Parasternal Short

There are 4 levels in the parasternal long axis (PLA) the aortic valve (AV), mitral valve (MV), papillary and apex.

Transducer Position (Figure 1)

  • Start at the parasternal long axis (PLA) rotate the transducer clockwise 90
  • Then rotate from the 2-10 o’clock position until the indicator bisects the left clavicle
  • By tilting the transducer base to the apex, obtain different short axis images

Image orientation (Figure 2, Figure 3)

Aortic Valve (Figure 4)

  • Tilt/fan the transducer up towards the patients head until the centrally located AV comes into view
  • Adjust until the AV appears a perfect quarter sized circle in the middle of the screen
  • If the MV is seen first, tilt the transducer face slightly up to get the AV window

Mitral Valve (Figure 5)

  • From the AV tilt the transducer face down to open the mitral valve

Papillary Muscle (Figure 6)

  • From the MV tilt the face down until the round papillary muscles are seen
  • Adjust the depth so that the LV fills about three quarters of the screen


  • Continue to tilt the transducer down towards the patient’s feet to obtain an image of the tip of the LV

Assessments and Measurements

Aortic Valve

  • AV function
  • Peak Velocity Tricuspid jet
  • Estimate pulmonary systolic artery pressure

Mitral Valve

  • MV function

Papillary Muscle

  • Right ventricular function
  • Right ventricular pressure and/or volume overload
  • Septal flattening, D-shaped LV


  • Apical dyskinesia
  • Apical aneurysm


Some centers do apex to base, either is fine so long as it is systematic


Figure 1 - PSA Transducer Placement

Figure 2 - PSA Levels

Figure 3 - PSA Levels

Figure 4 - PSA Ideal Aortic Valve Level

Figure 5 - PSA Ideal Mitral Valve Level

Figure 4 - PSA Ideal Papillary Muscle Level


Moore, Christopher L., and Joshua A. Copel. “Point-of-care ultrasonography.” New England Journal of Medicine 364.8 (2011): 749-757.