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← Section I · Physical Principles, Instrumentation, Examination Principles
I.G

Standard Plane Positions – Standard Imaging Planes

8 cards

Notes

Standard TTE windows

Parasternal long axis (PLAX)

  • Imaged from left parasternal 3rd–4th intercostal space.
  • Structures: LV (basal to mid), IVS, AMVL and PMVL, AV, ascending aorta, LA, PMVL region.
  • Measurements: LVIDd/LVIDs, IVSd, PWTd, LA AP diameter, aortic root at sinuses of Valsalva.

Parasternal short axis (PSAX)

  • Levels (from base to apex):
    1. Aortic valve - trileaflet AV, tricuspid, pulmonic valve, RVOT.
    2. Mitral valve - "fish-mouth" MV; commissural anatomy.
    3. Mid-papillary - LV chamber quantification for wall motion, key intraop view.
    4. Apex - apical LV.

Apical 4-chamber (A4C)

  • All four chambers; septal and lateral walls; RA, RV, TV, MV.
  • Foreshortening warning: aligned axially; must include entire LV apex.

Apical 5-chamber (A5C)

  • A4C with LVOT/AV rotated into view; used for CW across AV.

Apical 2-chamber (A2C)

  • LV inferior and anterior walls.

Apical 3-chamber (A3C / apical LAX)

  • LV posterior/inferolateral and anteroseptal walls; LVOT visualized.

Subcostal

  • 4-chamber and IVC views. Best for atrial septum (interrogates perpendicular to septum - highest ASD sensitivity).

Suprasternal

  • Aortic arch, brachiocephalic vessels, descending aorta origin. PW/CW for coarctation gradient.

Mitral leaflet segmentation

  • Anterior leaflet: A1 (lateral), A2 (middle), A3 (medial).
  • Posterior leaflet: P1 (lateral), P2 (middle), P3 (medial).
  • Used in prolapse localization and mitral repair planning.

Aortic valve cusps

  • Right coronary cusp (RCC), Left coronary cusp (LCC), Non-coronary cusp (NCC).
  • Arantius nodules at the center of each cusp's free edge.

Standard TEE views

  • 28 views per ASE guidelines (upper esophageal, mid esophageal, transgastric, deep transgastric).
  • Mid esophageal 4Ch: 0–20°. 2Ch: 90°. LAX: 125–135°. Commissural: 50–70°.
  • Transgastric: always anteflex; mid-papillary short-axis is the primary intraoperative view.

Cards

  • basicI.G-001
    Name the four short-axis parasternal levels from base to apex.
    → 1) Aortic valve. 2) Mitral valve. 3) Mid-papillary. 4) Apex.
  • basicI.G-002
    Which parasternal short-axis level is the primary intraoperative view?
    → Mid-papillary level. Used for wall-motion assessment and volume status during surgery.
  • basicI.G-003
    Which view is most sensitive for detecting an atrial septal defect on TTE?
    → Subcostal 4-chamber. The septum is imaged perpendicular to the beam, avoiding drop-out.
  • basicI.G-004
    From which view do you assess the aortic arch and search for coarctation on TTE?
    → Suprasternal notch view.
  • basicI.G-005
    Name the six mitral leaflet segments.
    → Anterior: A1 (lateral), A2 (middle), A3 (medial). Posterior: P1 (lateral), P2 (middle), P3 (medial).
  • basicI.G-006
    Name the three aortic valve cusps.
    → Right coronary cusp (RCC), Left coronary cusp (LCC), and Non-coronary cusp (NCC).
  • basicI.G-007
    Which two LV walls are visualized in the apical 2-chamber view?
    → Inferior and anterior walls.
  • basicI.G-008
    Which two LV walls are visualized in the apical 3-chamber (LAX) view?
    → Anteroseptal (or inferoseptal) and inferolateral (posterior). The LVOT is also seen.