Subcostal Window: 4 Chamber, Short Axis and Inferior Vena Cava Views

This chapter deals with the Subcostal Window, when the Transducer probe is placed below the diaphragm and the Heart is evaluated across it. The Subcostal Short Axis View, the Subcostal 4 Chamber View and the Subcostal evaluation of the Inferior Vena Cava are described. Normally, the Subcostal View is included in the protocol in order to reinforce the findings of Parasternal Short Axis (PSAX) View and the Apical 4 Chamber View. But due to the angulation of the images, its utility is enhanced for the evaluation of the Inter Atrial Septum, Inter Ventricular Septum etc., as described later. Moreover, by avoiding the chest for capturing the images, the Subcostal Short Axis View becomes useful in obese patients, patients with COPD, newborn infants with rapid breathing and post operative patients with chest bandages etc. Additionally, in this view, the Inferior Vena Cava can be evaluated in the Longitudinal Plane and the entry of the Hepatic Vein into it can be well visualized. The respiratory variation of the Inferior Vena Cava is helpful to ascertain Right Atrial Pressure both in normal and increased conditions. Hepatic Venous flow and its reversal can be studied as well to judge increased Right Atrial Pressure and its impact on Hepatic function (Cardiac Cirrhosis). Wherever necessary schematic labelled diagrams help the reader to understand the concepts. Thus, after reading this chapter, one would become knowledgeable of the utility of the Subcostal View in various situations.