Parasternal Aorta Short-Axis View at the Aortic Valve Level (PSAX-AV) is one of the standard two-dimensional (2D) transthoracic echocardiographic views obtained by rotating the transducer approximately 90° clockwise from the parasternal long-axis view. It provides an en-face cross-sectional image of the aortic valve, displaying its characteristic three cusps (right coronary, left coronary, and non-coronary cusps) in the classic "Mercedes-Benz" configuration. This view also visualizes the aortic root, sinuses of Valsalva, right ventricular outflow tract (RVOT), pulmonary valve, main pulmonary artery, tricuspid valve, right atrium, left atrium, and interatrial septum. The PSAX-AV view is routinely used to evaluate aortic valve morphology and function, congenital heart disease, pulmonary valve abnormalities, proximal great vessel anatomy, and atrial septal defects. It is an essential imaging plane for comprehensive assessment of valvular heart disease and Doppler evaluation during transthoracic echocardiography.
1. Introduction
The Parasternal Aorta Short-Axis View at the Aortic Valve Level (PSAX-AV) is a fundamental transthoracic echocardiographic imaging plane obtained by rotating the transducer approximately 90° clockwise from the parasternal long-axis position. This view provides an en-face cross-sectional image of the aortic valve and surrounding cardiac structures. It is widely used for assessment of the aortic valve, pulmonary valve, right ventricular outflow tract (RVOT), proximal pulmonary artery, atrial septum, and congenital heart disease.
Commonly Used PSAX-AV View Abbreviations
Abbreviation
Full View Name
PSAX-AV
Parasternal Short-Axis View at Aortic Valve Level
PSAX
Parasternal Short-Axis View
PLAX
Parasternal Long-Axis View
A4C
Apical Four-Chamber View
A2C
Apical Two-Chamber View
A5C
Apical Five-Chamber View
SC4C
Subcostal Four-Chamber View
SSN
Suprasternal Notch View
2. Scanning Method
Patient Position
Supine or left lateral decubitus position.
Left lateral decubitus usually provides better acoustic windows.
Transducer
Phased-array cardiac transducer.
Frequency: 2–5 MHz.
Probe Position
Left parasternal border.
3rd or 4th intercostal space.
Probe Marker
Rotate approximately 90° clockwise from PLAX so the probe marker points toward the patient's left shoulder (1–2 o'clock).
Technique
Begin from the parasternal long-axis view.
Rotate the transducer clockwise approximately 90°.
Adjust depth and gain.
Tilt slightly superiorly until the aortic valve appears centrally.
Optimize visualization of the RVOT, pulmonary valve, pulmonary artery, tricuspid valve and atrial septum.
3. Section Structure
Structures Visualized
Aortic Valve (Right, Left and Non-coronary Cusps)
Aortic Root
Sinuses of Valsalva
Ascending Aorta
Right Ventricular Outflow Tract (RVOT)
Pulmonary Valve
Main Pulmonary Artery
Right Pulmonary Artery
Left Atrium
Right Atrium
Interatrial Septum
Tricuspid Valve
4. Measuring Method and Normal Values
Measurements obtained from this view include the aortic annulus, sinus of Valsalva, sinotubular junction, proximal ascending aorta, pulmonary artery diameter and RVOT dimensions. Valve morphology and opening motion are carefully assessed in systole and diastole. Color Doppler is routinely used to evaluate valvular stenosis, regurgitation and intracardiac shunts.
Measurement
Normal Value
Aortic Annulus
18–26 mm
Sinus of Valsalva
29–45 mm (adult)
Sinotubular Junction
22–36 mm
Ascending Aorta
22–36 mm
Main Pulmonary Artery
20–30 mm
RVOT Diameter
21–35 mm
5. Clinical Application
Assessment of aortic valve morphology.
Evaluation of bicuspid aortic valve.
Assessment of aortic stenosis.
Assessment of aortic regurgitation.
Pulmonary valve evaluation.
RVOT assessment.
Detection of atrial septal defects.
Assessment of proximal pulmonary artery.
Evaluation of congenital heart disease.
Guidance for Doppler examination.
6. Diagnosable Pathology
Bicuspid Aortic Valve
Aortic Stenosis
Aortic Regurgitation
Aortic Valve Endocarditis
Aortic Root Dilatation
Ascending Aortic Aneurysm
Pulmonary Valve Stenosis
Pulmonary Regurgitation
Atrial Septal Defect (ASD)
Tetralogy of Fallot
Double Outlet Right Ventricle (DORV)
Pulmonary Hypertension
Congenital Aortic Valve Abnormalities
RVOT Obstruction
Great Vessel Anomalies
SonoAcademy Digital MCQ Examination
Topic: Parasternal Aorta Short-Axis View at the Aortic Valve Level (PSAX-AV) – 2D Echocardiography
Total Questions: 10 |
Total Marks: 10 |
Time: 30 Minutes
Instruction: Enter your details, start the examination, answer all questions, submit the examination, and download your PDF marksheet after completion.
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Topic: Parasternal Aorta Short-Axis View at the Aortic Valve Level (PSAX-AV) – 2D Echocardiography
Parasternal Left Ventricular Long-Axis View (PLVLA) is one of the most important standard two-dimensional (2D) transthoracic echocardiographic views. It provides a longitudinal image of the heart, allowing detailed evaluation of the left ventricle, left atrium, mitral valve, aortic valve, left ventricular outflow tract (LVOT), aortic root, interventricular septum, left ventricular posterior wall, and ascending aorta. The PLVLA view is routinely used to assess cardiac anatomy, chamber dimensions, ventricular systolic function, wall thickness, valvular morphology, and aortic root abnormalities. It also serves as the primary reference view for M-mode measurements and quantitative assessment during a comprehensive echocardiographic examination.
1. Introduction
The Parasternal Left Ventricular Long-Axis (PLVLA) view is one of the
fundamental transthoracic echocardiographic imaging planes. It provides a
long-axis section of the heart, allowing visualization of the left ventricle,
left atrium, mitral valve, aortic valve, left ventricular outflow tract
(LVOT), aortic root, interventricular septum, and left ventricular posterior
wall. This view is essential for routine cardiac examination and quantitative
assessment of chamber size, ventricular function, valvular morphology and
aortic root pathology.
Commonly Used PLVLA View Abbreviations
Abbreviation
Full View Name
PLVLA
Parasternal Left Ventricular Long-Axis View
PSAX
Parasternal Short-Axis View
A4C
Apical Four-Chamber View
A2C
Apical Two-Chamber View
A3C / APLAX
Apical Three-Chamber View / Apical Long-Axis View
A5C
Apical Five-Chamber View
SC4C
Subcostal Four-Chamber View
IVC
Inferior Vena Cava View
SSN
Suprasternal Notch View
2. Scanning Method
Patient Position
Supine or left lateral decubitus position.
Left lateral position improves visualization.
Transducer
Phased-array cardiac probe.
Frequency: 2–5 MHz.
Probe Position
Left parasternal border.
2nd–5th intercostal space.
Probe Marker
Directed toward the patient's right shoulder (10 o'clock).
Technique
Place probe beside the sternum.
Adjust depth and gain.
Rotate and angle until LV, LA, MV, AV, LVOT and aortic root are visualized.
Freeze the best image for measurement.
3. Section Structure
Structures Visualized
Right Ventricular Outflow Tract (RVOT)
Interventricular Septum (IVS)
Left Ventricular Cavity (LV)
Left Ventricular Posterior Wall (LVPW)
Mitral Valve
Left Atrium
Aortic Valve
Left Ventricular Outflow Tract
Aortic Root
Ascending Aorta
Pericardium
4. Measuring Method and Normal Values
Posterior–anterior dimensions of the left ventricular cavity, right ventricular cavity, and left atrial cavity can be obtained in this view. The left and right ventricular cavities are measured at the level of the mitral valve chordae during diastole. The normal left ventricular internal diameter is 38 ± 10 mm, while the normal right ventricular internal diameter is 25 ± 10 mm. The left atrial diameter is 33 ± 5 mm, measured at the middle of the left atrium during systole. The aortic valve annulus measures 20 ± 4 mm from the anterior inner edge to the posterior inner edge at the attachment of the aortic valve during systole. The aortic sinus measures 26 ± 8 mm from the anterior inner edge to the posterior inner edge at the level of the sinus of Valsalva during systole. The ascending aorta measures 25 ± 10 mm at a point 2 cm above the aortic sinus during systole. The coronary sinus measures 7 ± 4 mm in the anterior–posterior dimension from the anterior inner edge to the posterior inner edge.
Measurement
Normal Value
IVSd
6–10 mm
LVIDd
Male 42–59 mm Female 39–53 mm
LVIDs
25–40 mm
LVPWd
6–10 mm
Left Atrial Diameter
27–40 mm
Aortic Root Diameter
20–37 mm
Ejection Fraction
55–70%
Fractional Shortening
28–44%
5. Clinical Application
Assessment of LV size.
Evaluation of LV systolic function.
Wall thickness measurement.
Mitral valve assessment.
Aortic valve assessment.
Aortic root measurement.
LVOT evaluation.
Detection of pericardial effusion.
Follow-up of cardiomyopathy.
Assessment of hypertensive heart disease.
6. Diagnosable Pathology
Left Ventricular Hypertrophy (LVH)
Dilated Cardiomyopathy (DCM)
Hypertrophic Cardiomyopathy (HCM)
Left Ventricular Systolic Dysfunction
Regional Wall Motion Abnormality (RWMA)
Mitral Valve Prolapse (MVP)
Mitral Stenosis (MS)
Mitral Regurgitation (MR)
Aortic Stenosis (AS)
Aortic Regurgitation (AR)
Aortic Root Dilatation
Pericardial Effusion
Infective Endocarditis
LVOT Obstruction
Intracardiac Mass or Thrombus
SonoAcademy Digital MCQ Examination
Topic: Parasternal Left Ventricular Long-Axis View (PLVLA) – 2D Echocardiography
Total Questions: 10 |
Total Marks: 10 |
Time: 30 Minutes
Instruction: Enter your details, start the examination, answer all questions, submit the examination, and download your PDF marksheet after completion.
Time Left:
30:00
Exam Result
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Topic: Parasternal Left Ventricular Long-Axis View (PLVLA) – 2D Echocardiography
Basic Views of B-Mode Echocardiography are standard two-dimensional ultrasound views used to evaluate cardiac chambers, valves, septa, pericardium, ventricular function, and major vessels. Proper image acquisition helps in accurate diagnosis, documentation, and follow-up of cardiac abnormalities.
🔶 Introduction
B-mode echocardiography, also called two-dimensional echocardiography, is a real-time ultrasound technique used to visualize cardiac anatomy and motion. It provides grayscale images of the heart and helps assess chamber size, wall motion, valve morphology, septal integrity, pericardium, and great vessels.
🔶 Clinical Indications
1. Chest pain or suspected cardiac disease. 2. Dyspnea or heart failure assessment. 3. Murmur evaluation. 4. Valvular heart disease. 5. Cardiomyopathy. 6. Congenital heart disease screening. 7. Pericardial effusion assessment. 8. Follow-up after cardiac treatment or surgery.
🔶 Patient Preparation
No special fasting is usually required. Explain the procedure to the patient. The patient is commonly positioned in the left lateral decubitus position to improve acoustic access. ECG leads may be attached if required. Apply adequate ultrasound gel to obtain good probe contact.
🔶 Equipment
Ultrasound Machine: Echocardiography-capable system. Probe: Phased-array cardiac transducer, commonly 2–5 MHz in adults. Modes: B-mode, M-mode, Color Doppler, Pulsed-Wave Doppler, Continuous-Wave Doppler, and Tissue Doppler if available. Accessories: ECG cable, ultrasound gel, patient couch, and image recording system.
🔶 Structures Evaluated
1. Left atrium and right atrium. 2. Left ventricle and right ventricle. 3. Mitral, tricuspid, aortic, and pulmonary valves. 4. Interventricular and interatrial septa. 5. Left ventricular outflow tract and right ventricular outflow tract. 6. Aortic root and ascending aorta. 7. Pulmonary artery. 8. Pericardium and pericardial space.
🔶 Routine Measurements
1. Left ventricular internal diameter in diastole and systole. 2. Interventricular septal thickness. 3. Posterior wall thickness. 4. Left atrial size or volume. 5. Aortic root diameter. 6. Ejection fraction estimation. 7. Right ventricular size and function. 8. Pericardial effusion measurement if present.
🔶 Normal Findings
Normal B-mode echocardiography shows normal chamber size, preserved ventricular contraction, normal valve opening and closing motion, intact septa, no obvious intracardiac mass or thrombus, no significant pericardial effusion, and normal relationship of great vessels.
🔶 Common Abnormal Findings
1. Left ventricular dilatation or hypertrophy. 2. Regional wall motion abnormality. 3. Reduced ejection fraction. 4. Valvular thickening, calcification, stenosis, or regurgitation. 5. Right ventricular enlargement. 6. Pericardial effusion. 7. Intracardiac thrombus or mass. 8. Septal defects or congenital abnormalities.
🔶 Documentation
Save representative images and clips from standard views. Document measurements, chamber sizes, valve morphology, ventricular function, septal appearance, pericardial findings, and any abnormality. Include patient details, date, study type, and final impression in the report.
🔶 Clinical Applications
B-mode echocardiography is useful for cardiac screening, assessment of heart failure, evaluation of valve disease, detection of pericardial effusion, evaluation of cardiomyopathy, follow-up of congenital heart disease, and monitoring after cardiac procedures.
🔶 Advantages
1. Non-invasive and safe. 2. Real-time cardiac imaging. 3. No ionizing radiation. 4. Portable and widely available. 5. Useful for bedside evaluation. 6. Allows assessment of anatomy and function.
🔶 Limitations
Image quality may be limited by obesity, lung interference, chest wall deformity, poor acoustic window, tachycardia, patient movement, or inability to position the patient properly. Some lesions may require Doppler, contrast echocardiography, CT, MRI, or transesophageal echocardiography for further evaluation.
2D Echo
