Parasternal Aorta Short-Axis View
At the Aortic Valve Level

Parasternal Aorta Short-Axis View At the Aortic Valve Level

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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

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Thursday, 2 July 2026