Case Series: The Right Parasternal View and its prognostic value in detecting pathological abnormalities on Transthoracic Echocardiography

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Cardiac abnormalities (aortic aneurysm, aortic stenosis, atrial septal defect, right atrial thrombus) (n=4). Intervention: Right parasternal view (RPV) echocardiography vs. Standard echocardiographic views. Primary outcome: Detection of pathological abnormalities.

Q: What does this research mean for the field?

Complementary use of the right parasternal view in transthoracic echocardiography provides decisive diagnostic information that can be missed or underestimated by standard echocardiographic windows. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Neve Moore; A Lacerna; Juan Ortegarestrepo; Roxy Senior; R Khattar; Wei Li; Sitali Mushemi-Blake

doi:10.1093/ehjcr/ytag537

July 18, 2026European Heart Journal - Case ReportsOpen Access

Case Series: The Right Parasternal View and its prognostic value in detecting pathological abnormalities on Transthoracic Echocardiography

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Key result

Adding right parasternal echocardiography detects decisive pathology missed by standard views to guide management.

n=4

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Why the study?

The right parasternal view is infrequently used in routine clinical practice despite potentially providing valuable complementary diagnostic information when standard views reveal abnormalities or inconsistent measurements.

Does the right parasternal view improve the detection of pathological abnormalities compared to standard views in patients undergoing transthoracic echocardiography?

Key Points

To highlight the diagnostic and prognostic utility of adding the right parasternal view to standard transthoracic echocardiography protocols when conventional windows yield discordant or incomplete findings.
Case series evaluating N=4 adult patients undergoing transthoracic echocardiography to assess complex or discordant cardiovascular abnormalities.
Right parasternal imaging performed with patients positioned in a deep right decubitus posture, placing the transducer in the second or third intercostal space to optimize acoustic alignment.
Adjunctive right parasternal imaging provided decisive diagnostic clarity that altered clinical management across all 4 cases where standard windows missed or underestimated pathology.
The window successfully characterized mid to distal ascending aortic pathology, identifying an intimal dissection flap within a 70 mm aneurysm that was poorly visualized on standard left parasternal views.

Study Design

Type

Case Report (n=4)

Structured PICO

Does the right parasternal view improve the detection of pathological abnormalities compared to standard views in patients undergoing transthoracic echocardiography?

P

Population

Four female patients aged 32 to 70 years with various cardiac pathologies where standard echocardiographic views were insufficient or discordant.

I

Intervention

Right parasternal view (RPV) during transthoracic echocardiography

C

Comparator

Standard echocardiographic views (left parasternal, apical, subcostal, suprasternal)

O

Outcome

Detection of pathological abnormalities and diagnostic yieldsurrogate

Limitations

Requires steep right-hand side positioning which may be difficult for patients with limited mobility
Obesity, lung, and rib artefacts may inhibit the ability to obtain an adequate view
Time constraints can limit incorporation in a standard examination
Requires patient to be in a steep right-hand side position, difficult for limited mobility
Obesity, lung, and rib artefacts may inhibit adequate views
Time constraints in standard examination

Implication

The right parasternal view is a valuable complementary echocardiographic window that can reveal critical diagnoses missed by standard views, particularly in aortic, valvular, and congenital heart diseases.

Abstract

Background Two-dimensional echocardiography is the most widely used imaging modality for immediate diagnosis, due to its easy access and cost effectiveness. International guidelines recommend four standard views to perform a comprehensive minimum dataset for every adult patient, namely left parasternal, apical, subcostal and suprasternal views. Case summary In this case series, we revisit the right parasternal view (RPV). Although it is infrequently used in routine clinical practice, it provides valuable complementary information, particularly when abnormalities are found on the minimum dataset or when measurement results are inconsistent. Including this view in the imaging protocol adds only a few extra minutes but can yield important additional diagnostic information. Discussion Presented are four cases in which the complementary use of RPV provided decisive diagnostic information that were either missed or underestimated by standard echocardiographic windows and influenced clinical management; re-emphasising the value of adding this view during a routine examination.

Discussion

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Cite This Study

Moore et al. (2026) conducted a case report in Cardiac abnormalities (aortic aneurysm, aortic stenosis, atrial septal defect, right atrial thrombus) (n=4). Right parasternal view (RPV) echocardiography vs. Standard echocardiographic views was evaluated on Detection of pathological abnormalities. The complementary use of the right parasternal view provided decisive diagnostic information missed or underestimated by standard echocardiographic windows, altering clinical management.

synapsesocial.com/papers/6a5dbb058bd453d3397ac08c https://doi.org/10.1093/ehjcr/ytag537

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Case Series: The Right Parasternal View and its prognostic value in detecting pathological abnormalities on Transthoracic Echocardiography

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Case Series: The Right Parasternal View and its prognostic value in detecting pathological abnormalities on Transthoracic Echocardiography

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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