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‘The 20 Views’ Annual Comprehensive Review & Update of Perioperative Echo. LV axis model. 17 segment model of the Left ventricle. ME four chamber. LV walls: 6 Basal Inferoseptal 12 Mid Inferoseptal 16 Apical Septal 3 Basal Anterolateral 9 Mid Anterolateral 14 Apical Lateral - PowerPoint PPT Presentation
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‘The 20 Views’Annual Comprehensive
Review & Update of Perioperative Echo
LV axis model
17 segment model of the Left ventricle
ME four chamber
RA
TV
RV
LA
MV
LV
LV walls:
6 Basal Inferoseptal
12 Mid Inferoseptal
16 Apical Septal
3 Basal Anterolateral
9 Mid Anterolateral
14 Apical Lateral
17 Apical Cap
6
16
A2 P1S
12 9
14
A1
RV free wall
A or P(depending upon probe flexion)
3
17
ME two chamber
LA
LV
LAA
5
11
15
2
8
13
LV walls:
5 Basal Inferior
11 Mid Inferior
15 Apical Inferior
2 Basal Anterior
8 Mid Anterior
13 Apical Anterior
17 Apical Cap
Valve leaflets:
Carpentier Classification
Mitral- Anterior(A1, A2, A3)
Posterior(P3)
P3
Left Atrial Appendage (LAA)
A3
A2A1
17
ME LAX
LA
LV
P2 A2
AV
RV
4
10 7
1
LV walls:
4 Basal Inferolateral
10 Mid Inferolateral
1 Basal Anteroseptal
7 Mid Anteroseptal
15 Apical Inferior
13 Apical Anterior
14 Apical Lateral
16 Apical Septal
17 Apical Cap
Valve leaflets:
Carpentier Classification
Mitral- Anterior(A2)
Posterior(P2)
14 or 15 13 or 16
17
TG mid SAX
RV
LV
PM pap
AL pap
7
8
9
10
11
12
LV walls:
8 Mid Anterior
7 Mid Anteroseptal
12 Mid Inferoseptal
11 Mid Inferior
10 Mid Inferolateral
9 Mid Anterolateral
Papillary Muscles:
Anterolateral papillary muscle (AL pap)
Posteromedial papillary muscle (PM pap)
TG basal SAX
RV
LV
A2
P2
1
2
3
4
5
6
LV walls:
2 Basal Anterior
1 Basal Anteroseptal
6 Basal Inferoseptal
5 Basal Inferior
4 Basal Inferolateral
3 Basal Anterolateral
Valve leaflets:
Carpentier Classification
Mitral- Anterior
A1, A2, A3
and Posterior
P1, P2, P3
P3
P1
A1
A3
TG Apical SAX (Not part of original 20 views)
13
14
15
16
13 Apical Anterior14 Apical Lateral15 Apical Inferior16 Apical Septal
LV
RV
16 segment LV model
Older LV model nomenclature Replaced by 17 segment model
Regional Wall Model
Transthoracic imaging planes
Mitral valve axis model
Mitral Valve Anatomy
CarpentierClassification
ME mitral commissural
LA
LV
A2P1
PM pap AL pap
Valve leaflets:
Mitral- Anterior Scallops
(A2)
and Posterior Scallops
(P1, P3)
Papillary Muscles:
Anterolateral papillary muscle (AL pap)
Posteromedial papillary muscle (PM pap)
P3
TG two chamber
LV
LA
LAA
PL
AL
Valve leaflets:
Mitral- Anterior(AL)
and Posterior(PL)
Left Atrium (LA)Left Atrial Appendage (LAA)Left Ventricle (LV)
ME AV SAX
LA
RA
RVOT
PV
NCC LCC
RCC
IASAortic ValveNon coronary cusp (NCC)Left coronary cusp (LCC)Right coronary cusp (RCC)
Left Atrium (LA)Right Atrium (RA)Intra atrial septum (IAS)Pulmonic valve (PV)Right ventricular outflow tract (RVOT)
ME AV LAX
LA
LV
PL
AL
Asc Ao
AV
Valve leaflets:
Mitral- Anterior(AL)
and Posterior(PL)
Aortic Valve (AV)Right Coronary Cusp (RCC)Non Coronary Cusp(NCC)Left Coronary Cusp
(LCC)
RV
RCC
NCC or LCC
Ascending Aorta (Asc Ao)
TG LAX
RV
AV
Asc Ao
PL
ALLV
Right Ventricle (RV)Aortic Valve (AV)Ascending Aorta (Asc Ao)
Valve leaflets:
Mitral- Anterior(AL)
and Posterior(PL)
deep TG LAX
LV
PLAL
LA
RV
AVAo
Left Ventricle (LV)Right Ventricle (RV)Left Atrium (LA)
Aortic Valve (AV)Aorta (Ao)
Valve leaflets:
Mitral- Anterior(AL)
and Posterior(PL
ME bicaval
LA
RA
IAS
IVCSVC
Left Atrium (LA)Right Atrium (RA)Inferior Vena Cava (IVC)Superior Vena Cava (SVC)Intra atrial septum (IAS)
Fossa Ovalis
Right Atrial Appendage
Eustachian valve
ME RV inflow-outflow
LARA
TCV
RV
PV
AV
Left Atrium (LA)Right Atrium (RA)Tricuspid Valve (TCV)Pulmonic Valve (PV)Aortic Valve (AV)Right Ventricular Outflow Tract (RVOT)
ALPL
Valve leaflets:
Tricuspid- Anterior(AL)
and Posterior(PL)
Inferior RV free wall
RVOT
TG RV inflow
RARV
TCV
Right Atrium (RA)Right Ventricle (RV)Tricuspid Valve (TCV)
PL
AL
Valve leaflets:
Tricuspid- Anterior(AL)
and Posterior(PL)
ME asc aortic SAX
Rt PA
PASVC
Asc
Pulmonary Artery (PA)Right Pulmonary Artery (Rt PA)Superior Vena Cava (SVC)Ascending Aorta (Asc)
ME asc aortic LAX
Rt PA
Asc
Ascending Aorta (Asc)Right Pulmonary Artery(Rt PA)
Orientation:
DistalProximal
Aorta-esophageal position
As probe withdrawn from patient, TURN probe to the LEFT to keep aorta image in the center of the video screen
desc aortic SAX
Ao
Aorta (Ao)Orientation
desc aortic LAX
Ao
Aorta (Ao)
Caudad Cephalad
Orientation
UE aortic arch LAX
Aortic Arch
Distal
Proximal
Orientation
UE aortic arch SAX
PA
PV
RVOT
Aortic arch
L Subclavian artery
Left brachiocephalic vein
Pulmonary artery (PA)Pulmonic valve (PV)Right ventricular outflow tract (RVOT)
Orientation
• References:Shanewise JS, Cheung AT, Aronson S, et al. ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. Anesth Analg 1999;89:870-74.