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4-1
PX
Ask the patient to turn to the left side. LV
Make sure you set the total gain and depth for optimal visualisa- RV AMVL
4-1
PX
RA LA
STANDARD EXAMINATION
1. Start with the parasternal long axis (PLAX) showing the mitral Parasternal Subcostal Apical 4-1
valve(MV) and the aortic valve(AV). The aorta should be open. A4C
PX
2: Hypokinesia 7
7. Rotate the probe to the 2 chamber view (A2C). LA 3. Akinesia 2
8
13 12
6
8. Rotate the probe to the 3 chamber view (A3C) (same struc- 4. Dyskinesia 14 17 16
tures visible as PLAX). 5. Aneurysmatic 9 11
15 5
9. Record color in the MV and AV in the A3C, the MV in the A2C Anterolateral papillary muscle
3
10
and the MV, AV, TV in A4C and A5C. Posteromedial papillary muscle LV 4
RV
10. Record a pulsed wave(PW) doppler just at the tips of the MV 1. basal anterior 7. mid anterior 13. apical anterior
leaflets for E/A ratio and record an PW tissue velocity imaging 2. basal anteroseptal 8. mid anteroseptal 14. apical septal
SUBCOSTAL VIEW 3. basal inferoseptal 9. mid inferoseptal 15. apical inferior
signal(TVI) of the interventricular septum. 4. basal inferior 10. mid inferior 16. apical lateral
LA 5. basal inferolateral 11. mid inferolateral 17. apex
11. Record a continuous wave(CW) in the AV.
4-1
PX
If you have any comments please e-mail to Ivo van der Bilt: vanderbilt@cardionetworks.org This reference card is for education purposes only. When in doubt consult a Cardiologist. For more information: www.echopedia.org.
ASSESSMENT OF DIASTOLIC FUNCTION AORTIC VALVE STENOSIS SEVERITY MITRAL VALVE REGURGITATION SEVERITY MITRAL VALVE STENOSIS WILKINS SCORE
2.0
ΔE/A<0.5 ΔE/A<0.5 ΔE/A≥0.5 ΔE/A≥0.5 ΔE/A<0.5 Supportive Systolic dominant Intermediate Dense, triangular CW 3 Valve continues 5-8 mm, Calcium ex- Extending to
Velocity, m/s
Mitral Inflow at Mild Moderate Severe flow in pulmonary signs/findings Doppler MR jet to move forward extending tending into distal third of chords
Peak Valsalva E
A veins E-wave dominant mitral in diastole, mainly through en- mid portion
Maneuver Specific Central Jet, width>25% Signs of Central Jet, width ≥ A-wave dominant inflow (E >1.2m/s)4. from the base tire leaflet of leaflet
0 LVOT2 AR>mild 65% of LVOT2 mitral inflow4 Dilated LV/LA3.
Vena contracta <0.3 cm2 present but Vena contracta > Soft density, para- 4 No or minimal >8-10 mm Extensive Extensive, extending
Velocity, m/s
Doppler Tissue 0
E/e'<10 E/e'<10 E/e'≥10 E/e'≥10 E/e'≥10 No/brief early diastolic no criteria for 0.6cm2 bolic CW Doppler MR forward movement throughout to papillary muscle
Imaging of Mitral a'
flow reversal in descending severe AR signal of the leaflets in most of the
0.15
Annular Motion e' aorta Normal LV size1 diastole leaflet
S≥D S>D S<D or S<D or S<D or Supportive Pressure half time > 500 ms Intermediate Pressure half-time < Quantitave6
ARdur>Adur+30 ms ARdur>Adur+30 ms ARdur>Adur+30 ms
2.0
ARdur<Adur ARdur<Adur
Normal LV size1 values 200 ms EROA(cm2) <0.20 0.2-0.29/0.3-0.4 ≥0.40 LEFT VENTRICULAR FUNCTION
Velocity, m/s