https://echopedia.org/api.php?action=feedcontributions&user=77.234.244.30&feedformat=atomEchopedia - User contributions [en]2024-03-29T07:17:07ZUser contributionsMediaWiki 1.39.5https://echopedia.org/index.php?title=Normal_Values_of_TTE&diff=37Normal Values of TTE2021-01-09T14:22:23Z<p>77.234.244.30: /* References */</p>
<hr />
<div>Below an up-to-date list of echocardiographic normal values.<br />
=Left Ventricle=<br />
==Left Ventricular Systolic Function==<br />
{| class="wikitable" style="font-size:90%;"<br />
|+'''Reference limits and values and partition values of left ventricular function<ref>ASE</ref>'''<br />
<br />
|-<br />
! rowspan="2" style="width:200px" | &nbsp;<br />
! colspan="4" | Women !! colspan="4" | Men<br />
<br />
|-<br />
! style="width:80px" | Reference range<br />
! style="width:80px" | Mildly abnormal<br />
! style="width:80px" | Moderately abnormal<br />
! style="width:80px" | Severely abnormal<br />
! style="width:80px" | Reference range<br />
! style="width:80px" | Mildly abnormal<br />
! style="width:80px" | Moderately abnormal<br />
! style="width:80px" | Severely abnormal<br />
<br />
|-<br />
| colspan="9" | '''Linear method'''<br />
<br />
|-<br />
| style="padding-left:12px" | Endocardial fractional shortening, %<br />
| align="center" | 27–45<br />
| align="center" | 22–26<br />
| align="center" | 17–21<br />
| align="center" | &le;16<br />
| align="center" | 25–43<br />
| align="center" | 20–24<br />
| align="center" | 15–19 <br />
| align="center" | &le;14<br />
<br />
|-<br />
| style="padding-left:12px" | Midwall fractional shortening, %<br />
| align="center" | 15–23 <br />
| align="center" | 13–14 <br />
| align="center" | 11–12 <br />
| align="center" | &le;10 <br />
| align="center" | 14–22 <br />
| align="center" | 12–13 <br />
| align="center" | 10–11 <br />
| align="center" | &le;10<br />
<br />
|-<br />
| colspan="9" | '''2D Method'''<br />
<br />
|-<br />
| style="padding-left:12px" |<font color="green">''' Ejection fraction, %'''</font><br />
| align="center" |<font color="green">''' &ge;55'''</font><br />
| align="center" | <font color="green">'''45–54'''</font><br />
| align="center" |<font color="green">''' 30–44'''</font><br />
| align="center" |<font color="green">''' &lt;30'''</font><br />
<br />
| align="center" | <font color="green">'''&ge;55'''</font><br />
| align="center" |<font color="green">''' 45–54'''</font><br />
| align="center" | <font color="green">'''30–44'''</font><br />
| align="center" | <font color="green">'''&lt;30'''</font><br />
<br />
|-<br />
| colspan="9" | <ul><br />
<li>2D, Two-dimensional.</li><br />
<li><font color="green">'''Green values'''</font>: Recommended and best validated.</li><br />
</ul><br />
<br />
|}<br />
==Left Ventricular Diastolic Function==<br />
[[File:diastolicfunction.svg|500px|thumb|left|Practical approach to LV diastolic function grading. Ater <cite>ASEDF</cite>]]<br />
{{clr}}<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Normal values for Doppler-derived diastolic measurements<cite>ASEDF</cite>'''<br />
<br />
|-<br />
! style="border-bottom:hidden" | &nbsp;<br />
! colspan="4" | Age group (y)<br />
<br />
|-<br />
! style="width:120px" | Measurement<br />
! 16-20<br />
! 21-40<br />
! 41-60<br />
! &gt;60<br />
<br />
|-<br />
| IVRT (ms)<br />
| align="center" | 50 &plusmn; 9 (32-68)<br />
| align="center" | 67 &plusmn; 8 (51-83)<br />
| align="center" | 74 &plusmn; 7 (60-88)<br />
| align="center" | 87 &plusmn; 7 (73-101)<br />
<br />
|-<br />
| E/A ratio<br />
| align="center" | 1.88 &plusmn; 0.45 (0.98-2.78)<br />
| align="center" | 1.53 &plusmn; 0.40 (0.73-2.33)<br />
| align="center" | 1.28 &plusmn; 0.25 (0.78-1.78)<br />
| align="center" | 0.96 &plusmn; 0.18 (0.6-1.32)<br />
<br />
|-<br />
| DT (ms)<br />
| align="center" | 142 &plusmn; 19 (104-180)<br />
| align="center" | 166 &plusmn; 14 (138-194)<br />
| align="center" | 181 &plusmn; 19 (143-219)<br />
| align="center" | 200 &plusmn; 29 (142-258)<br />
<br />
|-<br />
| A duration (ms)<br />
| align="center" | 113 &plusmn; 17 (79-147)<br />
| align="center" | 127 &plusmn; 13 (101-153)<br />
| align="center" | 133 &plusmn; 13 (107-159)<br />
| align="center" | 138 &plusmn; 19 (100-176)<br />
<br />
|-<br />
| PV S/D ratio<br />
| align="center" | 0.82 &plusmn; 0.18 (0.46-1.18)<br />
| align="center" | 0.98 &plusmn; 0.32 (0.34-1.62)<br />
| align="center" | 1.21 &plusmn; 0.2 (0.81-1.61)<br />
| align="center" | 1.39 &plusmn; 0.47 (0.45-2.33)<br />
<br />
|-<br />
| PV Ar (cm/s)<br />
| align="center" | 16 &plusmn; 10 (1-36)<br />
| align="center" | 21 &plusmn; 8 (5-37)<br />
| align="center" | 23 &plusmn; 3 (17-29)<br />
| align="center" | 25 &plusmn; 9 (11-39)<br />
<br />
|-<br />
| PV Ar duration (ms)<br />
| align="center" | 66 &plusmn; 39 (1-144)<br />
| align="center" | 96 &plusmn; 33 (30-162)<br />
| align="center" | 112 &plusmn; 15 (82-142)<br />
| align="center" | 113 &plusmn; 30 (53-173)<br />
<br />
|-<br />
| Septal e&acute; (cm/s)<br />
| align="center" | 14.9 &plusmn; 2.4 (10.1-19.7)<br />
| align="center" | 15.5 &plusmn; 2.7 (10.1-20.9)<br />
| align="center" | 12.2 &plusmn; 2.3 (7.6-16.8)<br />
| align="center" | 10.4 &plusmn; 2.1 (6.2-14.6)<br />
<br />
|-<br />
| Septal e&acute;/a&acute; ratio<br />
| align="center" | 2.4<sup>&lowast;</sup><br />
| align="center" | 1.6 &plusmn; 0.5 (0.6-2.6)<br />
| align="center" | 1.1 &plusmn; 0.3 (0.5-1.7)<br />
| align="center" | 0.85 &plusmn; 0.2 (0.45-1.25)<br />
<br />
|-<br />
| Lateral e&acute; (cm/s)<br />
| align="center" | 20.6 &plusmn; 3.8 (13-28.2)<br />
| align="center" | 19.8 &plusmn; 2.9 (14-25.6)<br />
| align="center" | 16.1 &plusmn; 2.3 (11.5-20.7)<br />
| align="center" | 12.9 &plusmn; 3.5 (5.9-19.9)<br />
<br />
|-<br />
| Lateral e&acute;/a&acute; ratio<br />
| align="center" | 3.1<sup>&lowast;</sup><br />
| align="center" | 1.9 &plusmn; 0.6 (0.7-3.1)<br />
| align="center" | 1.5 &plusmn; 0.5 (0.5-2.5)<br />
| align="center" | 0.9 &plusmn; 0.4 (0.1-1.7)<br />
<br />
|-<br />
| colspan="5" | <ul><br />
<li>Data are expressed as mean &plusmn; SD (95% confidence interval). Note that for e&acute; velocity in subjects aged 16 to 20 years, values overlap with those for subjects aged 21 to 40 years. This is because e&acute; increases progressively with age in children and adolescents. Therefore, the e&acute; velocity is higher in a normal 20-year-old than in a normal 16-year-old, which results in a somewhat lower average e&acute; value when subjects aged 16 to 20 years are considered.</li><br />
<li><sup>&lowast;</sup> Standard deviations are not included because these data were computed, not directly provided in the original articles from which they were derived.</li><br />
</ul><br />
<br />
|}<br />
<br />
==Left Ventricular Mass and Geometry==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Reference limits and partition values of left ventricular mass and geometry<cite>ASE</cite>'''<br />
<br />
|-<br />
! rowspan="2" style="width:170px" | &nbsp;<br />
! colspan="4" | Women !! colspan="4" | Men<br />
<br />
|-<br />
! style="width:80px" | Reference <br/>range <br />
! style="width:80px" | Mildly <br/>abnormal <br />
! style="width:80px" | Moderately <br/>abnormal <br />
! style="width:80px" | Severely <br/>abnormal <br />
! style="width:80px" | Reference <br/>range <br />
! style="width:80px" | Mildly <br/>abnormal <br />
! style="width:80px" | Moderately <br/>abnormal <br />
! style="width:80px" | Severely <br/>abnormal<br />
<br />
|-<br />
| colspan="9" | '''Linear Method'''<br />
<br />
|-<br />
| style="padding-left:12px" | LV mass, g<br />
| align="center" | 67–162 <br />
| align="center" | 163–186 <br />
| align="center" | 187–210 <br />
| align="center" | &ge;211 <br />
| align="center" | 88–224 <br />
| align="center" | 225–258 <br />
| align="center" | 259–292 <br />
| align="center" | &ge;293<br />
<br />
|-<br />
| style="padding-left:12px" | <font color="green">'''LV mass/BSA, g/m<sup>2</sup>'''</font><br />
| align="center" | <font color="green">'''43–95 '''</font><br />
| align="center" | <font color="green">'''96–108 '''</font><br />
| align="center" | <font color="green">'''109–121 '''</font><br />
| align="center" | <font color="green">'''&ge;122'''</font> <br />
| align="center" | <font color="green">'''49–115 '''</font><br />
| align="center" | <font color="green">'''116–131 '''</font><br />
| align="center" | <font color="green">'''132–148 '''</font><br />
| align="center" | <font color="green">'''&ge;149'''</font><br />
<br />
|-<br />
| style="padding-left:12px" | LV mass/height, g/m <br />
| align="center" | 41–99 <br />
| align="center" | 100–115 <br />
| align="center" | 116–128 <br />
| align="center" | &ge;129 <br />
| align="center" | 52–126 <br />
| align="center" | 127–144 <br />
| align="center" | 145–162 <br />
| align="center" | &ge;163<br />
<br />
|-<br />
| style="padding-left:12px" | LV mass/height<sup>2</sup>, g/m<sup>2</sup><br />
| align="center" | 18–44 <br />
| align="center" | 45–51 <br />
| align="center" | 52–58 <br />
| align="center" | &ge;59 <br />
| align="center" | 20–48 <br />
| align="center" | 49–55 <br />
| align="center" | 56–63 <br />
| align="center" | &ge;64<br />
<br />
|-<br />
| style="padding-left:12px" | Relative wall thickness, cm <br />
| align="center" | 0.22–0.42 <br />
| align="center" | 0.43–0.47 <br />
| align="center" | 0.48–0.52 <br />
| align="center" | &ge;0.53 <br />
| align="center" | 0.24–0.42 <br />
| align="center" | 0.43–0.46 <br />
| align="center" | 0.47–0.51 <br />
| align="center" | &ge;0.52<br />
<br />
|-<br />
| style="padding-left:12px" | <font color="green">'''Septal thickness, cm'''</font> <br />
| align="center" | <font color="green">'''0.6–0.9'''</font><br />
| align="center" | <font color="green">'''1.0–1.2 '''</font><br />
| align="center" | <font color="green">'''1.3–1.5 '''</font><br />
| align="center" | <font color="green">'''&ge;1.6'''</font> <br />
| align="center" | <font color="green">'''0.6–1.0 '''</font><br />
| align="center" | <font color="green">'''1.1–1.3 '''</font><br />
| align="center" | <font color="green">'''1.4–1.6 '''</font><br />
| align="center" | <font color="green">'''&ge;1.7'''</font><br />
<br />
|-<br />
| style="padding-left:12px" | <font color="green">'''Posterior wall thickness, cm'''</font> <br />
| align="center" | <font color="green">'''0.6–0.9 '''</font> <br />
| align="center" | <font color="green">'''1.0–1.2 '''</font> <br />
| align="center" | <font color="green">'''1.3–1.5 '''</font> <br />
| align="center" | <font color="green">'''&ge;1.6'''</font> <br />
| align="center" | <font color="green">'''0.6–1.0 '''</font> <br />
| align="center" | <font color="green">'''1.1–1.3 '''</font> <br />
| align="center" | <font color="green">'''1.4–1.6 '''</font> <br />
| align="center" | <font color="green">'''&ge;1.7'''</font><br />
<br />
|-<br />
| colspan="9" | '''2D Method'''<br />
<br />
|-<br />
| style="padding-left:12px" | LV mass, g <br />
| align="center" | 66–150 <br />
| align="center" | 151–171 <br />
| align="center" | 172–182 <br />
| align="center" | &gt;193 <br />
| align="center" | 96–200 <br />
| align="center" | 201–227 <br />
| align="center" | 228–254 <br />
| align="center" | &gt;255<br />
<br />
|- <br />
| style="padding-left:12px" | <font color="green">'''LV mass/BSA, g/m<sup>2</sup>'''</font> <br />
| align="center" | <font color="green">'''44–88 '''</font><br />
| align="center" | <font color="green">'''89–100 '''</font><br />
| align="center" | <font color="green">'''101–112 '''</font><br />
| align="center" | <font color="green">'''&ge;113'''</font> <br />
| align="center" | <font color="green">'''50–102 '''</font><br />
| align="center" | <font color="green">'''103–116 '''</font><br />
| align="center" | <font color="green">'''117–130 '''</font><br />
| align="center" | <font color="green">'''&ge;131'''</font><br />
<br />
|- <br />
| colspan="9" | <br />
<ul><br />
<li>BSA, Body surface area; LV, left ventricular; 2D, 2-dimensional.</li><br />
<li><font color="green">'''Green values'''</font>: Recommended and best validated.</li><br />
</ul><br />
|}<br />
<br />
==Left Ventricular Size==<br />
{| class="wikitable" style="font-size:90%;"<br />
|+'''Reference limits and partition values of left ventricular size<cite>ASE</cite>'''<br />
<br />
|-<br />
! rowspan="2" style="width:200px" | &nbsp;<br />
! colspan="4" | Women !! colspan="4" | Men<br />
<br />
|-<br />
! style="width:80px" | Reference <br/>range <br />
! style="width:80px" | Mildly <br/>abnormal <br />
! style="width:80px" | Moderately <br/>abnormal <br />
! style="width:80px" | Severely <br/>abnormal <br />
! style="width:80px" | Reference <br/>range <br />
! style="width:80px" | Mildly <br/>abnormal <br />
! style="width:80px" | Moderately <br/>abnormal <br />
! style="width:80px" | Severely <br/>abnormal<br />
<br />
|-<br />
| colspan="9" | '''LV dimension'''<br />
|-<br />
| style="padding-left:12px" | LV diastolic diameter || align="center" | 3.9–5.3 || align="center" | 5.4–5.7 || align="center" | 5.8–6.1 || align="center" | &ge;6.2 || align="center" | 4.2–5.9 || align="center" | 6.0–6.3 || align="center" | 6.4–6.8 || align="center" | &ge;6.9<br />
<br />
|-<br />
| style="padding-left:12px" | LV diastolic diameter/BSA, cm/m<sup>2</sup><br />
| align="center" | 2.4–3.2<br />
| align="center" | 3.3–3.4<br />
| align="center" | 3.5–3.7<br />
| align="center" | &ge;3.8<br />
| align="center" | 2.2–3.1<br />
| align="center" | 3.2–3.4<br />
| align="center" | 3.5–3.6<br />
| align="center" | &ge;3.7<br />
<br />
|-<br />
| style="padding-left:12px" | LV diastolic diameter/height, cm/m<br />
| align="center" | 2.5–3.2<br />
| align="center" | 3.3–3.4<br />
| align="center" | 3.5–3.6<br />
| align="center" | &ge;3.7<br />
| align="center" | 2.4–3.3<br />
| align="center" | 3.4–3.5<br />
| align="center" | 3.6–3.7<br />
| align="center" | &ge;3.8<br />
<br />
|-<br />
| colspan="9" | '''LV volume'''<br />
<br />
|-<br />
| style="padding-left:12px" | LV diastolic volume, mL<br />
| align="center" | 56–104<br />
| align="center" | 105–117<br />
| align="center" | 118–130<br />
| align="center" | &ge;131<br />
| align="center" | 67–155<br />
| align="center" | 156–178<br />
| align="center" | 179–201<br />
| align="center" | &ge;201<br />
<br />
|-<br />
| style="padding-left:12px" | <font color="green">'''LV diastolic volume/BSA, mL/m<sup>2</sup>'''</font><br />
| align="center" | <font color="green">'''35–75'''</font><br />
| align="center" | <font color="green">'''76–86'''</font><br />
| align="center" | <font color="green">'''87–96'''</font><br />
| align="center" | <font color="green">'''&ge;97'''</font><br />
| align="center" | <font color="green">'''35–75'''</font><br />
| align="center" | <font color="green">'''76–86'''</font><br />
| align="center" | <font color="green">'''87–96'''</font><br />
| align="center" | <font color="green">'''&ge;97'''</font><br />
<br />
|-<br />
| style="padding-left:12px" | LV systolic volume, mL<br />
| align="center" | 19–49<br />
| align="center" | 50–59<br />
| align="center" | 60–69<br />
| align="center" | &ge;70<br />
| align="center" | 22–58<br />
| align="center" | 59–70<br />
| align="center" | 71–82<br />
| align="center" | &ge;83<br />
<br />
|-<br />
| style="padding-left:12px" | <font color="green">'''LV systolic volume/BSA, mL/m<sup>2</sup>'''</font><br />
| align="center" | <font color="green">'''12–30'''</font><br />
| align="center" | <font color="green">'''31–36'''</font><br />
| align="center" | <font color="green">'''37–42'''</font><br />
| align="center" | <font color="green">'''&ge;43'''</font><br />
| align="center" | <font color="green">'''12–30'''</font><br />
| align="center" | <font color="green">'''31–36'''</font><br />
| align="center" | <font color="green">'''37–42'''</font><br />
| align="center" | <font color="green">'''&ge;43'''</font><br />
<br />
|-<br />
| colspan="9" | <ul><br />
<li>BSA, body surface area; LV, left ventricular.</li><br />
<li><font color="green">'''Green values'''</font>: Recommended and best validated.</li><br />
</ul><br />
|}<br />
<br />
=Right Ventricle=<br />
==Right Ventricular and Pulmonary Artery Size==<br />
{| class="wikitable" style="font-size:90%;"<br />
|+'''Reference limits and partition values of right ventricular and pulmonary artery size<cite>ASE</cite>'''<br />
<br />
|-<br />
! style="width:200px" | &nbsp;<br />
! style="width:130px" | Reference range <br />
! style="width:130px" | Mildly abnormal <br />
! style="width:130px" | Moderately abnormal <br />
! style="width:130px" | Severely abnormal<br />
<br />
|-<br />
| colspan="5" | '''RV dimensions'''<br />
<br />
|-<br />
| style="padding-left:12px" | Basal RV diameter (RVD 1), cm <br />
| align="center" | 2.0–2.8 <br />
| align="center" | 2.9–3.3 <br />
| align="center" | 3.4–3.8 <br />
| align="center" | &ge;3.9<br />
<br />
|-<br />
| style="padding-left:12px" | Mid-RV diameter (RVD 2), cm<br />
| align="center" | 2.7–3.3<br />
| align="center" | 3.4–3.7 <br />
| align="center" | 3.8–4.1 <br />
| align="center" | &ge;4.2<br />
<br />
|-<br />
| style="padding-left:12px" | Base-to-apex length (RVD 3), cm <br />
| align="center" | 7.1–7.9 <br />
| align="center" | 8.0–8.5 <br />
| align="center" | 8.6–9.1 <br />
| align="center" | &ge;9.2<br />
<br />
|-<br />
| colspan="5" | '''RVOT diameters'''<br />
<br />
|-<br />
| style="padding-left:12px" | Above aortic valve (RVOT 1), cm <br />
| align="center" | 2.5–2.9 <br />
| align="center" | 3.0–3.2 <br />
| align="center" | 3.3–3.5 <br />
| align="center" | &ge;3.6<br />
<br />
|-<br />
| style="padding-left:12px" | Above pulmonic valve (RVOT 2), cm <br />
| align="center" | 1.7–2.3 <br />
| align="center" | 2.4–2.7 <br />
| align="center" | 2.8–3.1<br />
| align="center" | &ge;3.2<br />
<br />
|-<br />
| colspan="5" | '''PA diameter'''<br />
<br />
|-<br />
| style="padding-left:12px" | Below pulmonic valve (PA 1), cm <br />
| align="center" | 1.5–2.1 <br />
| align="center" | 2.2–2.5 <br />
| align="center" | 2.6–2.9<br />
| align="center" | &ge;3.0<br />
<br />
|-<br />
| colspan="5" | <ul><li>RV, Right ventricular; RVOT, right ventricular outflow tract; PA, pulmonary artery.</li><br />
<li>Data from Foale et al.<cite>Foale</cite></li></ul><br />
<br />
|}<br />
<br />
==Right Ventricular Size and Function==<br />
{| class="wikitable" style="font-size:90%;"<br />
|+'''Reference limits and partition values of right ventricular size and function as measured in the apical 4-chamber view<cite>ASE</cite>'''<br />
<br />
|-<br />
! style="width:170px" | <br />
! style="width:130px" | Reference range<br />
! style="width:130px" | Mildly abnormal<br />
! style="width:130px" | Moderately abnormal<br />
! style="width:130px" | Severely abnormal<br />
<br />
|-<br />
| RV diastolic area, cm<sup>2</sup><br />
| align="center" | 11–28 <br />
| align="center" | 29–32<br />
| align="center" | 33–37<br />
| align="center" | &ge;38<br />
<br />
|-<br />
| RV systolic area, cm<sup>2</sup><br />
| align="center" | 7.5–16 <br />
| align="center" | 17–19 <br />
| align="center" | 20–22 <br />
| align="center" | &ge;23<br />
<br />
|-<br />
| RV fractional area change, %<br />
| align="center" | 32–60 <br />
| align="center" | 25–31 <br />
| align="center" | 18–24 <br />
| align="center" | &le;17<br />
<br />
|-<br />
| TAPSE, (cm)<br />
| align="center" | 1.5-2.0<cite>ASE</cite><br />
| align="center" | 1.3-1.5<cite>Hamer</cite><br />
| align="center" | 1.0-1.2<cite>Hamer</cite><br />
| align="center" | <1.0<cite>Hamer</cite><br />
<br />
|-<br />
| colspan="6" |<br />
<ul><br />
<li>RV, Right ventricular.</li><br />
<li>Data from Weyman.<cite>Weyman</cite></li><br />
</ul><br />
<br />
|}<br />
<br />
=Atria=<br />
==Left Atrial Dimensions / Volumes==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Reference limits and partition values for left atrial dimensions/volumes<cite>ASE</cite>'''<br />
<br />
|-<br />
! rowspan="2" style="width:200px" | &nbsp;<br />
! colspan="4" | Women<br />
! colspan="4" | Men<br />
<br />
|- <br />
! style="width:80px" | Reference range<br />
! style="width:80px" | Mildly abnormal<br />
! style="width:80px" | Moderately abnormal<br />
! style="width:80px" | Severely abnormal<br />
! style="width:80px" | Reference range<br />
! style="width:80px" | Mildly abnormal<br />
! style="width:80px" | Moderately abnormal<br />
! style="width:80px" | Severely abnormal<br />
<br />
|-<br />
| colspan="9" | '''Atrial dimensions<br />
'''<br />
|-<br />
| style="padding-left:12px" | LA diameter, cm <br />
| align="center" | 2.7–3.8 <br />
| align="center" | 3.9–4.2 <br />
| align="center" | 4.3–4.6 <br />
| align="center" | &ge;4.7 <br />
| align="center" | 3.0–4.0 <br />
| align="center" | 4.1–4.6 <br />
| align="center" | 4.7–5.2 <br />
| align="center" | &ge;5.2<br />
<br />
|-<br />
| style="padding-left:12px" | LA diameter/BSA, cm/m<sup>2</sup> <br />
| align="center" | 1.5–2.3 <br />
| align="center" | 2.4–2.6 <br />
| align="center" | 2.7–2.9 <br />
| align="center" | &ge;3.0 <br />
| align="center" | 1.5–2.3 <br />
| align="center" | 2.4–2.6 <br />
| align="center" | 2.7–2.9 <br />
| align="center" | &ge;3.0<br />
<br />
|-<br />
| style="padding-left:12px" | RA minor-axis dimension, cm <br />
| align="center" | 2.9–4.5 <br />
| align="center" | 4.6–4.9 <br />
| align="center" | 5.0–5.4 <br />
| align="center" | &ge;5.5 <br />
| align="center" | 2.9–4.5 <br />
| align="center" | 4.6–4.9 <br />
| align="center" | 5.0–5.4 <br />
| align="center" | &ge;5.5<br />
<br />
|-<br />
| style="padding-left:12px" | RA minor-axis dimension/BSA, cm/m<sup>2</sup> <br />
| align="center" | 1.7–2.5 <br />
| align="center" | 2.6–2.8 <br />
| align="center" | 2.9–3.1 <br />
| align="center" | &ge;3.2 <br />
| align="center" | 1.7–2.5 <br />
| align="center" | 2.6–2.8 <br />
| align="center" | 2.9–3.1 <br />
| align="center" | &ge;3.2<br />
<br />
|-<br />
| colspan="9" | '''Atrial area'''<br />
<br />
|-<br />
| style="padding-left:12px" | LA area, cm<sup>2</sup> <br />
| align="center" | &le;20 <br />
| align="center" | 20–30 <br />
| align="center" | 30–40 <br />
| align="center" | &gt;40 <br />
| align="center" | &le;20 <br />
| align="center" | 20–30 <br />
| align="center" | 30–40 <br />
| align="center" | &gt;40<br />
<br />
|-<br />
| colspan="9" | '''Atrial volumes'''<br />
<br />
|-<br />
| style="padding-left:12px" | LA volume, mL <br />
| align="center" | 22–52 <br />
| align="center" | 53–62 <br />
| align="center" | 63–72 <br />
| align="center" | &ge;73 <br />
| align="center" | 18–58 <br />
| align="center" | 59–68 <br />
| align="center" | 69–78<br />
| align="center" | &ge;79<br />
<br />
|-<br />
| style="padding-left:12px" |<font color="green">'''LA volume/BSA, mL/m<sup>2</sup>'''</font><br />
| align="center" | <font color="green">'''22 ± 6'''</font><br />
| align="center" | <font color="green">'''29–33'''</font><br />
| align="center" | <font color="green">'''34–39'''</font><br />
| align="center" | <font color="green">'''&ge;40'''</font><br />
| align="center" | <font color="green">'''22 ± 6'''</font><br />
| align="center" | <font color="green">'''29–33'''</font><br />
| align="center" | <font color="green">'''34–39'''</font><br />
| align="center" | <font color="green">'''&ge;40'''</font><br />
|-<br />
| colspan="9" |<br />
<ul><br />
<li>BSA, Body surface area; LA, left atrial; RA, right atrial.</li><br />
<li><font color="green">'''Green values'''</font>: Recommended and best validated.</li><br />
</ul><br />
<br />
|}<br />
==Left Atrial Pressure==<br />
[[File:LAP_normalEF.svg|thumb|left|400px|Estimation of left atrial pressure in normal LVEF. After <cite>ASEDF</cite>]]<br />
[[File:LAP_reducedEF.svg|thumb|400px|Estimation of left atrial pressure in reduced LVEF. After <cite>ASEDF</cite>]]<br />
{{clr}}<br />
<br />
=Aortic Valve=<br />
==Aortic valve stenosis - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Recommendations for classification of AS severity<cite>ASEVS</cite>'''<br />
<br />
|-<br />
! style="width:150px" | &nbsp;<br />
! style="width:100px" | Aortic sclerosis<br />
! style="width:100px" | Mild<br />
! style="width:100px" | Moderate<br />
! style="width:100px" | Severe<br />
<br />
|-<br />
| Aortic jet velocity (m/s)<br />
| style="text-align:center" | &le;2.5 m/s<br />
| style="text-align:center" | 2.6-2.9<br />
| style="text-align:center" | 3.0-4.0<br />
| style="text-align:center" | &gt;4.0<br />
<br />
|-<br />
| Mean gradient (mmHg)<br />
| style="text-align:center" | -<br />
| style="text-align:center" | &lt;20 (&lt;30<sup>a</sup>)<br />
| style="text-align:center" | 20-40<sup>b</sup> (30-50<sup>a</sup>)<br />
| style="text-align:center" | &gt;40<sup>b</sup> (&gt;50<sup>a</sup>)<br />
<br />
|-<br />
| AVA (cm<sup>2</sup>)<br />
| style="text-align:center" | -<br />
| style="text-align:center" | &gt;1.5<br />
| style="text-align:center" | 1.0-1.5<br />
| style="text-align:center" | &lt;1<br />
<br />
|-<br />
| Indexed AVA (cm<sup>2</sup>/m<sup>2</sup>)<br />
| style="text-align:center" | &nbsp;<br />
| style="text-align:center" | &gt;0.85<br />
| style="text-align:center" | 0.60-0.85<br />
| style="text-align:center" | &lt;0.6<br />
<br />
|-<br />
| Velocity ratio<br />
| style="text-align:center" | &nbsp;<br />
| style="text-align:center" | &gt;0.50 <br />
| style="text-align:center" | 0.25-0.50 <br />
| style="text-align:center" | &lt;0.25<br />
<br />
|-<br />
| colspan="5" |<ul><br />
<li><sup>a</sup>ESC Guidelines.<cite>ESCAS</cite></li><br />
<li><sup>b</sup>AHA/ACC Guidelines.<cite>AHAAS</cite></li><br />
</ul><br />
<br />
|}<br />
==Aortic regurgitation - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Application of specific and supportive signs, and quantitative parameters in the grading of aortic regurgitation severity<cite>ASERE</cite>'''<br />
<br />
|-<br />
! style="width:160px" | &nbsp;<br />
! style="width:250px" | Mild <br />
! colspan="2" | Moderate <br />
! style="width:250px" | Severe<br />
<br />
|-<br />
! Specific signs for AR severity<br />
| style="vertical-align:top" | <ul><br />
<li>Central Jet, width &lt; 25% of LVOT<sup>&sigmaf;</sup></li><br />
<li>Vena contracta &lt; 0.3 cm<sup>&sigmaf;</sup></li><br />
<li>No or brief early diastolic flow reversal in descending aorta</li><br />
</ul><br />
| style="vertical-align:top" colspan="2" | <ul><li>Signs of AR&gt;mild present but no criteria for severe AR</li></ul><br />
| style="vertical-align:top" | <ul><br />
<li>Central Jet, width &ge; 65% of LVOT<sup>&sigmaf;</sup></li><br />
<li>Vena contracta &gt; 0.6cm<sup>&sigmaf;</sup></li><br />
</ul><br />
<br />
|-<br />
! Supportive signs<br />
| style="vertical-align:top" | <ul><br />
<li>Pressure half-time &gt; 500 ms</li><br />
<li>Normal LV size<sup>&lowast;</sup></li><br />
</ul><br />
| style="vertical-align:top" colspan="2" | <ul><li>Intermediate values</li></ul><br />
| <ul><br />
<li>Pressure half-time &lt; 200 ms</li><br />
<li>Holodiastolic aortic flow reversal in descending aorta</li><br />
<li>Moderate or greater LV enlargement<sup>&lowast;&lowast;</sup></li><br />
</ul><br />
<br />
|-<br />
| colspan="5" | '''Quantitative parameters<sup>&psi;</sup>'''<br />
<br />
|-<br />
| style="padding-left:12px" | R Vol, ml/beat<br />
| align="center" | &lt; 30<br />
| align="center" style="width:125px" | 30-44<br />
| align="center" style="width:125px" | 45-59<br />
| align="center" | &ge; 60<br />
<br />
|-<br />
| style="padding-left:12px" | RF %<br />
| align="center" | &lt; 30<br />
| align="center" | 30-39<br />
| align="center" | 40-49<br />
| align="center" | &ge; 50<br />
<br />
|-<br />
| style="padding-left:12px" | EROA, cm<sup>2</sup><br />
| align="center" | &lt; 0.10<br />
| align="center" | 0.10-0.19<br />
| align="center" | 0.20-0.29<br />
| align="center" | &ge; 0.30<br />
<br />
|-<br />
| colspan="5" | <br />
<ul><br />
<li><em>AR</em>, Aortic regurgitation; <em>EROA</em>, effective regurgitant orifice area; <em>LV</em>, left ventricle; <em>LVOT</em>, left ventricular outflow tract; <em>R Vol</em>, regurgitant volume; <em>RF</em>, regurgitant fraction.</li><br />
<li><sup>&lowast;</sup> LV size applied only to chronic lesions. Normal 2D measurements: LV minor-axis &le; 2.8 cm/m<sup>2</sup>, LV end-diastolic volume &le; 82 ml/m<sup>2</sup> (2).</li><br />
<li><sup>&sigmaf;</sup> At a Nyquist limit of 50–60 cm/s.</li><br />
<li><sup>&lowast;&lowast;</sup> In the absence of other etiologies of LV dilatation.</li><br />
<li><sup>&psi;</sup> Quantitative parameters can help sub-classify the moderate regurgitation group into mild-to-moderate and moderate-to-severe regurgitation as shown.</li><br />
</ul><br />
<br />
|}<br />
<br />
<br />
=Mitral Valve=<br />
==Mitral regurgitation - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Application of specific and supportive signs, and quantitative parameters in the grading of mitral regurgitation severity<cite>ASERE</cite>'''<br />
<br />
|-<br />
! style="width:160px" | &nbsp;<br />
! style="width:250px" | Mild <br />
! colspan="2" | Moderate <br />
! style="width:250px" | Severe<br />
<br />
|-<br />
! Specific signs of severity<br />
| style="vertical-align:top" | <ul><br />
<li>Small central jet &lt;4 cm<sup>2</sup> or &lt;20% of LA area<sup>&psi;</sup></li><br />
<li>Vena contracta width &lt;0.3 cm</li><br />
<li>No or minimal flow convergence</li><br />
</ul><br />
| style="vertical-align:top" colspan="2" | <ul><li>Signs of MR&gt;mild present, but no criteria for severe MR</li></ul><br />
| style="vertical-align:top" | <ul><br />
<li>Vena contracta width &ge; 0.7cm <em>with</em> large central MR jet (area &lt; 40% of LA) or with a wall-impinging jet of any size, swirling in LA<sup>&psi;</sup></li><br />
<li>Large flow convergence<sup>&sigmaf;</sup></li><br />
<li>Systolic reversal in pulmonary veins</li><br />
<li>Prominent flail MV leaflet or ruptured papillary muscle</li><br />
</ul><br />
<br />
|-<br />
! Supportive signs<br />
| style="vertical-align:top" | <ul><br />
<li>Systolic dominant flow in pulmonary veins</li><br />
<li>A-wave dominant mitral inflow<sup>&Phi;</sup></li><br />
<li>Soft density, parabolic CW Doppler MR signal</li><br />
<li>Normal LV size<sup>&lowast;</sup></li><br />
</ul><br />
| style="vertical-align:top" colspan="2" | <ul><li>Intermediate signs/findings</li></ul><br />
| style="vertical-align:top" | <ul><br />
<li>Dense, triangular CW Doppler MR jet</li><br />
<li>E-wave dominant mitral inflow (E &gt;1.2 m/s)<sup>&Phi;</sup> Enlarged LV and LA size<sup>&lowast;&lowast;</sup>, (particularly when normal LV function is present).</li><br />
</ul><br />
<br />
|-<br />
| colspan="5" | '''Quantitative parameters<sup>&phi;</sup>'''<br />
<br />
|-<br />
| style="padding-left:12px" | R Vol (ml/beat)<br />
| align="center" | &lt; 30<br />
| style="width:125px" align="center" | 30-44<br />
| style="width:125px" align="center" | 45-59<br />
| align="center" | &ge; 60<br />
<br />
|-<br />
| style="padding-left:12px" | RF (%)<br />
| align="center" | &lt; 30<br />
| align="center" | 30-39<br />
| align="center" | 40-49<br />
| align="center" | &ge; 50<br />
<br />
|-<br />
| style="padding-left:12px" | EROA (cm<sup>2</sup>)<br />
| align="center" | &lt; 0.20<br />
| align="center" | 0.20-0.29<br />
| align="center" | 0.30-0.39<br />
| align="center" | &ge; 0.40<br />
<br />
|-<br />
| colspan="5" | <ul><br />
<li><em>CW</em>, Continuous wave; <em>EROA</em>, effective regurgitant orifice area; <em>LA</em>, left atrium; <em>LV</em>, left ventricle; <em>MV</em>, mitral valve; <em>MR</em>, mitral regurgitation; <em>R Vol</em>, regurgitant volume; <em>RF</em>, regurgitant fraction.</li><br />
<li><sup>&lowast;</sup> LV size applied only to chronic lesions. Normal 2D measurements: LV minor axis &le; 2.8 cm/m<sup>2</sup>, LV end-diastolic volume &le; 82 ml/m<sup>2</sup>, maximal LA antero-posterior diameter &le; 2.8 cm/m<sup>2</sup>, maximal LA volume &le; 36 ml/m<sup>2</sup> (2;33;35).</li><br />
<li><sup>&lowast;&lowast;</sup> In the absence of other etiologies of LV and LA dilatation and acute MR.</li><br />
<li><sup>&psi;</sup> At a Nyquist limit of 50-60 cm/s.</li><br />
<li><sup>&Phi;</sup> Usually above 50 years of age or in conditions of impaired relaxation, in the absence of mitral stenosis or other causes of elevated LA pressure.</li><br />
<li><sup>&sigmaf;</sup> Minimal and large flow convergence defined as a flow convergence radius &lt; 0.4 cm and &le; 0.9 cm for central jets, respectively, with a baseline shift at a Nyquist of 40 cm/s; Cut-offs for eccentric jets are higher, and should be angle corrected (see text).</li><br />
<li><sup>&phi;</sup> Quantitative parameters can help sub-classify the moderate regurgitation group into mild-to-moderate and moderate-to-severe as shown.</li><br />
</ul><br />
<br />
|}<br />
==Mitral stenosis - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Recommendations for classification of mitral stenosis severity<cite>ASEVS</cite>'''<br />
<br />
|-<br />
! style="width:200px" | &nbsp;<br />
! style="width:80px" | Mild <br />
! style="width:80px" | Moderate<br />
! style="width:80px" | Severe<br />
<br />
|-<br />
| colspan="4" | '''Specific findings'''<br />
<br />
|-<br />
| style="padding-left:12px" | Valve area (cm<sup>2</sup>)<br />
| align="center" | &gt;1.5<br />
| align="center" | 1.0-1.5<br />
| align="center" | &lt;1.0<br />
<br />
|-<br />
| colspan="4" | '''Supportive findings'''<br />
<br />
|-<br />
| style="padding-left:12px" | Mean gradient (mmHg)<sup>a</sup><br />
| align="center" | &lt;5<br />
| align="center" | 5-10<br />
| align="center" | &gt;10<br />
<br />
|-<br />
| style="padding-left:12px" | Pulmonary artery pressure (mmHg)<br />
| align="center" | &lt;30<br />
| align="center" | 30-50<br />
| align="center" | &gt;50<br />
<br />
|-<br />
| colspan="4" | <ul><li><sup>a</sup>At heart rates between 60 and 80 bpm and in sinus rhythm.</li></ul><br />
<br />
|}<br />
==Mitral valve stenosis - Wilkins score==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Assessment of mitral valve anatomy according to the Wilkins score<cite>Wilkins</cite>'''<br />
<br />
|-<br />
! style="width:50px" | Grade<br />
! style="width:170px" | Mobility <br />
! style="width:170px" | Thickening <br />
! style="width:170px" | Calcification <br />
! style="width:170px" | Subvalvular Thickening<br />
<br />
|-<br />
| style="vertical-align:top" | 1<br />
| style="vertical-align:top" | Highly mobile valve with only leaflet tips restricted<br />
| style="vertical-align:top" | Leaflets near normal in thickness (4-5 mm)<br />
| style="vertical-align:top" | A single area of increased echo brightness<br />
| style="vertical-align:top" | Minimal thickening just below the mitral leaflets<br />
<br />
|-<br />
| style="vertical-align:top" | 2<br />
| style="vertical-align:top" | Leaflet mid and base portions have normal mobility<br />
| style="vertical-align:top" | Midleaflets normal, considerable thickening of margins (5-8 mm)<br />
| style="vertical-align:top" | Scattered areas of brightness confined to leaflet margins<br />
| style="vertical-align:top" | Thickening of chordal structures extending to one-third of the chordal length<br />
<br />
|-<br />
| style="vertical-align:top" | 3<br />
| style="vertical-align:top" | Valve continues to move forward in diastole, mainly from the base<br />
| style="vertical-align:top" | Thickening extending through the entire leaflet (5-8mm)<br />
| style="vertical-align:top" | Brightness extending into the mid-portions of the leaflets<br />
| style="vertical-align:top" | Thickening extended to distal third of the chords<br />
<br />
|-<br />
| style="vertical-align:top" | 4<br />
| style="vertical-align:top" | No or minimal forward movement of the leaflets in diastole<br />
| style="vertical-align:top" | Considerable thickening of all leaflet tissue (&gt;8-10mm)<br />
| style="vertical-align:top" | Extensive brightness throughout much of the leaflet tissue<br />
| style="vertical-align:top" | Extensive thickening and shortening of all chordal structures extending down to the papillary muscles<br />
<br />
|-<br />
| colspan="5" |<ul><li>The total score is the sum of the four items and ranges between 4 and 16.</li></ul><br />
<br />
|}<br />
==Mitral stenosis - routine measurements==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Recommendations for data recording and measurement in routine use for mitral stenosis quantitation<cite>ASEVS</cite>'''<br />
<br />
|-<br />
! Data element<br />
! Recording<br />
! Measurement<br />
<br />
|-<br />
! rowspan="5" | Planimetry<br />
<br />
|-<br />
| style="vertical-align:top; " | - 2D parasternal short-axis view<br />
| style="vertical-align:top; " | - contour of the inner mitral orifice<br />
<br />
|-<br />
| style="vertical-align:top; " | - determine the smallest orifice by scanning from apex to base<br />
| style="vertical-align:top; " | - include commissures when opened<br />
<br />
|-<br />
| style="vertical-align:top; " | - positioning of measurement plan can be oriented by 3D echo<br />
| style="vertical-align:top; " | - in mid-diastole (use cine-loop)<br />
<br />
|- <br />
| style="vertical-align:top" | - lowest gain setting to visualize the whole mitral orifice<br />
| style="vertical-align:top" | - average measurements if atrial fibrillation<br />
<br />
|-<br />
! rowspan="4" | Mitral flow<br />
<br />
|-<br />
| style="vertical-align:top; " | - continuous-wave Doppler<br />
| style="vertical-align:top; " | - mean gradient from the traced contour of the diastolic mitral flow<br />
<br />
|-<br />
| style="vertical-align:top; " | - apical windows often suitable (optimize intercept angle)<br />
| style="vertical-align:top; " | - pressure half-time from the descending sLope of the E-wave (mid-diastole slope if not linear)<br />
<br />
|-<br />
| style="vertical-align:top" | - adjust gain setting to obtain well-defined flow contour<br />
| style="vertical-align:top" | - average measurements if atrial fibrillation<br />
<br />
|-<br />
! rowspan="3" | Systolic pulmonary artery pressure<br />
<br />
|-<br />
| style="vertical-align:top; " | - continuous-wave Doppler<br />
| style="vertical-align:top; " | - maximum velocity of tricuspid regurgitant flow<br />
<br />
|-<br />
| style="vertical-align:top" | - multiple acoustic windows to optimize intercept angle<br />
| style="vertical-align:top" | - estimation of right atrial pressure according to inferior vena cava diameter<br />
<br />
|-<br />
! rowspan="8" | Valve anatomy<br />
<br />
|-<br />
| rowspan="2" style="vertical-align:top; " | <br />
- parasternal short-axis view<br />
<br />
|-<br />
| style="vertical-align:top; " | <br />
- valve thickness (maximum and heterogeneity)<br><br />
- commissural fusion<br><br />
- extension and location of localized bright zones (fibrous nodutes or calcification)<br />
<br />
|-<br />
| rowspan="2" style="vertical-align:top; " | <br />
- parasternal long-axis view<br />
<br />
|-<br />
| style="vertical-align:top; " | <br />
- valve thickness<br><br />
- extension of calcification<br><br />
- valve pliability<br><br />
- subvalvular apparatus (chordal thickening, fusion, or shortening)<br />
|-<br />
| rowspan="2" style="vertical-align:top" | - apical two-chamber view<br />
<br />
|-<br />
| style="vertical-align:top; " | - subvalvular apparatus (chordal thickening, fusion, or shortening)<br><br />
|-<br />
| colspan="2"|<br />
Detail each component and summarize in a score<br />
<br />
|}<br />
<br />
<br />
=Tricuspid Valve=<br />
==Tricuspid regurgitation - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Echocardiographic and Doppler parameters used in grading tricuspid regurgitation severity<cite>ASERE</cite>'''<br />
<br />
|-<br />
! style="width:200px" | Parameter <br />
! style="width:200px" | Mild <br />
! style="width:200px" | Moderate<br />
! style="width:200px" | Severe<br />
<br />
|-<br />
| Tricuspid valve<br />
| Usually normal<br />
| Normal or abnormal<br />
| Abnormal/Flail leaflet/Poor coaptation<br />
<br />
|-<br />
| RV/RA/IVC size<br />
| Normal<sup>&lowast;</sup><br />
| Normal or dilated<br />
| Usually dilated<sup>&lowast;&lowast;</sup><br />
<br />
|-<br />
| Jet area-central jets (cm<sup>2</sup>)<sup>&sect;</sup><br />
| &lt; 5<br />
| 5-10<br />
| &gt; 10<br />
<br />
|-<br />
| VC width (cm)<sup>&Phi;</sup><br />
| Not defined<br />
| Not defined, but &lt; 0.7<br />
| &gt; 0.7<br />
<br />
|-<br />
| PISA radius (cm)<sup>&psi;</sup><br />
| &le; 0.5<br />
| 0.6-0.9<br />
| &gt; 0.9<br />
<br />
|-<br />
| Jet density and contour–CW<br />
| Soft and parabolic<br />
| Dense, variable contour<br />
| Dense, triangular with early peaking<br />
<br />
|-<br />
| Hepatic vein flow&dagger;<br />
| Systolic dominance<br />
| Systolic blunting<br />
| Systolic reversal<br />
<br />
|-<br />
| colspan="4" |<br />
<ul><br />
<li><em>CW</em>, Continuous wave Doppler; <em>IVC</em>, inferior vena cava; <em>RA</em>, right atrium; <em>RV</em>, right ventricle; <em>VC</em>, vena contracta width.</li><br />
<li><sup>&lowast;</sup> Unless there are other reasons for RA or RV dilation. Normal 2D measurements from the apical 4-chamber view: RV medio-lateral end-diastolic dimension &le; 4.3 cm, RV end-diastolic area &le; 35.5 cm<sup>2</sup>, maximal RA medio-lateral and supero-inferior dimensions &le; 4.6 cm and 4.9 cm respectively, maximal RA volume &le; 33 ml/m<sup>2</sup>(35;89).</li><br />
<li><sup>&lowast;&lowast;</sup> Exception: acute TR.</li><br />
<li><sup>&sect;</sup> At a Nyquist limit of 50-60 cm/s. Not valid in eccentric jets. Jet area is not recommended as the sole parameter of TR severity due to its dependence on<br />
hemodynamic and technical factors.</li><br />
<li><sup>&Phi;</sup> At a Nyquist limit of 50-60 cm/s.</li><br />
<li><sup>&psi;</sup> Baseline shift with Nyquist limit of 28 cm/s.</li><br />
<li>&dagger; Other conditions may cause systolic blunting (eg. atrial fibrillation, elevated RA pressure).</li><br />
</ul><br />
|}<br />
<br />
==Tricuspid stenosis - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Findings indicative of haemodynamically significant tricuspid stenosis<cite>ASEVS</cite>'''<br />
<br />
|-<br />
| colspan="2" | '''Specific findings'''<br />
<br />
|-<br />
| style="width:190px; padding-left:12px" | Mean pressure gradient<br />
| style="width:80px" | &ge;5 mmHg<br />
<br />
|-<br />
| style="padding-left:12px" | Inflow time-velocity integral<br />
| &gt;60 cm<br />
<br />
|-<br />
| style="padding-left:12px" | <em>T</em><sub>1/2</sub><br />
| &ge;190 ms<br />
<br />
|-<br />
| style="padding-left:12px" | Valve area by continuity equation<sup>a</sup><br />
| &le;1 cm<sup>2</sup><br />
<br />
|-<br />
| colspan="2" | '''Supportive findings'''<br />
<br />
|-<br />
| style="padding-left:12px" | Enlarged right atrium &ge;moderate<br />
|<br />
<br />
|-<br />
| style="padding-left:12px" | Dilated inferior vena cava<br />
|<br />
<br />
|-<br />
| colspan="2" | <ul><br />
<li><sup>a</sup>Stroke volume derived from left or right ventricular outflow. In the presence of more than mild TR, the derived valve area will be underestimated. Nevertheless, a value &le;1 cm<sup>2</sup> implies a significant haemodynamic burden imposed by the combined lesion.<br />
</li><br />
</ul><br />
|}<br />
<br />
=Pulmonary Valve=<br />
==Pulmonary regurgitaion - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Echocardiographic and Doppler parameters used in grading pulmonary regurgitation severity<cite>ASERE</cite>'''<br />
<br />
|-<br />
! style="width:200px" | Parameter <br />
! style="width:200px" | Mild <br />
! style="width:200px" | Moderate<br />
! style="width:200px" | Severe<br />
<br />
|-<br />
| Pulmonic valve<br />
| Normal<br />
| Normal or abnormal<br />
| Abnormal<br />
<br />
|-<br />
| RV size<br />
| Normal<sup>&lowast;</sup><br />
| Normal or dilated<br />
| Dilated<br />
<br />
|-<br />
| Jet size by color Doppler<sup>&sect;</sup><br />
| Thin (usually &lt; 10 mm in length) with a narrow origin<br />
| Intermediate<br />
| Usually large, with a wide origin; May be brief in duration<br />
<br />
|-<br />
| Jet density and deceleration rate –CW&dagger;<br />
| Soft; Slow deceleration<br />
| Dense; variable deceleration<br />
| Dense; steep deceleration, early termination of diastolic flow<br />
<br />
|-<br />
| Pulmonic systolic flow compared to systemic flow –PW<sup>&phi;</sup><br />
| Slightly increased<br />
| Intermediate<br />
| Greatly increased<br />
<br />
|-<br />
| colspan="4" |<br />
<ul><br />
<li><em>CW</em>, Continuous wave Doppler; <em>PR</em>, pulmonic regurgitation; <em>PW</em>, pulsed wave Doppler; <em>RA</em>, right atrium; <em>RF</em>, regurgitant fraction; <em>RV</em>, right ventricle.</li><br />
<li><sup>&lowast;</sup> Unless there are other reasons for RV enlargement. Normal 2D measurements from the apical 4-chamber view; RV medio-lateral end-diastolic dimension &le; 4.3 cm, RV end-diastolic area &le; 35.5 cm<sup>2</sup>(89).</li><br />
<li><sup>&lowast;&lowast;</sup> Exception: acute PR</li><br />
<li><sup>&sect;</sup> At a Nyquist limit of 50-60 cm/s.</li><br />
<li><sup>&phi;</sup> Cut-off values for regurgitant volume and fraction are not well validated.</li><br />
<li>&dagger; Steep deceleration is not specific for severe PR.</li><br />
</ul><br />
<br />
|}<br />
==Pulmonary stenosis - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Grading of pulmonary stenosis<cite>ASEVS</cite>'''<br />
<br />
|-<br />
! style="width:150px" | &nbsp;<br />
! style="width:80px" | Mild<br />
! style="width:80px" | Moderate<br />
! style="width:80px" | Severe<br />
<br />
|-<br />
| Peak velocity (m/s)<br />
| align="center" | &lt;3<br />
| align="center" | 3-4<br />
| align="center" | &gt;4<br />
<br />
|-<br />
| Peak gradient (mmHg)<br />
| align="center" | &lt;36<br />
| align="center" | 36-64<br />
| align="center" | &gt;64<br />
<br />
|}<br />
<br />
=Inferior Caval Vein=<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Estimate of central veinous pressure using ICV echo'''<br />
<br />
|-<br />
! style="width:150px" | CVP<br />
! style="width:80px" | IVC collaps on inspiration<br />
! style="width:80px" | IVC diameter<br />
<br />
|-<br />
| CVP 0-5 cm<br />
| align="center" | total collaps<br />
| align="center" | < 1.5 cm<br />
<br />
|-<br />
| CVP 5-10 cm<br />
| align="center" | >50%<br />
| align="center" | 1.5 to 2.5 cm<br />
<br />
|-<br />
| CVP 11-15 cm<br />
| align="center" | <50%<br />
| align="center" | 1.5 to 2.5 cm<br />
<br />
|-<br />
| CVP 16-20 cm<br />
| align="center" | <50%<br />
| align="center" | > 2.5 cm<br />
<br />
|-<br />
| CVP > 20 cm<br />
| align="center" | no change<br />
| align="center" | > 2.5 cm<br />
<br />
|}<br />
<br />
=References=<br />
Click on the reference to link directly to the manuscript<br />
<biblio> <br />
#Foale pmid=3730205 <br />
#Weyman isbn=0812112075<br />
#ASE pmid=16458610<br />
#ASEVS pmid=19130998<br />
#Wilkins pmid=3190958<br />
#ESCAS pmid=17259184<br />
#ACCAS pmid=18848134<br />
#ASERE pmid=12835667<br />
#ASEDF pmid=19187853<br />
#Hamer isbn=9031362352<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/normal-values/ Normal values - all measurements (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Assessment_of_the_mitral_valve&diff=7277Assessment of the mitral valve2021-01-09T14:18:45Z<p>77.234.244.30: /* Doppler echocardiogram */</p>
<hr />
<div>==Introduction==<br />
The mitral valve is the first structure of the heart identified through echocardiogram. The echocardiographic evaluation of the mitral valve is composed of multiple 2D views, M-mode tracing, and Doppler flow evaluation. If these three techniques are contraindicated, a transesophageal echocardiogram can be performed. Together, these procedures are able to give accurate information regarding the mitral valve’s functions and abnormalities, if present.<br />
<br />
==Anatomy==<br />
The orientation of the mitral valve’s anterior leaflet is to the anterior chest wall, making the anterior leaflet ideal target for sound reflection. The anterior leaflet also has a large margin-to-base ratio, making it highly mobile. The anatomic windows which can be used to record the mitral valve through ultrasound are the apical, precordium, and subxiphoid.<br />
<br />
==Assessment techniques==<br />
===M-mode echocardiogram===<br />
M-mode echocardiogram is done from the precordium and guided from 2D short and long axis views. Normally, the anterior leaflet of the mitral valve shows a motion pattern which is the reflection of the ventricular filling’s phasic nature and produces an M-shaped pattern. The posterior image, on the other hand, shows a W-shaped pattern with smaller excursion.<br />
<br />
The E-point, which is the initial opening diastolic movement of the mitral valve, occurs because of the rapid left ventricular filling. During the F-point, the valve assumes an almost closed position during the mid-diastole. This reflects the deceleration of the inflow as the pressure gradient between the ventricle and the atrium is reduced. This early diastolic closure, which is usually more than 60 mm/s, called the E-F slope.<br />
<br />
There is continuous blood flow from the pulmonary veins to the left ventricle during the mid-diastolic phase known as the conduit phase, During this phase, the atrium acts as a passive channel instead of a reservoir. The mitral valve opens a second time, termed as A point, after atrial contraction, completing the letter M’s second peak. The deceleration of atrial inflow and the isometric LV contraction results in final closure.<br />
<br />
===2D echocardiogram===<br />
The 2D echocardiogram appearance of a normal mitral valve is dependent on the imaging plane used. <br />
*Parasternal short axis: ovoid orifice appearance or “fish mouth”<br />
*Parasternal long axis and apical: clapping hands <br />
But generally, the mitral valve should appear as a two-leaflet structure, mobile enough to respond to diastolic filling but still able to form a stable coaptation plane during systole.<br />
<br />
The mitral valve leaflets are translucent and thin and the chordae of each leaflet is connected to both papillary muscles. Each mitral valve leaflet is represented by two linear echoes on M-mode. On 2D imaging, the valve can be seen as thin and homogeneous and less than 4 mm thick. This thickness, however, is also dependent upon transducer frequency.<br />
<br />
A lower frequency of 2.5 mHz is preferred by many sonographers as it permits adequate images even in difficult patients and is ideal for Doppler flow. Although with this frequency, even normal valves may appear thicker so if an abnormality is suspected, a higher frequency of 3.5 mHz is used to determine if it is indeed thickened. In general, compared to an aortic root, a normal mitral valve is thinner when imaged under the same conditions. <br />
<br />
Using the 2D echocardiographic exam, the chordate, papillary muscles, and the mitral annulus can also be appreciated. The papillary muscles are best seen in the parasternal short axis anterolaterally and psoteromedially. On 2D imaging, examination of the mitral annulus is limited to diameter measurement and determination of the presence of calcification. <br />
<br />
===Doppler echocardiogram===<br />
Using Doppler echocardiogram on the mitral valve would reveal that the velocity patter of the blood going into the left ventricle at diastole resembles the M-shaped pattern seen in the M-mode of the same structure. Blood flow is rapid at the early phases of filling, very low during the conduit phase of the mid-diastole, and accelerates at the atrial contraction.<br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/mitral-valve/ Mitral valve - all measurements (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Classification_of_valve_stenosis_and_regurgitation&diff=12Classification of valve stenosis and regurgitation2021-01-09T14:15:56Z<p>77.234.244.30: /* References */</p>
<hr />
<div>=Aortic Valve=<br />
==Aortic valve stenosis - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Recommendations for classification of AS severity<cite>ASEVS</cite>'''<br />
<br />
|-<br />
! style="width:150px" | &nbsp;<br />
! style="width:100px" | Aortic sclerosis<br />
! style="width:100px" | Mild<br />
! style="width:100px" | Moderate<br />
! style="width:100px" | Severe<br />
<br />
|-<br />
| Aortic jet velocity (m/s)<br />
| style="text-align:center" | &le;2.5 m/s<br />
| style="text-align:center" | 2.6-2.9<br />
| style="text-align:center" | 3.0-4.0<br />
| style="text-align:center" | &gt;4.0<br />
<br />
|-<br />
| Mean gradient (mmHg)<br />
| style="text-align:center" | -<br />
| style="text-align:center" | &lt;20 (&lt;30<sup>a</sup>)<br />
| style="text-align:center" | 20-40<sup>b</sup> (30-50<sup>a</sup>)<br />
| style="text-align:center" | &gt;40<sup>b</sup> (&gt;50<sup>a</sup>)<br />
<br />
|-<br />
| AVA (cm<sup>2</sup>)<br />
| style="text-align:center" | -<br />
| style="text-align:center" | &gt;1.5<br />
| style="text-align:center" | 1.0-1.5<br />
| style="text-align:center" | &lt;1<br />
<br />
|-<br />
| Indexed AVA (cm<sup>2</sup>/m<sup>2</sup>)<br />
| style="text-align:center" | &nbsp;<br />
| style="text-align:center" | &gt;0.85<br />
| style="text-align:center" | 0.60-0.85<br />
| style="text-align:center" | &lt;0.6<br />
<br />
|-<br />
| Velocity ratio<br />
| style="text-align:center" | &nbsp;<br />
| style="text-align:center" | &gt;0.50 <br />
| style="text-align:center" | 0.25-0.50 <br />
| style="text-align:center" | &lt;0.25<br />
<br />
|-<br />
| colspan="5" |<ul><br />
<li><sup>a</sup>ESC Guidelines.<cite>ESCAS</cite></li><br />
<li><sup>b</sup>AHA/ACC Guidelines.<cite>AHAAS</cite></li><br />
</ul><br />
<br />
|}<br />
==Aortic regurgitation - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Application of specific and supportive signs, and quantitative parameters in the grading of aortic regurgitation severity<cite>ASERE</cite>'''<br />
<br />
|-<br />
! style="width:160px" | &nbsp;<br />
! style="width:250px" | Mild <br />
! colspan="2" | Moderate <br />
! style="width:250px" | Severe<br />
<br />
|-<br />
! Specific signs for AR severity<br />
| style="vertical-align:top" | <ul><br />
<li>Central Jet, width &lt; 25% of LVOT<sup>&sigmaf;</sup></li><br />
<li>Vena contracta &lt; 0.3 cm<sup>&sigmaf;</sup></li><br />
<li>No or brief early diastolic flow reversal in descending aorta</li><br />
</ul><br />
| style="vertical-align:top" colspan="2" | <ul><li>Signs of AR&gt;mild present but no criteria for severe AR</li></ul><br />
| style="vertical-align:top" | <ul><br />
<li>Central Jet, width &ge; 65% of LVOT<sup>&sigmaf;</sup></li><br />
<li>Vena contracta &gt; 0.6cm<sup>&sigmaf;</sup></li><br />
</ul><br />
<br />
|-<br />
! Supportive signs<br />
| style="vertical-align:top" | <ul><br />
<li>Pressure half-time &gt; 500 ms</li><br />
<li>Normal LV size<sup>&lowast;</sup></li><br />
</ul><br />
| style="vertical-align:top" colspan="2" | <ul><li>Intermediate values</li></ul><br />
| <ul><br />
<li>Pressure half-time &lt; 200 ms</li><br />
<li>Holodiastolic aortic flow reversal in descending aorta</li><br />
<li>Moderate or greater LV enlargement<sup>&lowast;&lowast;</sup></li><br />
</ul><br />
<br />
|-<br />
| colspan="5" | '''Quantitative parameters<sup>&psi;</sup>'''<br />
<br />
|-<br />
| style="padding-left:12px" | R Vol, ml/beat<br />
| align="center" | &lt; 30<br />
| align="center" style="width:125px" | 30-44<br />
| align="center" style="width:125px" | 45-59<br />
| align="center" | &ge; 60<br />
<br />
|-<br />
| style="padding-left:12px" | RF %<br />
| align="center" | &lt; 30<br />
| align="center" | 30-39<br />
| align="center" | 40-49<br />
| align="center" | &ge; 50<br />
<br />
|-<br />
| style="padding-left:12px" | EROA, cm<sup>2</sup><br />
| align="center" | &lt; 0.10<br />
| align="center" | 0.10-0.19<br />
| align="center" | 0.20-0.29<br />
| align="center" | &ge; 0.30<br />
<br />
|-<br />
| colspan="5" | <br />
<ul><br />
<li><em>AR</em>, Aortic regurgitation; <em>EROA</em>, effective regurgitant orifice area; <em>LV</em>, left ventricle; <em>LVOT</em>, left ventricular outflow tract; <em>R Vol</em>, regurgitant volume; <em>RF</em>, regurgitant fraction.</li><br />
<li><sup>&lowast;</sup> LV size applied only to chronic lesions. Normal 2D measurements: LV minor-axis &le; 2.8 cm/m<sup>2</sup>, LV end-diastolic volume &le; 82 ml/m<sup>2</sup> (2).</li><br />
<li><sup>&sigmaf;</sup> At a Nyquist limit of 50–60 cm/s.</li><br />
<li><sup>&lowast;&lowast;</sup> In the absence of other etiologies of LV dilatation.</li><br />
<li><sup>&psi;</sup> Quantitative parameters can help sub-classify the moderate regurgitation group into mild-to-moderate and moderate-to-severe regurgitation as shown.</li><br />
</ul><br />
<br />
|}<br />
<br />
<br />
=Mitral Valve=<br />
==Mitral regurgitation - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Application of specific and supportive signs, and quantitative parameters in the grading of mitral regurgitation severity<cite>ASERE</cite>'''<br />
<br />
|-<br />
! style="width:160px" | &nbsp;<br />
! style="width:250px" | Mild <br />
! colspan="2" | Moderate <br />
! style="width:250px" | Severe<br />
<br />
|-<br />
! Specific signs of severity<br />
| style="vertical-align:top" | <ul><br />
<li>Small central jet &lt;4 cm<sup>2</sup> or &lt;20% of LA area<sup>&psi;</sup></li><br />
<li>Vena contracta width &lt;0.3 cm</li><br />
<li>No or minimal flow convergence</li><br />
</ul><br />
| style="vertical-align:top" colspan="2" | <ul><li>Signs of MR&gt;mild present, but no criteria for severe MR</li></ul><br />
| style="vertical-align:top" | <ul><br />
<li>Vena contracta width &ge; 0.7cm <em>with</em> large central MR jet (area &lt; 40% of LA) or with a wall-impinging jet of any size, swirling in LA<sup>&psi;</sup></li><br />
<li>Large flow convergence<sup>&sigmaf;</sup></li><br />
<li>Systolic reversal in pulmonary veins</li><br />
<li>Prominent flail MV leaflet or ruptured papillary muscle</li><br />
</ul><br />
<br />
|-<br />
! Supportive signs<br />
| style="vertical-align:top" | <ul><br />
<li>Systolic dominant flow in pulmonary veins</li><br />
<li>A-wave dominant mitral inflow<sup>&Phi;</sup></li><br />
<li>Soft density, parabolic CW Doppler MR signal</li><br />
<li>Normal LV size<sup>&lowast;</sup></li><br />
</ul><br />
| style="vertical-align:top" colspan="2" | <ul><li>Intermediate signs/findings</li></ul><br />
| style="vertical-align:top" | <ul><br />
<li>Dense, triangular CW Doppler MR jet</li><br />
<li>E-wave dominant mitral inflow (E &gt;1.2 m/s)<sup>&Phi;</sup> Enlarged LV and LA size<sup>&lowast;&lowast;</sup>, (particularly when normal LV function is present).</li><br />
</ul><br />
<br />
|-<br />
| colspan="5" | '''Quantitative parameters<sup>&phi;</sup>'''<br />
<br />
|-<br />
| style="padding-left:12px" | R Vol (ml/beat)<br />
| align="center" | &lt; 30<br />
| style="width:125px" align="center" | 30-44<br />
| style="width:125px" align="center" | 45-59<br />
| align="center" | &ge; 60<br />
<br />
|-<br />
| style="padding-left:12px" | RF (%)<br />
| align="center" | &lt; 30<br />
| align="center" | 30-39<br />
| align="center" | 40-49<br />
| align="center" | &ge; 50<br />
<br />
|-<br />
| style="padding-left:12px" | EROA (cm<sup>2</sup>)<br />
| align="center" | &lt; 0.20<br />
| align="center" | 0.20-0.29<br />
| align="center" | 0.30-0.39<br />
| align="center" | &ge; 0.40<br />
<br />
|-<br />
| colspan="5" | <ul><br />
<li><em>CW</em>, Continuous wave; <em>EROA</em>, effective regurgitant orifice area; <em>LA</em>, left atrium; <em>LV</em>, left ventricle; <em>MV</em>, mitral valve; <em>MR</em>, mitral regurgitation; <em>R Vol</em>, regurgitant volume; <em>RF</em>, regurgitant fraction.</li><br />
<li><sup>&lowast;</sup> LV size applied only to chronic lesions. Normal 2D measurements: LV minor axis &le; 2.8 cm/m<sup>2</sup>, LV end-diastolic volume &le; 82 ml/m<sup>2</sup>, maximal LA antero-posterior diameter &le; 2.8 cm/m<sup>2</sup>, maximal LA volume &le; 36 ml/m<sup>2</sup> (2;33;35).</li><br />
<li><sup>&lowast;&lowast;</sup> In the absence of other etiologies of LV and LA dilatation and acute MR.</li><br />
<li><sup>&psi;</sup> At a Nyquist limit of 50-60 cm/s.</li><br />
<li><sup>&Phi;</sup> Usually above 50 years of age or in conditions of impaired relaxation, in the absence of mitral stenosis or other causes of elevated LA pressure.</li><br />
<li><sup>&sigmaf;</sup> Minimal and large flow convergence defined as a flow convergence radius &lt; 0.4 cm and &le; 0.9 cm for central jets, respectively, with a baseline shift at a Nyquist of 40 cm/s; Cut-offs for eccentric jets are higher, and should be angle corrected (see text).</li><br />
<li><sup>&phi;</sup> Quantitative parameters can help sub-classify the moderate regurgitation group into mild-to-moderate and moderate-to-severe as shown.</li><br />
</ul><br />
<br />
|}<br />
==Mitral stenosis - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Recommendations for classification of mitral stenosis severity<cite>ASEVS</cite>'''<br />
<br />
|-<br />
! style="width:200px" | &nbsp;<br />
! style="width:80px" | Mild <br />
! style="width:80px" | Moderate<br />
! style="width:80px" | Severe<br />
<br />
|-<br />
| colspan="4" | '''Specific findings'''<br />
<br />
|-<br />
| style="padding-left:12px" | Valve area (cm<sup>2</sup>)<br />
| align="center" | &gt;1.5<br />
| align="center" | 1.0-1.5<br />
| align="center" | &lt;1.0<br />
<br />
|-<br />
| colspan="4" | '''Supportive findings'''<br />
<br />
|-<br />
| style="padding-left:12px" | Mean gradient (mmHg)<sup>a</sup><br />
| align="center" | &lt;5<br />
| align="center" | 5-10<br />
| align="center" | &gt;10<br />
<br />
|-<br />
| style="padding-left:12px" | Pulmonary artery pressure (mmHg)<br />
| align="center" | &lt;30<br />
| align="center" | 30-50<br />
| align="center" | &gt;50<br />
<br />
|-<br />
| colspan="4" | <ul><li><sup>a</sup>At heart rates between 60 and 80 bpm and in sinus rhythm.</li></ul><br />
<br />
|}<br />
==Mitral valve stenosis - Wilkins score==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Assessment of mitral valve anatomy according to the Wilkins score<cite>Wilkins</cite>'''<br />
<br />
|-<br />
! style="width:50px" | Grade<br />
! style="width:170px" | Mobility <br />
! style="width:170px" | Thickening <br />
! style="width:170px" | Calcification <br />
! style="width:170px" | Subvalvular Thickening<br />
<br />
|-<br />
| style="vertical-align:top" | 1<br />
| style="vertical-align:top" | Highly mobile valve with only leaflet tips restricted<br />
| style="vertical-align:top" | Leaflets near normal in thickness (4-5 mm)<br />
| style="vertical-align:top" | A single area of increased echo brightness<br />
| style="vertical-align:top" | Minimal thickening just below the mitral leaflets<br />
<br />
|-<br />
| style="vertical-align:top" | 2<br />
| style="vertical-align:top" | Leaflet mid and base portions have normal mobility<br />
| style="vertical-align:top" | Midleaflets normal, considerable thickening of margins (5-8 mm)<br />
| style="vertical-align:top" | Scattered areas of brightness confined to leaflet margins<br />
| style="vertical-align:top" | Thickening of chordal structures extending to one-third of the chordal length<br />
<br />
|-<br />
| style="vertical-align:top" | 3<br />
| style="vertical-align:top" | Valve continues to move forward in diastole, mainly from the base<br />
| style="vertical-align:top" | Thickening extending through the entire leaflet (5-8mm)<br />
| style="vertical-align:top" | Brightness extending into the mid-portions of the leaflets<br />
| style="vertical-align:top" | Thickening extended to distal third of the chords<br />
<br />
|-<br />
| style="vertical-align:top" | 4<br />
| style="vertical-align:top" | No or minimal forward movement of the leaflets in diastole<br />
| style="vertical-align:top" | Considerable thickening of all leaflet tissue (&gt;8-10mm)<br />
| style="vertical-align:top" | Extensive brightness throughout much of the leaflet tissue<br />
| style="vertical-align:top" | Extensive thickening and shortening of all chordal structures extending down to the papillary muscles<br />
<br />
|-<br />
| colspan="5" |<ul><li>The total score is the sum of the four items and ranges between 4 and 16.</li></ul><br />
<br />
|}<br />
==Mitral stenosis - routine measurements==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Recommendations for data recording and measurement in routine use for mitral stenosis quantitation<cite>ASEVS</cite>'''<br />
<br />
|-<br />
! Data element<br />
! Recording<br />
! Measurement<br />
<br />
|-<br />
! rowspan="5" | Planimetry<br />
<br />
|-<br />
| style="vertical-align:top; " | - 2D parasternal short-axis view<br />
| style="vertical-align:top; " | - contour of the inner mitral orifice<br />
<br />
|-<br />
| style="vertical-align:top; " | - determine the smallest orifice by scanning from apex to base<br />
| style="vertical-align:top; " | - include commissures when opened<br />
<br />
|-<br />
| style="vertical-align:top; " | - positioning of measurement plan can be oriented by 3D echo<br />
| style="vertical-align:top; " | - in mid-diastole (use cine-loop)<br />
<br />
|- <br />
| style="vertical-align:top" | - lowest gain setting to visualize the whole mitral orifice<br />
| style="vertical-align:top" | - average measurements if atrial fibrillation<br />
<br />
|-<br />
! rowspan="4" | Mitral flow<br />
<br />
|-<br />
| style="vertical-align:top; " | - continuous-wave Doppler<br />
| style="vertical-align:top; " | - mean gradient from the traced contour of the diastolic mitral flow<br />
<br />
|-<br />
| style="vertical-align:top; " | - apical windows often suitable (optimize intercept angle)<br />
| style="vertical-align:top; " | - pressure half-time from the descending sLope of the E-wave (mid-diastole slope if not linear)<br />
<br />
|-<br />
| style="vertical-align:top" | - adjust gain setting to obtain well-defined flow contour<br />
| style="vertical-align:top" | - average measurements if atrial fibrillation<br />
<br />
|-<br />
! rowspan="3" | Systolic pulmonary artery pressure<br />
<br />
|-<br />
| style="vertical-align:top; " | - continuous-wave Doppler<br />
| style="vertical-align:top; " | - maximum velocity of tricuspid regurgitant flow<br />
<br />
|-<br />
| style="vertical-align:top" | - multiple acoustic windows to optimize intercept angle<br />
| style="vertical-align:top" | - estimation of right atrial pressure according to inferior vena cava diameter<br />
<br />
|-<br />
! rowspan="8" | Valve anatomy<br />
<br />
|-<br />
| rowspan="2" style="vertical-align:top; " | <br />
- parasternal short-axis view<br />
<br />
|-<br />
| style="vertical-align:top; " | <br />
- valve thickness (maximum and heterogeneity)<br><br />
- commissural fusion<br><br />
- extension and location of localized bright zones (fibrous nodutes or calcification)<br />
<br />
|-<br />
| rowspan="2" style="vertical-align:top; " | <br />
- parasternal long-axis view<br />
<br />
|-<br />
| style="vertical-align:top; " | <br />
- valve thickness<br><br />
- extension of calcification<br><br />
- valve pliability<br><br />
- subvalvular apparatus (chordal thickening, fusion, or shortening)<br />
|-<br />
| rowspan="2" style="vertical-align:top" | - apical two-chamber view<br />
<br />
|-<br />
| style="vertical-align:top; " | - subvalvular apparatus (chordal thickening, fusion, or shortening)<br><br />
|-<br />
| colspan="2"|<br />
Detail each component and summarize in a score<br />
<br />
|}<br />
<br />
<br />
=Tricuspid Valve=<br />
==Tricuspid regurgitation - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Echocardiographic and Doppler parameters used in grading tricuspid regurgitation severity<cite>ASERE</cite>'''<br />
<br />
|-<br />
! style="width:200px" | Parameter <br />
! style="width:200px" | Mild <br />
! style="width:200px" | Moderate<br />
! style="width:200px" | Severe<br />
<br />
|-<br />
| Tricuspid valve<br />
| Usually normal<br />
| Normal or abnormal<br />
| Abnormal/Flail leaflet/Poor coaptation<br />
<br />
|-<br />
| RV/RA/IVC size<br />
| Normal<sup>&lowast;</sup><br />
| Normal or dilated<br />
| Usually dilated<sup>&lowast;&lowast;</sup><br />
<br />
|-<br />
| Jet area-central jets (cm<sup>2</sup>)<sup>&sect;</sup><br />
| &lt; 5<br />
| 5-10<br />
| &gt; 10<br />
<br />
|-<br />
| VC width (cm)<sup>&Phi;</sup><br />
| Not defined<br />
| Not defined, but &lt; 0.7<br />
| &gt; 0.7<br />
<br />
|-<br />
| PISA radius (cm)<sup>&psi;</sup><br />
| &le; 0.5<br />
| 0.6-0.9<br />
| &gt; 0.9<br />
<br />
|-<br />
| Jet density and contour–CW<br />
| Soft and parabolic<br />
| Dense, variable contour<br />
| Dense, triangular with early peaking<br />
<br />
|-<br />
| Hepatic vein flow&dagger;<br />
| Systolic dominance<br />
| Systolic blunting<br />
| Systolic reversal<br />
<br />
|-<br />
| colspan="4" |<br />
<ul><br />
<li><em>CW</em>, Continuous wave Doppler; <em>IVC</em>, inferior vena cava; <em>RA</em>, right atrium; <em>RV</em>, right ventricle; <em>VC</em>, vena contracta width.</li><br />
<li><sup>&lowast;</sup> Unless there are other reasons for RA or RV dilation. Normal 2D measurements from the apical 4-chamber view: RV medio-lateral end-diastolic dimension &le; 4.3 cm, RV end-diastolic area &le; 35.5 cm<sup>2</sup>, maximal RA medio-lateral and supero-inferior dimensions &le; 4.6 cm and 4.9 cm respectively, maximal RA volume &le; 33 ml/m<sup>2</sup>(35;89).</li><br />
<li><sup>&lowast;&lowast;</sup> Exception: acute TR.</li><br />
<li><sup>&sect;</sup> At a Nyquist limit of 50-60 cm/s. Not valid in eccentric jets. Jet area is not recommended as the sole parameter of TR severity due to its dependence on<br />
hemodynamic and technical factors.</li><br />
<li><sup>&Phi;</sup> At a Nyquist limit of 50-60 cm/s.</li><br />
<li><sup>&psi;</sup> Baseline shift with Nyquist limit of 28 cm/s.</li><br />
<li>&dagger; Other conditions may cause systolic blunting (eg. atrial fibrillation, elevated RA pressure).</li><br />
</ul><br />
|}<br />
<br />
==Tricuspid stenosis - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Findings indicative of haemodynamically significant tricuspid stenosis<cite>ASEVS</cite>'''<br />
<br />
|-<br />
| colspan="2" | '''Specific findings'''<br />
<br />
|-<br />
| style="width:190px; padding-left:12px" | Mean pressure gradient<br />
| style="width:80px" | &ge;5 mmHg<br />
<br />
|-<br />
| style="padding-left:12px" | Inflow time-velocity integral<br />
| &gt;60 cm<br />
<br />
|-<br />
| style="padding-left:12px" | <em>T</em><sub>1/2</sub><br />
| &ge;190 ms<br />
<br />
|-<br />
| style="padding-left:12px" | Valve area by continuity equation<sup>a</sup><br />
| &le;1 cm<sup>2</sup><br />
<br />
|-<br />
| colspan="2" | '''Supportive findings'''<br />
<br />
|-<br />
| style="padding-left:12px" | Enlarged right atrium &ge;moderate<br />
|<br />
<br />
|-<br />
| style="padding-left:12px" | DHated inferior vena cava<br />
|<br />
<br />
|-<br />
| colspan="2" | <ul><br />
<li><sup>a</sup>Stroke volume derived from left or right ventricular outflow. In the presence of more than mild TR, the derived valve area will be underestimated. Nevertheless, a value &le;1 cm<sup>2</sup> implies a significant haemodynamic burden imposed by the combined lesion.<br />
</li><br />
</ul><br />
|}<br />
<br />
=Pulmonary Valve=<br />
==Pulmonary regurgitaion - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Echocardiographic and Doppler parameters used in grading pulmonary regurgitation severity<cite>ASERE</cite>'''<br />
<br />
|-<br />
! style="width:200px" | Parameter <br />
! style="width:200px" | Mild <br />
! style="width:200px" | Moderate<br />
! style="width:200px" | Severe<br />
<br />
|-<br />
| Pulmonic valve<br />
| Normal<br />
| Normal or abnormal<br />
| Abnormal<br />
<br />
|-<br />
| RV size<br />
| Normal<sup>&lowast;</sup><br />
| Normal or dilated<br />
| Dilated<br />
<br />
|-<br />
| Jet size by color Doppler<sup>&sect;</sup><br />
| Thin (usually &lt; 10 mm in length) with a narrow origin<br />
| Intermediate<br />
| Usually large, with a wide origin; May be brief in duration<br />
<br />
|-<br />
| Jet density and deceleration rate –CW&dagger;<br />
| Soft; Slow deceleration<br />
| Dense; variable deceleration<br />
| Dense; steep deceleration, early termination of diastolic flow<br />
<br />
|-<br />
| Pulmonic systolic flow compared to systemic flow –PW<sup>&phi;</sup><br />
| Slightly increased<br />
| Intermediate<br />
| Greatly increased<br />
<br />
|-<br />
| colspan="4" |<br />
<ul><br />
<li><em>CW</em>, Continuous wave Doppler; <em>PR</em>, pulmonic regurgitation; <em>PW</em>, pulsed wave Doppler; <em>RA</em>, right atrium; <em>RF</em>, regurgitant fraction; <em>RV</em>, right ventricle.</li><br />
<li><sup>&lowast;</sup> Unless there are other reasons for RV enlargement. Normal 2D measurements from the apical 4-chamber view; RV medio-lateral end-diastolic dimension &le; 4.3 cm, RV end-diastolic area &le; 35.5 cm<sup>2</sup>(89).</li><br />
<li><sup>&lowast;&lowast;</sup> Exception: acute PR</li><br />
<li><sup>&sect;</sup> At a Nyquist limit of 50-60 cm/s.</li><br />
<li><sup>&phi;</sup> Cut-off values for regurgitant volume and fraction are not well validated.</li><br />
<li>&dagger; Steep deceleration is not specific for severe PR.</li><br />
</ul><br />
<br />
|}<br />
==Pulmonary stenosis - severity==<br />
{| class="wikitable" style="font-size:90%;"<br />
<br />
|+'''Grading of pulmonary stenosis<cite>ASEVS</cite>'''<br />
<br />
|-<br />
! style="width:150px" | &nbsp;<br />
! style="width:80px" | Mild<br />
! style="width:80px" | Moderate<br />
! style="width:80px" | Severe<br />
<br />
|-<br />
| Peak velocity (m/s)<br />
| align="center" | &lt;3<br />
| align="center" | 3-4<br />
| align="center" | &gt;4<br />
<br />
|-<br />
| Peak gradient (mmHg)<br />
| align="center" | &lt;36<br />
| align="center" | 36-64<br />
| align="center" | &gt;64<br />
<br />
|}<br />
<br />
<br />
=References=<br />
Click on the reference to link directly to the manuscript<br />
<biblio><br />
#Foale pmid=3730205 <br />
#Weyman isbn=0812112075<br />
#ASE pmid=16458610<br />
#ASEVS pmid=19130998<br />
#Wilkins pmid=3190958<br />
#ESCAS pmid=17259184<br />
#ACCAS pmid=18848134<br />
#ASERE pmid=12835667<br />
#ASEDF pmid=19187853<br />
#Hamer isbn=9031362352<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/normal-values/ Normal values (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Aortic_Valve&diff=536Aortic Valve2021-01-09T14:09:48Z<p>77.234.244.30: /* Insufficiency */</p>
<hr />
<div>==Anatomy==<br />
The normal aortic valve consists of three equally sized valve cusps, namely the right coronary cusp (R), the left coronary cusp (L) and the non-coronary cusp (N).<br />
<br />
[[Image:Aovalv.svg|300px]]<br />
<br />
With 2D echocardiography, the valve can be assessed in the PLAX, where one sees the RCC and the NCC. In a normal aortic tricuspid valve, the closure line is between the RCC and NCC and usually in the center of the aortic valve ring. However, the aortic valve can be even better assessed in the PSAXao, where the three cusps in systole almost form a circle and in diastole an inverted Mercedes-Benz logo. Assessing the number of cusps is done in systole, because the valve is open and because in the closed position raphes can be misinterpreted. With 3D echocardiography you can now also get wonderful images of the aortic valve.<br />
<br />
{| class="wikitable" cellpadding="0" cellspacing="0" border="0"<br />
|-<br />
|Video<br />
|-<br />
!3D (TEE) view of the aortic valve to exclude vegetations.<br />
|}<br />
<br />
==Aortic valve variants (PLAX ao)==<br />
<br />
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="600px"<br />
|-<br />
|Video<br />
|Video<br />
|-<br />
!Tricuspid (normal) <br />
!Bicuspid<br />
|-<br />
|Video<br />
|Video<br />
|-<br />
!Quadricuspide <br />
!Unicuspide<br />
|}<br />
<br />
==Bicuspid aortic valve==<br />
The bicuspid aortic valve is the most common cardiac valve abnormality. Here are two leaflets fused during the development. A bicuspid aortic valve occurs in 1-2% of the population and twice as often in men compared to women.<br />
<br />
A bicuspid aortic valve can be hereditary, both familial clustering and isolated valve defects are documented. The incidence of bicuspid aortic valve may reach 10% in certain families. A bicuspid aortic valve is often associated with other congenital heart defects, including coarctation of the aorta. Usually there is a fusion between the LCC and RCC (70%). In many cases, the bicuspid aortic valve does not cause any problems. Later in life, the valve will calcify early causing a stenosis and possibly also regurgitation through malcoaptation of the affected cusps.<br />
<br />
==Stenosis==<br />
<br />
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="700"<br />
|-<br />
|colspan="2"|'''Causes'''<br />
|-<br />
|'''Supravalvulair:''' <br />
(usually congenital)<br />
|<br />
*A pleat or membrane of the aorta<br />
*Narrowing of the aorta<br />
*William's Syndrome<br />
|-<br />
|'''Valvular:'''<br />
|<br />
*Congenital form; often bicuspid aortic valve<br />
*Due to rheumatic fever<br />
*Degenerative form<br />
|-<br />
|'''Subvalvular:'''<br />
|<br />
*Congenital anomaly: a membrane in LVOT<br />
*Hypertrophic obstructive cardiomyopathy, an autosomal dominant hereditary disorder<br />
*Aortic subvalvular stenosis has also been described as a result of lysosomal storage diseases<br />
|}<br />
<br />
Some patients have no symptoms, but sudden, unexpected death may be the first phenomenon. Fatigue, shortness of breath and lack of oxygen during exertion, chest pain and dizziness and fainting during exercise are other symptoms. The left ventricle must develop higher pressures in aortic valve stenosis in order to generate an adequate blood pressure. Depending on the severity and cause of the problem, a valve replacement may be indicated.<br />
<br />
Click [[Aortic Valve Stenosis|'''here''']] for quantification of aortic valve stenosis.<br />
<br />
==Insufficiency==<br />
<br />
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="700"<br />
|-<br />
|colspan="2"|'''Causes'''<br />
|-<br />
|'''Congenital'''<br />
|<br />
*Bicuspid aortic valve<br />
|-<br />
|'''Risk of damage to the aortic valve'''<br />
|<br />
*Rheumatic fever<br />
*Degeneracy<br />
*Endocarditis<br />
*Syphilis<br />
*Trauma<br />
*Metabolic diseases, such as the mucopolysaccharidosen<br />
|-<br />
|'''Aortic dilation'''<br />
|<br />
*Connective tissue disease, such as Marfan's syndrome, Ehlers-Danlos syndrome,<br />
*Aneurysm by inflammation, such as syphilis, vasculitis.<br />
*Aneurysm atherosclerotic lesions in aorta<br />
*Aortic dissection<br />
|}<br />
<br />
A serious aortic regurgitation causes a volume overload of the left ventricle. Since the blood that has just been ejected, returns immediately and causes left ventricular overload and subsequently heart failure may occur. Patients complain of fatigue and shortness of breath. The valve, and possibly a part of the aortic arch, may be replaced.<br />
<br />
Click [[Aortic Valve Insufficiency|'''here''']] for quantification of aortic valve insufficiency.<br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/aortic-valve/ Aortic valve - all measurements (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Right_Ventricle&diff=7243Right Ventricle2021-01-09T14:08:46Z<p>77.234.244.30: /* References */</p>
<hr />
<div>==The Right Ventricle==<br />
<br />
The contractile function of the RV is difficult to measure due to its complex anatomy. Historically, there has been very little attention paid to this part of the heart since it was assumed that the RV only played a passive role. However, in the last three decades it has been shown that the function of the RV actually does play an important role in the survival of several disease states. There are a number of echocardiographic measurements to measure RV function which can also provide insights into the mechanisms of RV dysfunction.<br />
<br />
===Right ventricular dimensions===<br />
<br />
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="700px"<br />
|-<br />
!<br />
!Reference range <br />
!Mildly abnormal <br />
!Moderately abnormal <br />
!Severely abnormal<br />
|-<br />
|colspan="5"|'''RV dimensions'''<br />
|-<br />
!Basal RV diameter (RVD 1), cm<br />
|align="center"|2.0–2.8 <br />
|align="center"|2.9–3.3 <br />
|align="center"|3.4–3.8 <br />
|align="center"|≥3.9<br />
|-<br />
!Mid-RV diameter (RVD 2), cm <br />
|align="center"|2.7–3.3 <br />
|align="center"|3.4–3.7 <br />
|align="center"|3.8–4.1 <br />
|align="center"|≥4.2<br />
|-<br />
!Base-to-apex length (RVD 3), cm<br />
|align="center"|7.1–7.9 <br />
|align="center"|8.0–8.5 <br />
|align="center"|8.6–9.1 <br />
|align="center"|≥9.2<br />
|-<br />
!<nowiki>*</nowiki>RV diastolic area, cm<sup>2</sup> <br />
|align="center"|11–28 <br />
|align="center"|29–32 <br />
|align="center"|33–37 <br />
|align="center"|≥38<br />
|-<br />
!<nowiki>*</nowiki>RV systolic area, cm<sup>2</sup> <br />
|align="center"|7.5–16 <br />
|align="center"|17–19 <br />
|align="center"|20–22 <br />
|align="center"|≥23<br />
|-<br />
|colspan="5"|'''RVOT diameters'''<br />
|-<br />
!Above aortic valve (RVOT 1), cm<br />
|align="center"|2.5–2.9 <br />
|align="center"|3.0–3.2 <br />
|align="center"|3.3–3.5 <br />
|align="center"|≥3.6<br />
|-<br />
!Above pulmonic valve (RVOT 2), cm<br />
|align="center"|1.7–2.3 <br />
|align="center"|2.4–2.7 <br />
|align="center"|2.8–3.1 <br />
|align="center"|≥3.2<br />
|-<br />
|colspan="5"|<nowiki>*</nowiki>'''Reference limits and partition values of right ventricular size and function as measured in apical 4-chamber view.'''<br />
|}<br />
<br />
===Right ventricular function===<br />
<br />
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="700px"<br />
|-<br />
!<br />
!Reference range <br />
!Mildly abnormal <br />
!Moderately abnormal <br />
!Severely abnormal<br />
|-<br />
|<nowiki>*</nowiki>'''RV fractional area change, %'''<br />
|align="center"|32–60 <br />
|align="center"|25–31 <br />
|align="center"|18–24 <br />
|align="center"|≤17<br />
|-<br />
|<nowiki>*</nowiki>'''TAPSE, cm''' <br />
|align="center"|1.5-2.0 <br />
|align="center"|1.3-1.5 <br />
|align="center"|1.0-1.2 <br />
|align="center"|<1.0<br />
|-<br />
|<nowiki>*</nowiki>'''RV MPI''' <br />
|align="center"|<0.28<br />
|<br />
|<br />
| <br />
|-<br />
|<nowiki>*</nowiki>'''Dp/DT''' <br />
|align="center"|>400mmHg<br />
|<br />
|<br />
| <br />
|- <br />
|<nowiki>*</nowiki>'''RV TDI doppler (S'), cm/s''' <br />
|align="center"|>11.5<br />
|<br />
|<br />
| <br />
|-<br />
|colspan="5"|<nowiki>*</nowiki>'''Reference limits and partition values of right ventricular size and function as measured in apical 4-chamber view.<cite>1</cite>'''<br />
|}<br />
<br />
==Fractional Area Change==<br />
<br />
With this method, the percentage difference in the traced RV during systole and diastole is assessed. Here again the apical 4CH is used for accuracy. A difference in surface area of less than 35%, fits with a reduced function. This method is frequently used in clinical practice.<br />
<br />
{| class="wikitable" cellpadding="0" cellspacing="0" border="0"<br />
|-<br />
![[Image:RVFAC01.png|350px]]<br />
<br />
Good RV function<br />
![[Image:RVFAC02.png|350px]]<br />
<br />
Decreased RV function<br />
|}<br />
<br />
==Dp/DT==<br />
<br />
These methods make use of the determination of the speed of movement of the myocardium itself and of the determination of pressure differences between the compartments of the right heart. A simple physiological measure of RV function is the pressure produced during RV systole. This can be determined as Dp/DT, and for this purpose the systolic acceleration speed of the tricuspid regurgitation signal is determined during the isovolumetric contraction phase. This can be done by measuring the time interval in the continuous wave signal where TR is between 1 and 2 m/s.<br />
<br />
Therefore, by definition, the time interval for a differential pressure of 12mmHg is assessed (4V^2). This number, 12, is divided by the time interval in seconds, a result less than 400 mmHg/sec is an indication for a reduced right ventricular function.<br />
<br />
Click [http://csecho.ca/cardiomath/?eqnHD=echo&eqnDisp=dpdtrvc '''here'''] for dP/DT calculation.<br />
<br />
==RV myocardial performance index (MPI)==<br />
<br />
The MPI or Tei index is a dimensionless index and a measure of efficiency of the systole. This index is the ratio between the sum of both isovolumic times and ejection time. The isovolumic relaxation time is the time between the closing of the pulmonary valve and the beginning of the opening of the tricuspid valve. The time in which blood flows through the pulmonary valve is named the ejection time. The larger the portion of the time that is used for actual ejection of blood, the better the function of the chamber. This is the underlying idea of the performance index. So the higher the index, the less efficient the RV.<br />
<br />
Unfortunately, it is often rather difficult to measure. The easiest method to assess the Tei index is a tissue doppler signal of the RV in a AP4CH view. The tissue Doppler method allows for measurement of the Tei index or MPI as well as S', E', and A', all from a single image. You divide the isovolumic time (assessed as the time between TV closure (end of A') and opening (start of E') minus the ejection time) by the ejection time: <br />
<br />
TEI index (RV MPI) = IVCT + IVRT / RVET = TCOT - RVET / RVET<br />
<br />
The normal values of left and right ventricle differ. Due to the high pressures which must be generated by the LV, the isovolumic times of the LV are relatively long. The RV generates less pressure and therefore the index also lower with an average at around 0.28. A Tei index above 0.55 (TDI) is considered abnormal.<br />
<br />
{| class="wikitable" cellpadding="0" cellspacing="0" border="0"<br />
|-<br />
![[Image:RVMPI.png]]<br />
<br />
RV MPI measured using TDI and PW in TVannulus.<br />
|}<br />
<br />
Click [http://csecho.ca/cardiomath/?eqnHD=echo&eqnDisp=mpiteirv '''here'''] for MPI calculation.<br />
<br />
The determination of the RV function, occurs regularly on the eye, or even not at all. Unfortunately, this ensures that many RV pathology is not recognized. Using various echo techniques may result in a good statement about the function of the RV. Never restrict to one technique, but always more views to assess its function. This reduces the risk of troublesome and even erroneous interpretations.<cite>2</cite><br />
<br />
==References==<br />
<biblio><br />
#1 pmid=20620859<br />
#2 pmid=15842967 <br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/right-ventricle/ Right ventricle - all measurements (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Diastolic_Function&diff=553Diastolic Function2021-01-09T14:07:57Z<p>77.234.244.30: /* References */</p>
<hr />
<div>==The Left Ventricle==<br />
<br />
There is still much uncertainty about the pathophysiology of diastolic heart failure, effective treatment has not surfaced yet while it has a similar high mortality and morbidity rate when compared to systolic heart failure. One of the characteristics of diastolic heart failure is an increased LV diastolic stiffness. There are several important measurements echocardiographic measurement to estimate cardiac diastolic performance.<br />
<br />
==Left ventricular diastolic function==<br />
<br />
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="800px"<br />
|-<br />
!colspan="6"|<br />
===Normal Values diastolic parameters===<br />
|-<br />
!rowspan="2" valign="middle"|Measurement <br />
!colspan="4"|Age group (y)<br />
|-<br />
!16-20 <br />
!21-40 <br />
!41-60 <br />
!>60<br />
|-<br />
!IVRT (ms) <br />
|50 ± 9 (32-68) <br />
|67 ± 8 (51-83) <br />
|74 ± 7 (60-88) <br />
|87 ± 7 (73-101)<br />
|-<br />
!E/A ratio <br />
|1.88 ± 0.45 (0.98-2.78) <br />
|1.53 ± 0.40 (0.73-2.33) <br />
|1.28 ± 0.25 (0.78-1.78) <br />
|0.96 ± 0.18 (0.6-1.32)<br />
|-<br />
!DT (ms) <br />
|142 ± 19 (104-180) <br />
|166 ± 14 (138-194) <br />
|181 ± 19 (143-219) <br />
|200 ± 29 (142-258)<br />
|-<br />
!A duration (ms) <br />
|113 ± 17 (79-147) <br />
|127 ± 13 (101-153) <br />
|133 ± 13 (107-159) <br />
|138 ± 19 (100-176)<br />
|-<br />
!PV S/D ratio <br />
|0.82 ± 0.18 (0.46-1.18) <br />
|0.98 ± 0.32 (0.34-1.62) <br />
|1.21 ± 0.2 (0.81-1.61) <br />
|1.39 ± 0.47 (0.45-2.33)<br />
|-<br />
!PV Ar (cm/s) <br />
|16 ± 10 (1-36) <br />
|21 ± 8 (5-37) <br />
|23 ± 3 (17-29) <br />
|25 ± 9 (11-39)<br />
|-<br />
!PV Ar duration (ms) <br />
|66 ± 39 (1-144) <br />
|96 ± 33 (30-162) <br />
|112 ± 15 (82-142) <br />
|113 ± 30 (53-173)<br />
|-<br />
!Septal e´ (cm/s) <br />
|14.9 ± 2.4 (10.1-19.7) <br />
|15.5 ± 2.7 (10.1-20.9) <br />
|12.2 ± 2.3 (7.6-16.8) <br />
|10.4 ± 2.1 (6.2-14.6)<br />
|-<br />
!Septal e´/a´ ratio <br />
|2.4* <br />
|1.6 ± 0.5 (0.6-2.6) <br />
|1.1 ± 0.3 (0.5-1.7) <br />
|0.85 ± 0.2 (0.45-1.25)<br />
|-<br />
!Lateral e´ (cm/s) <br />
|20.6 ± 3.8 (13-28.2) <br />
|19.8 ± 2.9 (14-25.6) <br />
|16.1 ± 2.3 (11.5-20.7) <br />
|12.9 ± 3.5 (5.9-19.9)<br />
|-<br />
!Lateral e´/a´ ratio <br />
|3.1* <br />
|1.9 ± 0.6 (0.7-3.1) <br />
|1.5 ± 0.5 (0.5-2.5) <br />
|0.9 ± 0.4 (0.1-1.7)<br />
|-<br />
|colspan="6"|<br />
*Data are expressed as mean ± SD (95% confidence interval). Note that for e´ velocity in subjects aged 16 to 20 years, values overlap with those for subjects aged 21 to 40 years. This is because e´ increases progressively with age in children and adolescents. Therefore, the e´ velocity is higher in a normal 20-year-old than in a normal 16-year-old, which results in a somewhat lower average e´ value when subjects aged 16 to 20 years are considered.<cite>1</cite><br />
*<nowiki>*</nowiki>Standard deviations are not included because these data were computed, not directly provided in the original articles from which they were derived.<br />
|}<br />
<br />
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="800px"<br />
|-<br />
!<br />
===Schematic diastolic filling patterns===<br />
|-<br />
|'''A patient with dyspnea, preserved systolic LV function, dilated left atrium and elevated pulmonary artery systolic pressure, without any significant mitral valve disease that could explain these findings, is the patient that requires an intensified search for diastolic LV dysfunction.'''<br />
|-<br />
|align="center" bgcolor="FFFFFF"|[[Image:Diastole.svg]]<br />
|-<br />
|'''I:''' impaired relaxation, '''II:''' moderate diastolic dysfunction (pseudonormal), '''III:''' restrictive left ventricular filling (impaired LV compliance), ECG: electrocardiogram, MI: mitral inflow, MA: mitral annular velocities, PVF: pulmonary venous flow, Vp: velocity of flow progression, LA: left atrium, PASP: pulmonary artery systolic pressure.<cite>2</cite><br />
<br />
Click [http://www.ecocardiografia.info/didat_diast_en_II.htm '''here'''] for animation on diastolic dysfunction<br />
|}<br />
<br />
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="800px"<br />
|-<br />
!<br />
<br />
===Diastolic function flowchart <cite>1</cite>===<br />
|-<br />
|align="center" bgcolor="FFFFFF"|[[Image:500px-Diastolicfunction svg.png]]<br />
|}<br />
<br />
==References==<br />
<biblio><br />
#1 pmid=19270053<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/diastolic-function/ Diastolic Function - all measurements (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Left_Ventricular_Dimensions&diff=577Left Ventricular Dimensions2021-01-09T14:06:25Z<p>77.234.244.30: /* References */</p>
<hr />
<div>==The Left Ventricle==<br />
[[Image:LeftVentricle.svg|200px|right|thumb|'''Example:''' Measurement end - Diastolic wall thickness (red) + LV diameter (green)]]<br />
<br />
Each echocardiogram includes an evaluation of the LV dimensions, wall thicknesses and function. <br />
<br />
Good measurements are essential and may have implications for therapy. The LV dimensions must be measured when the end-diastolic and end-systolic valves (MV and AoV) are closed in the parasternal long axis (PLAX) view. The measurement is performed in the basal portion of the LV by the chordae.<br />
<br />
===Left ventricular dimensions===<br />
<br />
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="700px"<br />
|-<br />
!rowspan="2"|<br />
!colspan="4"|Women <br />
!colspan="4"|Men<br />
|-<br />
|align="center"|'''Reference range''' <br />
|align="center"|'''Mildly abnormal''' <br />
|align="center"|'''Moderately abnormal''' <br />
|align="center"|'''Severely abnormal''' <br />
|align="center"|'''Reference range''' <br />
|align="center"|'''Mildly abnormal''' <br />
|align="center"|'''Moderately abnormal'''<br />
|align="center"|'''Severely abnormal'''<br />
|-<br />
|colspan="9"|'''LV dimension'''<br />
|-<br />
|LV diastolic diameter, cm <br />
|align="center"|3.9–5.3 <br />
|align="center"|5.4–5.7 <br />
|align="center"|5.8–6.1 <br />
|align="center"|≥6.2 <br />
|align="center"|4.2–5.9 <br />
|align="center"|6.0–6.3 <br />
|align="center"|6.4–6.8 <br />
|align="center"|≥6.9<br />
|-<br />
|LV diastolic diameter/BSA, cm/m<sup>2</sup> <br />
|align="center"|2.4–3.2 <br />
|align="center"|3.3–3.4 <br />
|align="center"|3.5–3.7 <br />
|align="center"|≥3.8 <br />
|align="center"|2.2–3.1 <br />
|align="center"|3.2–3.4 <br />
|align="center"|3.5–3.6 <br />
|align="center"|≥3.7<br />
|-<br />
|LV diastolic diameter/height, cm/m <br />
|align="center"|2.5–3.2 <br />
|align="center"|3.3–3.4 <br />
|align="center"|3.5–3.6 <br />
|align="center"|≥3.7 <br />
|align="center"|2.4–3.3 <br />
|align="center"|3.4–3.5 <br />
|align="center"|3.6–3.7 <br />
|align="center"|≥3.8<br />
|-<br />
|colspan="9"|'''LV volume'''<br />
|-<br />
|LV diastolic volume, mL <br />
|align="center"|56–104 <br />
|align="center"|105–117 <br />
|align="center"|118–130 <br />
|align="center"|≥131 <br />
|align="center"|67–155 <br />
|align="center"|156–178 <br />
|align="center"|179–201 <br />
|align="center"|≥201<br />
|-<br />
!LV diastolic volume/BSA, mL/m<sup>2</sup> <br />
!35–75 <br />
!76–86 <br />
!87–96 <br />
!≥97 <br />
!35–75 <br />
!76–86 <br />
!87–96 <br />
!≥97<br />
|-<br />
|LV systolic volume, mL <br />
|align="center"|19–49 <br />
|align="center"|50–59 <br />
|align="center"|60–69 <br />
|align="center"|≥70 <br />
|align="center"|22–58 <br />
|align="center"|59–70 <br />
|align="center"|71–82 <br />
|align="center"|≥83<br />
|-<br />
!LV systolic volume/BSA, mL/m<sup>2</sup> <br />
!12–30 <br />
!31–36 <br />
!37–42 <br />
!≥43 <br />
!12–30 <br />
!31–36 <br />
!37–42 <br />
!≥43<br />
|-<br />
|colspan="9"|<br />
*BSA, body surface area; LV, left ventricular.<br />
*'''Bold values:''' Recommended and best validated.<cite>1</cite><br />
|}<br />
<br />
===Left ventricular geometry and mass===<br />
<br />
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="700px"<br />
|-<br />
!rowspan="2"|<br />
!colspan="4"|Women <br />
!colspan="4"|Men<br />
|-<br />
|align="center"|'''Reference range''' <br />
|align="center"|'''Mildly abnormal''' <br />
|align="center"|'''Moderately abnormal''' <br />
|align="center"|'''Severely abnormal''' <br />
|align="center"|'''Reference range''' <br />
|align="center"|'''Mildly abnormal''' <br />
|align="center"|'''Moderately abnormal'''<br />
|align="center"|'''Severely abnormal'''<br />
|-<br />
|colspan="9"|'''Linear Method'''<br />
|-<br />
|LV mass, g <br />
|align="center"|67–162 <br />
|align="center"|163–186 <br />
|align="center"|187–210 <br />
|align="center"|≥211 <br />
|align="center"|88–224 <br />
|align="center"|225–258 <br />
|align="center"|259–292 <br />
|align="center"|≥293<br />
|-<br />
!LV mass/BSA, g/m2 <br />
!43–95 <br />
!96–108 <br />
!109–121 <br />
!≥122 <br />
!49–115 <br />
!116–131 <br />
!132–148 <br />
!≥149<br />
|-<br />
|LV mass/height, g/m <br />
|align="center"|41–99 <br />
|align="center"|100–115 <br />
|align="center"|116–128 <br />
|align="center"|≥129 <br />
|align="center"|52–126 <br />
|align="center"|127–144 <br />
|align="center"|145–162 <br />
|align="center"|≥163<br />
|-<br />
|LV mass/height<sup>2</sup>, g/m2 <br />
|align="center"|18–44 <br />
|align="center"|45–51 <br />
|align="center"|52–58 <br />
|align="center"|≥59 <br />
|align="center"|20–48 <br />
|align="center"|49–55 <br />
|align="center"|56–63 <br />
|align="center"|≥64<br />
|-<br />
|Relative wall thickness, cm <br />
|align="center"|0.22–0.42 <br />
|align="center"|0.43–0.47 <br />
|align="center"|0.48–0.52 <br />
|align="center"|≥0.53 <br />
|align="center"|0.24–0.42 <br />
|align="center"|0.43–0.46 <br />
|align="center"|0.47–0.51 <br />
|align="center"|≥0.52<br />
|-<br />
!Septal thickness, cm <br />
!0.6–0.9 <br />
!1.0–1.2 <br />
!1.3–1.5 <br />
!≥1.6 <br />
!0.6–1.0 <br />
!1.1–1.3 <br />
!1.4–1.6 <br />
!≥1.7<br />
|-<br />
!Posterior wall thickness, cm <br />
!0.6–0.9 <br />
!1.0–1.2 <br />
!1.3–1.5 <br />
!≥1.6 <br />
!0.6–1.0 <br />
!1.1–1.3 <br />
!1.4–1.6 <br />
!≥1.7<br />
|-<br />
|colspan="9"|'''2D Method'''<br />
|-<br />
|LV mass, g<br />
|align="center"|66–150 <br />
|align="center"|151–171 <br />
|align="center"|172–182 <br />
|align="center"|>193 <br />
|align="center"|96–200 <br />
|align="center"|201–227 <br />
|align="center"|228–254 <br />
|align="center"|>255<br />
|-<br />
!LV mass/BSA, g/m<sup>2</sup> <br />
!44–88 <br />
!89–100 <br />
!101–112 <br />
!≥113 <br />
!50–102 <br />
!103–116 <br />
!117–130 <br />
!≥131<br />
|-<br />
|colspan="9"|<br />
*BSA, body surface area; LV, left ventricular.<br />
*'''Bold values:''' Recommended and best validated.<cite>1</cite><br />
*Click [http://csecho.ca/cardiomath/?eqnHD=echo&eqnDisp=lvmlvmi '''here'''] for calculation of LV mass.<br />
|}<br />
<br />
==References==<br />
<biblio><br />
#1 Echocardiographic derived measures are reported as internal diameter. Armstrong WF, Ryan, T, "Evaluation of systolic function of the left ventricle" in "Feigenbaum's Echocardiography", 7th ed, Philadelphia, Lippincott Williams & Wilkins, p.123.<br />
#2 pmid=16458610<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/left-ventricle/ Left ventricular dimensions - all measurements (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Subcostal_view&diff=6591Subcostal view2021-01-09T14:01:59Z<p>77.234.244.30: /* Sources */</p>
<hr />
<div>{{DevelopmentPhase}}<br />
{{auteurs|<br />
|mainauthor= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|moderator= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|supervisor=<br />
}}<br />
<br />
==How to Get a Good Subcostal View==<br />
The subcostal views of the heart allows the assessment of both the left and right sides of the heart, which is not possible with parasternal planes. To get a good subcostal view image, the patient is placed in a supine position. The subcostal view is found by placing the transducer just below the xyphoid, under the ribcage.<br />
To obtain the subcostal four chamber view, place the transducer over the center of the epigastrium and tilt it downward from the suprasternal notch to the left shoulder of the patient. The image produced will be similar to the apical four chamber view. The short-axis subcostal view on the other hand is similar to the parasternal view and is ideal for studying the right side of the heart.<br />
==Structures Seen in Subcostal View===<br />
The four cardiac chambers, the right ventricular outflow tract, the aorta, and the vena cava can be visualized in the subcostal view. Sometimes, it is also possible to visualize a portion of the abdominal aorta. Pointing the transducer toward the right side of the patient would result in a good view of showing the liver and suprahepatic veins, as well as a transverse cross section of the inferior vena cava.<br />
==Purposes of the Subcostal View==<br />
The subcostal view is important for the assessment of the presence of emphysema and chronic obstructive lung disease. Defects of the atrial septum is evaluated with the use of this view. Also, the analysis of lateral and inferior wall contractility, apex of the right ventricle, presence of pericardial effusion is done. Wall motion may be assessed at the level of the septum and let ventricular inferoposterior.<br />
==Example==<br />
{{IncludeFlash<br />
|flash_string=<flash>file=subcostal_normal.swf|quality=best|align=center|width=300|height=200</flash><br />
|Description=Subcostal view of a normal heart<br />
|file_name=subcostal_normal<br />
}}<br />
{{clr}}<br />
==Sources==<br />
<biblio><br />
#Zamorano isbn=1848824203<br />
#Feigenbaum1 isbn=0781795575<br />
#Nihoyannopoulos isbn=1848822928<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/view/26/ Subcostal view - Image & video (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Suprasternal_view&diff=6535Suprasternal view2021-01-09T13:59:24Z<p>77.234.244.30: /* Sources */</p>
<hr />
<div>{{DevelopmentPhase}}<br />
{{auteurs|<br />
|mainauthor= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|moderator= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|supervisor=<br />
}}<br />
<br />
==How to Get a Good Suprasternal View==<br />
The suprasternal view is found placing the transducer on angulus Lidovici. The suprasternal view is usually a routine part of echocardiograms for adults, although it is not always clear. It is obtained while the patient is supine with his or her head extended backward (chin up).Here, the transducer is placed on the suprasternal notch. The index marker must be pointed up toward the head of the patient.<br />
<br />
Depending on the orientation of the transducer, two different images of the aorta may be viewed. To obtain the suprasternal short axis, rotate the transducer 90 degrees clockwise from the long axis, while orientation of the transducer parallel to the trachea will give the suprasternal long axis.<br />
<br />
==Structures that can be seen in the Suprasternal View==<br />
The suprasternal view permits the visualization of the following structures: ascending and descending aorta and the aortic arch. Also, both the left sublclavian arteries left carotid arteries can be assessed with this view. The left atrium and the right pulmonary artery may be seen under the aortic arch. <br />
<br />
<br />
==Example of a suprasternal view==<br />
This a normal heart<br />
{{IncludeFlash<br />
|flash_string=<flash>file=SuprasternalNormal.swf|quality=best|align=center|width=300|height=200</flash><br />
|Description=Suprasternal view of a normal heart<br />
|file_name=SuprasternalNormal<br />
}}<br />
{{clr}}<br />
==Sources==<br />
<biblio><br />
#Allen isbn=0397552629<br />
#Feigenbaum1 isbn=0781795575<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/view/29/ Suprasternal view - Image & video (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Apical_5_Chamber&diff=6426Apical 5 Chamber2021-01-09T13:57:13Z<p>77.234.244.30: /* Sources */</p>
<hr />
<div>{{DevelopmentPhase}}<br />
{{auteurs|<br />
|mainauthor= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|moderator= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|supervisor=<br />
}}<br />
<br />
==How to Get a Good Apical Five Chamber View==<br />
To obtain a good apical five chamber view, the apical four chamber view must first be acquired. The apical five chamber view is found by placing the transducer on the apex of the heart, near the Ictus Cordis. A slight counterclockwise and upward tilt of the of the transducer from will show the image of what is considered the fifth chamber, the aorta. This movement will make the image of the right atrium and tricuspid valve disappear from the monitor, replacing it with the image of the aorta. The aorta can now be seen in the position where the crux cordis was.<br />
To get a better view, the transducer may be moved an intercostal space higher and laterally to align the ultrasound beam with the left ventricular outflow tract. <br />
==Structures Seen in an Apical Five Chamber View==<br />
The following structures may be seen in the apical five chamber view: aorta, aortic valve, left ventricular outflow tract, proximal segment of the ascending thoracic aorta. These structures may be evaluated in relation to the mitral valve and the interventricular septum.<br />
==Purposes of an Apical Five Chamber View==<br />
The presence of the aortic stenosis and the assessment of its severity may be achieved with the help of a good apical five chamber view, as well as detection of aortic regurgitation. Using the color Doppler helps in the assessment of the aortic regurgitation and stenosis and even acceleration around the aortic outflow tract.<br />
==Example of an apical 5 chamber view==<br />
This a normal heart<br />
{{IncludeFlash<br />
|flash_string=<flash>file=A5Cnormal.swf|quality=best|align=center|width=300|height=200</flash><br />
|Description=Apical 5 chamber view of a normal heart<br />
|file_name=A5Cnormal<br />
}}<br />
{{clr}}<br />
==Sources==<br />
<biblio><br />
#Zamorano isbn=1848824203<br />
#Feigenbaum1 isbn=0781795575<br />
#Nihoyannopoulos isbn=1848822928<br />
<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/view/17/ A5C - Image & video (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Apical_2_chamber&diff=674Apical 2 chamber2021-01-09T13:56:11Z<p>77.234.244.30: /* External links */</p>
<hr />
<div>{{DevelopmentPhase}}<br />
{{auteurs|<br />
|mainauthor= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|moderator= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|supervisor=<br />
}}<br />
<br />
==How to Get a Good Apical Two Chamber View==<br />
[[File:Heart apical 2chamber.jpg|thumb|An apical two chamber view of the heart]]<br />
[[File:Heart apical 2chamber myocadial regions.svg|An apical two chamber view of the heart]]<br />
The apical two chamber view is found by placing the transducer on the apex of the heart, near the Ictus Cordis. Rotation of the transducer by 35 to 45 degrees counterclockwise and angled toward the right shoulder will allow visualization of the apical two chamber view. This view permits the assessment of the inferior and anterior walls of the left ventricle. You will know that you have acquired a true apical two chamber view when right-sided structures are not seen. The landmark of a true apical two chamber is the coronary sinus, a small circular structure found at the atrioventricular junction.<br />
<br />
==Purposes of Getting a Good Apical Two Chamber View==<br />
This view permits the assessment and evaluation of left ventricular size and function. The coronary sinus, its size and structural condition may also be viewed. Its significance lies in the fact that a dilated coronary sinus can mean abnormal attachment of pulmonary veins and other abnormalities. Other pathologic processes such as the presence of inferior or anterior wall motion abnormalities can be seen using the apical two chamber view. Left ventricular thrombus can also be detected and its presence confirmed. <br />
==Doppler Imaging in Apical Two Chamber View==<br />
Doppler imaging is essentially done in this view to assess flow across the mitral valve. Patients without cardiac pathologies would manifest a flow pattern of two peaks. These are the E (rapid filling in the diastole) and the A (result of atrial contraction) waves. Normally, the A wave is smaller than the E wave. The presence of pathologies and the influence of other factors such as blood pressure and age, however, may cause different patterns. <br />
Color Doppler is used to appreciate flow direction and to determine velocity and pressure measurements.<br />
==Example of an Apical Two Chamber view==<br />
This a normal heart <br />
{{IncludeFlash<br />
|flash_string=<flash>file=A2Cnormal.swf|quality=best|align=center|width=300|height=200</flash><br />
|Description=Apical 2 chamber view of a normal heart<br />
|file_name=A2Cnormal<br />
}}<br />
<br />
{{clr}}<br />
<br />
==Sources==<br />
<biblio><br />
#Allen isbn=0397552629<br />
#Feigenbaum1 isbn=0781795575<br />
<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/view/20/ A2C - Image & video (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Standard_imaging_Views&diff=6437Standard imaging Views2021-01-09T13:55:46Z<p>77.234.244.30: /* External links */</p>
<hr />
<div>'''Parasternal Imaging Planes'''<br />
*[[Parasternal long axis]]<br />
*[[Parasternal short axis]]<br />
'''Apical Imaging Planes'''<br />
*[[Apical 4 chamber]]<br />
*[[Apical 2 chamber]]<br />
*[[Apical 3 chamber]]<br />
*[[Apical 5 Chamber]]<br />
*[[suprasternal view]]<br />
*[[subcostal view]]<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/views/ 41 echo views - Images & Videos (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Standard_imaging_Views&diff=6436Standard imaging Views2021-01-09T13:55:18Z<p>77.234.244.30: /* External links */</p>
<hr />
<div>'''Parasternal Imaging Planes'''<br />
*[[Parasternal long axis]]<br />
*[[Parasternal short axis]]<br />
'''Apical Imaging Planes'''<br />
*[[Apical 4 chamber]]<br />
*[[Apical 2 chamber]]<br />
*[[Apical 3 chamber]]<br />
*[[Apical 5 Chamber]]<br />
*[[suprasternal view]]<br />
*[[subcostal view]]<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/view/20/ 41 echo views - Images & Videos (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Apical_3_chamber&diff=6459Apical 3 chamber2021-01-09T13:54:48Z<p>77.234.244.30: /* Sources */</p>
<hr />
<div>{{DevelopmentPhase}}<br />
{{auteurs|<br />
|mainauthor= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|moderator= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|supervisor=<br />
}}<br />
<br />
==How to Get a Good Apical Three Chamber View==<br />
The apical three chamber view is found by placing the transducer on the apex of the heart, near the Ictus Cordis. The apical three chamber view is also known as the apical long axis view. This view may be obtained by rotating the transducer counterclockwise by 30–45 degrees away the apical two chamber view while the head of the transducer stays on the same position as it were for the apical four chamber view. The posterior apex may be adequately viewed from the apical three chamber view. The following other structures may also be appreciated: the left ventricle (along with the septum, posterior walls, and portions of the apex), aortic valve, ascending aorta, left ventricular outflow tract, left atrium, and mitral valve (posterior and anterior leaflets).<br />
==Purposes of Getting a Good Apical Three Chamber View==<br />
The apical three chamber view is similar to the parasternal long axis view. Aneurysms, wall motion abnormalities, and the presence of clot can all be assessed from this view. As mentioned, the anterior and posterior leaflets can be observed, therefore allowing the evaluation of mitral valve structure and integrity. Since there is complete visualization of the left atrium, its contents, area, and size are can be completely evaluated. The left ventricular outflow tract may be evaluated for subaortic obstructions or membranes.<br />
==Doppler Imaging in Apical Three Chamber View==<br />
As with apical two chamber view, Doppler may be used to assess the mitral valve more thoroughly. The following may be ascertained through Doppler: presence of regurgitation, stenosis, and blood flow velocities. Doppler is especially applicable for assessing the maximum velocities across the aortic valve and outflow tract, especially when apical five chamber view is suboptimal, and can measure the diameter of the outflow tract of the left ventricle. <br />
Outflow and valvular velocities may be measured in cases of aortic stenosis, while site of obstruction may be identified in cases of subaortic stenosis. Suboartic obstruction may be identified when the velocity exceeds the Nyquist limit. Doppler may also be sued to evaluate for the presence of aortic insufficiency.<br />
==Example of an Apical Three Chamber View==<br />
<br />
{{IncludeFlash<br />
|flash_string=<flash>file=A3Cnormal.swf|quality=best|align=center|width=300|height=200</flash><br />
|Description=Apical 3 chamber view of a normal heart<br />
|file_name=A3Cnormal<br />
}}<br />
{{clr}}<br />
==Sources==<br />
<biblio><br />
#Allen isbn=0397552629<br />
#Feigenbaum1 isbn=0781795575<br />
#Nihoyannopoulos isbn=1848822928<br />
<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/view/22/ A3C - Image & video (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Apical_2_chamber&diff=673Apical 2 chamber2021-01-09T13:53:44Z<p>77.234.244.30: /* Sources */</p>
<hr />
<div>{{DevelopmentPhase}}<br />
{{auteurs|<br />
|mainauthor= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|moderator= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|supervisor=<br />
}}<br />
<br />
==How to Get a Good Apical Two Chamber View==<br />
[[File:Heart apical 2chamber.jpg|thumb|An apical two chamber view of the heart]]<br />
[[File:Heart apical 2chamber myocadial regions.svg|An apical two chamber view of the heart]]<br />
The apical two chamber view is found by placing the transducer on the apex of the heart, near the Ictus Cordis. Rotation of the transducer by 35 to 45 degrees counterclockwise and angled toward the right shoulder will allow visualization of the apical two chamber view. This view permits the assessment of the inferior and anterior walls of the left ventricle. You will know that you have acquired a true apical two chamber view when right-sided structures are not seen. The landmark of a true apical two chamber is the coronary sinus, a small circular structure found at the atrioventricular junction.<br />
<br />
==Purposes of Getting a Good Apical Two Chamber View==<br />
This view permits the assessment and evaluation of left ventricular size and function. The coronary sinus, its size and structural condition may also be viewed. Its significance lies in the fact that a dilated coronary sinus can mean abnormal attachment of pulmonary veins and other abnormalities. Other pathologic processes such as the presence of inferior or anterior wall motion abnormalities can be seen using the apical two chamber view. Left ventricular thrombus can also be detected and its presence confirmed. <br />
==Doppler Imaging in Apical Two Chamber View==<br />
Doppler imaging is essentially done in this view to assess flow across the mitral valve. Patients without cardiac pathologies would manifest a flow pattern of two peaks. These are the E (rapid filling in the diastole) and the A (result of atrial contraction) waves. Normally, the A wave is smaller than the E wave. The presence of pathologies and the influence of other factors such as blood pressure and age, however, may cause different patterns. <br />
Color Doppler is used to appreciate flow direction and to determine velocity and pressure measurements.<br />
==Example of an Apical Two Chamber view==<br />
This a normal heart <br />
{{IncludeFlash<br />
|flash_string=<flash>file=A2Cnormal.swf|quality=best|align=center|width=300|height=200</flash><br />
|Description=Apical 2 chamber view of a normal heart<br />
|file_name=A2Cnormal<br />
}}<br />
<br />
{{clr}}<br />
<br />
==Sources==<br />
<biblio><br />
#Allen isbn=0397552629<br />
#Feigenbaum1 isbn=0781795575<br />
<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/echo/projekcia/20/ A2C - Image & video (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Apical_4_chamber&diff=695Apical 4 chamber2021-01-09T13:52:38Z<p>77.234.244.30: /* Sources */</p>
<hr />
<div>{{DevelopmentPhase}}<br />
{{auteurs|<br />
|mainauthor= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|moderator= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|supervisor=<br />
}}<br />
<br />
<br />
==How to Get a Good Apical Four Chamber View==<br />
[[File:Heart apical 4c anatomy.jpg|thumb|An apical four chamber view of the heart]]<br />
[[File:Heart_apical_4_chamber.svg|thumb]]<br />
The apical four chamber view is found by placing the transducer on the apex of the heart, near the apical impulse. The general rotation of the heart can be seen in the [[Parasternal long axis]] and one can follow a line to the apex of the heart on the patient's left side. Often it helps if the patient rotates to their left so that the heart becomes closer to the transducer.<br />
<br />
==Purposes and Characteristics of a Good Apical Four Chamber View==<br />
This view is important in the assessment of size and function of the ventricles, atria, and the vascular structure and function. It also allows the visualization of the septal and lateral free walls and the apex of the left ventricle. The mitral and tricuspid valve and the interventricular and interatrial septa are also seen. In an ideal apical four chamber view, the apex of the left ventricle is at the center of where the septum and lateral wall meet.<br />
<br />
The atria and apex of the heart can be observed in the image’s lower and upper regions, respectively. The left and right cavities of the heart and their respective atrio-ventricular valves are found in the right and left regions of the image, respectively. <br />
Usually, the mitral valve can be seen at a slightly higher position than the tricuspid valve. To identify ventricular chambers properly, bear in mind the correct location of the leaflets: the anterior mitral leaflet is near the cephalic edge of the septum, inserting into the left atrio-ventricular groove, and the septal leaflet of the tricuspid is below the anterior mitral leaflet. <br />
<br />
==Example of an Apical Four Chamber view==<br />
By convention, the probe is positioned with the marker to the patient's left axilla so that the left ventricle is shown on the viewer's right side. In the picture, the left ventricle is on the top right with the left atrium opening into it through the mitral valve, and the right ventricle is on the left side with the right atrium opening into it through the tricuspid valve. This view is useful to compare the sizes of the left and right ventricular walls and to find out whether or not a pericardial effusion is present. If a pericardial effusion is present then a dark (non-echogenic) space will be seen between the outer ventricular walls and the pericardial sac.<br />
{{IncludeFlash<br />
|flash_string=<flash>file=A4C_normal.swf|quality=best|align=center|width=300|height=200</flash><br />
|Description=Apical 4 chamber view of a normal heart<br />
|file_name=A4C_normal<br />
}}<br />
{{clr}}<br />
==Sources==<br />
<biblio><br />
#Zamorano isbn=1848824203<br />
#Feigenbaum1 isbn=0781795575<br />
#Nihoyannopoulos isbn=1848822928<br />
<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/view/14/ A4C - Image & video (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Parasternal_short_axis&diff=6420Parasternal short axis2021-01-09T13:50:47Z<p>77.234.244.30: /* Sources */</p>
<hr />
<div>{{DevelopmentPhase}}<br />
{{auteurs|<br />
|mainauthor= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|moderator= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|supervisor=<br />
}}<br />
<br />
==Purposes of Getting a Good Parasternal Short Axis View==<br />
The parasternal short axis view is the cross-sectional view of the heart. It analyzes the different sections of the heart from the base to the apex. This view is useful in helping with the diagnosis of mitral stenosis and congenital heart disease, among others.<br />
==How to Get a Good Parasternal Short Axis View==<br />
[[Image:Heart_normal_short_axis_echo.png|thumb|Image showing the left parasternal short axis transection (SAX) of the heart and the different structures]]<br />
As with the parasternal long axis, the probe placement in locating the parasternal short axis is still the same, but the rotation and orientation of the beam differ.<br />
This view is usually taken right after the parasternal long axis view. So with the probe already at the left side of the sternum, to get a good parasternal short axis view, start with rotating the transducer 90° clockwise. The probe has tendency to slide so apply light pressure while manipulating it. For a better view, the patient may be placed in a left lateral decubitus position or the probe may be moved to higher intercostal spaces.<br />
{{clr}}<br />
==Levels of Imaging in PSS==<br />
Theoretically, there are numerous short axes between the apex and base of the heart. However, the parasternal short axis view (SAX) is usually made on three levels: mitral valve level, midpapillary level, and aortic level. <br />
<br />
==Mitral Valve Level==<br />
The tip of the anterior mitral valve leaflet is the most useful starting point in starting this level of inspection of the parasternal short axis view. This level shows the cross section of the left ventricle defined by the thick muscular walls of the interventricular septum and the lateral free wall. Proper recording in this level allows assessment of the wall motion of the mid-left ventricle and mitral leaflet excursion as well as visualization of a part of the right ventricle. Any abnormalities in the curvature of the interventricular septum, and its motion, shape, or position may be detected. <br />
A common feature of this level is the so-called “goldfish mouth” look of the mitral valve leaflets. Subtly weeping the beam of the probe from the base to the apex will provide the opportunity to assess the mitral valve orifices, mitral valve chordae and their insertion in the papillary muscles, and coaptation of the leaflets.<br />
The use of color Doppler while in the mitral level is useful in the diagnosis of mitral valve regurgitation and its origin and, with M-mode, its timing as well. <br />
{{IncludeFlash<br />
|flash_string=<flash>file=Test13.swf|quality=best|align=center|width=300|height=200</flash><br />
|file_name=Test13<br />
|Description=Echocardiographic parasternal short axis. Note the typical shape of the mitral valve <br />
}}<br />
{{clr}}<br />
==Midpapillary Level==<br />
Tilting the probe toward the apex scans the midpapillary plane of the parasternal short axis. This level in the parasternal short axis view shows the left ventricle clearly between the two papillary muscle groups. The left ventricle is bordered by lateral free wall on its right, the muscular interventricular septum on its left, and the inferior free wall at the bottom. The right ventricle is easily visualized and differentiated from the left because it has only one prominent papillary muscle.<br />
This view is ideally used for ventricular wall motion segmental analysis. Thickening and wall motion is visualized in ten segments of the mitral valve and papillary muscle levels.<br />
{{IncludeFlash<br />
|flash_string=<flash>file=SAXPAP_normal.swf|quality=best|align=center|width=300|height=200</flash><br />
|Description=A parasternal short axis on midpapillary level<br />
|file_name=SAXPAP_normal<br />
}}<br />
{{clr}}<br />
==Aortic Level==<br />
[[Image:Heart_aortic_short_axis_section.jpg|thumb|left|Heart aortic short axis]]<br />
The base of the heart or the aortic level of the parasternal long axis view can be visualized by tilting the transducer toward the patient’s right shoulder and by rotating it clockwise. The aortic valve is between the left atrium (anterior) and the right ventricle (posterior). The aortic valve and its three leaflets are part of the so-called Y-shape configuration composed of the coronary in the upper region, right coronary in the lower left, and non-coronary in the left. The following conditions can be assessed using the aortic level of the parasternal short axis view: aortic root size, structural alterations of the Valsalva sinus, proximal aortic dissection, and presence of anomalies of the aortic valve and abnormalities of the valve leaflets.<br />
Aside from the aortic valve, the other structures that may be observed from this level are the tricuspid valve (at the left of the aortic valve and above the posteroseptal leaflet), right ventricular outflow tract (along the aortic root), pulmonary valve (at the right and anterior to the aortic valve), and the pulmonary artery and both its left and right branches (around the aorta).<br />
This view is often omitted and is hard to acquire.<br />
{{IncludeFlash<br />
|flash_string=<flash>file=SAXAP_normal.swf|quality=best|align=left|width=300|height=200</flash><br />
|Description=A parasternal short axis on apical level<br />
|file_name=SAXAP_normal<br />
}}<br />
{{clr}}<br />
==Sources==<br />
<biblio><br />
#Zamorano isbn=1848824203<br />
#Feigenbaum1 isbn=0781795575<br />
<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/view/07/ PSAX - Image & video (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Parasternal_long_axis&diff=6505Parasternal long axis2021-01-09T13:10:00Z<p>77.234.244.30: /* External links */</p>
<hr />
<div>{{DevelopmentPhase}}<br />
{{auteurs|<br />
|mainauthor= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|moderator= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|supervisor=<br />
}}<br />
<br />
[[Image:echo_heart_parasternal_long_axis.jpg|thumb|Image showing the left parasternal long axis transection (PSLAX) of the heart by the ultrasound waves]]<br />
==How to Get a Good PLAX View==<br />
To get a good PLAX view, begin with placing the transducer in the third or fourth intercostal space and adjust as necessary, moving a few intercostals spaces up or down. Better results are obtained if the patient is placed in a left lateral decubitus position. This will allow better visualization of the mid-portion and base of the left ventricle, both leaflets of the mitral valve, the aortic valve and the aortic root, the left atrium and the right ventricle. <cite>Nihoyannopoulos</cite><br />
The transducer is traditionally moved and pointed toward the right shoulder to parallel the beam to the major axis of the left ventricle and to pass it through the center of the left ventricular chamber. Gradual medial to lateral angulation until the left ventricle size is at its maximum will allow one to see the minor axis at its maximal state and the mitral valve leaflet excursion at its greatest. Minor axis dimensions may then be viewed and recorded.<br />
==Purposes of Getting a Good Parasternal Long Axis (PLAX) View==<br />
Echocardiographic examination of the heart usually begins with a PLAX view. Acquiring a good PLAX view is important to assess left ventricular contractility and to determine the presence of pericardial effusion and right ventricular strain.<br />
==Characteristics of a Good PLAX View==<br />
One will be able to know of a good PLAX view is taken when the septum is oriented almost horizontally, clearly delineating between the left and right side of the heart, and the apex of the of the left ventricle and the tricuspid valve are not visualized. The mitral and aortic valves, however, should be visible.<br />
==Structures that can be seen in the PLAX view==<br />
[[Image:Heart_normal_lpla_echo_view.png|thumb|Schematic diagram of the different structures seen in a good PLAX view.]]<br />
*Right ventricle<br />
*Left ventricle<br />
*Mitral valve<br />
*Left atrium<br />
*Descending aorta<br />
*Aortic valve<br />
*Aortic root<br />
*Pericardium<br />
*Right ventricular inflow and outflow tracts<br />
{{clr}}<br />
==2D Echo Measurements==<br />
Majority of measurements are done with 2D echo imaging. Once the best diastolic frame having the largest left ventricular cavity is chosen, septal and posterior wall thickness, left ventricular diastolic cavity, and aortic root diameter can be determined. Use a systolic frame to measure the dimensions of the left ventricle and the left atrial diameter.<br />
<br />
==M-Mode Echo Measurement==<br />
[[Image:PLAX_Mmode.jpg|thumb|alt=Alt text|Image showing the left parasternal long axis transection (PSLAX) of the heart by M-mode imaging.]]<br />
<br />
Determining left ventricular dimensions and ejection fraction are few of the cases wherein M-mode imaging is used. It is one-dimensional and usually relies on the correct alignment of the M-mode along the left ventricle.<br />
<br />
==Using Color Doppler Ultrasound== <br />
It is sometimes necessary to use color Doppler ultrasound when valvular regurgitation is suspected, although this method should not be used to as the final diagnostic tool to determine valve dysfunction as the Doppler beam is nearly perpendicular to the flow. Instead, the presence of valvular regurgitation is based on the cardiac cycle, not the color-coding.<cite>Feigenbaum1</cite> <br />
<br />
==Example==<br />
This is a parasternal long axis view of a normal heart. <br />
{{IncludeFlash<br />
|flash_string=<flash>file=PLAXnormal.swf|quality=best|align=center|width=300|height=200</flash><br />
|Description=A parasternal long axis<br />
|file_name=PLAXnormal<br />
}}<br />
{{clr}}<br />
<br />
==References==<br />
<biblio><br />
#Nihoyannopoulos isbn=1848822928<br />
#Feigenbaum1 isbn=0781795575<br />
<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/view/01/ PLAX - Image & video (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Parasternal_long_axis&diff=6504Parasternal long axis2021-01-09T13:08:59Z<p>77.234.244.30: /* References */</p>
<hr />
<div>{{DevelopmentPhase}}<br />
{{auteurs|<br />
|mainauthor= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|moderator= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|supervisor=<br />
}}<br />
<br />
[[Image:echo_heart_parasternal_long_axis.jpg|thumb|Image showing the left parasternal long axis transection (PSLAX) of the heart by the ultrasound waves]]<br />
==How to Get a Good PLAX View==<br />
To get a good PLAX view, begin with placing the transducer in the third or fourth intercostal space and adjust as necessary, moving a few intercostals spaces up or down. Better results are obtained if the patient is placed in a left lateral decubitus position. This will allow better visualization of the mid-portion and base of the left ventricle, both leaflets of the mitral valve, the aortic valve and the aortic root, the left atrium and the right ventricle. <cite>Nihoyannopoulos</cite><br />
The transducer is traditionally moved and pointed toward the right shoulder to parallel the beam to the major axis of the left ventricle and to pass it through the center of the left ventricular chamber. Gradual medial to lateral angulation until the left ventricle size is at its maximum will allow one to see the minor axis at its maximal state and the mitral valve leaflet excursion at its greatest. Minor axis dimensions may then be viewed and recorded.<br />
==Purposes of Getting a Good Parasternal Long Axis (PLAX) View==<br />
Echocardiographic examination of the heart usually begins with a PLAX view. Acquiring a good PLAX view is important to assess left ventricular contractility and to determine the presence of pericardial effusion and right ventricular strain.<br />
==Characteristics of a Good PLAX View==<br />
One will be able to know of a good PLAX view is taken when the septum is oriented almost horizontally, clearly delineating between the left and right side of the heart, and the apex of the of the left ventricle and the tricuspid valve are not visualized. The mitral and aortic valves, however, should be visible.<br />
==Structures that can be seen in the PLAX view==<br />
[[Image:Heart_normal_lpla_echo_view.png|thumb|Schematic diagram of the different structures seen in a good PLAX view.]]<br />
*Right ventricle<br />
*Left ventricle<br />
*Mitral valve<br />
*Left atrium<br />
*Descending aorta<br />
*Aortic valve<br />
*Aortic root<br />
*Pericardium<br />
*Right ventricular inflow and outflow tracts<br />
{{clr}}<br />
==2D Echo Measurements==<br />
Majority of measurements are done with 2D echo imaging. Once the best diastolic frame having the largest left ventricular cavity is chosen, septal and posterior wall thickness, left ventricular diastolic cavity, and aortic root diameter can be determined. Use a systolic frame to measure the dimensions of the left ventricle and the left atrial diameter.<br />
<br />
==M-Mode Echo Measurement==<br />
[[Image:PLAX_Mmode.jpg|thumb|alt=Alt text|Image showing the left parasternal long axis transection (PSLAX) of the heart by M-mode imaging.]]<br />
<br />
Determining left ventricular dimensions and ejection fraction are few of the cases wherein M-mode imaging is used. It is one-dimensional and usually relies on the correct alignment of the M-mode along the left ventricle.<br />
<br />
==Using Color Doppler Ultrasound== <br />
It is sometimes necessary to use color Doppler ultrasound when valvular regurgitation is suspected, although this method should not be used to as the final diagnostic tool to determine valve dysfunction as the Doppler beam is nearly perpendicular to the flow. Instead, the presence of valvular regurgitation is based on the cardiac cycle, not the color-coding.<cite>Feigenbaum1</cite> <br />
<br />
==Example==<br />
This is a parasternal long axis view of a normal heart. <br />
{{IncludeFlash<br />
|flash_string=<flash>file=PLAXnormal.swf|quality=best|align=center|width=300|height=200</flash><br />
|Description=A parasternal long axis<br />
|file_name=PLAXnormal<br />
}}<br />
{{clr}}<br />
<br />
==References==<br />
<biblio><br />
#Nihoyannopoulos isbn=1848822928<br />
#Feigenbaum1 isbn=0781795575<br />
<br />
</biblio><br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/view/01/ PLAX - Parasternal long axis (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=Parasternal_long_axis&diff=6503Parasternal long axis2021-01-09T13:08:44Z<p>77.234.244.30: </p>
<hr />
<div>{{DevelopmentPhase}}<br />
{{auteurs|<br />
|mainauthor= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|moderator= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|supervisor=<br />
}}<br />
<br />
[[Image:echo_heart_parasternal_long_axis.jpg|thumb|Image showing the left parasternal long axis transection (PSLAX) of the heart by the ultrasound waves]]<br />
==How to Get a Good PLAX View==<br />
To get a good PLAX view, begin with placing the transducer in the third or fourth intercostal space and adjust as necessary, moving a few intercostals spaces up or down. Better results are obtained if the patient is placed in a left lateral decubitus position. This will allow better visualization of the mid-portion and base of the left ventricle, both leaflets of the mitral valve, the aortic valve and the aortic root, the left atrium and the right ventricle. <cite>Nihoyannopoulos</cite><br />
The transducer is traditionally moved and pointed toward the right shoulder to parallel the beam to the major axis of the left ventricle and to pass it through the center of the left ventricular chamber. Gradual medial to lateral angulation until the left ventricle size is at its maximum will allow one to see the minor axis at its maximal state and the mitral valve leaflet excursion at its greatest. Minor axis dimensions may then be viewed and recorded.<br />
==Purposes of Getting a Good Parasternal Long Axis (PLAX) View==<br />
Echocardiographic examination of the heart usually begins with a PLAX view. Acquiring a good PLAX view is important to assess left ventricular contractility and to determine the presence of pericardial effusion and right ventricular strain.<br />
==Characteristics of a Good PLAX View==<br />
One will be able to know of a good PLAX view is taken when the septum is oriented almost horizontally, clearly delineating between the left and right side of the heart, and the apex of the of the left ventricle and the tricuspid valve are not visualized. The mitral and aortic valves, however, should be visible.<br />
==Structures that can be seen in the PLAX view==<br />
[[Image:Heart_normal_lpla_echo_view.png|thumb|Schematic diagram of the different structures seen in a good PLAX view.]]<br />
*Right ventricle<br />
*Left ventricle<br />
*Mitral valve<br />
*Left atrium<br />
*Descending aorta<br />
*Aortic valve<br />
*Aortic root<br />
*Pericardium<br />
*Right ventricular inflow and outflow tracts<br />
{{clr}}<br />
==2D Echo Measurements==<br />
Majority of measurements are done with 2D echo imaging. Once the best diastolic frame having the largest left ventricular cavity is chosen, septal and posterior wall thickness, left ventricular diastolic cavity, and aortic root diameter can be determined. Use a systolic frame to measure the dimensions of the left ventricle and the left atrial diameter.<br />
<br />
==M-Mode Echo Measurement==<br />
[[Image:PLAX_Mmode.jpg|thumb|alt=Alt text|Image showing the left parasternal long axis transection (PSLAX) of the heart by M-mode imaging.]]<br />
<br />
Determining left ventricular dimensions and ejection fraction are few of the cases wherein M-mode imaging is used. It is one-dimensional and usually relies on the correct alignment of the M-mode along the left ventricle.<br />
<br />
==Using Color Doppler Ultrasound== <br />
It is sometimes necessary to use color Doppler ultrasound when valvular regurgitation is suspected, although this method should not be used to as the final diagnostic tool to determine valve dysfunction as the Doppler beam is nearly perpendicular to the flow. Instead, the presence of valvular regurgitation is based on the cardiac cycle, not the color-coding.<cite>Feigenbaum1</cite> <br />
<br />
==Example==<br />
This is a parasternal long axis view of a normal heart. <br />
{{IncludeFlash<br />
|flash_string=<flash>file=PLAXnormal.swf|quality=best|align=center|width=300|height=200</flash><br />
|Description=A parasternal long axis<br />
|file_name=PLAXnormal<br />
}}<br />
{{clr}}<br />
<br />
==References==<br />
<biblio><br />
#Nihoyannopoulos isbn=1848822928<br />
#Feigenbaum1 isbn=0781795575<br />
<br />
</biblio></div>77.234.244.30https://echopedia.org/index.php?title=Parasternal_long_axis&diff=6502Parasternal long axis2021-01-09T13:08:16Z<p>77.234.244.30: </p>
<hr />
<div>{{DevelopmentPhase}}<br />
{{auteurs|<br />
|mainauthor= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|moderator= [[user:Vdbilt|I.A.C. van der Bilt]]<br />
|supervisor=<br />
}}<br />
<br />
[[Image:echo_heart_parasternal_long_axis.jpg|thumb|Image showing the left parasternal long axis transection (PSLAX) of the heart by the ultrasound waves]]<br />
==How to Get a Good PLAX View==<br />
To get a good PLAX view, begin with placing the transducer in the third or fourth intercostal space and adjust as necessary, moving a few intercostals spaces up or down. Better results are obtained if the patient is placed in a left lateral decubitus position. This will allow better visualization of the mid-portion and base of the left ventricle, both leaflets of the mitral valve, the aortic valve and the aortic root, the left atrium and the right ventricle. <cite>Nihoyannopoulos</cite><br />
The transducer is traditionally moved and pointed toward the right shoulder to parallel the beam to the major axis of the left ventricle and to pass it through the center of the left ventricular chamber. Gradual medial to lateral angulation until the left ventricle size is at its maximum will allow one to see the minor axis at its maximal state and the mitral valve leaflet excursion at its greatest. Minor axis dimensions may then be viewed and recorded.<br />
==Purposes of Getting a Good Parasternal Long Axis (PLAX) View==<br />
Echocardiographic examination of the heart usually begins with a PLAX view. Acquiring a good PLAX view is important to assess left ventricular contractility and to determine the presence of pericardial effusion and right ventricular strain.<br />
==Characteristics of a Good PLAX View==<br />
One will be able to know of a good PLAX view is taken when the septum is oriented almost horizontally, clearly delineating between the left and right side of the heart, and the apex of the of the left ventricle and the tricuspid valve are not visualized. The mitral and aortic valves, however, should be visible.<br />
==Structures that can be seen in the PLAX view==<br />
[[Image:Heart_normal_lpla_echo_view.png|thumb|Schematic diagram of the different structures seen in a good PLAX view.]]<br />
*Right ventricle<br />
*Left ventricle<br />
*Mitral valve<br />
*Left atrium<br />
*Descending aorta<br />
*Aortic valve<br />
*Aortic root<br />
*Pericardium<br />
*Right ventricular inflow and outflow tracts<br />
{{clr}}<br />
==2D Echo Measurements==<br />
Majority of measurements are done with 2D echo imaging. Once the best diastolic frame having the largest left ventricular cavity is chosen, septal and posterior wall thickness, left ventricular diastolic cavity, and aortic root diameter can be determined. Use a systolic frame to measure the dimensions of the left ventricle and the left atrial diameter.<br />
<br />
==M-Mode Echo Measurement==<br />
[[Image:PLAX_Mmode.jpg|thumb|alt=Alt text|Image showing the left parasternal long axis transection (PSLAX) of the heart by M-mode imaging.]]<br />
<br />
Determining left ventricular dimensions and ejection fraction are few of the cases wherein M-mode imaging is used. It is one-dimensional and usually relies on the correct alignment of the M-mode along the left ventricle.<br />
<br />
==Using Color Doppler Ultrasound== <br />
It is sometimes necessary to use color Doppler ultrasound when valvular regurgitation is suspected, although this method should not be used to as the final diagnostic tool to determine valve dysfunction as the Doppler beam is nearly perpendicular to the flow. Instead, the presence of valvular regurgitation is based on the cardiac cycle, not the color-coding.<cite>Feigenbaum1</cite> <br />
<br />
==Example==<br />
This is a parasternal long axis view of a normal heart. <br />
{{IncludeFlash<br />
|flash_string=<flash>file=PLAXnormal.swf|quality=best|align=center|width=300|height=200</flash><br />
|Description=A parasternal long axis<br />
|file_name=PLAXnormal<br />
}}<br />
{{clr}}<br />
<br />
==References==<br />
<biblio><br />
#Nihoyannopoulos isbn=1848822928<br />
#Feigenbaum1 isbn=0781795575<br />
<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/view/01/ PLAX - Parasternal long axis (TECHmED)]<br />
</biblio></div>77.234.244.30https://echopedia.org/index.php?title=Standard_imaging_Views&diff=6435Standard imaging Views2021-01-09T09:59:03Z<p>77.234.244.30: </p>
<hr />
<div>'''Parasternal Imaging Planes'''<br />
*[[Parasternal long axis]]<br />
*[[Parasternal short axis]]<br />
'''Apical Imaging Planes'''<br />
*[[Apical 4 chamber]]<br />
*[[Apical 2 chamber]]<br />
*[[Apical 3 chamber]]<br />
*[[Apical 5 Chamber]]<br />
*[[suprasternal view]]<br />
*[[subcostal view]]<br />
==External links==<br />
* [https://www.techmed.sk/en/echo/views/ 41 echo views - Images & Videos (TECHmED)]</div>77.234.244.30https://echopedia.org/index.php?title=References&diff=1450References2021-01-09T08:13:56Z<p>77.234.244.30: </p>
<hr />
<div>==Books==<br />
<biblio><br />
#Otto isbn=978-0721607894<br />
#easy isbn=978-0443061882<br />
#Feigenbaum isbn=978-0781731980<br />
</biblio><br />
==Online recources==<br />
*[https://techmed.sk/en/echo/new-examination/ Online free e-learning echocardiography (TECHmED)]<br />
*[http://www.asecho.org/ Am. Soc. of Echoc. Guidelines]<br />
*[http://www.halls.md/body-surface-area/bsa.htm Body Surface Area calculator]<br />
*[http://www2.umdnj.edu/%7Eshindler/abc.html Alphabetical Index of Echocardiographic Images and Text]<br />
*[http://www.echoincontext.com/ Echo in context]<br />
*[http://www2.umdnj.edu/%7Eshindler/eq2.html Echocardiographic Equations]<br />
*[http://www.echo-web.com/index.html Echoweb online course]<br />
*[http://www.drj.nl/pda/RAP.htm RAP estimates]<br />
*[http://www.anaesthetist.com/icu/organs/heart/tee/#top TEE views]<br />
*[http://www.ucsf.edu/teeecho/TEE/index.htm Society of Cardiovascular Anesthesiologists Intraoperative Exam]<br />
*[http://info.med.yale.edu/intmed/cardio/chd/contents/index.html Yale Congenital Heart Disease]<br />
*[http://info.med.yale.edu/intmed/cardio/imaging/contents.html Yale Echo atlas]</div>77.234.244.30