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‘The 20 Views’ Annual Comprehensive Review & Update of Perioperative Echo.

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Presentation on theme: "‘The 20 Views’ Annual Comprehensive Review & Update of Perioperative Echo."— Presentation transcript:

1 ‘The 20 Views’ Annual Comprehensive Review & Update of Perioperative Echo

2 LV axis model

3 17 segment model of the Left ventricle

4 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 Valve leaflets: Mitral- Anterior(A1, A2) and Posterior(P1) Tricuspid- Septal(S) Anterior (A), Posterior (P) A2 P1 S 12 9 14 A1 RV free wall A or P (depending upon probe flexion) 3 17

5 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 A2 A1 17

6 ME LAX LA LV P2 A2 AV RV 4 107 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

7 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)

8 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

9 TG Apical SAX (Not part of original 20 views) 13 14 15 16 13 Apical Anterior 14 Apical Lateral 15 Apical Inferior 16 Apical Septal LV RV

10

11 16 segment LV model Older LV model nomenclature Replaced by 17 segment model

12 Regional Wall Model Transthoracic imaging planes

13 Mitral valve axis model

14 Mitral Valve Anatomy Carpentier Classification

15 ME mitral commissural LA LV A2 P1 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

16 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)

17 ME AV SAX LA RA RVOT PV NCCLCC RCC IAS Aortic Valve Non 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)

18 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)

19 TG LAX RV AV Asc Ao PL AL LV Right Ventricle (RV) Aortic Valve (AV) Ascending Aorta (Asc Ao) Valve leaflets: Mitral- Anterior(AL) and Posterior(PL)

20 deep TG LAX LV PLAL LA RV AV Ao Left Ventricle (LV) Right Ventricle (RV) Left Atrium (LA) Aortic Valve (AV) Aorta (Ao) Valve leaflets: Mitral- Anterior(AL) and Posterior(PL

21 ME bicaval LA RA IAS IVC SVC 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

22 ME RV inflow-outflow LA RA 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

23 TG RV inflow RA RV TCV Right Atrium (RA) Right Ventricle (RV) Tricuspid Valve (TCV) PL AL Valve leaflets: Tricuspid- Anterior(AL) and Posterior(PL)

24 ME asc aortic SAX Rt PA PA SVC Asc Pulmonary Artery (PA) Right Pulmonary Artery (Rt PA) Superior Vena Cava (SVC) Ascending Aorta (Asc)

25 ME asc aortic LAX Rt PA Asc Ascending Aorta (Asc) Right Pulmonary Artery (Rt PA) Orientation: DistalProximal

26 Aorta-esophageal position As probe withdrawn from patient, TURN probe to the LEFT to keep aorta image in the center of the video screen

27 desc aortic SAX Ao Aorta (Ao) Orientation

28 desc aortic LAX Ao Aorta (Ao) CaudadCephalad Orientation

29 UE aortic arch LAX Aortic Arch Distal Proximal Orientation

30 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

31 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.


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