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Transthoracic Two-Dimensional
Echocardiography in the Dog and Cat
William P. Thomas, DVM, Cathy E. Gaber, DVM, Gilbert J. Jacobs,
DVM, Paul M. Kaplan, DVM, Christophe W. Lombard, Dr Med Vet,
N. Sydney Moise, DVM, and Bradley L. Moses, DVM
(The Echocardiography Committee of The Specialty of Cardiology,
American College of Veterinary Internal Medicine)
Recommendations are presented for standardized imaging planes and display conventions for two-dimensional echocardiography in the dog and cat. Three transducer locations (windows) provide access
to consistent imaging planes: the right parasternal location, the left caudal (apical) parasternal location,
and the left cranial parasternal location. Recommendations for image display orientations are very
similar to those for comparable human cardiac images, with the heart base or cranial aspect of the heart
displayed to the examiners right on the video display. From the right parasternal location, standard
views include a long-axis four-chamber view and a long-axis left ventricular outflow view, and short-axis
views at the levels of the left ventricular apex, papillary muscles, chordae tendineae, mitral valve, aortic
valve, and pulmonary arteries. From the left caudal (apical) location, standard views include long-axis
two-chamber and four-chamber views. From the left cranial parasternal location, standard views include
a long-axis view of the left ventricular outflow tract and ascending aorta (with variations to image the
right atrium and tricuspid valve, and the pulmonary valve and pulmonary artery), and a short-axis view of
the aortic root encircled by the right heart. These images are presented by means of idealized line
drawings. Adoption of these standards should facilitate consistent performance, recording, teaching, and
communicating results of studies obtained by two-dimensional echocardiography. (Journal of Veterinary
Internal Medicine 1993; 7:247-252. Copyright 0 1993 by the American College of Veterinary Internal
Medicine.)
From the Department of Veterinary Medicine, University of California, Davis (Thomas), Department of Small Animal Clinical Sciences,
Michigan State University (Gaber),Department ofSmall Animal Medicine, University of Georgia (Jacobs), 8C Old Colony Drive, Westford,
MA (Kaplan), Department of Clinical Sciences, Cornell University
(Moise), Roberts Animal Hospital, Hanover, MA (Moses), and Klinik
Fur Kleine Haustiere, Tierspital der Universitat Bern, Switzerland
(Lombard).
Accepted April 5 , 1993.
Reprint requests: Dr. William P. Thomas, DVM, Dept. ofVM:Medicine, University of California, Davis, CA 956 16.
Copyright 0 1993 by the American College of Veterinary Internal
Medicine
089 I -6640/93/0704-0008$3.00/0
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THOMAS ET AL
the ACVIM and the executive committee of the Academy of Veterinary Cardiology.
Introduction
The following qualifications must be considered in using
the techniques recommended in this article:
1. The imaging planes and orientations described here
Journal of Veterinary
Internal Medicine
effects of this and other sedatives on the 2DE examination of dogs and cats have not been reported. Ideally,
hair is clipped over the left and right precordial transducer locations. However, satisfactory images can also
be obtained in many animals by parting the relatively
thin hair coat at these points and by liberal use of coupling gel.
Dogs and cats may be examined in upright (standing,
sitting, sternal) or lateral recumbent positions without
substantial alteration of examination technique. In most
patients, however, lung interference will be minimized
and image quality enhanced by positioning the animal in
lateral recumbency on a table, stand, or other device that
allows transducer manipulation and examination from
beneath the animal.
Transducer Locations
There are three general transducer locations (windows) that provide access to consistent imaging planes
(Fig 1). The right parasternal location is located between
the right 3rd and 6th intercostal spaces (usually 4th to
5th) between the sternum and costochondral junctions.
The left caudal (apical) parasternal location is located
between the left 5th and 7th intercostal spaces, as close to
the sternum as possible. The left cranial parasternal loca-
Vol. 7
. NO.4, 1993
ABBREVIATIONS
FOR FIGURES
2 THROUGH
7
RA
RAu
RV
RVO
TV
PV
LPA
RPA
CaVC
VS
LA
LAu
LV
LVO
LVW
PM
CH
MV
AMV
PMV
A0
LC
RC
NC
0
Right atrium
Right auricle
Right ventricle
Right ventricular outflow tract
Tricuspid valve
Pulmonary valve
Left pulmonary artery
Right pulmonary artery
Caudal vena cava
Ventricular septum
Left atrium
Left auricle
Left ventricle
Left ventricular outflow tract
Left ventricular wall
Papillary muscle
Chorda tendineae
Mitral valve
Anterior mitral valve cusp
Posterior mitral valve cusp
Aorta
Left coronary cusp
Right coronary cusp
Noncoronary cusp
Transducer index mark
Image Orientation
As recommended for human examinations, the index
mark on the two-dimensional transducer (which marks
the edge of the imaging plane) should normally be oriented to indicate the part of the cardiac image that will
appear on the right side of the image display. The transducer index mark should then be pointed either toward
the base of the heart (long-axis views) or cranially toward
the patients head (short-axis views). Because most
current two-dimensional echocardiographs have leftright image reversal capability, individual examiners
may prefer to reverse the orientation of the transducer
index mark, especially when performing studies with the
transducer directed upward through holes or notches in
the examination table. In these studies, many operators
may find it easier to rotate the beam counterclockwise to
change from right intercostal long-axis to short-axis
views, resulting in an index mark directed caudally instead of cranially. Regardless of the orientation of the
index mark, however, the general rule is that the heart
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THOMAS ET AL.
Short-Axis Views
heart, and with the transducer index mark pointing cranially (or cranioventrally), an orientation obtained by
90" clockwise rotation of the beam plane from the longaxis views, a series of short-axis views are obtained.
Proper short-axis orientation is identified by the circular
symmetry of the left ventricle or aortic root. Short-axis
planes at the level of the left ventricular apex, papillary
muscles, chordae tendineae, mitral valve, and aortic
valve should be obtained, respectively, by angling of the
beam plane from apex (ventral) to base (dorsal). Proper
short-axis alignment at the aortic valve level often requires additional slight clockwise rotation of the beam
plane. In some animals, further dorsal angulation allows
imaging of the proximal ascending aorta, right atrium,
and right pulmonary artery. The images should be displayed with the cranial part of the image to the right and
the right heart encircling the left ventricle and aorta
clockwise (right ventricular outflow tract and pulmonary
valve to the right) (Fig 3).
printed should follow the recommendations in this article. In addition, the images should be displayed so that
the transducer artifact and near field echoes appear at
the top and the far field echoes toward the bottom of the
display. Inversion of the image so that the near field
echoes appear at the bottom of the display (an orientation favored by many pediatric cardiologists), may be
preferred by individual examiners, but is not recommended for routine recording and publication of images.
Short-Axis Views
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25 1
Lonq-Axis View 1
FIG. 5. Left caudal (apical) parasternal location, four-chamber views
(see abbreviations list above).
Long-Axis View 2
With the beam plane placed into a left-caudal to rightcranial orientation and then directed dorsally toward the
heart base, and with the transducer index mark pointing
caudally and to the left, a four-chamber view of the heart
may be obtained (Fig 5). Note that this is the only view in
which the transducer index mark is pointing caudally
and to the left, opposite the normal convention. Depending on the exact location of the caudal (apical) window, the appearance of this view varies between animals
more than most other views. The image should show the
ventricles in the near field closest to the transducer and
the atria in the far field, with the heart oriented vertically. The left heart (left ventricle, mitral valve, and left
atrium) should appear to the right and the right heart to
Long-Axis View 3
FIG.6. Left cranial parasternal location. long-axis views (see abbreviations list above).
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Short-Axis View
With the beam plane oriented approximately perpendicular to the long axis of the body and to the long axis of