Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point of care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

For more information, click below.


Subscribers log in here


Transthoracic echocardiography: Normal cardiac anatomy and tomographic views

Topic Outline

GRAPHICS

INTRODUCTION

Transthoracic echocardiography (TTE) is the primary noninvasive imaging modality for quantitative and qualitative evaluation of cardiac anatomy and function [1,2]. Two-dimensional (2D) Echocardiography provides tomographic or "thin slice" imaging. Comprehensive echocardiographic examination typically involves imaging the heart from multiple "viewing" orientations. A three-dimensional appreciation of cardiac anatomy is needed to integrate 2D (and M mode) echocardiographic information.

Echocardiographs equipped with three-dimensional capability have been developed to overcome the disadvantages of tomography [3-5]. These devices generally acquire a volumetric data set which can then be displayed in custom orientations. The specific clinical advantages of three-dimensional echocardiography are being defined. (See "Three-dimensional echocardiography".)

The nomenclature, standard protocol, and normal views associated with transthoracic echocardiography are reviewed here. The instrumentation and physics associated with echocardiography, along with discussions of various echocardiographic techniques, are presented separately. (See "Echocardiography essentials: Physics and instrumentation" and "Principles of Doppler echocardiography" and "Tissue Doppler echocardiography".)

NOMENCLATURE

Each tomographic view is defined by the transducer position (parasternal, apical, subcostal, suprasternal) and view (long axis, short axis, 4 chamber, 5 chamber). Transducer position is altered by placing the transducer at various locations on the thorax, while the view is manipulated by a combination of angulation and rotation. Due to limitations imposed by the thoracic skeleton and lungs, not all permutations of both variables result in clinically useful images.

Orientation — While acceptance is not universal, most labs follow the recommendations of the American Society of Echocardiography with respect to image display. With this convention, the transducer position is depicted at the top of the screen, with anatomy more distant from the transducer depicted at progressively lower regions of the display, the lateral/left structures to the right, and medial/right structures to the left. A linear calibration scale is provided for all 2-D and M-mode measurements.

                 

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: Apr 2013. | This topic last updated: Mar 6, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. Pearlman JD, Triulzi MO, King ME, et al. Limits of normal left ventricular dimensions in growth and development: analysis of dimensions and variance in the two-dimensional echocardiograms of 268 normal healthy subjects. J Am Coll Cardiol 1988; 12:1432.
  2. Otto CM. Textbook of Clinical Echocardiography, 4th edition, Saunders Elsevier, 2009.
  3. Wang XF, Deng YB, Nanda NC, et al. Live three-dimensional echocardiography: imaging principles and clinical application. Echocardiography 2003; 20:593.
  4. Panza JA. Real-time three-dimensional echocardiography: an overview. Int J Cardiovasc Imaging 2001; 17:227.
  5. Lange A, Palka P, Burstow DJ, Godman MJ. Three-dimensional echocardiography: historical development and current applications. J Am Soc Echocardiogr 2001; 14:403.
  6. Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002; 105:539.
  7. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18:1440.
  8. Parmley WW, Chatterjee K. Cardiology, Vol. 3, Lippincott, Philadelphia 1994.
  9. Silverman NH, Schiller NB. Apex echocardiography. A two-dimensional technique for evaluating congenital heart disease. Circulation 1978; 57:503.