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KEY IMAGES – PLAX, PSSA, A4C

Parasternal long axis (PLAX)

Correct plane has LA, MV, LV, LV outflow tract, AV, aortic root, septum, RV, RA, descending aorta.

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Video 08-01: Parasternal long axis view (PLAX)

In the parasternal long axis window, it is important to identify all of the relevant anatomy to ensure that the correct plane is being evaluated. That includes the right ventricular outflow tract (near the top of the screen), the intraventricular septum, the left ventricle, the mitral valve, the left atrium, the aortic valve, and the descending aorta (near the bottom of the screen)

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PLAX-labeled anatomy

Ao = aorta; AV = aortic valve; LA = left atrium; LV = left ventricle; MV = mitral valve; RA = right atrium; RV = right ventricle; TV = tricuspid valve.

Hand position

Indicator dot toward right shoulder, 3rd to 5th intercostal space, as close to sternum as possible.

Parasternal short axis (PSSA)

Fan from apex to base to find LV, RV, pap, cordae, MV, AV, aortic root; RV, TV, RA, pulmonic valve.

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Video 08-02: Parasternal short axis view (PSSA)

This parasternal short axis video is taken at the level of the papillary muscles. The crescentic right ventricle can be seen on the left side of the screen. The concentric circle of the LV can be seen in the center of the scree, with the hyperechoic papillary muscles at 5 and 7 o'clock inside the LV. This is a normal heart with a normal ejection fraction. If the transducer is fanned toward the right shoulder (so the tail of the probe is angled toward the left hip), then the mitral valve could be evaluated, followed by the aortic valve. Fanning toward the left hip (tail toward the right shoulder) would allow visualization of the apex.

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PSSA-labeled anatomy at level of papillary muscle (pap)

Hand position

Indicator toward left shoulder. This plane is 90 degrees clockwise in exact location of optimal PLAX view.

Apical four-chamber (A4C)

Identify LV, RV, MV, TV, LA, RA

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Video 08-03: Apical four chamber view (A4C)

This normal ultrasound demonstrates all four chambers of the heart. On the ...

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