Echocardiography Views and Color Doppler for Impella®

“Echocardiography is an important part of managing our patients on Impella,” states Michael Galvin, a clinical educator at Abiomed. In this short video he identifies the 4 major echocardiogram views, describes the orientation and location of the ultrasound probe in each view, and highlights the anatomy seen in each view. He also explains how to determine whether the Impella is positioned correctly using Color Doppler.

Michael explains that there are 4 major views that make up a full echocardiogram. In other words, there are 4 places on the chest for placing the ultrasound probe:

• Parasternal
• Apical
• Subcostal/subxipoid
• Suprasternal notch

Typically the echocardiogram starts with the parasternal long-axis view, which is one of the best views for looking at Impella. In this view, you can see the aortic valve, the mitral valve, the walls of the left ventricle, and the papillary muscles. 

The apical view is also useful for assessing Impella position. In this view you can see the aortic valve, mitral valve, and walls of the left ventricle, including the septum.

The subcostal view is the best view for assessing the inferior vena cava (IVC) and evaluating pericardial effusion. Michael explains the importance of visualizing the IVC when assessing right-sided volume and pressure.

The last view is the suprasternal notch, which shows the ascending and descending aorta and the aortic arch. This view does not show Impella well but is helpful for assessing blood flow through the aortic arch. 

Color and spectral Doppler are also part of a normal echocardiogram. Color Doppler reveals direction of blood flow and is useful for examining blood flow through the heart and heart valves. Color Doppler is helpful for assessing Impella position because a mosaic pattern of flow is seen at the Impella outlet. When Impella is properly positioned, this mosaic pattern should be seen above the level of the aortic valve. Spectral Doppler provides tracings of blood flow to quanitfy the volume and speed of blood moving through the heart. Michael explains that spectral Doppler is of limited use when a patient is supported with Impella because flow from the Impella motor creates an artifact. Therefore, evaluation of valve function with spectral Doppler should be done after the Impella has been removed.