position: apex of heart • Market dot direction: points towards left shoulder • Structures seen same as apical 4 chamber view and AV + Proximal AO • The 5th chamber added is the LVOT
- 29. Apical 2 chamber view (AP2C) Transducer position: apex of the heart • Marker dot direction: points towards left side of the neck (45 degrees anti-clockwise from A4C view) • STRUCTURES SEEN • LV anterior wall • LV inferior wall
- 31. Subcostal view Patient positioning • The patient should ideally be placed in a supine position for a subcostal view examination. • The abdomen has to be relaxed to allow indentation of the probe into the epigastrium.
- 32. • Transducer position: under the xiphisternum • Marker dot direction: points towards left shoulder • Best window in paeds • ASD is best seen in this view
- 33. • STRUCTURES SEEN same as AP4CH View LA,LV RA,RV IAS IVS MV TV LV lat wall LV apex
- 34. Following structures are better seen as compared to AP4CH view a) Inferior vena cava and hepatic veins b) Descending abdominal aorta c) IAS d) Pericardial effusion
- 35. Sub costal
- 37. • Transducer position: suprasternal notch • Market dot direction: points towards left jaw • Structures seen • Ascending AO • PA • BEST VIEW FOR ARCH OF AORTA
- 39. RIGHT PARASTERNAL VIEW • Patient positioning • Pt lies in the semi recumbent position on his or her Right side. • The Right arm is tucked under the head and the left arm lies around the left side of the body
- 40. • Transducer position: Rt sternal edge; 2-4th intercostal space • Market dot direction: points towards left shoulder • Structures seen • AV • Aortic root