Chapter 4: Normal Anatomy

0°

Transverse plane to probe shaft long axis, and horizontal to plane of the body
Oblique to cardiac SAX

45°

SAX view of cardiac basal structures (e.g., aortic valve)

90°

Longitudinal plane parallel to probe shaft LAX and sagittal (vertical) to plane of the body
Oblique to the cardiac LAX
Parallel to the ascending and descending thoracic aorta

135°

LAX view of cardiac structures (LV and LVOT)

180°

Mirror image of the 0° transverse plane

Abbreviations: LAX, long axis; LV, left ventricle; LVOT, left ventricular outflow tract; SAX, short axis.

1

ME 5C
Angle: 0-10°
(Figure 4.6)

Chambers: LA, LV, LVOT, RA, RV
Valves: AoV, MV, TV
Septum: IVS

2

ME 4C
Angle: 0-10°
(Figure 4.7)

Chambers: LA, LV, RA, RV
Valves: MV, TV
Septum: IVS, IAS

3

ME Mitral commissural
Angle: 50-70°
(Figure 4.10)

Chambers: LA, LV
Valves: MV
Other: coronary sinus, papillary muscle, chordae tendinae

4

ME 2C
Angle: 80-100°
(Figure 4.11)

Chambers: LA, LV
Valves: MV
Other: coronary sinus, LAA

5

ME LAX
Angle: 120-140°
(Figure 4.12)

Chambers: LA, LV, LVOT, RVOT
Valves: AoV, MV
Septum: IVS
Vessels: Aortic root

6

ME AoV LAX
Angle: 120-140°
(Figure 4.13)

Chambers: LA, LVOT, RVOT
Valves: AoV, MV
Septum: IVS
Vessels: Aortic root

7

ME Ascending aorta LAX
Angle: 90-110°
(Figure 4.14)

Vessels: Asc Ao, RPA

8

ME Ascending Aorta SAX
Angle: 0-30°
(Figure 4.15)

Vessels: Asc Ao, PA, SVC

9

ME RUPV
Angle: 0-30°
(Figure 4.38)

Vessels: Asc Ao, RUPV, SVC
Other: LMCA

10

ME AoV SAX 
Angle: 25-45°
(Figure 4.34)

Chambers: LA, RA, RV, RVOT
Valves: AoV, PV, TV, PV,
Septum: IVS, IAS
Vessels: PA

11

ME RV Inflow-Outflow
Angle: 50-70°
(Figure 4.28)

Chambers: LA, RA, RV, RVOT
Valves: AoV, TV, PV
Septum: IVS, IAS
Vessels: PA
Other: RVSP and SP estimation

12

ME Modified Bicaval TV
Angle: 50-70°
(Figure 4.30)

Chambers: LA, RA, RAA, RV
Valves: TV
Septum: IAS
Vessels: IVC, SVC
Other: RVSP and SPAP estimation

13

ME Bicaval
Angle: 90-110°
(Figure 4.29)

Chambers: LA, RA, RAA
Valves: TV
Septum: IAS
Vessels: IVC, SVC, Ao
Other: coronary sinus

14a

ME RUPV
Angle: 90-110°
(Figure 4.37 and see Figure 27.6 and 27.9)

Chamber: LA
Vessels: RPA, RUPV, SVC, Ao

14b

ME LUPV
Angle: 90-110°
(Figure 4.36 and see Figure 27.7 and 27.8)

Chamber: LA, LAA
Vessels: aortic arch, LUPV, LPA

15

ME LAA
Angle: 90-110°
(Figure 4.32)

Chamber: LAA
Vessels: LUPV

16

TG Basal SAX
Angle: 0-20°
(Figure 4.17)

Chambers: LV, RV
Valves: MV, TV
Septum: IVS
Other: chordae tendinae

17

TG Mid papillary SAX
Angle: 0-20°
(Figure 4.16)

Chambers: LV, RV
Septum: IVS
Other: papillary muscles

18

TG Apical SAX
Angle: 0-20°
(Figure 4.18)

Chambers: LV, RV

19

TG RV basal SAX
Angle: 0-20°
(Figure 4.21)

Chambers: LV, RV, RVOT
Valves: TV, PV
Septum: IVS

20

TG RV Inflow outflow
Angle: 0-20°
(Figure 4.20)

Chambers: RA, RV, RVOT
Valves: TV, PV
Septum: IVS, IAS
Vessels: PA, Asc Ao

21

DTG 5C
Angle: 0-20°
(Figure 4.24)

Chambers: LA, LV, LVOT, RA, RV
Valves: AoV, MV, TV
Septum: IVS,
Vessels: Aortic root
Other: CO estimation

22

TG 2C LAX
Angle: 90-110°
(Figure 4.19)

Chambers: LA, LV, LAA
Valves: MV

23

TG RV inflow
Angle: 90-110°
(Figure 4.23)

Chambers: RA, RV, RVOT
Valves: TV
Vessels: Ao, PA

24

TG LAX
Angle: 120-140°
(Figure 4.22)

Chambers: LA, LV, LVOT
Valves: AoV
Septum: IVS
Vessels: Aortic root
Other: LVOT VTI and CO estimation

25

Descending aorta SAX
Angle: 0-10°
(Figure 4.25)

Vessels: Des Ao, hemiazygos and azygos vein, intercostal arteries
Other: Left pleural space

26

Descending aorta LAX Angle: 90-100°
(Figure 4.25)

Vessels: Des Ao, intercostal arteries
Other: Left pleural space

27

UE Aortic arch LAX
Angle: 0-10°
(Figure 4.26)

Vessels: Aortic arch, innominate and hemiazygos vein
Other: mediastinal tissue

28

UE Aortic arch SAX 
Angle: 70-90°
(Figure 4.27)

Valve: PV
Vessels: aortic arch, PA, innominate and hemiazygos vein
Other: mediastinal tissue

29

DE 2C RV 
Angle: 0-10°
(Figure 4.9)

Chambers: RA, RV
Valve: TV
Septum: IVS
Other: coronary sinus

30

DE RV inflow-outflow
Angle: 60-90°
(Figure 4.31)

Chambers: RA, RV, RVOT
Valves: TV
Septum: IAS
Other: RVSP and SPAP estimation if TR

Additional cardiac and extra-cardiac views (TELUS and TEGAUS) appear in other chapters.

Abbreviations: 2C, two-chamber; 4C, four-chamber; 5C, five-chamber; Asc, ascending; Ao, aorta; AoV, aortic valve; CO, cardiac output; DE, deep-esophageal; Des, descending; DTG, deep transgastric; IAS, interatrial septum; IVC, inferior vena cava; IVS, interventricular septum; LA, left atrium; LAA, left atrial appendage; LAX, long-axis; LMCA, left main coronary artery; LV, left ventricle; LVOT, left ventricular outflow tract; ME, mid-esophageal; MV, mitral valve; PA, pulmonary artery; PV, pulmonic valve; RA, right atrium; RAA, right atrial appendage; RPA, right pulmonary artery; RV, right ventricle; RVOT, right ventricular outflow tract; RVOT, right ventricular outflow tract; RVSP, right ventricular systolic pressure; SAX, short-axis; SVC, superior vena cava; SPAP, systolic pulmonary artery pressure; TELUS, transesophageal lung ultrasound; TG, transgastric; TGAUS, transgastric abdominal ultrasound; TR, tricuspid regurgitation; TV, tricuspid valve; UE, upper esophageal; VTI, velocity time integral. Adapted from Hahn et al.

Systolic

Diastolic

Mean

RA

1–8

RV

15–30

1–8

PA

15–30

4–12

9–18

LA

2–12

LV

100–140

3–12

Aorta

100–140

60–90

70–105

Abbreviations: LA, left atrium; LV, left ventricle; PA, pulmonary artery; RA, right atrium; RV, right ventricle.