Mastering the suprasternal view of the aorta in echocardiography

In this video, you will learn how to display an optimized suprasternal view of the aorta using transthoracic echo. You will also be able to recognize the structures, assess them, and decide whether they are normal or not.

After completing this course, you’ll be able to perform a basic transthoracic echo (TTE) exam without the help of a more senior colleague. Using practical demos, we’ll teach you echo anatomy and show you how to operate the machine, obtain the standard TTE views, differentiate normal from abnormal, and confidently assess and report anything you find!

[00:00:00] This shows where the suprasternal view of the aorta is taken. So, the probe is up here now. We're scanning through the aortic arch and the vessels and then onto the heart beneath. So, this is another view, where we need to alter the position of our patient slightly because we're going to scan suprasternally, from the suprasternal notch. So, Kim, if you don't mind, I'm just going to put these pillows underneath your shoulders and then ask you to extend your neck down, like that. We need to be quite careful with this view.

[00:00:30] It's not particularly comfortable and it's certainly not for the elderly, if they get stiff necks and having pressure to the suprasternal notch is quite unpleasant, so it's always a good idea just to keep checking that the patient's feeling alright. So, I will get my probe and make sure that the notch is pointing towards the left shoulder and then I'll just position in the suprasternal notch, like this and I can reduce my depth, here. I think my width is about right.

[00:01:00] To find the view, sometimes it's useful to put some color on. That the blue surge down the descending aorta, that we see here, can help you navigate yourself a bit. And what I'm looking for are the head and neck vessels, up here. So, one, two, and there will be one up here as well. That's what it should look like. This is a diagram of the suprasternal view of the aorta. Our probe will be at the top of the screen, here. We're looking at the ascending aorta,

[00:01:30] the arch itself, and then the descending aorta, here. We also get the head and neck vessels. So, this first one is the innominate, some people call it the brachiocephalic artery. Then we have the left common carotid and then we have the left subclavian. Sometimes, you can see the right branch of the pulmonary artery beneath the arch. So, we're going to be scanning in a suprasternal view. So, I'm pointing the probe notch towards the left shoulder so I can

[00:02:00] see the arch, like this. I'm going to have a hunt around for those head and neck vessels. They're not the easiest to see and the color Doppler hopefully will help me. So, what I'm looking for are three different vessels, coming off up here, at the arch. There we are, so there's one, two, three. So, we have the innominate,

[00:02:30] the left cephalic, and the left subclavian is there. So, I'm just going to alter my view, here, to get more of the descending aorta in and I'll just put some color and then we'll see the flow down the descending aorta. We'll see how it's more turbulent as it goes around the inside of the arch, there. We don't see

[00:03:00] the ascending aorta particularly well, which would be here but we are seeing the right branch of the pulmonary artery. If we had a patent ductus arteriosus, we might see it in this view. If we had a patient with aortic regurgitation, we would put color here and look for a surge of red

[00:03:30] up the descending aorta. This is actually a normal amount of flow up the descending aorta. We see it on this inner side, here and it's quite a brief flash. So, that's actually a normal finding. If there was a coarctation, we would notice that, usually around here somewhere and that would be a narrowing at the top of the descending aorta and what would flag us there would be turbulent flow but this is all nice and normal.

[00:04:00] Because we're not seeing so much of the ascending, the top of the ascending aorta, here and we might want to, for a patient who is suspected of having a dissection. We might be really keen to see that bit of the aorta. What we can do is just try moving the patient, so if you don't mind rolling onto your right side, so you're facing me. Let's take one of these pillows away. That's it. And what we do is we scan, we just move over a little bit so we're scanning again, with the probe pointed towards the

[00:04:30] left shoulder, in the second or third rib space, like this. And here, we're getting the ascending aorta and if I'm not sure whether it is or not, I'll just put color on and I'll see that I got systolic flow and a really nice view, actually, of the top of the ascending aorta. So, I could measure the diameters and I could check for dissection.