Normal anatomy, views & variants
The normal heart in every window, TTE and TOE — and the variants (Chiari network, crista, false tendons, moderator band) that are not disease.
Numbers to remember
- A standard TTE has a defined minimum dataset of views and measurements [17,98]
- Normal values are age-, sex- and body-size-specific [1,97]
Questions echo must answer
Knowing the normal heart well is what lets you see disease. This page collects normal views, normal function and the anatomical variants that are often mistaken for pathology [17,98].
- Is every structure seen in at least two views?[17]
- Are dimensions within the normal range for this person?[1,97]
- Is a "mass" actually a normal variant?Chiari network, Eustachian valve, crista terminalis, moderator band, false tendons, lipomatous septum [176].
Acquisition protocol
- ParasternalPLAX, RV inflow, RV outflow, PSAX at aortic, mitral, papillary and apical levels.
- ApicalA4C, A5C, A2C, A3C, RV-focused.
- SubcostalFour-chamber, short axis, IVC.
- SuprasternalArch.
- TOEMid-oesophageal, transgastric and upper-oesophageal views [35].
Diagnosis & severity
| Variant | Where | How to recognise it |
|---|---|---|
| Chiari network | RA | Mobile, fenestrated strands near the IVC orifice |
| Eustachian valve | RA–IVC junction | A ridge or flap at the IVC entry |
| Crista terminalis | RA posterior wall | Fixed muscular ridge |
| Moderator band | RV apex | Muscle band from septum to free wall |
| False tendon | LV | Thin cord across the cavity |
| Lipomatous septum | Atrial septum | Dumb-bell shape sparing the fossa ovalis |
Thresholds that change management
- A normal variant needs no follow-up; say so clearly in the report to prevent repeat imaging.
Pitfalls & mimics
- Calling variants disease — the commonest reason for unnecessary TOE and anticoagulation [176].
- Foreshortened views make a normal LV look abnormal [17].