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Left atrium is excellently visulaised in para sternal long axis view . . . still , the vital feeding vessels to this chamber ,Th

Posted Mar 09 2010 7:02pm

The most famous and popular view in clinical echocardiography is para sternal long axis view.It gives us an instant information about the status of left atrium , left ventricle and aorta.Left atrium appears to be seen in full. Still , one should realise it is far from truth.There is a huge blind spot  for left atrium in this view .

For a complete imaging of LA one need to do a short axis view at aortic level, and of course a 4 chamber view . All these three views put together , can at best give a 80%  exploration of LA .The rest of the  20%(  some times vital !) can be seen only be transesophageal echo .

Why para sternal long axis fail to give even glimpse of the 4 pulmonary veins ?

  • Pulmonary veins are probably ,  the most vital structure  in LA . There are 4 veins , generally  arranged in 2 pairs
  • Unfortunately all these 4 veins does  not  interrupt the ultrasound beam in this view .The beam in para sternal view crosses  the anterior and lateral surfaces and to a  very small area of inter atiral septum(  IAS )
  • These enter  the posterior surface of the LA in an oblique angle . The angle of entry is widely variable .Some times they need to run a parallel course with LA posterior wall . This makes recognition and delineation  of PV from LA very difficult ..
  • Since all   4 pulmonary veins are located in the posterior aspect of LA ,  they  are best visualized either in apical 4 chamber (Right pulmonary veins) or short axis views(Left pulmonary veins)

When can pulmonary veins visible in PS- LAX view ?

When PVs take an abnormal course like in TAPVC or when they enter coronary sinus etc .

Rarely ,  huge LA enlargement may pull or push the PVs and make them visible in LAX view.

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