Q. Show the Apical View of Transducer Position?

For the patient with dextrocardia transducer is kept on right chest with marker towards left side. Morphological parameters to identify the ventricles are seen in this view. Gradient across both AV valves and semilunar valves can be taken.

This view is also helpful in recognizing various types of VSDs, displacement of tricuspid leaflet (~bs/tein's anamoly of tricuspid valve) and AVSD. ASD is never diagnosed in this vidw because false dropouts are common due to angle between ultrasound beam and inter atrial septum. A good four chamber apical view is very helpful in makibg structural as well as functional diagnosis of heart disease. If symmetry of four chamber view is lost one should look for dilatation or hypoplasia of chambers. Total anomalous pulmonary venous drainage is suspected if left atria is bald i.e. no pulmonary venous opening seen and PFO/ ASD is shunting right to left along with dilated RARV. Partial anomalous pulmonary venous cbnnections (PA PVC) of single or multiple pulmonary veins should be looked foi if right sided chambers are enlarged in absence of ASD and RVOT obstruction. Pulmonary veins are best seen in sub-costal, apical, parasternal views. Tkicuspid atresia or Hypoplastic Tricuspid Valve are easily recognized in this view. Dilated LV, presence of MR with glistening of papillary muscles gives clue about ALCAPA. Hypertrophied LV may be seen when coarctation of aorta Cs associated. If LA and LV are dilated one should suspect PDA. In a new bod having hypertrophied LV, if apex is formed by RV, critical aortic stenosis is a Ejossibility. However, one has to decide about adequacy of LV in such a situation.