Table 2 Parasternal views

Goal

LV size and function, RV size, RV wall motion, pericardial effusion, left pleural effusion. Mitral and aortic valve thickening. Significant valvular regurgitation - color Doppler

LV size, wall thickness, and function. RV size and function. Main pulmonary artery (dilated or not). Pericardial effusion. Aortic valve thickening. Significant valvular regurgitation - color Doppler

Patient position

Far left lateral, when possible

Far left lateral, when possible

Initial transducer placement

Second or third ICS, as close to the sternum as possible, with the transducer ‘marker’ directed at approximately 11 o’clock (towards right shoulder)

Second or third ICS, as close to the sternum as possible. From the PLAX view, rotate the transducer clockwise or to your right until the transducer ‘marker’ is at approximately 2 o’clock

Search for the best imaging ‘window’

Move the transducer up or down an ICS to search for the best view. Structures should appear horizontal on the screen. Image in the middle of the screen by adjusting transducer position

Mid-LV: angle the transducer slightly laterally and inferiorly or towards the patient’s left hip to image the mid-LV. Visualize the tips of the papillary muscles within the LV, below the level of the mitral valve. LV should appear round with RV clearly visualized. If the LV appears ‘egg-shaped’ or oblong and the RV is not visualized, slide the transducer ‘up’ an ICS

If the apex appears to be positioned ‘uphill’ on the screen, slide the transducer ‘up’ an ICS

Main pulmonary artery: angle the transducer slightly laterally and slightly superiorly or toward the patient’s left shoulder with a slight clockwise rotation. You may need to move up an ICS, but in doing so may not be able to visualize the pulmonary artery bifurcation

Increase the ‘depth’ to 20 to 24 cm to image the presence of a possible pleural effusion

Decrease the depth to approximately 14 to 16 cm, depending on the size of the heart, to fill the screen with cardiac structure