This document provides an overview of various echocardiographic views used to visualize cardiac structures and diagnose pathologies. It describes the apical and parasternal views including the 4-chamber, 5-chamber, 2-chamber, and short-axis views. Each view is explained in terms of the structures seen and pathologies that can be identified. Measurement techniques like Simpson's method for ejection fraction are also summarized.

1. Focussed Pediatric Echocardiographic
Workshop
APICAL + PARASTERNAL VIEWS
(PLAX+ PSAX)
MURTAZA KAMAL
JULY 17TH, 2022

2. SCOPE…

3. DISCLAIMER….

4. TRIBUTE…..

5. APICAL VIEWS…

6. APICAL 4C VIEW
Good view to assess atrial+ ventricular size and function
Assess for TV+ MV morphology and for evidence of stenosis/ regurgitation
Pathologies identified:
VSD, ASD
TV/ MV abnormalities
PV abnormalities
RA, LA dilation
RV/ LV dilation/ hypertrophy/ dysfunction
Pericardial effusion

7. A4C

8. A4C CORONARY SINUS
Obtained from A4C (tilted posteriorly): Coronary sinus as it drains into RA
Pathologies identified:
• Partially unroofed CS (CS- ASD)
• Dilated CS

9. A4C CS

10. A4CV EF (SIMPSON’S BIPLANE METHORD)

11. A4CV EF (SIMPSON’S BIPLANE METHORD)
Ejection Fraction (EF) = (LV end-diastolic volume -
LV end-systolic volume)/LV end-diastolic volume
•Normal: ≥ to 55%
•Mildly depressed: 45-54%
•Moderately depressed: 30-44%
•Severely depressed: <30%

12. A5C VIEW
Excellent view to assess LVOT and flow across aortic valve
• Pathologies identified:
• AV abnomalitims:
• AS
• SAM
• HCM with septal hypertrophy
• Supravalvar AS
• MV abnormality:
◦ MVP
◦ Supravalvar mitral ring
◦ MV arcade
◦ Parachute MV

13. A5CV

14. A2C VIEW
Good view to assess LA size and LV systolic function
•Pathologies identified:
• LA dilation
• LV dilation
• LV dysfunction

15. A2C VIEW

16. A4C PULMONARY VALVE
View obtained tilted very anteriorly is a good view to assess RVOT + PV
• Pathologies identified:
• Pulmonary stenosis
◦ Subvalvar
◦ Valvar
◦ Supravalvar
• VSDs

17. A4C VIEW PV

18. PARASTERNAL VIEWs

19. PARASTERNAL LONG
AXIS VIEWs (PLAX)

20. PLAX LVOT & AORTA, MITRAL
Good view to profile MV, LV+ LVOT, flow across MV, AV
Pathologies identified:
• SAM
• MV abnormalities (prolapse, dysplasia,
• stenosis/ regurgitation, systolic anterior motion)
• VSDs
• AS/ AR
• LV hypertrophy/ dilatation
• LV dysfunction
• Aortic root and ascending aortic dilation
• Pericardial effusion

21. PLAX LVOT & AORTA, MITRAL

22. PLAX TV
PLAX view tilted posteriorly
Optimal views to assess and quantify TR
Pathologies identified:
•TV abnormality (prolapse, regurgitation)
•PAH (RVSP)
•Unroofed or partially unroofed CS (CS- ASD)
•RV hypertrophy/ dilation
•RV dysfunction

23. PLAX TV

24. PLAX PV
Tilted anteriorly
Excellent view to profile distal RVOT, assess PV morphology and MPA
Pathologies identified:
PDA
•PV abnormality
◦PS
◦Supravalvar PS
◦Pulmonary regurgitation
•RVOT obstruction
◦Tetralogy of Fallot
◦DCRV
◦RVOT aneurysm

25. PLAX PV

26. PLAX AORTIC ROOT & STJ
Focuses on LVOT, AV, Aortic root, STJ and Ascending aorta
Pathologies identified:
•Aortic root dilation/ aneurysm
• (Marfan Syndrome)
•Ascending aortic dilation
• (Bicuspid aortic valve)
•AS/ AR
•SAM

27. PLAX AORTIC ROOT & STJ

28. PARASTERNAL SHORT
AXIS VIEWs (PSAX)

29. PSAX RVOT & AORTIC VALVE
Good view to assess AV arcitecture, TV, RVOT and IAS
Pathologies identified:
•BAV
•OS ASD
•VSD (perimembranous)
•TV abnormality: Ebstein anomaly,
•TV dysplasia
•RVOT obstruction: DCRV, TOF
•PS: Subvalvar, Valvar, Supravalvar

30. PSAX RVOT & AORTIC VALVE

31. PSAX PV, BPAs
Excellent view to profile and assess PA arcitecture,MPA & BPAs
Pathologies identified:
•PV (PS/ PR)
•PS:
◦Subvalvar
◦Valvar
◦Supravalvar
•TOF
•APW
•Branch PA stenosis
•PDA

32. PSAX PV, BPAs

33. HIGH PSAX FOCUSSED ON BPAs
(PANTS VIEW)
Obtained from high PSAX
Pathologies identified:
Can profile distal MPA & BPAs
•Branch PA dilation/ hypoplasia/ stenosis
•MPA dilation/ hypoplasia/ stenosis
•APW
•PDA

34. HIGH PSAX FOCUSSED ON BPAs
(PANTS VIEW)

35. PSAX AORTIC VALVE ZOOMED
Ideal view to profile 3 coronary cusps
Pathologies identified:
• BAV
• Anomalous coronary artery (left or right)
• Endocarditis (aortic valve vegetation)
• VSD
• AR (defines mechanism and origin of regurgitation)

36. PSAX AORTIC VALVE ZOOMED

37. PSAX VENTRICULAR PAPILLARY MUSCLES
Obtained from PSAX: Ideal view for profiling RV/ LV, assessing wall thickness and ventricular systolic function
M-mode measurements obtained from this view
Pathologies identified:
• VSDs
• RVH/ dilation/ dysfunction. LVH/ dilation/ dysfunction
◦ M-mode: Quanitfy ventricle size/ thickness and shortening fraction
◦ Trace LV systolic and diastolic areas to calculate EF
• Pressure and volume assessment
◦ Diastolic IVS flattening: Volume loaded RV
◦ Systolic IVS flattening: Elevated RVSP (PAH, PS, VSD)
• Dyskinetic or paradoxical IVS motion
◦ Previous surgical repair with VSD patch
• MV abnormality
◦ Single papillary muscle, closely spaced or hypoplastic papillary muscles

38. PSAX VENTRICULAR PAPILLARY MUSCLES

39. PSAX EF CALCULATION

40. PSAX MITRAL VALVE
View obtained from PSAX
Excellent view for profiling anterior and posterior leaflets of MV
Pathologies identified:
Mitral valve abnormalities
◦Dysplasia
◦Prolapse
◦Cleft
◦Regurgitation

41. PSAX MITRAL VALVE

42. PSAX APEX
View obtained from PSAX view
Profiles LV apex
Pathologies identified:
Apical ventricular dysfunction
•LV apical trabeculations (LV non compaction cardiomyopathy)
•Apical muscular VSD

43. PSAX APEX

44. PSAX RCA
View obtained PSAX view
One of the ideal views for profiling origin/ caliber/ course of RCA
Pathologies identified:
•Anomalous RCA
•RCA dilation/ aneurysm

45. PSAX RCA

46. PSAX LCA
View obtained from PSAX view
One of the ideal views for profiling origin/ caliber/ course of LCA
Pathologies identified:
•Anomalous coronary artery
◦ALCAPA
◦ALCA from right coronary artery
•Coronary artery diltion/ aneurysm

47. PSAX LCA

48. JUST DO IT….