TnECHO

Subcostal

The subcostal view is essential in newborns. Due to the echogenecity of the liver, it offers a great view for a sweep to evaluate for function, pericardial effusion and anatomy. Because newborns are sensitive from the abdomen, one may go very gently to acquire images in this view. It is also a great view for line positioning (bicaval view) and for the position of the umbilical arterial line. One may also appreciate presence of pleural effusion in that view, by sliding towards the lung fields. The first view here evaluates the situs, with the aorta to the left of the IVC. One should sweep to ensure that the IVC connects, as expected, to the right atrium.

This is a sweep in the subcostal view from posterior to anterior in the long-axis. One may appreciate nicely the performance of both the LV and the RV. We can also appreciate the respective outflow tracts.

In this view, one may observe a small restrictive muscular VSD. The sweep outlines the anatomy and interrogates the inter-ventricular septum throughout its length.

One may appreciate the SVC connecting to the right atrium, as well as a inter-atrial septal defect between the RA and the left atrium.

Measurement of the SVC at its right atrial connection. One may also use this view to locate the tip of a central line.

Left to right Patent foramen ovale (PFO)

Bidirectional PFO

Right to left PFO

Bidirectional PFO

Left to right PFO

Right to left PFO

Subcostal short-axis view. In 2D, one may appreciate the sweep. Visualisation of the IVC connecting to the RA (with the eustachian valve), as well as the SVC connecting to the RA. This view is ideal to visualize the RVOT (especially if a suspicion of pulmonary stenosis). It is also ideal to interrogate the flow in the descending Aorta. This view allows to evaluate for the insertion of the tricuspid valve apparatus.

PW of the SVC flow, as well as VTI of the SVC flow.

This is the view to rule out sinus venosus defect, as well as interrogate SVC flow. A sinus venosus defect is seen when a right pulmonary vein unroofs in the SVC.

Subcostal view with descending aortic flow. One may recognize the aorta as the large vessel along the spine.

Retrograde flow in the descending aorta from ductal steal.

Subcostal view showing the descending aorta with red flow (coming towards the probe) indicating forward flow with the umbilical arterial line in the descending aorta.

Subcostal view of the descending aorta with colour flow. An umbilical arterial catheter is observed with the tip at the level of the diaphragm. The flow in the celiac artery is seen.

Various degree of holo-diastolic retrograde flow in the descending abdominal aorta

2D and Colour visualizing the celiac and superior mesenteric artery branching from the descending aorta from the subcostal view. One may also appreciate an umbilical arterial line in the descending aorta.

Bicaval view with VV-ECMO cannula in the SVC

Umbilical arterial line in the descending aorta, arriving at the diaphragmatic junction.

Umbilical venous line in the IVC entering the RA.

Umbilical venous line in the IVC entering the RA.

Created by Gabriel Altit - Neonatologist / Créé par Gabriel Altit (néonatalogiste) - © NeoCardioLab - 2020