Parasternal Protocol

Parasternal ProtocolLindsey SimonJanuary 16, 2013PLAX LVOT

Anatomy: RV, IVS, LVOT, ascending aorta, right coronary cusp and non coronary cusp of aortic valve, LV, anterior and posterior leaflets of MV, LA, pericardium, lung

Technique: Transducer was placed between the 3rd and 5th intercostal spaces. The notch was pointed in the 10 oclock position towards the patients right shoulder. The heel/toe technique was used to help straighten the image out across the screen and the transducer was slightly twisted to help open up the left ventricle and the LVOT. The M-mode tracing as taken through the aortic valve. Aortic root is measured and end diastole from the outer edge of the anterior aortic root to the inner edge of the posterior aortic wall. The LA is measured at end systole between the anterior side of the posterior aortic wall to and the anterior side of the posterior left atrial wall. Aortic valve systolic separation measures the maximal opening of the aortic valve cusps during ventricular systole.

2PLAX LVOT

Anatomy: RV, IVS, LVOT, ascending aorta, right coronary cusp and non coronary cusp of aortic valve, LV, anterior and posterior leaflets of MV, LA, pericardium, lung

Technique: Transducer was placed between the 3rd and 5th intercostal spaces. The notch was pointed in the 10 oclock position towards the patients right shoulder. The heel/toe technique was used to help straighten the image out across the screen and the transducer was slightly twisted to help open up the left ventricle and the LVOT. The M-mode tracing was taken through the mitral valve. The E-F slope is measured at the steepest portion of the anterior MV during early diastole and then the other caliper is placed at the end of the slope. EPSS is meausred from the MV E point to the lowest point of the IVS.

3PLAX LVOT

Anatomy: RV, IVS, LVOT, ascending aorta, right coronary cusp and non coronary cusp of aortic valve, LV, anterior and posterior leaflets of MV, LA, pericardium, lung

Technique: Transducer was placed between the 3rd and 5th intercostal spaces. The notch was pointed in the 10 oclock position towards the patients right shoulder. The heel/toe technique was used to help straighten the image out across the screen and the transducer was slightly twisted to help open up the left ventricle and the LVOT. The M-mode tracing was taken through the left ventricle.

4PLAX LVOT

Anatomy: RV, IVS, LVOT, ascending aorta, right coronary cusp and non coronary cusp of aortic valve, LV, anterior and posterior leaflets of MV, LA, pericardium, lung

Technique: Transducer was placed between the 3rd and 5th intercostal spaces. The notch was pointed in the 10 oclock position towards the patients right shoulder. The heel/toe technique was used to help straighten the image out across the screen and the transducer was slightly twisted to help open up the left ventricle and the LVOT. Measurements were taken at end diastole from the RV side of the IVS to the LV side to measure the IVS, from the endocardium of the IVS to the endocardium of the LVPW to measure the LV, and from the endocardium of the LVOW to the the epicardium to measure the posterior wall.

5PLAX LVOT

Anatomy: RV, IVS, LVOT, ascending aorta, right coronary cusp and non coronary cusp of aortic valve, LV, anterior and posterior leaflets of MV, LA, pericardium, lung

Technique: Transducer was placed between the 3rd and 5th intercostal spaces. The notch was pointed in the 10 oclock position towards the patients right shoulder. The heel/toe technique was used to help straighten the image out across the screen and the transducer was slightly twisted to help open up the left ventricle and the LVOT. The aortic root was measured from inner edge to inner edge at the Sinus of Valvsalva at end diastole.

6PLAX RVIT

Anatomy: RA, anterior leaflet and inferoposterior leaflet of TV, RV

Technique: Transducer notch was pointed in the 10 oclock position towards the patients right shoulder. I angled the transducer tail up so the beam would be angled inferiorly. The patient was asked to let out all of her air to keep the lungs from covering the image. 7PLAX RVOT

Anatomy: RV, Pulmonic Valve, MPA, right and left pulmonary arteries

Technique: Transducer notch was pointed in the 10 oclock position towards the patients right shoulder. I angled the transducer tail down so the beam would be angled superiorly. The patient was asked to let out all of her air to keep the lungs from covering the image.

8PSAX Level of Aortic Valve

Anatomy: LA, IAS, RA, TV, RV, Pulmonic Valve, MPA, aorta, right coronary cusp, left coronary cusp, and non coronary cusp

Technique: Transducer placed between 3rd and 5th intercostal spaces. The notch was rotated 90 degrees clockwise from the long axis plane. The transducer was twisted slightly to get the aortic valve in clearly and angled slightly superiorly. Color Doppler wasp laced over the pulmonary valve to check for regurgitation or stenosis.

9PSAX Level of Mitral Valve

Anatomy: anterior leaflet and posterior leaflet of MV, LVOT

Technique: Transducer placed between 3rd and 5th intercostal spaces. The notch was rotated 90 degrees clockwise from the long axis plane. Transducer beam angled slightly more inferior than AV image, transducer tail starting to move from inferior to superior position. 10PSAX Level of Apex

Anatomy: Trabeculations of the apex of LV

Technique: Transducer placed between 3rd and 5th intercostal spaces. The notch was rotated 90 degrees clockwise from the long axis plane. Transducer beam angled inferiorly with the tail superior towards the patients head.

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