Examination
Heart rate
integer
Sinus rhythm
text
Atrial fibrillation
text
Pacemaker
text
Pacemaker type
text
Other rhythm
text
Image quality
Parasternal long axis
text
Parasternal short axis
text
4-CH (with LA/ RA) A: 2D mode(sequece) S: 1. Atrial and ventricular septum 2. Lateral wall of the LV 3. LA+RA area 4. Tricuspid valve (anterior and septal leaflet) and mitral valve (anterior and posterior leaflet) 5. LVEF (visual estimation) Q: 1. The septum should be perpendicular 2. The septal mitral valve insertion should be at the same height as the tricuspid valve insertion 3. The left ventricle should be visualised in such a way that an axis as long as possible (from the middle of the connecting line of the mitral leaflet insertion points to the apex) is displayed 4. The depth should be minimised in order to visualise the LA as large as possible and in its entirety R: Measurements (see Table 12 - Measurements in the apical four-chamber view) DZHK-SOP-K-08: Transthoracic echocardiography, Version: V1.0, Valid as of: 01.09.2014 4-CH (without LA/ RA) A: 2D mode(sequence) S: 1. Ventricular septum 2. Lateral wall of the LV 3. Tricuspid valve (anterior and septal leaflet) 4. Mitral valve (anterior and posterior leaflet) 5. LVEF (biplane according to Simpson, see also 2-CH) 6. RV area and function 7. Assessment: pericardium/ pericardial border Q: 1. The LV should be displayed along its long axis to avoid shortening. If necessary, take separate images to allow for an assessment of the LV and RV, as an optimal simultaneous visualisation is not always possible. (image optimised for the right side for right-ventricular measurements) 2. The penetration depth should be minimised in order to visualise the LV as large as possible and with the complete apex (the LA should be cut off) R: 1. Visual assessment of the LV function / kinetics of the septal and lateral wall (wall motion disorder: yes, no, unknown, not assessed) 2. Measurements (see Table 13-Measured values for the left and right ventricular diameter, Table 14–Heart valve parameters on the 2D image and Table 15-Calculated parameters from the planimetry)
text
A: 2D (sequence) S:Left atrium and left ventricle (septal and inferolateral segments), aortic valve (right coronary and non-coronary cusp) as well as A2- and P2-segments of the mitral valve, measurements of the aortic valve/mitral valve in the three-chamber view only complementary, performance as previously outlined Q: 1. The left ventricle should be visualised in the optimal length and completely stretched 2. The septum should be perpendicular to the lower part of the image R: Visual assessment of the anteroseptal and inferolateral wall sections, the measurements of the aortic valve are performed analogously to the measurements in the apical five-chamber view.
text
A: 2D (sequence) S: Complete visualisation of the anterior and inferior part of the LV and of the left atrium as well as of the mitral valve, segment P1, A2 and P3 (optionally coronary sinus/left atrial appendage), measurements of the mitral valve as outlined in the section on the four-chamber view Q: 1. The left ventricle should be visualised in the optimal length and completely stretched 2. The septum should be perpendicular to the lower part of the image R: Visual assessment of the kinetics of the anterior and inferior wall sections, the measurements in the area of the mitral valve are performed analogously to the measurement in the four-chamber view. The LA volumetry (end-systolic) should be recorded biplane (from the insonation in the four-and two-chamber view)
text
Subcostal
text
Dimensions (long axis: M-mode parasternal)
Parameters of 2D image rendition/M-mode Depending on the manufacturer's specifications, always use the lowest sound output power at which ultrasound images with sufficient quality can be obtained. Adjust the overall gain and depth regulation until the structures in the 2D image sector are optimally delimited. The same applies to the gain in the longitudinal direction or lateral direction; adjust the settings depending on the cross-sectional plane and the desired image quality. To achieve an optimal contrast on the images, also adjust the compression individually depending on the examination conditions. A frame rate of 50 frames/second is advisable.
text
Aortic root diameter (endsystolic)
integer
Left atrium diameter (end-systolic)
integer
Interventricular septum (end-diastolic)
integer
Leftventricular end-diastolic diameter
integer
Left ventricular posterior wall
integer
Left ventricular end-systolic diameter
integer
2-D measurements (4CH and 2CH apical, subcostal)
Left ventricular ejection fraction
integer
Echocardiography method
text
Left ventricular end-diastolic volume
integer
Left ventricular end-systolic volume
integer
Left atrium longitudinal (end-systolic) in apical 4-chamber view
integer
Left atrium transversal (end-systolic) in apical 4-chamber view
integer
Left atrial area 4-chamber view (end-systolic)
float
Left atrial area 2-chamber view (end-systolic)
float
Wall motion disorder
text
RV dilation is defined by means of the mid-ventricular end-diastolic diameter (RVED2). RV dilation is defined as RVED2 > 34 mm
text
A: M-mode S: Distance between the end-diastolic and end-systolic movement of the lateral insertionof the tricuspid valve Q: The M-mode beam should be positioned in the lateral tricuspid valve annulus. The direction of movement of the lateral tricuspid annulus has to be parallel to the M-mode scan line; the angle of insonation may have to be adjusted for this R: Measurements Measured parameter (unit) TAPSE (mm) Measuring time ES to ED Position of the measuring points Endocardial border line (ES) Endocardial border line (ED)
integer
MAPSE (mitral annular plane systolic excursion) lateral
integer
MAPSE (mitral annular plane systolic excursion) septal
integer
Pericardial effusion is present when echo free pericardial separation is demonstrated at the end of the diastole (>1 mm ) A pericardial effusion should always be evaluated in different cross-sectional planes, usually in the parasternal long axis, in the apical 4-chamber view and in the subcostal cross-section. The width of the effusion can be measured at the end of the diastole using the M-mode recording in the parasternal long axis, if possible orthogonally to the separation caused by the effusion or alternatively by means of apical cross-sectional images. Effusions that are visible at the end of the diastole can be classified as small (20 mm).
text
Vena cava diameter
integer
Vena cava response to breathing
text
Mitral valve Doppler (PW)
Tissue Doppler (TDI)
Measuring times: Early diastole. Position of the measuring points: Vmaxof the E'-wave
float
Measuring times: Late diastole. Position of the measuring points: Vmax of the A'-wave.
float
Measuring times: Systolic. Position of the measuring points: Vmax of the S'-wave.
float
Lateral TDI cannot be measured
boolean
Measuring time: Early diastole. Position of the measuring points: Vmax of the E'-wave.
float
Measuring time: Late diastole. Position of the measuring points: Vmax of the A'-wave.
float
Measuring time: Systolic. Position of the measuring points: Vmax of the S'-wave.
float
Septal TDI cannot be measured
boolean
Pulmonary venous flow
Pulmonary venous systolic velocity
integer
Pulmonary venous diastolic velocity
integer
Valves
Mitral valve
text
Status post mitral valve surgery
text
Mitral valve morphology
text
Mitral sclerosis
text
Mitral leaflet calcification
text
Mitral annular calcification
text
Mitral valve separation disorder
text
Flail mitral leaflet
text
Myxomatous prolapse
text
Prolapse due to fibroelastic deficiency
text
Pseudo-prolapse
text
See SOPs (part 3.5.7, Quantification of valve defects, in version 1.0) for severity grading.
text
See SOPs (part 3.5.7, Quantification of valve defects, in version 1.0) for severity grading.
text
Aortic valve
text
Status post aortic valve surgery
text
Aortic valve morphology
text
Aortic valve sclerosis
text
Aortic valve calcification
text
Aortic valve separation disorder
text
Bicuspid aortic valve
text
See SOPs (part 3.5.7, Quantification of valve defects, in version 1.0) for severity grading.
text
See SOPs (part 3.5.7, Quantification of valve defects, in version 1.0) for severity grading.
text
Pulmonary valve
text
Pulmonary valve morphology
text
Pulmonary valve sclerosis
text
Pulmonary valve calcification
text
Pulmonary valve separation disorder
text
See SOPs (part 3.5.7, Quantification of valve defects, in version 1.0) for severity grading.
text
Tricuspid valve
text
Tricuspid valve morphology
text
Tricuspid valve sclerosis
text
Tricuspid valve calcification
text
Ebstein anomaly
text
Tricuspid valve anomaly
text
Tricuspid valve separation disorder
text
See SOPs (part 3.5.7, Quantification of valve defects, in version 1.0) for severity grading.
text