Echocardiography uses ultrasound to examine the heart. Different techniques are used, including M-mode for motion over time, 2D for cross-sectional imaging of anatomy and measurements, and Doppler to study blood flow velocity and direction. Views are obtained by positioning the transducer in different locations and orientations to visualize cardiac structures in various planes, such as parasternal long and short axis, apical 4-chamber, and subcostal. Proper transducer positioning is important for high quality imaging of the heart.

2. 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.

5. VENTRICLES

11. )MV(
TYPES OF CHORDAE TENDINEAE

12. )AV(

13. )PV(

18. 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

19. TRANSDUCER POSITIONS
AND TOMOGRAPHIC VIEWES

20. LOOK TO THE DIRECTION OF THE
ULTRASOUND BEAM

21. 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.

26. 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

27. PV
TV

30. 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

31. Parasternal short axis
a 90° clockwise rotation

34. 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

37. 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

38. 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

44. 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.

46. 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.

48. Apical two-chamber
60°

49. 60°
I A

51. 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°

53. 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.

56. 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

58. 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

59. 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

61. RPA
D.AO
RPA
D.AO
Suprasternal view
LONG AXIS SHORT AXIS
LA