Transthoracic echocardiography

Last revised by Andrew Murphy on 23 Mar 2023

Standard transthoracic echocardiography (TTE) is the most commonly performed form of echocardiography. It consists of five standardized windows which are obtained in a standardized sequence 1. Obtaining views from the left parasternal, apical, subcostal, and suprasternal notch windows is mandatory for a complete echocardiography protocol. The right parasternal window is the fifth window, which is sometimes used to view the ascending aorta. The aforementioned windows are used to obtain long axis plane, short axis plane, and apical plane images as follows:  

Essential views
  • left parasternal window
    • long axis view (PLAX)
      • increased depth
      • left ventricle
      • zoomed aortic valve
      • zoomed mitral valve
      • right ventricular outflow 
      • right ventricular inflow
    • short axis view (PSAX)
      • level great vessels
        • focus on pulmonic valve
        • focus on aortic valve
        • zoomed aortic valve
        • focus on tricuspid valve
      • focus on pulmonic valve and pulmonic artery
      • level of mitral valve
      • level of papillary muscles
      • level of apex
  • apical window
    • four-chamber view (A4C)
      • zoomed left ventricle
      • right ventricular focused
      • posterior angulation
    • five-chamber view (A5C)
    • two-chamber view (A2C)
    • long axis view (A3C)
      • zoomed left ventricle
  • subcostal window
  • suprasternal notch window
Additional views
  • left parasternal window
  • apical window
    • right ventricular two-chamber view
  • subcostal window
    • superior vena cava view
    • long-axis abdominal aorta view
    • transverse inferior vena cava view
    • focused interatrial septum view
    • short axis view
      • right ventricular outflow tract
      • great vessels
      • mitral valve
      • papillary muscles
      • apex
  • right parasternal window

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Cases and figures

  • Case 1: parasternal long axis view (PLAX)
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  • Case 2: parasternal long axis view (zoomed aortic valve)
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  • Case 3: parasternal short axis view (great vessels)
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  • Case 4: parasternal short axis view (mitral valve)
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  • Case 5: parasternal short axis view (papillary muscles)
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  • Case 6: apical 4 chamber view (A4C)
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  • Case 7: apical 2 chamber view (A2C)
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  • Case 8: subcostal 4 chamber view (SC4C)
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  • Case 9: subcostal long-axis inferior vena cava view (SC IVC)
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  • Case 10: subcostal long-axis abdominal aorta view
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  • Case 11: suprasternal notch (aortic arch view)
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