The Standard Twodimensional Examination

The heart can be imaged through a multitude of planes with 2D echocardiography. To help standardize the 2D examination, the American Society of Echocardiography has recommended that cardiac imaging be performed in three orthogonal planes: long-axis (from aortic root to the apex), short-axis (perpendicular to long axis), and four-chamber (traversing both ventricles and atria through the mitral and tricuspid valves)34 (Fig. 13-12). It is important to recognize that the long and short axes are those of the heart, not the body. These three planes can be visualized using four basic transducer positions: parasternal, apical, subcostal, and suprasternal333^ Figs. 13-13/1, Q+S; B, and Q. In general, the long-axis plane is best imaged from parasternal, apical, and occasionally the suprasternal positions, while the short-axis plane is best imaged in the parasternal and subcostal positions. The four-chamber views are obtained from the apical and subcostal positions. The American Society of Echocardiography recognizes that these basic positions and planes may be modified somewhat and recommends that an image obtained within 45 degrees of a basic orthogonal plane be identified with that orthogonal plane. Table 13-2 lists the standard transducer positions and transthoracic echocardiographic views. Anatomic drawings of the various imaging planes are seen in B*Figs. 13-13, B»;H; 13-14, B»;B; 13-15, B+;B; 13-16, B»;H; 13-17, B»;B; 13-18, B+;B; 13-19 and s 13-20.

Basic Echocardiographic Images

Figure 13-12: The three basic tomographic imaging planes used in echocardiography: long-axis, short-axis, and four-chamber. LV = left ventricle; LA = left atrium; RV = right ventricle; RA = right atrium; PA = pulmonary artery; AO = aorta. (From Hagan AD, DeMaria AN. Clinical Applications of Two-Dimensional Echocardiography and Cardiac Doppler. Boston: Little, Brown; 1989, with permission.)

Figure 13-12: The three basic tomographic imaging planes used in echocardiography: long-axis, short-axis, and four-chamber. LV = left ventricle; LA = left atrium; RV = right ventricle; RA = right atrium; PA = pulmonary artery; AO = aorta. (From Hagan AD, DeMaria AN. Clinical Applications of Two-Dimensional Echocardiography and Cardiac Doppler. Boston: Little, Brown; 1989, with permission.)

Table 13-2: Standard Two-Dimensional Echocardiography Transducer Positions

Parasternal Position

Long axis

Left ventricular long axis Right ventricular long Right ventricular outflow Short axis

Short axis through the plane of The cardiac base

The mitral valve

The chordae tendineae

The papillary muscles The apex

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