1. Adult Echocardiography Lesson Two Anatomy Review
Harry H. Holdorf

2. Which valve separates the areas of greatest pressure differences
Which valve separates the areas of greatest pressure differences? Mitral valve Know the SVC, Ao, and PA vessels. Know the Left anterior descending LAD coronary artery & great cardiac vein. LAD lies in the anterior interventricular groove or SULCUS (groove). Great Cardiac Vein pairs with the LAD. On exam: arrows can point to either the RVOT or the epi-cardial layer (fat pad).

3. A view from the top Tricuspid = anterior cusp, medial cusp, Posterior cusp Mitral = anterior cusp, posterior cusp Aortic =left, right, posterior cusp Pulmonic = anterior, right left cusp

5. Posterior aspect of coronary circulation

6. Parasternal Long Axis (LAX) LV

7. LAX

9. Know basic anatomy by other imaging techniques such as MRI.
Which aortic leaflet is the superior one in the parasternal long axis view?
Right leaflet
The left leaflet is the posterior one, and is the non-coronary
Know basic anatomy by other imaging techniques such as MRI.

10. MRI of DAo

11. Tricuspid Leaflets RV Inflow Tract
Name the tricuspid leaflets.
Posterior and anterior
Know the Tricuspid inflow tract view: this is the only standard view in which you see the posterior Tricuspid valve leaflet.

12. Tricuspid (RV) Inflow Tract Hint: Red flow in IVC

13. Parasternal Short Axis (SAX) Ao Valve

14. Coronary blood flow
The coronary arteries come off the
Sinuses of Valsalva
During which phase do the coronaries fill?
Early diastole

15. Parasternal short axis Coronaries

16. Coronary blood flow in Diastole

17. Fractional shortening, 2D = >25%
Normal Measurements
End diastole, nl 2D= cm
End systole, nl 2D = cm
Fractional shortening, 2D = >25%
End systole = frame preceding MV opening, or the time when the cardiac dimension is smallest.
End diastole = frame after mitral valve closure or frame in cardiac cycle where dimension is largest

18. Ao Measurements-Sinotubular Junction
AO-aortic valve annulus (hinge point of aortic leaflets)
AO-Sinuses (the maximal diameter in the sinuses of Valsalva)
Ao sinotubular junction (transition between the sinuses of Valsalva and the tubular portion of the ascending aorta)
Ascending aorta (largest diameter of ascending aorta). Measurements should be performed when the walls of the aorta are best seen.

20. ASE 17 segments of the Heart wall

21. 17 segments

22. Suprasternal Arch
What vascular structure is often visualized under the aortic arch?
Right Pulmonary Artery
Name the vessels coming off the arch via proximal to distal:
Innominate (proximal)
Left carotid
Left Subclavian (distal)

23. Suprasternal arch
The best images of the ascending aorta are often obtained from the suprasternal transducer window.
The vessels coming off the arch are the following:
Innominate (Proximal)
Left Carotid (Mid)
Left Subclavian (Distal)

24. Image of the Suprasternal Arch

25. Aortic Coarctation
What cardiac pathology is associated with bicuspid aortic valves?
Coarctation of the aorta
Where do most aortic coarctations occur?
After the take-off of the left subclavian artery, or within the aortic isthmus

26. Aortic Coarctation

27. Apical Four Chamber View
Where are the pulmonary veins located? Which ones are seen in this view?
Right and left upper (superior) pulmonary veins

28. Apical Four Chamber View

29. Apical Long Axis View
Which other view would give you the same information as the parasternal LAX?
Apical LAX

30. Apical Long Axis

31. Apical Two Chamber
Which standard 2D TTE view typically allows viewing of the LAA?
Apical 2 chamber

32. Apical Two Chamber View

33. Apical Two Chamber View

34. Coronary Sinus from LAX
Where is the coronary sinus located?
Posterior AV groove
To visualize the coronary sinus in the apical 4 chamber view, you should tilt the transducer:
Posterior

35. Coronary sinus from LAX

36. Which valve sits at the opening of the coronary sinus?
Thebesian

37. Subcostal IVC

38. Subcostal IVC

39. Normal Pulmonary Venous Inflow
a wave = atrial contraction
s wave = systolic inflow
d wave = diastolic inflow
What portion of the pulmonary venous PW Doppler represents atrial systole?
a wave

40. Normal Pulmonary Venous Inflow

41. TEE Views & Anatomy
Conditions suited for TEE Prosthetic valves Aortic Dissection Endocarditis Intracardiac Source of Embolus (SOE) Difficult to image Chest wall Others…

42. Safety Problems with TEE
Patient discomfort
Airway compromise
Vagal response or other hemodynamic compromise
Electrical or temperature hazard
Esophageal or tracheal trauma
Transmission of infection
At what temperature is it unsafe to use a TEE probe?
40-45C

43. TEE 4 chamber

44. TEE SAX of the aortic valve

45. Locate the LA appendage by TEE
Know TEE views by esophageal level Know mid esophageal-ME and degrees

46. Aortic leaflets by TEE

48. Lesson Three Cardiac physiology
End Lesson Two
Lesson Three Cardiac physiology