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ECHO in Context
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 LEARN THE BASICS: Echocardiography | Doppler


The Changing Left Ventricle

Aortic Valve Disease: New Dimensions in Evaluation and Management

Heart Failure: Echo's Role in and Emerging Health Crisis

Chest Pain in Children & Adults: The Role of Echo

Mitral Regurgitation: New Concept

The Falling Left Ventricle: Diastolic & Systolic Function

Changing the Outcome of Coronary Artery Disease
Digital Integration
Doppler Echo

Chest Pain in Children and Adults

Mitral Regurgitation: New Concepts

Diastolic and Systolic Function

Changing the Outcome of CAD

2000 MV
2001 Chest Pain
2002 Heart Failure

Parasternal Short-Axis Plane
Aortic Valve Level
skillB_fig. 36  The short axis plane at aortic valve level with parasternal transducer position indicated.
Fig. 36 The short axis plane at aortic valve level with parasternal transducer position indicated.

Further tilting of the transducer toward the subject's right shoulder, combined with slight rotation clockwise, brings the scan plane above the level of the mitral valve annulus, so that it transects the two atria (Fig. 37). In the center is the aorta, with its three cusps visible. Below the aorta is the left atrium, with the interatrial septum running diagonally downward and to the left, dividing it from the right atrium. The plane of the section passes diagonally across the tricuspid valve annulus, above the posteroseptal leaflet, part of which is still visible. Above the tricuspid valve is the crista supraventricularis and part of its parietal band. The outflow tract of the right ventricle arches over the top of the aorta toward the pulmonary valve, the posterior cusp of which is seen.

Fig. 37

These features are depicted on the echocardiographic image (Figs. 38 and 39). There is usually some "dropout" in the atrial septum in the region of the fossa ovalis where it is very thin. While lack of continuity of the atrial septum on the echo display is therefore not diagnostic of an atrial septal defect, this view can be used in conjunction with echocardiographic contrast studies to demonstrate interatrial shunts. Microbubbles, generated by rapid injection of fluid into a peripheral vein, enter the right atrium. Even where the dominant shunt is left to right, there is usually a small amount of flow from right to left at the onset of systole, and this is indicated by passage of a few microbubbles across the interatrial septum into the left atrium.

Figs. 38-39

Tilting the transducer slightly further moves the scan plane above the level of the aortic valve. In this position, it is possible to visualize the ostium of the left coronary artery in a substantial proportion of subjects, and that of the right coronary artery in rather less. With further refinements in instrument resolution, it may become possible to detect major stenosis of the proximal coronary arteries with acceptable reliability.

Figs. 40-41

Further counterclockwise rotation aligns the scan plane along the main pulmonary artery, seen running posteriorly to the right of the aorta. It is frequently possible to visualize this vessel as far as the bifurcation into right and left pulmonary arteries, with the right seen turning behind the heart and the left in the opposite direction (Figs. 40 and 41). Finding the bifurcation is positive identification of the pulmonary artery, and thus is valuable in congenital heart disease.

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