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Surface Cardiac Ultrasound- The Planes

In this small section we will be going over the spatial representation of the cuts made by the cardiac probe on the FoCUSed exam.

Introduction

The ultrasound machine extrapolates a 2D image on a 3D object. If structures are not lined up correctly your ultrasound assessment may be incomplete or you may not make out any actionable information from the clips you have obtained. This is is a very visual section in which we will be using a 3D heart model and make the cuts needed for a FoCUSed exam. 

Animated Heart Model

1. Parasternal Short Axis

Psx
Nml Psx 01.gif

       RV
                    
           LV       Ant



   Inf
 
                         Lat

 

3D heart model seen from different angles with scan sector interrogating the short axis of the LV. The plane cast by the ultrasound beam appears from left to right on the corresponding clip.  Corresponding mid papillary view seen on the clip on the right lower corner. RV, right ventricle; LV, left ventricle; Ant, anterior wall; Lat, lateral wall; Inf, inferior wall. 

By moving the plane more proximal from the mid papillary short axis we get the parasternal short axis at the mitral valve level and at the aortic valve level.

NML Psx base.gif

RV

Nml Psx AV.gif

PV

TV

IAS

AV

Moving the probe towards the head or feet changes the view you see on the parasternal short axis view. TV, Tricuspid valve; RV, Right Ventricle; PV, Pulmonic valve; AV, Aortic valve; IAS, Interatrial septum; MV, Mitral valve.

PLx

2. Parasternal Long Axis

Nml Plx 02.gif

MV

Left Atrium

LV

AV

LVOT

RV

3D heart model seen from different angles with scan sector interrogating the long axis of the heart. The plane cast by the ultrasound beam appears from left to right on the corresponding clip. On the right lower corner, the representing 2d clip. LV, Left ventricle; RV, Right ventricle; AV, Aortic valve; LVOT, Left ventricle outflow tract; MV, Mitral Valve.  

3. Apical 4 chamber

A4c
Nml Ap4c 02.gif

RV

TV

LV

MV

Left Atrium

IAS

 3D heart model seen from different angles with scan sector interrogating the apical 4 chamber view of the heart. The plane cast by the ultrasound beam appears from left to right on the corresponding clip. 1. Parasternal short axis; 2, Parasternal long axis. 4 Subcostal View; 5 IVC view. LV, Left ventricle; RV, Right ventricle; AV, Aortic valve; IAS, Inter atrial septum; MV, Mitral valve; TV, Tricuspid valve. 

3. Apical 4 chamber To 5 chamber view

Here we appreciate the transition of the 4 chamber view to a 5 chamber view by tilting the ultrasound probe.

Nml Ap4c 02.gif
A4c aligning flow.gif