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. 2001 Jun;85(6):716-20.
doi: 10.1136/heart.85.6.716.

Anatomic basis of cross-sectional echocardiography

R H Anderson  1 , S Y Ho, S J Brecker
Affiliations

Anatomic basis of cross-sectional echocardiography

R H Anderson et al. Heart. 2001 Jun.
No abstract available

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Figures

Figure 1:
Figure 1:
The so-called "anatomical position". The subject is upright and facing the observer. Any structure within the body can be described within the references of the three orthogonal planes—two in the long axis and the third in the short axis.
Figure 2:
Figure 2:
The heart lies in the mediastinum with its own long axis tilted relative to the long axis of the body. Appreciation of this discrepancy is important in the setting of cross-sectional echocardiography.
Figure 3:
Figure 3:
The heart has been prepared by making casts of its "right" and "left" sides, shown in blue and red, respectively. When viewed from the front, it can be seen that the so-called "right heart" chambers are really anterior to the "left" sided counterparts.
Figure 4:
Figure 4:
A cross-section of the ventricular mass is shown as viewed in left anterior oblique orientation. The right ventricle is anterior to the circular left ventricle, to the left hand as viewed in the section. Note the fibrous continuity of the valvar leaflets in the roof of the left ventricle (dotted line), in contrast to the situation in the right ventricle where the supraventricular crest (SVC) separates the leaflets of the tricuspid and pulmonary valves.
Figure 5:
Figure 5:
The heart has been sectioned to simulate the parasternal long axis plane. This is shown with the cardiac apex to the left hand of the observer. The anterior surface is to the top of the panel.
Figure 6:
Figure 6:
This is a short axis cut across the middle of the ventricular mass—compare with the section shown in fig 4.
Figure 7:
Figure 7:
This section, taken to replicate the so-called "four chamber cut", is orientated in attitudinally correct position. It makes little sense to show this slice in upside down orientation. Note the off-setting of the septal hinges of the tricuspid and mitral valves (yellow double headed arrow). Note also the superior interatrial fold (shown again in fig 9).
Figure 8:
Figure 8:
This four chamber section comes from the same heart as the one shown in fig 7, but is cut more anteriorly. It shows how the subaortic outflow tract is interposed between the leaflets of the mitral valve and the septum, with the so-called membranous septum forming an integral part of the aortic root, separating the outflow tract from the right-sided chambers.
Figure 9:
Figure 9:
When studied with prior knowledge, the echocardiographer should be in a position to demonstrate all the features shown in this angled four chamber section. Thus, it should be possible to confirm that the so-called "septum secundum" is no more than a deep infolding between the venous attachments to the right and left atria. The true atrial septum is the flap valve, anchored on the muscular inferior rim.
Figure 10:
Figure 10:
With modern day equipment, particularly when combined with Doppler interrogation, it should be possible to show all the details of coronary arterial origin from the aortic root, illustrated here in the right posterior oblique projection.
See this image and copyright information in PMC

References

    1. Br Heart J. 1983 Nov;50(5):421-31 - PubMed
    1. Heart. 2000 Dec;84(6):670-3 - PubMed

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