Background

Transthoracic echocardiography (TTE) is non-invasive method to evaluate heart structure and function.

It is commonly used diagnostic tools in cardiology that provide real-time images of the heart using ultrasound waves.

TTE assesses heart function and identifies cardiac symptom causes. The test reveals heart chambers, valves, and surrounding blood vessels.

Echocardiography uses ultrasound waves for body imaging. Computer technology visualizes heart images using echoes from heartbeats.

Doppler ultrasound in echocardiograms assesses blood flow in heart chambers and valves.

It shows portability, safety, availability, and non-invasive assessment of heart morphology and physiology.

Many patients receive prior TTE before advanced imaging with CT or MRI for cardiac procedures.

A phased-array transducer is chosen for TTE, using multiple elements fired sequentially to generate a sector image with a wide field of view.

Indications

Evaluation of Cardiac Symptoms

Assessment of Left and Right Ventricular Function

Valvular Heart Disease

Infective Endocarditis

Pericardial Disease

Congenital Heart Disease

Aortic Disease

Embolic Events

Contraindications

Poor Acoustic Windows

Inability to Maintain Proper Positioning

Presence of Subcutaneous Emphysema

Esophageal or Gastric Surgery

Open Chest Wounds

Outcomes

Evaluates ventricular relaxation issues in HFpEF diagnosis. TTE confirms or rules out suspected cardiac conditions with details.

Evaluates pulmonary hypertension and right heart failure conditions.

It identifies thrombi in atrial fibrillation and myocardial infarction. Severity assessment guides surgical intervention decisions.

Obesity and lung disease decrease diagnostic accuracy and image quality.

Outcomes vary by clinical indication, imaging quality, and management decisions post-findings.

Equipment required

Echocardiography Machine

Transducer

Ultrasound Gel

Electrocardiogram Leads

Software & Image Processing Tools

Patient Preparation:

No fasting is required during TTE method. Patients should continue with their daily medications.

Patients need to remove upper cloths and wear a hospital gown for chest access.

Apply ultrasound gel on the probe to improve sound wave transmission.

Informed Consent:

Explain the procedure’s risks and potential complications clearly to the patient.

Patient Positioning:

Use left lateral decubitus for heart proximity and in supine positioned if left lateral is intolerable.

Figure. Transthoracic echocardiography

Step 1: Probe Selection and Placement

Select transducer type as phased-array transducer for deep penetration and cardiac imaging.

Standard probe positions are:

Parasternal window for Left side of the sternum

Apical window for near the apex of the heart

Subcostal window for below the sternum, useful for poor parasternal images

Suprasternal window for above the sternum, used for aortic imaging

Step 2: Image Acquisition

It captures multiple views to assess cardiac structure and function:

1. Parasternal Views:

For Parasternal Long Axis:

Views left ventricle, left atrium, right ventricle, aortic and mitral valves.

For Parasternal Short Axis:

Obtained by rotating the probe 90 degrees from PLAX.

1. Apical Views:

Apical 4-Chamber: Shows LV, RV, LA, RA, mitral, and tricuspid valves.

Apical 5-Chamber: Adds the left ventricular outflow tract (LVOT) and aortic valve.

Apical 2-Chamber: Evaluates the LV and LA.

Complications:

Discomfort

Hemodynamic Effects

Respiratory Distress

Arrhythmias

References

Transthoracic Echocardiography: Beginner’s Guide with Emphasis on Blind Spots as Identified with CT and MRI – PMC

References

Transthoracic Echocardiography: Beginner’s Guide with Emphasis on Blind Spots as Identified with CT and MRI – PMC