DR. MUHAMMAD BIN ZULFIQARPGR IV FCPS SIMS/SHLradiombz@gmail.com

19 Cardiac Anatomy andImaging Techniques Grainger and Allison

• FIGURE 19 Normal postero-anterior (left) and lateral (right) chest ■radiographs. Note normal cardiovascular structures: 1, contour of superior vena cava and other vessels; 2, contour of right atrium; 3, aortic knuckle; 4, left pulmonary artery at hilar level; 5, contour of left ventricle; 6, anterior contour of right ventricle and pulmonary outflow tract; 7, aortic arch; 8, upper posterior contour of left atrium; 9, lower posterior contour of left ventricle. Note relative bulging of left ventricular contour in relationship with inferior vena cava.

• FIGURE 19 Normal postero-anterior (left) and lateral (right) chest ■radiographs. Note normal cardiovascular structures: 1, contour of superior vena cava and other vessels; 2, contour of right atrium; 3, aortic knuckle; 4, left pulmonary artery at hilar level; 5, contour of left ventricle; 6, anterior contour of right ventricle and pulmonary outflow tract; 7, aortic arch; 8, upper posterior contour of left atrium; 9, lower posterior contour of left ventricle. Note relative bulging of left ventricular contour in relationship with inferior vena cava.

• FIGURE 19-2 Planning acquisition of standard cardiac views. On two ■transverse slices (A) and (B), the left ventricular vertical longaxis (VLA) (C) is planned by a plane transecting the mitral valve and the apex. The horizontal long-axis (HLA) (D) is obtained by acquiring a plane transecting the VLA through the mitral valve and apex. A short-axis image can be obtained perpendicular to HLA, at mid-ventricular (E) and basal level (F). The four-chamber (G) of the left ventricle (LV) is obtained as indicated from a plane transecting both LV and the right ventricle. The two-chamber (H) of the LV is acquired perpendicular to the four-chamber. The three-chamber LV (I) is obtained from a plane transecting the LV through the LV outflow tract.

• FIGURE 19-2 Planning acquisition of standard cardiac views. On two ■transverse slices (A) and (B), the left ventricular vertical longaxis (VLA) (C) is planned by a plane transecting the mitral valve and the apex. The horizontal long-axis (HLA) (D) is obtained by acquiring a plane transecting the VLA through the mitral valve and apex. A short-axis image can be obtained perpendicular to HLA, at mid-ventricular (E) and basal level (F). The four-chamber (G) of the left ventricle (LV) is obtained as indicated from a plane transecting both LV and the right ventricle. The two-chamber (H) of the LV is acquired perpendicular to the four-chamber. The three-chamber LV (I) is obtained from a plane transecting the LV through the LV outflow tract.

• FIGURE 19-2 Planning acquisition of standard cardiac views. On ■two transverse slices (A) and (B), the left ventricular vertical longaxis (VLA) (C) is planned by a plane transecting the mitral valve and the apex. The horizontal long-axis (HLA) (D) is obtained by acquiring a plane transecting the VLA through the mitral valve and apex. A short-axis image can be obtained perpendicular to HLA, at mid-ventricular (E) and basal level (F). The four-chamber (G) of the left ventricle (LV) is obtained as indicated from a plane transecting both LV and the right ventricle. The two-chamber (H) of the LV is acquired perpendicular to the four-chamber. The three-chamber LV (I) is obtained from a plane transecting the LV through the LV outflow tract.

• FIGURE 19-3 Bright-blood acquisition of ■the right ventricle. Right ventricular outflow tract (RVOT), main pulmonary artery (PA) and pulmonary valve (PV). RA, right atrium; RV, right ventricle; TV, tricuspid valve; Ao, aorta.

• FIGURE 19-4 Normal cardiac anatomy on black-■blood and bright-blood acquisitions, in sagittal (A, B) and coronal (C, D) views. Ao-Asc, ascending aorta; Ao-Arch, aortic arch; Ao-Desc, descending aorta; RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle; PA, pulmonary artery; RPA, right pulmonary artery

• FIGURE 19-4 Normal cardiac anatomy on black-blood ■and bright-blood acquisitions, in sagittal (A, B) and coronal (C, D) views. Ao-Asc, ascending aorta; Ao-Arch, aortic arch; Ao-Desc, descending aorta; RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle; PA, pulmonary artery; RPA, right pulmonary artery

• FIGURE 19-4 Normal cardiac anatomy on ■black-blood and bright-blood acquisitions, in sagittal (A, B) and coronal (C, D) views. Ao-Asc, ascending aorta; Ao-Arch, aortic arch; Ao-Desc, descending aorta; RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle; PA, pulmonary artery; RPA, right pulmonary artery

• FIGURE 19-5 Normal cardiac anatomy on transverse black-■blood acquisitions. Ao-Asc, ascending aorta; Ao-Arch, aortic arch; Ao-Desc, descending aorta; RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle; RVOT, right ventricular outflow tract; ; PA, main pulmonary artery; RPA, right pulmonary artery; LPA, left pulmonary artery; LAA, left atrial appendage; TV, tricuspid valve; MV, mitral valve; P, papillary muscle; LAD, left anterior descending coronary artery; cs, coronary sinus; pc, pericardium; T, trachea; C, carina; IVC, inferior vena cava; SVC, superior vena cava

• FIGURE 19-5 Normal cardiac anatomy on transverse ■black-blood acquisitions. Ao-Asc, ascending aorta; Ao-Arch, aortic arch; Ao-Desc, descending aorta; RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle; RVOT, right ventricular outflow tract; ; PA, main pulmonary artery; RPA, right pulmonary artery; LPA, left pulmonary artery; LAA, left atrial appendage; TV, tricuspid valve; MV, mitral valve; P, papillary muscle; LAD, left anterior descending coronary artery; cs, coronary sinus; pc, pericardium; T, trachea; C, carina; IVC, inferior vena cava; SVC, superior vena cava

• FIGURE 19-5 Normal cardiac anatomy on transverse black-blood ■acquisitions. Ao-Asc, ascending aorta; Ao-Arch, aortic arch; Ao-Desc, descending aorta; RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle; RVOT, right ventricular outflow tract; ; PA, main pulmonary artery; RPA, right pulmonary artery; LPA, left pulmonary artery; LAA, left atrial appendage; TV, tricuspid valve; MV, mitral valve; P, papillary muscle; LAD, left anterior descending coronary artery; cs, coronary sinus; pc, pericardium; T, trachea; C, carina; IVC, inferior vena cava; SVC, superior vena cava.

• FIGURE 19-5 Normal cardiac anatomy on transverse black-■blood acquisitions. Ao-Asc, ascending aorta; Ao-Arch, aortic arch; Ao-Desc, descending aorta; RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle; RVOT, right ventricular outflow tract; ; PA, main pulmonary artery; RPA, right pulmonary artery; LPA, left pulmonary artery; LAA, left atrial appendage; TV, tricuspid valve; MV, mitral valve; P, papillary muscle; LAD, left anterior descending coronary artery; cs, coronary sinus; pc, pericardium; T, trachea; C, carina; IVC, inferior vena cava; SVC, superior vena cava.

• FIGURE 19-5 Normal cardiac anatomy on transverse black-■blood acquisitions. Ao-Asc, ascending aorta; Ao-Arch, aortic arch; Ao-Desc, descending aorta; RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle; RVOT, right ventricular outflow tract; ; PA, main pulmonary artery; RPA, right pulmonary artery; LPA, left pulmonary artery; LAA, left atrial appendage; TV, tricuspid valve; MV, mitral valve; P, papillary muscle; LAD, left anterior descending coronary artery; cs, coronary sinus; pc, pericardium; T, trachea; C, carina; IVC, inferior vena cava; SVC, superior vena cava.

• FIGURE 19-6 Normal cardiac anatomy on bright-■blood two-, four- and three-chamber views. RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle; P, papillary muscle; TV, tricuspid valve; MV, mitral valve; AV, aortic valve; Ao, aorta; M, moderator band; ch, chordae tendineae

• FIGURE 19-6 Normal cardiac anatomy on bright-■blood two-, four- and three-chamber views. RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle; P, papillary muscle; TV, tricuspid valve; MV, mitral valve; AV, aortic valve; Ao, aorta; M, moderator band; ch, chordae tendineae

• FIGURE 19-7 Transverse black-blood (A) and bright-blood (B) ■acquisition illustrating the moderator band in the right ventricle. RA, right atrium; RV, right ventricle; LV, left ventricle; TV, tricuspid valve; M, moderator band; Ao-Desc, descending aorta.

• FIGURE 19-7 Transverse black-blood (A) and bright-blood ■(B) acquisition illustrating the moderator band in the right ventricle. RA, right atrium; RV, right ventricle; LV, left ventricle; TV, tricuspid valve; M, moderator band; Ao-Desc, descending aorta.

• FIGURE 19-8 A segmented gradient-echo acquisition of the ■aortic valve. In (A, B), the planning of the acquisition plane is presented in black-blood coronal view of the aorta during end diastole (A) and bright-blood at peak systole (B). In (C), a closed normal valve at end diastole and in (D), an opened normal valve with three cusps at peak systole is presented (L, left coronary cusp; R, right coronary cusp; N, non-coronary cusp). In (E), a bicuspid aortic valve is presented, with a fused non-coronary and right coronary cusp.

• FIGURE 19-8 A segmented gradient-echo acquisition of the aortic ■valve. In (A, B), the planning of the acquisition plane is presented in black-blood coronal view of the aorta during end diastole (A) and bright-blood at peak systole (B). In (C), a closed normal valve at end diastole and in (D), an opened normal valve with three cusps at peak systole is presented (L, left coronary cusp; R, right coronary cusp; N, non-coronary cusp). In (E), a bicuspid aortic valve is presented, with a fused non-coronary and right coronary cusp.

• FIGURE 19-8 A segmented gradient-echo acquisition of the ■aortic valve. In (A, B), the planning of the acquisition plane is presented in black-blood coronal view of the aorta during end diastole (A) and bright-blood at peak systole (B). In (C), a closed normal valve at end diastole and in (D), an opened normal valve with three cusps at peak systole is presented (L, left coronary cusp; R, right coronary cusp; N, non-coronary cusp). In (E), a bicuspid aortic valve is presented, with a fused non-coronary and right coronary cusp.

• FIGURE 19-9 Right ventricle. Transverse ■reconstruction showing the right ventricle (RV). Ao-Desc, descending aorta; FO, fossa ovalis; LA, left atrium; LV, left ventricle; M, moderator band; MV, mitral valve; RA, right atrium; RCA, right coronary artery; P, papillary muscle

• FIGURE 19-10 Left ventricular orientation. ■Longitudinal two-chamber (A), three-chamber (B), and four-chamber (C) reconstructions. Left ventricular short-axis reconstructions at the base (D), mid ventricular (E) and apical level (F). Ao, aorta; LA, left atrium; RA, right atrium; LV, left ventricle; RV, right ventricle.

• FIGURE 19-10 Left ventricular orientation. ■Longitudinal two-chamber (A), three-chamber (B), and four-chamber (C) reconstructions. Left ventricular short-axis reconstructions at the base (D), mid ventricular (E) and apical level (F). Ao, aorta; LA, left atrium; RA, right atrium; LV, left ventricle; RV, right ventricle.

• FIGURE 19-10 Left ventricular orientation. ■Longitudinal two-chamber (A), three-chamber (B), and four-chamber (C) reconstructions. Left ventricular short-axis reconstructions at the base (D), mid ventricular (E) and apical level (F). Ao, aorta; LA, left atrium; RA, right atrium; LV, left ventricle; RV, right ventricle.

• FIGURE 19-11 Coronary dominance. Three-dimensional volume-rendered ■images with frontal view and view from below showing right dominant coronary artery circulation (A) and left dominant coronary artery circulation (B). In right dominant coronary artery circulation, the posterior descending artery (PD) arises from the right coronary artery (RCA). In left dominant coronary artery circulation, the PD arises from the circumflex artery (Cx) (B). Note the short RCA with empty right atrioventricular groove (RAVG) which is normal in left dominant coronary artery circulation, and should not be confused with RCA occlusion. Side branches visualised: AM, acute marginal branch; D, diagonal branch; OM, obtuse marginal branch; PL, posterolateral branch; LV, left ventricle.

• FIGURE 19-11 Coronary dominance. Three-dimensional volume-rendered images ■with frontal view and view from below showing right dominant coronary artery circulation (A) and left dominant coronary artery circulation (B). In right dominant coronary artery circulation, the posterior descending artery (PD) arises from the right coronary artery (RCA). In left dominant coronary artery circulation, the PD arises from the circumflex artery (Cx) (B). Note the short RCA with empty right atrioventricular groove (RAVG) which is normal in left dominant coronary artery circulation, and should not be confused with RCA occlusion. Side branches visualised: AM, acute marginal branch; D, diagonal branch; OM, obtuse marginal branch; PL, posterolateral branch; LV, left ventricle.

• FIGURE 19-12 Coronary anatomy; segments. Transverse reconstructions ■showing (A) the left main coronary artery (LM); (B) proximal right coronary artery (RCA), proximal left anterior descending artery (LAD) with diagonal side branch (D), and proximal circumflex artery (Cx) with obtuse marginal branch (OM); (C) mid-LAD, mid-RCA and mid-Cx/OM; (D) distal-RCA and posterior descending branch (PD), distal-LAD. Pericardium is visualised as a thin line (arrows in D). Visualised pulmonary veins: LIPV, left inferior pulmonary vein; RMPV, right middle pulmonary vein; RSPV, right superior pulmonary vein. LA, left atrium; LAA, left atrium appendage; LV, left ventricle.

• FIGURE 19-12 Coronary anatomy; segments. Transverse reconstructions ■showing (A) the left main coronary artery (LM); (B) proximal right coronary artery (RCA), proximal left anterior descending artery (LAD) with diagonal side branch (D), and proximal circumflex artery (Cx) with obtuse marginal branch (OM); (C) mid-LAD, mid-RCA and mid-Cx/OM; (D) distal-RCA and posterior descending branch (PD), distal-LAD. Pericardium is visualised as a thin line (arrows in D). Visualised pulmonary veins: LIPV, left inferior pulmonary vein; RMPV, right middle pulmonary vein; RSPV, right superior pulmonary vein. LA, left atrium; LAA, left atrium appendage; LV, left ventricle.

• FIGURE 19-13 Coronary arteries and cardiac veins. Volume-rendered reconstructions ■for coronary artery and cardiac venous anatomy. Coronary arteries and side branches: AM, acute marginal branch of RCA (A); Cx, circumflex artery (B, C); D1 and D2, first and second diagonal branch (B); LAD, left anterior descending artery (B); LM, left main coronary artery (B); OM, obtuse marginal branch (B, C); PD, posterior descending branch (D); PL, posterolateral branch from RCA (D); RCA, right coronary artery (A, D); RVB, right ventricle branch (running to distal part of posterior interventricular groove, A, D). Cardiac veins: AIV, anterior interventricular vein (B); CS, Coronary sinus (D); GCV, great cardiac vein (C, D); LMV, left marginal vein (C); PIV, posterior interventricular vein (D); PLVV, posterior left ventricular vein (C, D); RAV, right atrial vein draining directly into right atrium (A).

• FIGURE 19-13 Coronary arteries and cardiac veins. Volume-rendered reconstructions ■for coronary artery and cardiac venous anatomy. Coronary arteries and side branches: AM, acute marginal branch of RCA (A); Cx, circumflex artery (B, C); D1 and D2, first and second diagonal branch (B); LAD, left anterior descending artery (B); LM, left main coronary artery (B); OM, obtuse marginal branch (B, C); PD, posterior descending branch (D); PL, posterolateral branch from RCA (D); RCA, right coronary artery (A, D); RVB, right ventricle branch (running to distal part of posterior interventricular groove, A, D). Cardiac veins: AIV, anterior interventricular vein (B); CS, Coronary sinus (D); GCV, great cardiac vein (C, D); LMV, left marginal vein (C); PIV, posterior interventricular vein (D); PLVV, posterior left ventricular vein (C, D); RAV, right atrial vein draining directly into right atrium (A).

• FIGURE 19-14 Absent left main. Double ■oblique orientation parallel to the aortic root showing separate coronary ostia of left anterior descending artery (LAD) and circumflex artery (Cx). The left main artery is absent. Right coronary artery (RCA) with conus branch (CB).

• FIGURE 19-15 Full-length display of coronary arteries. Three-■dimensional volume-rendered reconstructions in right anterior oblique (A) and left anterior oblique (D) view and curved multiplanar reconstructions (B, C, E, F) showing each coronary artery in two longitudinal perpendicular directions: the right coronary artery (RCA, in B), left anterior descending coronary artery (LAD, in C), circumflex artery (Cx, in E) and obtuse marginal branch (OM, in F). Note that the OM is much larger than the Cx (E) itself, which is usuallythe case. LM, Left main

• FIGURE 19-15 Full-length display of coronary arteries. Three-■dimensional volume-rendered reconstructions in right anterior oblique (A) and left anterior oblique (D) view and curved multiplanar reconstructions (B, C, E, F) showing each coronary artery in two longitudinal perpendicular directions: the right coronary artery (RCA, in B), left anterior descending coronary artery (LAD, in C), circumflex artery (Cx, in E) and obtuse marginal branch (OM, in F). Note that the OM is much larger than the Cx (E) itself, which is usuallythe case. LM, Left main

• FIGURE 19-15 Full-length display of coronary arteries. Three-■dimensional volume-rendered reconstructions in right anterior oblique (A) and left anterior oblique (D) view and curved multiplanar reconstructions (B, C, E, F) showing each coronary artery in two longitudinal perpendicular directions: the right coronary artery (RCA, in B), left anterior descending coronary artery (LAD, in C), circumflex artery (Cx, in E) and obtuse marginal branch (OM, in F). Note that the OM is much larger than the Cx (E) itself, which is usuallythe case. LM, Left main

• FIGURE 19-16 Invasive coronary angiography of the ■right coronary artery (RCA) in two different directions (left panel, left anterior oblique 45°; right panel, right anterior oblique 35°). RV, right ventricular branch; RDP, right posterior descending branch; RPL, right posterolateral branch; conus, conus branch.

• FIGURE 19-17 Invasive coronary angiography of the left coronary ■artery in two different directions (left panel, right anterior oblique 30°, 25° caudal angulation; right panel, left anterior oblique 50°, 25° cranial angulation). LM, left main coronary artery; LAD, left anterior descending coronary artery; Cx, circumflex coronary artery; OM, obtuse marginal branch; LPL, left posterolateral branch, S-branches, septal branches; D-branches, diagonal branches.

• FIGURE 19-18 Aortic valve. Multiplanar ■reconstructions at mid-diastole showing the closed aortic valve (AV) in coronal view (A), three-chamber view (B) and short-axis parallel to the aortic valve (C). S, sinus of Valsalva; MV, mitral valve; LV, left ventricle; LA, left atrium. Arrows in (C) point at the commissures.

• FIGURE 19-18 Aortic valve. Multiplanar ■reconstructions at mid-diastole showing the closed aortic valve (AV) in coronal view (A), three-chamber view (B) and short-axis parallel to the aortic valve (C). S, sinus of Valsalva; MV, mitral valve; LV, left ventricle; LA, left atrium. Arrows in (C) point at the commissures.

• FIGURE 19-19 Bicuspid aortic valve. ‘Short-axis’ double oblique ■transverse images parallel to the aortic valve, showing bicuspid aortic valve at diastole (A, closed) and at systole (B, slit-like opening due to fusion of left and right coronary cusp). Note the difference in noise level between the images, caused by ECG-dose modulation with full dose at diastole (during the cardiac rest phase for sharp imaging of the coronary arteries), and lower radiation dose at systole to save radiation dose.

• FIGURE 19-20 Mitral valve. Multiplanar reconstructions ■at mid-diastole showing the mitral valve (MV) in longitudinal two-chamber view (A), three-chamber view (B), four-chamber view (C) and short-axis view (D). Anterior mitral leaflet (arrow), posterior mitral leaflet (arrowhead). P, papillary muscles; Ch, chordae tendineae; AV, aortic valve; LV, left ventricle.

• FIGURE 19-20 Mitral valve. Multiplanar reconstructions ■at mid-diastole showing the mitral valve (MV) in longitudinal two-chamber view (A), three-chamber view (B), four-chamber view (C) and short-axis view (D). Anterior mitral leaflet (arrow), posterior mitral leaflet (arrowhead). P, papillary muscles; Ch, chordae tendineae; AV, aortic valve; LV, left ventricle.

• FIGURE 19-21 Pulmonary valve. Coronal (A), ■sagittal (B) and multiplanar reconstruction parallel to the pulmonary valve (C) showing the pulmonary valve (arrows). AV, aortic valve; LA, left atrium; LV, left ventricle; RV, right ventricle.

• FIGURE 19-21 Pulmonary valve. Coronal (A), ■sagittal (B) and multiplanar reconstruction parallel to the pulmonary valve (C) showing the pulmonary valve (arrows). AV, aortic valve; LA, left atrium; LV, left ventricle; RV, right ventricle.

• FIGURE 19-22 Tricuspid valve. Transverse ■reconstruction (A) and short-axis reconstruction parallel to the tricuspid valve (B), showing the tricuspid valve (arrows). LV, left ventricle; RV, right ventricle; MV, mitral valve; PV, pulmonary valve. Note that the tricuspid valve is difficult to recognise as compared to the mitral valve (B).

• FIGURE 19-23 Pulmonary veins. Volume-rendered ■(A) and maximum intensity projection (B) reconstructions, dorsal view (A) and frontal view (B). LA, left atrium; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein

• FIGURE 19-24 Parasternal long-axis view. ■LV, left ventricle; LA, left atrium; RVOT, right ventricular outflow tract; Ao, aorta; AV, aortic valve; MV, mitral valve.

• FIGURE 19-25 Parasternal short-axis aorta ■view. RA, right atrium; LA, left atrium; IAS, interatrial septum; RVOT, right ventricular outflow tract; AV, aortic valve; TV, tricuspid valve; PV, pulmonary valve; LPV, left pulmonary veins.

• FIGURE 19-26 Parasternal short-axis ■pulmonary artery view. RVOT, right ventricular outflow tract; AV, aortic valve; PV, pulmonary valve; PA, main pulmonary artery; RPA, right pulmonary artery; LPA, left pulmonary artery.

• FIGURE 19-27 Parasternal short-axis basal ■left ventricle view. LV, left ventricle; MV, mitral valve; MV aml, anterior leaflet mitral valve; MV pml, posterior leaflet mitral valve; RV, right ventricle; M, moderator band.

• FIGURE 19-28 Parasternal short-axis mid ■left ventricle view. LV, left ventricle; RV, right ventricle; AP, anterior papillary muscle; PP, posterior papillary muscle.

• FIGURE 19-29 Parasternal short-axis apex ■left ventricle. A, apex left ventricle; RV, right ventricle.

• FIGURE 19-30 (A) Apical ■four-chamber view. LV, left ventricle; S, septal myocardium; L, lateral myocardium; RV, right ventricle; LA, left atrium; RA, right atrium; MV, mitral valve; TV, tricuspid valve; M, moderator band; LPV, left pulmonary vein; IAS, inter-atrial septum; (B) detail of the inter-atrial septum. PS, primary septum; FO/SS, fossa ovalis/secondary septum

• FIGURE 19-31 Apical two-chamber view. ■LV, left ventricle; A, anterior myocardium; I, inferior myocardium; LA, left atrium; MV, mitral valve.

• FIGURE 19-32 Apical five-chamber view. LV, left ■ventricle; AS, anteroseptal myocardium; IL-P, inferolateral-posterior myocardium; LA, left atrium; MV, mitral valve; RV, right ventricle; RA, right atrium; AV, aortic valve; LVOT, left ventricular outflow tract; Ao, aorta-ascendens.

• FIGURE 19-33 Apical right ventricle view. ■RV, right ventricle; RA, right atrium; TV, tricuspid valve; S, septal myocardium; RV-L, right ventricle lateral myocardium.

• FIGURE 19-34 Subcostal four-chamber ■view. LV, left ventricle; RV, right ventricle; LA, left atrium; RA, right atrium; MV, mitral valve; TV, tricuspid valve; pc, pericardium.

• FIGURE 19-35 Subcostal inferior vena cava ■view. L, liver; IVC, inferior vena cava; RA, right atrium.

• FIGURE 19-36 Suprasternal view. Ao-Asc, ■ascending aorta; Ao-Arch, aortic arch; Ao-Desc, descending aorta; AC, common carotid artery; LSA, left subclavian artery; RPA, right pulmonary artery.

• FIGURE 19-37 ■Aortic valve short-axis. Normal aortic valve with right coronary cusp (R), left coronary cusp (L) and non-coronary cusp (N) in closed (upper panel) and open position (lower panel).

• FIGURE 19-38 ■Bicuspid aortic valve. Functionally bicuspid aortic valve with non-coronary cusp (N), and fusion (raphe) of the right coronary cusp (R) and left coronary cusp (L). Upper panel shows the aortic valve in closed and lower panel in open position.

• FIGURE 19-39 Transoesophageal ■echocardiographic view of the aortic valve in transverse/short-axis view (left panel) and longitudinal view (right panel). N, non-coronary cusp; R, right coronary cusp; L, left coronary cusp; LA, left atrium; LAA, left atrial appendage; RVOT, right ventricular outflow tract; LV, left ventricle; AV, aortic valve; Ao, ascending aor

• FIGURE 19-40 Transoesophageal ■echocardiographic views of the mitral valve. With multiplanar views, the different parts of the anterior mitral valve leaflet (A1, A 2, A3) and the posterior leaflet (P1, P2, P3) can be visualised

• FIGURE 19-40 Transoesophageal ■echocardiographic views of the mitral valve. With multiplanar views, the different parts of the anterior mitral valve leaflet (A1, A 2, A3) and the posterior leaflet (P1, P2, P3) can be visualised

• FIGURE 19-41 Three-■dimensional view of the aortic valve in closed (upper panel) and in open position (lower panel). The image is obtained with transoesophageal echocardiography. N, non-coronary cusp; R, right coronary cusp; L, left coronary cusp.

• FIGURE 19-42 Three-■dimensional view of the mitral valve with anterior leaflet and posterior leaflet in closed (upper panel) and in open position (lower panel). The image is obtained with transoesophageal echocardiography and the valve is seen from the left atrium. The different parts of the anterior mitral valve leaflet (A1, A 2, A3) and the posterior leaflet (P1, P2, P3) can be determined.

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