Echocardiography

 

Parasternal Long Axis View

2D imaging 3 sinus beats for focusing on LV/LA/LVOT/Ao

Color Doppler MV and AoV

M-mode through the mitral leaflet tips

Parasternal Long Axis of the RV inflow (RVIT) 

2D imaging 3 sinus beats of the TV leaflets and RV function and wall motion

2D zoom on the RV side of the TV – 3 beats for wall motion and structure(looking for posterior RV wall aneurysms)

Color Doppler of the TR

Parasternal Short Axis at the Base

2D imaging 3 sinus beats of high quality non-focused view

2D zoom Focusing on the AoV

Color Doppler RV inflow, RV outflow, Pulmonary Valve, PA

Spectral Doppler TR (CW), PV (CW)

Parasternal Short Axis at the Mitral and Tricuspid Valve levels

2D imaging 3 sinus beats to assess wall motion of both LV and RV

Parasternal Short Axis at the LV Mid-ventricle

2D imaging 3 sinus beats to assess LV and RV size and wall motion

Parasternal Short Axis at the LV Apex

2D imaging 3 sinus beats to assess LV and RV size and wall motion

 

Apical 4 Chamber

2D imaging 3 sinus beats of all 4 chambers for relative size and function, focusing on RV, focusing on TV

M-mode of the lateral TV annulus for TAPSE calculation

Color Doppler Mitral inflow and regurgitation, Tricuspid inflow and regurgitation

Spectral Doppler CW of MR optimizing scale and gain to see entire envelope, CW of TR optimizing scale and gain to see entire envelope, PW of mitral inflow (E and A waves),     PW of tricuspid inflow (E and A waves)

Tissue Doppler of the mitral tricuspid annulus-free and septal (optimize scale and baseline of the image so both systolic and diastolic waves can be measures)

Apical 5 Chamber

2D imaging 3 sinus beats focusing of LVOT/Aorta

Color Doppler through LVOT/AoV

Spectral Doppler LVOT (PW) just below AoV

Aortic valve (CW)

 

Apical 2 Chamber

2D imaging 3 sinus beats for LV wall motion

Color Doppler of the MR

Subcostal Long Axis

2D imaging 3 sinus beats to focus on RV free wall and apex function

Color Doppler of interatrial septum and TV/MV

Subcostal Short Axis

2D imaging 3 sinus beats to view RVOT and RVIT

Color Doppler of TV and PV

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The left ventricle diameter is measured in parasternal long axis, at the tip of the mitral leaflets, at the interface blood-internall wall.

LVED: left ventricle end-diastolic diameter, is the most important measurement. It is measured at end diastole, on the frame after mitral closure. It normally corresponds to the largest cardiac dimension.

LVES: left ventricle end-systolic diameter, is measured at end systole, on the frame preceding mitral valve opening. It corresponds to the smallest cardiac dimension.

M-mode measurements

  

The LV dimensions can be measured in M-mode. This imaging modality allows the visualization of each structure depending on the time and gives a better image resolution than 2D imaging. However you must be sure that the imaging beam is cutting perpendicularly the long axis of the left ventricle or you will overestimate the LV size.

Normal and abnormal values

LVED (mm)	Normal	Mildly dilated	Moderately dilated	Severely dilated
Men	42-59	60-63	64-68	>69
Women	39-53	54-57	58-61	>62

Normal values for walls thickness

	Normal	Mild hypertrophy	Moderate hypertrophy	Severe hypertrophy
Inter-ventricular septum and posterior wall thickness (mm)	6-10	11-13	14-16	>17

EF = { End-diastolic volume - End-systolic volume } / End-diastolic volume 

Normal values

	Hyperdynamic LV function	Normal LV function	Mild LV dysfunction	Moderate LV dysfunction	Severe LV dysfunction
EF (%)	>65	55-65	45-54	30-44	<30

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LA function

The left atrium has three major roles:

-contractile pump that delivers 15% to 30% of the LV filling

-reservoir that collects pulmonary venous return during ventricular systole

-conduit for the passage of stored blood from the LA to the LV during early ventricular diastole.

 

LA dimensions

LA size is important and has been related to adverse cardiovascular outcomes. LA dilatation reflects long-term increased filling pressure: diastolic dysfunction and/or mitral valve disease, stenosis or regurgitation.

LA size is measured at the end-systole, when the LA chamber is at its greatest dimension

LA area and volume in apical 4 chamber view

LA area and volume are the most reliable measurements for the determination of LA enlargement.

The measurement should be done at end-systole, on the frame just before the opening of the mitral valve. You need to get a good apical 4 chamber view. You will trace the inner border of the LA, excluding the area under the mitral valve annulus and the inlet of the pulmonary veins. The LA shape should be roughly square.

LA volume may be measured using Simpson’s rule, similar to its application for LV measurements, which states that the volume of a geometric figure can be calculated from the sum of the volumes of smaller figures of similar shape.

LA dimensions	Normal	Mildly dilated	Moderately dilated	Severely dilated
Diameter (mm)	28-40	41-46	47-52	>53
Major axis (mm)	41-61	62-67	68-76	>77
Area (cm2)	<20	20-30	30-40	>40
Volume (ml)	22-58	59-68	69-78	>79

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Mitral Regurgitation 

Apical 4 chamber. Mild MR : 

Apical4 chamber. Severe MR : 

Left Ventricle Segmentation

 

Echocardiogram Report Format

󰋮 Reason for study :

󰋮 Measure

LV wall setum cm, posterior cm,

LV diameter ED cm, ES cm,

EF %, Aorta diameter cm

LA size cm

󰋮 Findings

1. Chamber size (ex., Normal chamber size, LV 60mm, …)

2. Wall motion (ex., Slightly inferior wall hypokinesia, …)

3. LV systolic function (ex., Preserved LV systolic function, …)

4. Wall thickness (ex., Normal wall thickness, …)

5. Valve abnormality (ex., AR(trivial), MR(Ⅰ), …)

6. Diastolic dysfunction (ex., Diastolic dysfunction Gr1/4 (E/E’ 12), …)

7. Pericardial effusion 유무 (ex., No pericardial effusion, …)

󰋮 Comments (ex.)

Diastolic dysfunction Gr1/4

AR(trivial), MR(trivial)

Slightly inferior wall hypokinesia

# Intermittent VPCs during exam