Apical 3 chamber

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Author I.A.C. van der Bilt
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How to Get a Good Apical Three Chamber View

The apical three chamber view is found by placing the transducer on the apex of the heart, near the Ictus Cordis. The apical three chamber view is also known as the apical long axis view. This view may be obtained by rotating the transducer counterclockwise by 30–45 degrees away the apical two chamber view while the head of the transducer stays on the same position as it were for the apical four chamber view. The posterior apex may be adequately viewed from the apical three chamber view. The following other structures may also be appreciated: the left ventricle (along with the septum, posterior walls, and portions of the apex), aortic valve, ascending aorta, left ventricular outflow tract, left atrium, and mitral valve (posterior and anterior leaflets).

Purposes of Getting a Good Apical Three Chamber View

The apical three chamber view is similar to the parasternal long axis view. Aneurysms, wall motion abnormalities, and the presence of clot can all be assessed from this view. As mentioned, the anterior and posterior leaflets can be observed, therefore allowing the evaluation of mitral valve structure and integrity. Since there is complete visualization of the left atrium, its contents, area, and size are can be completely evaluated. The left ventricular outflow tract may be evaluated for subaortic obstructions or membranes.

Doppler Imaging in Apical Three Chamber View

As with apical two chamber view, Doppler may be used to assess the mitral valve more thoroughly. The following may be ascertained through Doppler: presence of regurgitation, stenosis, and blood flow velocities. Doppler is especially applicable for assessing the maximum velocities across the aortic valve and outflow tract, especially when apical five chamber view is suboptimal, and can measure the diameter of the outflow tract of the left ventricle. Outflow and valvular velocities may be measured in cases of aortic stenosis, while site of obstruction may be identified in cases of subaortic stenosis. Suboartic obstruction may be identified when the velocity exceeds the Nyquist limit. Doppler may also be sued to evaluate for the presence of aortic insufficiency.

Example of an Apical Three Chamber View

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Apical 3 chamber view of a normal heart
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Sources

  1. ISBN:0397552629 [Allen]
  2. ISBN:0781795575 [Feigenbaum1]
  3. ISBN:1848822928 [Nihoyannopoulos]