Echocardiographic examination

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TECHmED.sk

New examination
Left ventricle
LV diastolic function
Right ventricle
RV pressure
Kinetics and effusion
Atria and IVC
Aorta
AV
MV
TV
PV
Summary
Values
Views

Echocardiographic examination

TECHmED.sk

New
LV
LV diastole
RV
RV pressure
Kinetics
Atria
Aorta
AV
MV
TV
PV
Summary
Values
Views

Pulmonary valve

RegJet length (Regurgitant jet length of pulmonary valve) PSAX (level great vessels) focus on PV

RegJetlength

Regurgitant jet length

RegJet width (Regurgitant jet width of pulmonary valve) PSAX (level great vessels) focus on PV

RegJetwidth

Regurgitant jet width

PV annulus (Pulmonary valve annulus) PSAX (level great vessels) focus on PV

PVannulus

Pulmonary valve annulus

RegJet width (Regurgitant jet width of pulmonary valve) PV annulus (Pulmonary valve annulus)

RatioRegJet/PV

Ratio regurgitant jet width / pulmonary valve annulus

RegJet soft density (Regurgitant jet soft density) PSAX (level great vessels) pulmonary valve CW doppler

RegJetsoft density

Regurgitant jet soft density

RegJet hard density (Regurgitant jet hard density) PSAX (level great vessels) pulmonary valve CW doppler

RegJethard density

Regurgitant jet hard density

PHT RegJet (Pressure half time of pulmonary regurgitant jet) PSAX (level great vessels) pulmonary valve CW doppler

PHTRegJet

Pressure half time of pulmonary regurgitant jet

DT RegJet (Deceleration time of pulmonary regurgitant jet) PSAX (level great vessels) pulmonary valve CW doppler

DTRegJet

Deceleration time of pulmonary regurgitant jet

PR index - Regurgitation jet time duration PSAX (level great vessels) pulmonary valve CW doppler

RegJetduration

Regurgitation jet time duration

PR index - Total diastolic time PSAX (level great vessels) pulmonary valve CW doppler

Diastoleduration

Total diastolic time

PR index (Pulmonory regurgitation index) PSAX (level great vessels) pulmonary valve CW doppler

PR index

Pulmonory regurgitation index

PA reversal flow (Reversal flow in the branch pulmonary artery) PSAX (level great vessels) focus on branch pulmonary artery, PW doppler

PAreversal flow

Reversal flow in the branch pulmonary artery

RVD1 basal (Right ventricular basal diameter at end-diastole) echo A4C focused RV - right ventricle

RVD1basal

Right ventricular basal diameter at end-diastole

LVOT diameter - Left ventricular outflow tract diameter LVOT VTI - Velocity time integral of left ventricular outflow tract

SVAoV

Stroke volume via left ventricular outflow tract (aortic valve)

RVOT distal - Right ventricular outflow tract dimension at distal PSAX (level great vessels) focus on PV

RVOTdistal(PSAX)

Right ventricular outflow tract dimension at distal

RVOT VTI - Velocity time integral of right ventricular outflow tract PSAX (level great vessels) focus on PV, PW doppler - VTI of RVOT

VTIRVOT

Velocity time integral of right ventricular outflow tract

RVOT diastal - Right ventricular outflow tract dimension at distal Velocity time integral of right ventricular outflow tract

SVPV

Stroke volume pulmonary valve

RVOT diastal - Right ventricular outflow tract dimension at distal RVOT VTI - Velocity time integral of right ventricular outflow tract
LVOT VTI - Velocity time integral of left ventricular outflow tract LVOT diameter - Left ventricular outflow tract diameter

RFPV

Regurgitant fraction of pulmonary valve

Vmax PV (Maximal -peak velocity pulmonary valve) PSAX (level great vessels) pulmonary valve CW doppler

Vmax PV

Maximal (peak) velocity pulmonary valve

maxPG PV (Pulmonary valve maximal pressure gradient) PSAX (level great vessels) pulmonary valve CW doppler

maxPG PV

Pulmonary valve maximal pressure gradient

References:

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the ASE and EACVI (2015)

Recommendations for the Evaluation of LV Diastolic Function by Echocardiography: An Update from the ASE and EACVI (2016)

Recommendations on the use of echocardiography in adult hypertension: a report from the EACVI and the ASE (2015)

Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the EACVI and the ASE (2017)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: ASE, EACVI, ESC, CSE (2010)

Guidelines for the diagnosis and management of acute pulmonary embolism ESC, ERS (2019)

Echocardiography in aortic diseases: EAE recommendations for clinical practice (2010)

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

ESSENTIAL ECHOCARDIOGRAPHY A Companion to Braunwald’s Heart Disease

Coronary Artery Territories (Echocardiography Illustrated Book 4)

Regurgitation

RegJetlength
cm

Regurgitant jet length

RegJetwidth
cm

Regurgitant jet width

PVannulus
cm

Pulmonary valve annulus

RatioRegJet/PV
%

RatioRegJet/PV = RegJetwidth / PVannulus x 100

RegJetsoft density

Regurgitant jet soft density

RegJethard density

Regurgitant jet hard density

PHTRegJet
ms

Pressure half time of pulmonary regurgitant jet

DTRegJet
ms

Deceleration time of pulmonary regurgitant jet

RegJetduration
ms

Regurgitation jet time duration

Diastoleduration
ms

Total diastolic time

PR index

Pulmonory regurgitation index
PR index = RegJetduration/Diastoleduration

PAreversal flow

Reversal flow in the branch pulmonary artery

RVD1basal
cm

Right ventricular basal diameter at end-diastole

Volume

SVAoV
ml

Stroke volume of aortic valve
SVAoV = CSALVOT x VTILVOT

RVOTdistal(PSAX)
cm

Right ventricula outflow tract diameter (PSAX)
CSARVOT = π(RVOTdistal(PSAX)/2)2

VTIRVOT
cm

Velocity time integral of right ventricular outflow tract

SVPV
ml

Stroke volume of pulmonary valve
SVPV = CSARVOT x VTIRVOT

RFPV
%

Regurgitant fraction of pulmonary valve
RFPV = SVPV - SVAoV / SVPV x 100

Stenosis

Vmax PV
m/s

Maximal (peak) velocity pulmonary valve

maxPG PV
mmHg

Pulmonary valve maximal pressure gradient

RegJet length (Regurgitant jet length of pulmonary valve) PSAX (level great vessels) focus on PV

RegJetlength

Regurgitant jet length

Echocardiography: pulmonary regurgitation severity
Pulmonary regurgitation
Mild Moderate Severe
Pulmonic valve Normal Normal or abnormal Abnormal and may not be visible
Right ventricle (Size) Normal1

(RVD1basal <41mm)

Normal or dilated Dilated2

(RVD1basal >41mm)

RegJetlength

Regurgitant jet length
(Nyquist limit 50-70cm/s)

Thin with a narrow origin

(usually <10 mm in length)

Intermediate Broad origin; variable depth of penetration
RatioRegJet/PV

Ratio regurgitant jet width / pulmonary valve annulus

>70%3
RegJetdensity

Regurgitant jet density
(CW doppler)

Soft Dense Dense; early termination of diastolic flow
DTRegJet

Deceleration time of pulmonary regurgitant jet

Short4

(<260ms)

PHTRegJet

Pressure half time of pulmonary regurgitant jet

<100ms5
PR index6

Pulmonory regurgitation index

<0,77 <0,77
PAreversal flow

Reversal flow in the branch pulmonary artery

Yes
PV VTI / LVOT VTI7

Pulmonic systolic VTI compered to LVOT VTI

Slightly increased Intermediate Greatly increased
RF8

Regurgitant fraction of pulmonary valve

<20% 20-40% >40%
  1. Unless there are other reasons for RV enlargement.
  2. Exception: acute PR.
  3. Identifies a CMR-derived PR fraction >40%.
  4. Steep deceleration is not specific for severe PR.
  5. Not reliable in the presence of high RV end diastolic pressure.
  6. Defined as the duration of the PR signal divided by the total duration of diastole, with this cutoff identifying a CMR-derived PR fraction > 25%.
  7. Cutoff values for regurgitant volume and fraction are not well validated.
  8. RF data primarily derived from CMR with limited application with echocardiography.