II. Technique: Transducer

  1. Transducer orientation (start)
    1. Transducer Rotated 90 degrees clockwise from Parasternal Long Axis View
    2. Transducer 3-5 cm to the left of the left sternal border at 3rd to 5th intercostal space
    3. Transducer indicator pointed towards patient's left Shoulder (1:00 position)
  2. Transducer gradually tilted down heart axis to obtain 4 heart cross-sectional slices
    1. Aortic valve level
    2. Mitral valve level
    3. Mid-ventricle level
    4. Heart apex
  3. Images
    1. UltrasoundHeartPLAXAndPSAX.jpg
    2. ultrasoundProbePositionEchoPSAX.jpg
    3. ultrasoundProbePositionEchoPSAX_apical.jpg

III. Technique: Landmarks

  1. Landmarks: Aortic valve level
    1. Right ventricular outflow tract
    2. Tricuspid valve, aortic valve (peace or mercedes sign when tri-leaflet) and pulmonic valve
    3. Right atrium, left atrium and pulmonary artery
    4. ultrasoundBMP_cvPSAX_aorta2.jpg
  2. Landmarks: Mitral valve level
    1. Right ventricle
    2. Mitral valve (anterior and posterior leaflets appear as a fish mouth opening and closing)
    3. ultrasoundBMP_cvPSAX_MV2.jpg
  3. Landmarks: Mid-ventricle level (most useful short axis view for emergency department)
    1. Right ventricle
    2. Left ventricle (with trabeculations representing papillary muscles)
  4. Landmarks: Apical level
    1. Right ventricle (much smaller in size than left ventricle unless right ventricle dilated)
    2. Left ventricle
    3. ultrasoundBMP_cvPSAX_apex.jpg

IV. Interpretation

  1. Bicuspid aortic valve (Aortic valve level)
    1. Bicuspid valve is visualized with valve open (since bicuspid valve has a fused valve leaflet that is not evident in closed position)
    2. Tri-leaflet appearance (Mercedes symbol) will be seen in both bicuspid and tricuspid valve when valve closed
  2. Left ventricle wall motion abnormality (mid-ventricle level)
    1. Best view to see all left ventricle walls

V. Resources

  1. Parasternal Short Axis View Video (SonoSite)
    1. http://www.youtube.com/watch?v=EaLuCBXXINg
  2. Echocardiographer
    1. http://echocardiographer.org/

VI. References

  1. Mateer and Jorgensen (2012) Introduction and Advanced Emergency Medicine Ultrasound Conference, GulfCoast Ultrasound, St. Pete's Beach
  2. Noble (2011) Emergency and Critical Care Ultrasound, Cambridge University Press, New York, p. 61-88
  3. Orman, Dawson and Mallin in Majoewsky (2013) EM:Rap 13(1): 4-6
  4. Reardon (2011) Pocket Atlas Emergency Ultrasound, McGraw Hill, New York, p. 61-106

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