What are the top echocardiography (echo) views?

Standard Echocardiography Views

The standard echocardiography examination requires multiple acquisitions from parasternal, apical, subcostal, and suprasternal transducer positions to provide comprehensive cardiac assessment. 1

Transthoracic Echocardiography (TTE) Views

Parasternal Views

• Parasternal Long-Axis (PLAX)

  • Visualizes left ventricle, mitral valve, aortic valve, and left atrium
  • Provides assessment of LV size, function, and wall thickness
  • Allows evaluation of mitral and aortic valve morphology

• Parasternal Short-Axis (PSAX)

  • Multiple levels:
    1. Aortic valve level - visualizes aortic valve, right ventricular outflow tract, and pulmonary artery
    2. Mitral valve level - shows mitral valve leaflet motion and morphology
    3. Papillary muscle level - optimal for LV regional wall motion assessment
    4. Apex level - evaluates apical segments of the left ventricle

Apical Views

• Apical Four-Chamber (A4C)

  • Displays all four cardiac chambers simultaneously
  • Allows assessment of ventricular size and function
  • Enables evaluation of mitral and tricuspid valves
  • Critical for measuring tricuspid annular plane systolic excursion (TAPSE) for RV function 2

• Apical Two-Chamber (A2C)

  • Shows left ventricle and left atrium
  • Provides complementary views for LV wall motion assessment
  • Allows visualization of anterior and inferior walls

• Apical Three-Chamber (A3C)/Apical Long-Axis

  • Visualizes left ventricle, left atrium, aortic valve, and ascending aorta
  • Complements PLAX view for aortic and mitral valve assessment

Subcostal Views

• Subcostal Four-Chamber

  • Alternative window when apical views are suboptimal
  • Particularly useful for right heart assessment
  • Optimal for evaluation of interatrial septum and pericardial effusion

• Subcostal Short-Axis

  • Provides alternative view of the pericardium
  • Allows visualization of inferior vena cava for volume status assessment

Suprasternal Views

• Suprasternal Notch
  • Visualizes aortic arch and proximal great vessels
  • Useful for assessment of aortic coarctation and arch anomalies

Transesophageal Echocardiography (TEE) Views

TEE examination typically begins with real-time imaging modes and should include:

• Midesophageal Views:

  • 0° to 120° midesophageal views for mitral valve assessment
  • 60° midesophageal short-axis view for aortic valve
  • 120° midesophageal long-axis view for aortic valve
  • 0° to 30° midesophageal 4-chamber view for tricuspid valve 1

• Transgastric Views:

  • 40° transgastric view with anteflexion for mitral valve assessment

Three-Dimensional Echocardiography Considerations

For 3D echocardiography, standard anatomic planes are used for cropping:

1. Transverse plane - horizontal plane perpendicular to the body's long axis
2. Sagittal plane - vertical plane dividing the heart into right and left segments
3. Coronal plane - vertical plane dividing the heart into anterior and posterior segments 1

Clinical Pitfalls and Recommendations

• Image Acquisition Challenges:

  • Poor acoustic windows may limit visualization - use alternative views or consider contrast enhancement
  • Respiratory variations can affect image quality - instruct patients on breath-holding techniques
  • Ensure proper depth and gain settings for optimal visualization

• Interpretation Considerations:

  • Always correlate findings across multiple views for confirmation
  • When tracing the endocardium for LV volume calculations, exclude trabeculae from the LV cavity to avoid underestimation 1
  • For valve assessment, use multiple views to fully characterize morphology and function

• Technical Tips:

  • For 3D acquisitions, start with 2D imaging to localize the structure of interest
  • For patients unable to hold their breath during gated acquisitions, use single-beat acquisition mode
  • Select the highest resolution option that accommodates the volume of interest 1

By systematically obtaining these standard views, clinicians can comprehensively assess cardiac structure and function, leading to accurate diagnosis and appropriate management of cardiac conditions.