Step 1 – PLAX
Start with deep image to assess for effusion before optimising depth
Colour doppler AV & MV – overall view and zoomed.
M-mode through AV & MV – if correctly aligned.
LV measurements.
Zoom into AV:
- Measure LVOT with AV open
- Cusps, sinus, ST junction, prox ascending aorta – with AV closed.
- Repeat colour.
Zoom into MV. Repeat colour.
Step 2 – Tilted PLAX – anteriorly to RV outflow view
Colour doppler thorugh PV.
PW in RVOT – can measure RVOT Vmax.
CW – PV to assess for valvular pathology. Measure PV Vmax.
Step 3 – Tilted PLAX – posteriorly for RV inflow view
Best view for visualising tricuspid.
Colour doppler TV..
CW for valvular pathology.
Step 4 – PSAX
Best view for visualising RWMAs.
Start with base – assess TV if good view. Colour + CW.
PV + modified view for MPA/bifurcation.
- Measure RVOT
- Colour + CW
- PW – measure RVOT Vmax
- CW – measure PV Vmax.
Interatrial septum – colour to assess for defect..
AV at base – visual inspection for leaflets. Zoom + colour for AR.
Fan towards apex – to level of MV and zoom/colour.
Papillary muscles – M mode + measurements if needed. Visual assessment for RWMAs.
Fan to apex.
Step 5 – A4C – LV/LA
Visual assessment.
Colour over MV
PW – for E/A/dec time.
CW for valve pathology. Zoom into MV – repeat colour.
M-mode – MAPSE.
TDI – lat + septum – e’/a’/s’
Simpson’s/LV length
LA volume.
Step 6 – A4C – RV + RA
Visual assessment
Colour over TV.
CW for valve pathology.
Zoom + colour.
M-mode – TAPSE.
TDI – lat wall – RVS’.
Zoom into RA:
- Measure RA area.
- RA height(major axis)/width(minor axis).
- RV width at base/mid.
Colour over atrial septum.
Step 7 – A5C
Colour to include all of LV.
CW at leaflet tips – AV Vmax/VTI
PW in LVOT – LVOT Vmax/VTI
Step 8 – A2C
Visual assessment.
Simpson’s.
Colour/CW if req.
Measure LA volume.
Step 9 – A3C
Visual assessment for RWMAs.
Colour doppler.
Can repeat measurements for MV and AV – particularly in AS to increase accuracy.
Step 10 – Subcostal
Visual assessment.
Colour over atrial and ventricular septum.
Best view for identifying defects.
Measure width of RV free wall.
Step 11 – IVC
Visual assessment.
M-mode + sniff test for collapse if not ventilated.
Step 12 – Suprastenal notch
Measure arch + descending aorta.
PW in descending aorta.
Can use m-mode with colour if suspicion of dissection/reverse flow.