From Echocardiography in ICU

 

How to get the apical 5 chamber view?

 

To get the apical 5 chamber view, you need to have a good apical 4 chamber view. The objective will be to visualize the 5th chamber: the aorta.

Since the aorta is the most anterior, you will need to tilt your probe upwards (=angle up): the tricuspid valve and RA will go out of the imaging plane, the aorta will appear in the middle of the screen.

Sometimes you will need to go one intercostal space higher and more lateral to have a better alignement of your ultrasound beam with the LV outflow tract. 

 

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What will you see in Apical 5 chamber view?

Apical 5 chamber view is a good view to assess only the aortic valve and LVOT and their relations to the interventricular septum and mitral valve.

-Ao: left ventricle outflow tract and initial aorta. Apical 5 chamber view is not a very good view to look at the structure of the aortic valve, parasternal views are better. In apical 5 chamber view, you will be ideally located to assess aortic regurgitation and/or aortic stenosis. In this view you can quantitate the severity of aortic stenosis with CW-Doppler since your Doppler beam should be well aligned with the LVOT.

-LV, LA, RV and RA: apical 4 chamber view is better to assess these structures

Color Doppler in Apical 5 chamber

With color Doppler, you will be able to look for a regurgitation or an acceleration around the aortic outflow tract.

An aortic regurgitation will appear as a red (going toward the probe) flow, in diastole, from the aorta to the left ventricle.

An aortic or sub-aortic stenosis will be suspected if there is an acceleration (mosaic flow or aliasing) in this area.

 

In this example the aortic valve is normal, without regurgitation or stenosis.