002 // How to Image
How To Move The Transducer
Displacement
Rotation
Angulation
NOTE: Use enough US gel!
Imaging Windows
Parasternal
2nd - 4th intercostal
space left sternal border
Apical
4th - 5th intercostal
space, lateral!
Subcostal
Below xiphoid
Right parasternal
2nd - 4th intercostal
space, right sternal
border
Suprasternal
Jugulum sternum
NOTE: Use as many views as possible including atypical views and always
image so that the pathology of interest is best seen.
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002 // How to Image
Image View
Parasternal long axis views
Parasternal long axis view
Right parasternal long axis
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002 // How to Image
Parasternal short axis views
Parasternal short axis – Base
Parasternal short axis – MV
Parasternal short axis – Mid Ventricle
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002 // How to Image
Apical Views
Rotate counterclockwise
4 chamber view
2 chamber view
3 chamber view
The orientation of the septum denotes whether you are in a lateral or medial
position relative to the true apex. Use all views to fully examine all aspects of
the left and right ventricle.
Orientation of the apical views
5 chamber view
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002 // How to Image
Coronary sinus view
NOTE: Avoid foreshortening, place the transducer as lateral and caudal as
possible
Subcostal Views
Subcostal 4 chamber view
Inferior vena cava view (rotate counterclockwise)
NOTE: In some patients it is also possible to visualize the superior vena cava
in this view.
Subcostal short axis view (rotate clockwise)
NOTE: Perform subcostal views in all patient
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002 // How to Image
Subcostal Views
Subcostal 4 chamber view
Inferior vena cava view (rotate counterclockwise)
NOTE: In some patients it is also possible to visualize the superior vena cava
in this view.
Subcostal short axis view (rotate clockwise)
NOTE: Perform subcostal views in all patient
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002 // How to Image
Reference Values — MMode
NOTE: MMode - LA is measured in its largest extension at end-systole. Aortic
dimension is measured at end-diastole, shortly before the aortic valve opens!
Aorta (mm)
< 40
LVEDD (mm)
42 - 59
Left atrium (mm)
30 - 40
Posterior wall (mm)
6 - 10
IVS (mm)
6 - 10
Fractional Shortening (%)
> 25
Tricuspid Annular Plane
Systolic Excursion (TAPSE)
> 16mm
MAPSE (longitudinal LV
function)
> 12mm
Reference Values — Doppler
Aortic valve velocity (m/sec)
CW
0.9 - 1.7
LVOT velocity (m/sec)
PW
< 1.3
Pulmonic valve velocity (m/sec)
CW
0.5 - 1.0
Tricuspid valve
PW
0.3 - 0.7
Tricuspid regurgitation (m/sec)
CW
1.7— 2.3
E wave (m/sec)
PW
< 1.3
Mitral annulus e‘ (cm/sec)
TDI PW
0.8 - 1.3
Right ventricular lateral wall (cm/sec)
TDI PW
12.2 (41-60a) /
10.4 (>60a)
Color Doppler
2D before color!
Look for aliasing to
detect jets
Reduce PRF to detect low
velocity flow (e.g. ASD,
PFO)
Use higher frame rates
Use multiple views
Color as guide for CW/
PW
NOTE: Don´t expect to see the full extent and size of a color Doppler jet if 2D
image quality is poor
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