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2.3.1 Parasternal window - Long axis views | 123sonography

2 .3 .1 Pa r a s ter na l w indow - L ong a xis v iew s

For the

parasternal

window

you have

to

position the

patient on his/her left

side.

The

transducer is placed in a left-sided intercostal space (3rd or 4th intercostal space).

Parasternal long axis view

2. 3. 1. 1 S tand ard p aras te rnal l o ng -ax i s vi e w

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For the long axis the marker of the transducer points to the right shoulder. However, the exact orientation depends on the axis of the heart. If the patient is slim and the heart axis is steep, rotate the the transducer a little transducer must be further in clockwise direction. In obese and pyknic opposite

patients

rotated in counterclockwise

direction (in the

position).

The PLAX view should be optimized so that there is just a small or no angle between the anterior wall of the aorta and the septum. An "angle" between these structures is usually caused by an excessively low imaging position.

As you will see later, an "angle" denotes that the ventricle is imaged in oblique fashion. This leads to false M-Mode measurements. Although PLAX cannot be used for M-Mode

measurements, you can still interpret the 2D findings.

The PLAX view provides substantial information. Although the apical segments of the heart are not visible, you will obtain a good overview of cardiac function. Specifically, it allows you to interpret the morphology and motion of the interventricular septum. Since only a small portion of the RV is seen, PLAX is not ideal to interpret RV function. Other structures seen by this view are the aortic root and the left atrium. The size of the aorta should be measured here. To inspect the more cranial portions of the aorta it will be necessary to move the transducer up one intercostal space.

Parasternal long axis view

optimized for the ascending aorta

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If the quality of the image is good you will also be able to see the right coronary artery at its origin in the right coronary sinus.

Parasternal long axis view with the origin of the right coronary artery

The

PLAX

permits

measurement and

of is

the

size very

of

the

left for

atrium

(especially of

in

its

anterior/posterior

extension)

also

important

interpretation

valvular

function. At this site we are very close to the aortic and the mitral valve. In other words, the quality of the image is such that you can view details of the mitral valve and its subvalvular apparatus (papillary muscle, chordae).

If you tilt the transducer back and forth, parallel to the long axis you can image the different portions of the mitral valve and its subvalvular apparatus.

Other structures that can be seen in the PLAX view are the coronary sinus (at the junction between the left atrium and the left ventricle) and the descending aorta (behind the left atrium).

2 . 3 . 1 . 2 P a r a st er n a l l on g- a xi s of t he R V ( P L A X - R V )

For this view you simply need to tilt the transducer more to the right from the PLAX. This

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view is probably the best to display the tricuspid valve. In addition to the good image quality of the valve we will be able to "name" the individual leaflets: the anterior leaflet is seen in the near field and the posterior leaflet in the far field of the imaging sector (see also Chapter 13, Tricuspid Valve).

PLAX - LV

PLAX - RV

Comparison: Standard parasternal long axis (left) and parasternal long axis of the right ventricle

Use the PLAX -RV view to assess the tricuspid valve!

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