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Measurement of left ventricular end-diastolic diameter (EDD)
and end-systolic diameter (ESD) from M-mode, guided by a
parasternal short axis image (upper left) to optimize medial-
lateral beam orientation.
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2-D measurements for LVvolume calculations using the
biplane method of discs, inthe apical four-chamber (A4C) and
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at end-systole (LV ESD).
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LV Mass (AL) = 1.05 {[5/6 A1(a+d+t) ] - [5/6 A2(a+d) ]}
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Where Al = total LVarea; A2 = LVcavity area, Am = myocardial area, a is the
long or semi-major axis from widest minor axis radius to apex, b is the short-
axis radius (back calculated from the shon-axis cavity area), and d is the
truncated semimajor axis from widest short-axis diameter to mitral annulus
plane. Assuming a circular area, the radius (b) is computed and mean wall
thickness (t ) derived from the short-axis epicardial and cavity areas.
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Body Surface Area (m2)
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Echocardiographic Aortic Root Dimensions in Normal Children and Adults. AmJ Cardiol
1989;64:507-512 (with permission).
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Segmental of LVwalls based on schematic
views, in a parasternal short and apical long-axis
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Savage RM, Sears-Rogan P, Mathew JP. Q u i n o n e s MA, Cahalan MK, a nd Savino JS.
ASE/SCA Guideiines for Performing a Comprehensive Intraoperative Multiplane Transesophageal
Echocardiography Examlnation J Am Soc Echocardiogv 1999 Oct; 12(10); 884-900,
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M s m m m l o f w m Stenosis Page 1 : # 6
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AS E
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Am er ican So ciety of
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Findings indicative of
hemodynamically signifi c a nt t ri cuspi d s t e nos i s
l s p eci n c Findings
Mean p res s u re gradient
l
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l Ti/2
valve area by c ontinuity e qua tion
z 190 ms
51cm
supportive Findings
Enlarged right atrium 2 moderate
Dilated interior vena cava
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s n r n p is v s i u ms pssmansa VT! t r i t l d from
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velocity.
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Adapted lrom. Nagueh SF. Appleton CP. Glllebert TC, Marino PN. Oh JK. Smlsetn OA, Waggener/XD, Flacnskampl FA,
Recommendations for the Evaluation of Left Ventricular Dlastolrc Function by Echocardiography,
Eur J Ecnocarcirogr an d J Am Soc Echocardiogr 2009
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Adapied from Zughbi WA. Chambers JB, Dumesnrl JG, Foster E, Gottdiener JS. Grayburn PA, Khandheria BK, Levine RA, Marx GFI, Miiief FA,
Nakatani S, Ouinones MA, Fiakowski H, Rodriguez LL, Swamrnathan M, WaggonerAD. Weissman NJ, Zabalgoiiia M,
Recommendations for Evaluation oi Prosthetic Valves with Echocardiography and Doppler Ultrasound,
J Am Soc Echocardxogr 2009 Sept. 22(9) 975-1014
This ASE guideline document was e ndor se d by the Arriencan Coliege ol Cardiology Foundation, Amencan Heart Association,
European Association orEchocardiography. a registered branch oi European Society of Cardioiogy,
Canadian Socieiy oi Echocardiography, an d J ap an es e Society oi Echocardiography.
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Clinical information Date, type, and size of
replacement valve
Height, weight, and body
surface area
Symptoms and related
clinical Endings
Blood pressure and heart rate
Imaging of the valve Motion of leaflets or occluder
Structure and integrity of valve
and sewing ring
Doppler echocardiography
of the valve Contour of the jet velocity signal
Peak velocity and
mean gradient
Velocity-time integral (VTI) of
the jet
Doppler velocity index (DVI)
Pressure half-time (PHT) in
mitral and tricuspid valves
Effective orifice area (EOA)
Presence, location, and severity
v3;; of regurgitation
55,: Comparison
with previous Comparison of above parameters
post-operative study, helpful in suspected valvular
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AS E Am er ir aii So ciety ul
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The information on these pages doe s riot constitute the oiierlrig of medical advice by ASE.
and should not be used as the sole basis to make medical practice decisions.
Design and illustration by me dmovie c om e` Copyright 2010 The American Society oi Echocardiography
Guidelines for the Echocaidiographic
Wwwasecho ‘"9 Assessment o fth e Right Heart in Adults page 1 of 8
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Variable Abnormal
A. RV Basal (RVD1) > 4.2 cm
RV Mid (RVD2) > 3.5 cm
RV Longitudinal (RVD3) > 8.6 cm
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Tracing of the right atrium (RA) is Inferior vena cava (IVC) view.
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tricuspid annulus (TA), along the diameter (solid line) is measured
interatrial septum (IAS), superior perpendicular to the long axis of r,
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measured from the TA center to hepatic veins that lie l ':
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minor dimension is measured proximal to the ostium of the right
from the anterolateral wall to the atrium (RA).
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RA Major Dimension >5.3 cm
RA Minor Dimension >4.4 cm
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Guidelines for the Echocardiographic
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RCA: Posterior Descending Arte
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Doppler Parameters
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Jet width in central jets Narrow, Intermediate, Large,
LVO diameter) - Color* (s 25%) (26% -64%) (2 65%)
Jet density - CW Incomplete or
faint
Dense Dense
Jet deceleration rate Slow Variable Steep
(PHT, ms) - CW§ (> 500) (200-500) (<200)
LVO flow compared to Slightly Greatly
pulmonary flow PW - increased
Intermediate
increased
Diastolic flow reversal in the Absent or brief
descending aorta PW _ early diastolic
Intermediate
Prominent,
holodiastolic
Doppler Parameters
(Quantitative)
Regurgitant Volume < 30 ml/beat -
30 59 ml/beat 3 60 ml/beat
, f ,
Regurgilant Fraction < 30% -
30 50% 3 50%
i.z<'~/,,fi<z?>:;';‘/-;f,i r WAbnomiel mecnenloel valves; eg, immobile oocluder (valvular regurgitation), denisoenoe or rocking (paravslvular
i-//,,,,,,¢>,i,~,r,, iv, regurgitation); Abnormal biological valves: eg. Leatlet thickening or pmlapee (vat/utar), dehisoenoe or rocking
ii/‘/-iii
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(pafavalvular regurgitation)
° Parameter
applicable to oentraljets and is less accurate in eccentric jets; Nyquist limit ot 50-60 cmls
§ lrmuenosd by LVcompliance
GtApplies to chronic, late postoperative ARIn the absence of other etlologles
CW= continuous wave Doppler; LV= tell ventricle; LVO =left ventricular outflow tract; PHT = pressure halt-lime; PW=
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Echocardiograploy
for Selected Prosthetic Mitral alves
M un gradient P u k voloclty Pr assun Effective orlflco
Valve Sin lull-time (ms) : r u (cm*)
(mmHg) (mls)
23 5.0 1.9
25 5.57 2 2.3 1 .8 2 0 .3
sji-m<sn|a¢y manmrm 27 4.53 2 2.2 1.72 0_4
Tilting disc 29 4.26 2 1.6 1 6 2 0 .3
31 4.9 2 1.6 17 2 0.3
23 1 .9 2 0 .1 12627
25 3.6 2 0.6 1 .3 2 0 .1 9328 2.92 0.8
Curbomodics 27 3.46 2 1.03 1.61 20. 3 89220 2. 92 0.75
Bileafiei 29 3,39 2 0.97 1. 52203 88217 2 .3 2 0.4
31 3.32 2 0.87 1 .6 1 2 0 2 9 92224 2,821.14
33 4.B 2 2 .5 1. 5202 93212
27 8.0 2 2.0 1 .7 2 0 .3 98228
cnrwmar- sauna 29 4.7 2 2.0 1. 752027 92214
Stented biopmsfhesis 31 4.4 2 2.0 1.5-120.15 92219
33 6.0 2 3.0 93212
27 3.6 1.6 100
Clrpomior- Edwards 29 5.25 2 2.36 1.67 2 0.3 110215
partcardlal 31 4, 05 2 0.83 1.53 2 0,1 90211
Stented Bioplusthesis 33 1.0 0.0 80
27 5.0 2 2.0 1.3 20. 5
Nlncock I or not lpsslfl sd 29 2.46 2 0.79 115220 1. 5202
Stenled blopmsihesis 31 4.86 2 1.69 95217 1. 6202
33 3.87 2 2.0 90212 1,920.2
27 1.4 78
Mldtronic- Hall 29 1 .5 7 2 0 1 69215
Ti/ring dim: 31 1. 452012 77217
29 3.5 2 0.51 1. 62012
Ihdtronk: lntlm Porclm 31 4.2 2 1.44 1,620.26
Slsnted biopruslhssis 33 4.0 2 1.3 1 .4 2 0 2 4
35 3.2 2 1 , 7 7 1. 3205
23 8.0
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