Cardiac Assessment

Apical 4 chamber view. Eventual clockwise rotation to obtain the Apical 5 chamber view

Apical 4 chamber view. Left ventricle is on the right side of the screen.

Apical 2 chamber view. Once in Apical 4 chamber view, counterclockwise rotation to visualize the LV anterior and posterior wall. Left atrium and mitral valve can also be appreciated on this view.

Apical 5 chamber view - LV outflow tract is visualized

Line of interrogation is through the Apex and the attachement of the tricuspid valve of the free wall of the right ventricle. The M-Mode is used in order to measure the tricuspid annular plane systolic excursion (TAPSE), a measure of systolic function of the RV.

Line of interrogation is through the Apex and the attachement of the mitral valve of the lateral wall of the left ventricle. The M-Mode is used in order to measure the mitral annular plane systolic excursion (MAPSE), a measure of systolic function of the LV (longitudinal, which is not the main contractile power of the LV, the main is the circumferential plane).

Pulse-Wave Doppler in the inflow of the left ventricle using the Vascular present (vascular access or carotide)

Pulse-Wave Doppler at the LV outflow tract using the Vascular present (vascular access or carotide)

Sweep in the parasternal short axis

Parasternal short axis indicating good LV function (systolic). No clear pericardial effusion.

M-Mode can be done at the tip of the mitral valve leaflet in the parasternal short axis to measure the end diastolic diameter and the end systolic diameter of the LV in order to calculate the shortening fraction

M-mode through the Aortic Valve and the posterior left atrium, to calculate the Left Atrial to Aorta Ratio in parasternal short axis.

Using the cardiac preset of the probe (with the colour flow at high velocity filter), we can evaluate in the PDA view for the presence of a ductus arteriosus, and (if present) its directionality. In this case, there is no obvious PDA present.

Parasternal long axis view

M-Mode can be done at the tip of the mitral valve leaflet in the parasternal long axis to measure the end diastolic diameter and the end systolic diameter of the LV in order to calculate the shortening fraction

M-mode through the Aortic Valve and the posterior left atrium, to calculate the Left Atrial to Aorta Ratio in parasternal short axis.

Subcostal view. The Liver is on top of the screen. The right atrium sits on the liver and the left atrium is posterior.

By using colour flow from the cardiac present (pediatric) we can appreciate the presence of a left to right inter-atrial shunt (likely patent foramen ovale)