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  1. 1. Echocardiography is simply an ultrasound examination of the heart.During the examination, various different ultrasound modes or techniques are employed. -'M' mode produces a graphic tracing of the movement of a cardiac structure such as a valve leaflet over time. -Two dimensional echocardiography allows real time cross sectional imaging of the heart . This technique provides most of the information regarding the anatomy, most measurements of the heart. -Doppler echocardiography uses ultrasound to study the velocity, direction and character of flowing blood through the structures of the heart.
  4. 4. )AV(
  5. 5. )PV(
  6. 6. Each immage is determined by: -The transducer position (parasternal, apical, subcostal, suprasternal) Transducer position is altered by placing the transducer at various locations on the thorax -The tomographic view (long axis, short axis, 4- chamber, 5 chamber(. which is often manipulated by a combination of angulation and rotation of the transducer from the same position. LOOK TO THE DIRECTION OF THE ULTRASOUND BEAM
  9. 9. Parasternal long axis With the transducer in the 3rd or 4th right intercostal space immediately adjacent to the sternum and patient in left lateral decubitus a long-axis view of the heart is obtained which bisects the aortic and mitral valve, Proper positioning of the probe results in the ascending aorta being relatively horizontal in orientation. Lower intercostal positions may be necessary in patients with vertically oriented hearts due to chronic obstructive pulmonary disease.
  10. 10. Right ventricular inflow and outflow Inferomedial angulation from the parasternal long-axis position is performed to obtain the "right ventricular inflow" view which includes the right atrium, coronary sinus, septal and anterior leaflets of the tricuspid valve and basal right ventricle •Superior angulation of the probe permits depiction of the right ventricular outflow tract, including the pulmonic valve and main pulmonary artery. PVTV RA
  11. 11. PV TV
  12. 12. From the PLA orientation, a 90° clockwise rotation of the transducer with superior and inferior transducer manipulations permits delineation of the parasternal short axis (PSA) views: -At the base (aortic valve) view -Mid (mitral valve ) view -Mid ( papillary muscle) view -And apical levels view Parasternal short axis 70°to 110° clockwise
  13. 13. Parasternal short axis a 90° clockwise rotation
  14. 14. At the basal (aortic valve) level, the right atrium, septal and anterior leaflets of the tricuspid valve, right ventricular free wall, right ventricular outflow tract, pulmonic valve, main pulmonary artery, and left atrium can be seen "surrounding" the centrally oriented aortic valve. All three leaflets of the aortic valve may be identified, forming a "Y" configuration during ventricular diastole and "upside-down triangle" during ventricular systole
  15. 15. Slightly inferior angulation mitral valve level appears and the mitral orifice has a characteristic "ovoid" or "fish-mouth" appearance. the anterior mitral leaflet is located superiorly. - Slightly more inferior angulation results in visualization of the contracting left ventricle at the papillary muscle level , -More inferior angulation will visualize LV at apex level MV MV APEXAPEX
  16. 16. With the patient maintained in the left lateral decubitus position, the transducer is placed near the apex of the heart with an inferior orientation In the apical four-chamber view, all four chambers of the heart may be seen The left ventricle appears as a truncated ellipse,RV triangular with the interventricular septum, apex formed by LV, and lateral walls visualized. Apical four-chamber
  17. 17. Apical five-chamber •Anterior angulation and slight clockwise rotation of the transducer permits imaging of the left ventricular outflow tract, right and left leaflets of the aortic valve, and proximal ascending aorta .Anterior angulation alone (without rotation) often allows imaging of the left atrial appendage.
  18. 18. Apical two-chamber Counterclockwise rotation from the apical fourchamber orientation 60° results in acquisition of the apical two-chamber view In this orientation, the inferior and anterior walls of the left ventricle are visualized, along with the left ventricular apex and left atrial chamber.
  19. 19. Apical two-chamber 60°
  20. 20. 60° I A
  21. 21. Apical three-chamber Further 60° counterclockwise rotation from the apical two-chamber permits acquisition of the apical 3- champer view. the left ventricular outflow tract, infero-post.wall ,anterior septum, aortic leaflets, and proximal ascending aorta are seen The posterior mitral leaflet is displayed to the left of the screen and appears "shorter" than the anterior leaflet. The leaflets demonstrate an eccentric closure point. 60°
  22. 22. Subcostal four-chamber The subcostal views may be obtained either with the patient in supine position with the knees bent to relax the abdominal musculature. The transducer is positioned immediately below or to the right of the xiphoid process. This allows visualization of the basal, mid, and apical right ventricle, the inferior interventricular septum, and anterolateral left ventricular walls. The interatrial septum is oriented nearly perpendicular to the ultrasound beam.
  23. 23. Medial rotation of the transducer results in imaging of the hepatic veins and inferior vena cava as it enters the right atrium .Further angulation and posterior direction allows imaging of the abdominal aorta
  24. 24. Subcostal short axis In cases in which parasternal views are inadequate, rotation of the probe inferiorly from the subcostal four-chamber orientation will sometimes permit a subcostal short-axis view at the base and mid- ventricle. The anatomy depicted is similar to that described for the parasternal orientation
  25. 25. Suprasternal view With the patient supine and the neck extended, the transducer is placed in the suprasternal notch to obtain a long-axis image of the distal ascending, transverse, and proximal descending aorta. The take- off of the left carotid and left subclavian artery may also be appreciated. Centrally positioned and "beneath" the aortic arch is a short-axis of the right pulmonary artery This view may be particularly valuable for the evaluation of suspected patent ductus arteriosus, aortic coarctation, or aortic dissection. AV A.AO
  26. 26. RPA D.AO RPA D.AO Suprasternal view LONG AXIS SHORT AXIS LA