What is the best view to demonstrate an atrial septal defect (ASD)?

The subcostal four chamber view is the most effective echocardiographic perspective for visualizing an atrial septal defect (ASD). This view allows for an unobstructed examination of both the right and left atria, where the septal defect is typically located. By positioning the ultrasound probe beneath the xiphoid process and angling it towards the patient's left shoulder, the sonographer can ideally assess the interatrial septum. This approach provides a clear assessment of any defects in the wall separating the atria and can demonstrate the size and location of the ASD, along with any associated chamber enlargement that may occur as a result of the shunting of blood.

Other views, while useful for general cardiac assessment, do not offer the same clarity for diagnosing an ASD. The apical two chamber view, for instance, primarily focuses on the left atrium and left ventricle, which limits visibility of the interatrial septum. The parasternal short axis view provides cross-sectional imaging of the heart but may not distinctly capture the atrial anatomy and any potential defects that lie within. The suprasternal view targets the aortic arch and upper great vessels, making it inadequate for assessing the atrial septum directly. Thus