Neonatal echocardiography is becoming order of the day next only to TABC.It can give very objective information about cardiac structure and function aiding the treatment in time.Hence basic view are critical when we attept to cardiac ultra sound.

1. BED SIDE ECHOCARDIOGRAPHY
IN NEONATE
PROF(DR).MALLESH.K MBBS,MD,DNB,DM(CARDIOLOGY)
PEDIATRIC AND INTERVENTIONAL CARDIOLOGIST

2. • Echocardiography has become an invaluable tool in the
pediatric and neonatal intensive care unit. “Point-of-care,”
echocardiography allows:
• Identification of structural cardiac defects
• Assessment of hemodynamic status of the patient
• Guiding medical or interventional management of cardiac
defect

3. EQUIPMENT
There different cardiac ultra sound machines are available
Stand alone equipment is preferable to portable one
Stand alone cardiac ultra sound is legally acceptable than
portable
Equipment can have other functions as well depending on the
requirement
It preferable to have one or few so that one is well versed with

4. Precaustions before use
• One needs to know how to operate the equipment
• Functions keys need to be well understood before operating.
• Proper cardiac probe is connected
• Neonatal/pediatric probe is different from adult probe both in
frequency and size
• Check the pre-set before proceding to examination
• See that marker is in appropriate side

5. Mode
All modes to be used while doing echocardiography
• Two-dimensional (2D) mode
• colour flow Doppler mapping
• Pulsed-wave (PW) Doppler
• Continuous-wave (CW) Doppler
• M-mode

6. SCREEN
MODES FUNCTIONS KEY
PRESET BUTTON
SWITCH BUTTON

7. INCREASING OR
DECREASING DEPTH
OF IMAGE
TISSUE GAIN
COMPENSATION
FUNCTIONS KEY

8. MARKER OF THE
PROBE AND MAKER
ON THE DISPLAY
SCREEN TO BE ON
SAME SIDE

9. • High frequency probes focus at depth of 4–5 cm V/S low
frequency probes able to focus at 12–16 cm.
• High frequency 8-10MHz probes are used in neonates
• Low frequency probes are used in adults
• Mid-range frequency transducer used in toddlers or small
children.

10. The standard windows for
echocardiography
• Parasternal views (high left thorax just lateral to the sternum)
• Parasternal long axis and parasternal short axis
• Apical views (left lateral thorax just inferior and lateral to the
nipple(cardiac apex)
• Subcostal views (below the xiphoid region)
• Suprasternal view (in the suprasternal notch)

11. SUB COSTAL VIEW
• The subcostal view provides the
most comprehensive
information. Transverse views
should determine visceral situs as
well as the relationship of the
inferior vena cava and aorta
Probe is placed in subxiphoid region
with marker facing left of infant

12. Subcostal view
• We can generate multiple sequential
views and images by rotating probe in
clockwise and anticlock wise
• By orienting probe in sagittal, coronal
and cross section

13. APICAL 4 CHAMBER VIEW
• The apical view allow for visualization
of all four chambers with the heart
valves in a left-to-right orientation. The
four-chamber view identifies;
• Left and right atria
• anatomic right and left ventricles.
• Right and left atrioventricular valves
• Inter atrial and inter ventricular
septum

14. APICAL 4 CHAMBER VIEW
LEFT VENTRICLE
RIGHT
VENTRICLE
RIGHT ATRIA
LEFT ATRIA
MARKER

15. A5 CHAMBER VIEW
• Slight anterior tilt of probe in apical 4
chamber view aorta which is called
A5C view.
• This view helps in assessment o aortic
stenosis.regurgition, aortic peak
systolic velocity in fluid status
assessment

16. PARASTERNAL LONG AXIS VIEW
• Direction of marker to wards
right shoulder (in situs solitus)
• Direction of ultra sound waves
from right shoulder to left hip
• Placement of probe in left third
space (see the image)
• In the long axis view the left
ventricular inflow and outflow
tracts

17. Parasternal Long axis
• Good parasternllong axis means-
• Mitral and aortic valves clearly
visible
• LA and Proximal 2/3 of LV is
clearly visible
• RVOT is visible
• Aortic annulus, SOV, ascending
aorta is visible
• Descending aorta in cross section

18. PARASTERNAL LONG AXIS
RVOT
LV
LVOT
LA

19. PARASTERNAL SHORT AXIS VIEW
• Ninety degrees clockwise rotation
from parasternal long axis with out
changing the place will provide a short
axis view of the heart
• Allows for evaluation of the heart
chambers, the semilunar and
atrioventricular valves, and the
coronary arteries.

20. Parasternal short axis
• Series of short axis views can be
deduced
• Usually at the level of aortic
valve,mitral valve,papillary
muscles and apex.
• It gives morphology ,functions,
abnormalities of various
structures visible in this view

21. BASAL SHORT AXIS VIEW
Z
LA
AO
MPARVOT

22. The suprasternal views
• Obtained by placing the transducer in the suprasternal notch
with the child’s neck extended and slightly turned to the left.
• The supra sternal long and short axis views give information
regarding the side of the aortic arch, the ascending and
descending aorta with the head and neck vessels, the size and
branching of the pulmonary arteries, as well as anomalies of the
systemic and pulmonary venous return.
• A patent ductus arteriosus can also be imaged in this view.

23. SUPRASTERNAL VIEW
PROBE IN
SUPRASTERNLNOTCH

24. AORTIC ARCH IN
SUPRA STERNAL
LONG AXIS
AORTA AND SVC IN
SUPRASTERNAL SHORT
AXIS

25. SUPRA STERNAL LONG AXIS
ARCH OF AORTA WITH
AORTIC ARCH BRANCHES

26. THANK YOU