美國超聲心動圖學會（ASE）成立於1975年，是世界上最大的心臟影像國際組織。本文節選轉載美國超聲心動圖學會的《成人經胸超聲心動圖操作指南》有關基本切面--劍突下聲窗和切面及胸骨上窩切面方面的精彩內容。
D.劍突下聲窗和切面 ( SC Window and Views)
The SC window is used to assess the heart, pericardium, RV free wall thickness, and great vessels located in the abdomen (IVC and SVC, hepatic veins [Hvns], and abdominal aorta). It can be very useful for imaging the heart when the images are suboptimal from the parasternal window.The SC view is obtained with the patient laying supine with abdominal muscles relaxed. Having the patient bend his or her knees may help relax the stomach muscles, thereby making the views easier to obtain. The image may be further improved by acquiring it during held inspiration.
SC窗口用於評估心臟，心包，右室RV游離壁厚度和位於腹部的大血管（下腔靜脈IVC和上腔靜脈SVC，肝靜脈(Hvns)和腹主動脈）。當胸骨旁聲窗的圖像不理想的時候，劍突下對心臟進行成像可能非常有用。SC聲窗是通過患者仰臥松馳腹肌而獲得。讓病人曲膝可能有助於放鬆腹部肌肉，從而使圖像更容易獲得。在保持吸氣狀態時獲取圖像可能會進一步優化圖像質量。
1.劍突下四腔切面(SC Four-Chamber View)
SC imaging begins with the transducer placed on the patient´s abdomen at the junction of the rib cage (xiphoid process), with the index marker pointed to the patient´s left, at about a 3 o´clock position. The transducer is pointed toward the patient’s left shoulder, transecting the heart in a four-chamber orientation. From this image, the right atrium, TV, left atrium, MV, left ventricle, interatrial septum, and interventricular septum can be examined.This view is particularly important to assess the interatrial and interventricular septa for defects, and the RV wall thickness, as the ultrasound beam is perpendicular to each septum. A video clip should be recorded (Table 2.24).
開始SC成像時， 將探頭放置在患者腹部處的肋骨交叉處（劍突），指示標記指向患者左側約3點鐘位置。將探頭指向患者左肩，以4腔取向心臟橫切面。從這個圖像中，可以檢查RA、TV、LA、MV、LV、房間隔和室間隔。由於超聲波束垂直於每個間隔，因此該切面對評估房間隔缺損、室間隔缺損以及RV壁厚度特別重要。應記錄視頻（表2.24）。
2.24. SC 4C (見視頻65)
解剖圖像(Anatomic image)
二維經胸超聲圖像(2D TTE image)
採集圖像(Acquisition image)
劍突下聲窗4c切面 患者仰臥位 探頭位於劍突下，標記指向患者左肩，屏住呼吸
顯示結構(Structures to demonstrate)
LV MV RV TV IAS IVS RA LA
視頻65 顯示LV，MV，RV，TV，IAS，IVS，RA和LA
2.劍突下短軸切面( SC Short-Axis View)
From the four-chamber view,counterclockwise rotation of the transducer approximately 90° should result in a short-axis orientation of the heart. The liver and IVC are imaged by maintaining the short-axis orientation of the heart and pointing the transducer toward the patient’s liver(Table 2.25).
從四腔切面，將探頭逆時針旋轉大約90°便可得到心臟的短軸位。保持心臟的短軸位以顯示肝臟和下腔靜脈（IVC）並將探頭指向患者的肝臟（表2.25）。
2.25. SC下腔靜脈長軸 (見視頻66)
解剖圖像(Anatomic image)
二維經胸超聲圖像(2D TTE image)
採集圖像(Acquisition image)
劍突下聲窗 IVC切面 患者身體長軸
顯示結構(Structures to demonstrate)
IVC長軸
視頻66 SC窗口，IVC切面，顯示IVC的長軸
The primary purpose of this view in the routine examination is to show the IVC in the longitudinal plane for severalcentimeters as it courses into the rightatrium. A video clip of a respiratory cycle should be obtained of the longitudinal IVC. This view is used to measure the diameterof the IVC and to evaluate IVC diameter changes during respiration (collapsibility index) to estimate central venous pressure. The Hvns draining into the IVC should also be imaged from this view and a clip acquired (Table 2.26).
在例行檢查中應用該切面的主要目的是顯示數釐米 IVC縱進入RA。記錄縱斷面IVC在一個呼吸周期內的視頻。該切面用於測量IVC的直徑並評估IVC直徑在呼吸過程中的變化（塌陷指數），用以估計中心靜脈壓。匯入IVC的肝靜脈（Hvns）也應該呈現於在該視圖中，並且記錄一個視頻（表2.26）。
2.26. SC肝靜脈長軸 (見視頻67)
解剖圖像(Anatomic image)
二維經胸超聲圖像(2D TTE image)
採集圖像(Acquisition image)
劍突下聲窗 從IVC切面，探頭輕度向右上旋
顯示結構(Structures to demonstrate)
IVC Hvns
視頻67 SC窗口，IVC切面，顯示了IVC和Hvns
E.胸骨上切跡長軸切面(SSN Long-Axis View)
The patient is positioned supine with a pillow behind the shoulders so that the head can be tilted backward. Turning the patient’s face leftward, the transducer is placed in the SSN, with the index facing 12 o』clock initially, with gradual clockwise rotation toward the left shoulder (1 o』clock), and tilted toward the plane that cuts through the right nipple and the tip of the left scapula (Table 2.27). The structures visualized are the aorta (ascending, transverse, and descending), and the origins of the innominate, left common carotid, and left subclavian arteries. The right PA is demonstrated in cross-section. Additional views from the SSN window are provided in the appendix.
患者仰臥位，枕頭置於患者後肩，頭部略微後仰。患者面部向左傾斜，探頭置於胸骨上切跡，探頭標記最初指向 12 點鐘方向，然後朝左肩（1點鐘方向）逐漸順時鐘旋轉，再向右乳頭和左肩腳骨尖連線平面傾斜切入 (表 2.27)。此時可見主動脈升部，橫部和降部，無名動脈的起始部，左頸總動脈，左鎖骨下動脈。此時右肺動脈呈橫切面。附錄中提供了SSN窗口的其他視圖.。
2.27. SSN主動脈弓（見視頻68）
解剖圖像(Anatomic image)
二維經胸超聲圖像(2D TTE image)
採集圖像(Acquisition image)
探頭置於胸骨上切跡，探頭標記最初指向12點鐘方向，然後朝左肩（1點鐘方向）逐漸順時鐘旋轉
顯示結構(Structures to demonstrate)
Asc Ao Transverse arch Desc Ao Innom a LCCA LSA
視頻68 主動脈弓切面，顯示了Asc Ao，Transverse arch，Desc Ao，Innom a，LCCA和LSA
中文翻譯：蒲朝霞 夏向陽 浙江大學醫學院附屬第二醫院
中文校對：汪 峰 華盛頓州埃弗雷特普羅維登斯地區醫院
《超聲微視頻》對圖片及視頻整理編輯
原文：J Am Soc Echocardiogr. 2019 Jan;32(1):1-64.doi:10.1016/j.echo. 2018.06.004. Epub 2018 Oct 1.