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6  Echocardiography

85

 

 

 

 

2.10\ Apical Four-Chamber View

 

 

 

a1

 

 

a2

RV

 

 

LV

RA

 

 

LA

 

 

 

LIPV

RSPV

 

 

LSPV

b1

 

 

b2

RV

 

 

LV

 

 

MV

TV

 

 

 

 

 

RA

 

 

 

 

 

 

LA

RSPV

 

LIPV

 

 

LSPV

 

 

Fig. 6.14  Apical four-chamber view. (a) Diastole. (b) Systole

2.10.1\ Scanning Method

The patient lies supine or on the left lateral position. The probe is put on the left medioclavicular line (fifth intercostal space) or at the palpable apex of the heart. The ultrasound beam is directed towards the right shoulder.

2.10.2\ Section Structure

The chief structures visualized are the right ventricular free wall, right ventricle, interventricular septum, left ventricle, left ventricular lateral wall, right atrium, interatrial septum, left atrium, mitral valve, tricuspid valve, atrial vaults, and inlets of the pulmonary arteries.

2.10.3\ Measuring Method and Normal Value

The transverse diameters of right and left ventricle are measured in diastolic end at the chordae

tendineae level, while the transverse diameters of right and left atrium are measured in systole at the atrial middle level. Normal transverse diameter ranges of the following structures are right ventricle 20 ± 10 mm, left ventricle 40 ± 16 mm, right atrium 30 ± 10 mm, and left atrium 29 ± 11 mm.

2.10.4\ The Clinical Application

Cavity size of the atriums and ventricles, morphology and closing–opening motion of mitral and tricuspid valves, continuity of atrioventricular septum, intactness of crisscross heart, and number and Doppler wave of pulmonary artery inlet are noticed, while presence of abnormal echoness in the cavities, regional wall motion abnormality of left ventricle, and pericardial effusion can also be observed in this view.

86

S. He

 

 

2.11\ Parasternal Right Ventricular

OutflowTract Long-AxisView (1)

a1 a2

RVOT

 

PV

 

MPA

LV

MV

 

b1

b2

RVOT

mPA

LV

Fig. 6.15  Parasternal right ventricular outflow tract long-axis view (1). (a) Diastole. (b) Systole

2.11.1\ Scanning Method

The patient lies supine or on the left lateral position. The probe is put at the left sternal edge (third to fourth intercostal space). The ultrasound beam, on the base of left ventricular long-axis view, is tilted up slightly and rotated clockwise to direct the reference point towards the left shoulder.

nary artery, left ventricle, and short axis of mitral valve.

2.11.3\ Measuring Method and Normal Value

The right ventricular outflow anteroposterior diameter range is 22 ± 9 mm.

2.11.4\ The Clinical Application

2.11.2\ Section Structure

This view is mainly used to see the right ventricu-

The chief structures shown are the right ventricu-

lar outflow, pulmonary valve, and motion of the

lar infundibulum, pulmonary valve, main pulmo-

right ventricular wall.

6  Echocardiography

87

 

 

2.12\ Apical Left-Heart

Two-Chamber View

a1

a2

LVAW

LV

 

 

LVIW

 

LA

b1

b2

LV

LA

Fig. 6.16  Apical left-heart two-chamber view. (a) Diastole. (b) Systole

2.12.1\ Scanning Method

The patient lies supine or on the left lateral position. The probe is placed at the left sternal edge and the palpable apex of the heart. The ultrasound beam, on the base of the apical four-chamber view, is rotating about clockwise 50° without right heart to be imaged.

2.12.2\ Section Structure

The structures visualized are the left ventricular anterior wall, left ventricular inferior wall, apex, left atrium, and mitral valve.

2.12.3\ The Clinical Application

Thickness and motion of left ventricular anterior wall, left ventricular inferior wall, and apex are the chief items to be observed. By turning the probe right and left, mitral valve and mitral papillary muscle can also be shown clearly in this view.

88

S. He

 

 

2.13\ Apical Right-Heart Two-

Chamber View

a1

RV

RA

SVC

b1

RV

PTV

RA

SVC

Fig. 6.17  Apical right-heart two-chamber view. (a) Diastole. (b) Systole

a2

IVC

b2

ATV

IVC

2.13.1\ Scanning Method

The patient lies supine or on the left semilateral position. The probe is put near the left sternal edge. The beam, from the left ventricular long-­ axis view, is tilting inferiorly.

2.13.2\ Section Structure

The structures seen are the right ventricular anterior wall, right ventricle, right ventricular inferior wall, right atrium, and tricuspid valve.

2.13.3\ The Clinical Application

Emphases are put on the echoness and position of the posterior tricuspid leaflet in this view.