Suprasternal view

Suprasternal view allows for visualization of the aortic arch, measurement of the ascending, descending and transverse arch. It is also the opportunity to evaluate for coarctation, hypoplastic arch or presence of a posterior shelf leading to obstruction. PW Doppler may be obtained in the pre and post-ductal aorta, as well as in the ascending aorta. The angulation is optimal for assessing aortic stenosis CW-Doppler. 

B-Mode of the Aortic Arc (Ascending, transverse and descending). The origin of the brachiocephalic trunk, the left carotid and left subclavian artery can be visualized.

Colour box outlines that there is no sign of turbulence of acceleration.

Another example of an arch view with the corresponding colour box

Pre-ductal descending aorta indicating forward flow in systole and diastole. 

Post-ductal descending aorta PW-Doppler indicating reversal of flow during diastole (left to right ductus arteriosus leading to diastolic steal effect).

It is important to evaluate the bifurcation of the first vessel (brachiocephalic) to ensure a bifurcation towards the right side - left sided arch. In the presence of a right-sided arch, one may need to further delineate if there is presence of a vascular ring.

Cross-sectional view of the brachiocephalic trunk coming off the aorta, eventually branching into the right carotid and right subclavian artery while we are fanning the ultrasound probe towards the right shoulder of the baby. This corresponds to normal expected branching with a left sided arch. 

This view is also useful to assess SVC flow and presence of catheter's position in the upper limb entering the right atrium via the SVC.

Normative Values of Aortic Arch Structures in Premature Infants

Reference: Normative Values of Aortic Arch Structures in Premature Infants. J Am Soc Echocardiogr 2017;30:227-32.)

From: Recommendations for Quantification Methods During the Performance of a Pediatric Echocardiogram: A Report From the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. Lopez L. et al. J Am Soc Echocardiogr 2010;23:465-95. 

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Arch measurements

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