LV outflow tract diameter measurement

Figure 1. When the left ventricular outflow tract (lvot) diameter is difficult to visualize in the parasternal long axis view, adding color Doppler may help in delineating the septal endocardium just proximal to the aortic valve annulus (Figure 1, green arrow), where lvot diameter has to be measured. In Figure 1, blue systolic velocities in the lvot help the positioning of the caliper (Figure 2) (blue cross) on the septal endocardium.

Figure 2

To diastole or not ?

“The assessment of left ventricular diastolic function should be an integral part of a routine echocardiographic examination, particularly in patients presenting with dyspnea or heart failure. About half of patients with new diagnoses of heart failure have normal or near normal global ejection fractions.”

2D Aortic Arch measures

Suprasternal (jugular) 2D longitudinal view of aortic arch.

Measures: A. proximal arch; B. mid-arch; C. distal arch. AA: ascending aorta; TA: anonymous art. (brachiocephalic); CA: left carotid; SU: left subclavian art.

Measures should be performed “inner edge” to “inner edge”. I prefer to measure the arch at the “exit” point (C), which is also the (normal) smaller diameter, immediately distal to the left subclavian artery. When in doubt about the anatomy (poor image resolution), adding color Doppler may help identify the lumen of the aortic arch, and the correct diameter (gain should be kept low to avoid shadowing of the anatomy of the walls by “overflowing” color signal).

Paolo Barbier