It is not always possible to obtain a good apical window to look for tricuspid regurgitation, which is one parameter that we commonly look at in nephrology patients with volume overload and systemic venous congestion. If the patient has a decent parasternal window (remember, tricuspid valve is not seen in a typical PLAX view), right ventricular inflow view can be obtained from there by tilting the transducer towards the patient’s right hip. Slight changes in angle and rotation maybe necessary for optimal visualization of all the structures.

Following figure illustrates the relevant anatomy.

Following sonographic images demonstrate this view. Note the labeled image at the end. Presence of pacemaker wire (if the patient has one) in the middle of the cavity is also a clue that you are looking at the right heart.

Here is an image obtained from a patient with moderate to severe tricuspid regurgitation. You can also get a continuous wave Doppler tracing from this view to calculate right ventricular systolic pressure (RVSP).

Below: another patient with tricuspid regurgitation – color and continuous wave Doppler of TR jet.

In thin individuals, inferior vena cava can be seen from this view with slight rotation of the probe and/or going one intercostal space lower. Here is an example.

Below: Coronary sinus thrombus seen in this view