How to image individual pulmonary veins with transthoracic echocardiography

Although Doppler analysis of pulmonary veins (PVs) is crucial in the assessment of cardiac hemodynamics, there is controversy regarding individual anatomical PV imaging with transthoracic echocardiography (TTE). This report is a discussion of how to image PVs accurately using TTE. To resolve any contradiction, multiple TTE images were obtained during the selective catheterization of the PV in patients undergoing atrial fibrillation ablation procedure. Fluoroscopic images were used as a reference for the identification of each PV and simultaneous echocardiographic imaging of the catheter positioned in the distal PV was used for accurate anatomical localization of the ostium and distal part of the PV.