The Sonographer Attachment Programme At USA Report : Mayo Clinic Rochester =TTE= Part II

5.7 Mayo Clinic Stress Echo Lab Gonda 6:

Protocol For Tranthoracic Echocardiogram (TTE) 

      Indications

                  Echocardiography evaluates cardiac structure and function non-invasively without the use of ionizing radiation or iodinated contrast media.The Mayo echocardiography laboratory is an open access service which accepts all referrals aimed at the evaluation of ischemic, cardiomyopathic, valvular or pericardial pathology as well as the diagnosis and management of symptoms potentially referable to the cardiovascular system.

      Medications

·         Contrast agents (Definity)

·         Agitated Saline

·         Amyl Nitrite

Patient Educations

·         Information about echocardiography is printed on each patient’s itinerary of Clinic tests.  Prior to beginning the study, the imaging sonographer or physician explains the procedure and process of reviewing results; any additional teaching (i.e., Valsalva Maneuver, etc.) is provided as needed. Explanation of the test result is deferred to the referring physician.

Standard Views And Guidelines

Parasternal Long Axis

• 2D assessment of LV, LA, MV, AV, aortic root
• LVOT diameter
• 2D and/or M-mode LV cavity diastolic and systolic dimensions (may be donein parasternal short or long axis)
• 2D and/or M-mode LV wall thickness (may be done in parasternal short or long axis)
• 2D measurement of the proximal aortic root or ascending aorta
• Color-flow imaging of mitral and aortic valve/LVOT
• 2D images of right ventricular inflow and tricuspid valve
• Color-flow imaging of tricuspid valve
• CW Doppler of tricuspid regurgitation if present

     

      Parasternal Short Axis

·         2D imaging of left ventricle at base, mid, and apex

·         2D imaging of mitral valve

·         2D/color flow imaging of aortic valve

·         2D/color flow imaging of pulmonary valve/proximal pulmonary artery

·         2D/color flow imaging of tricuspid valve

·         CW Doppler of pulmonary valve if indicated

     

      Apical Window

·         2D imaging of left ventricle

§  four-chamber view

§  long-axis view

§  two-chamber

§  apical short axis

·         Left atrial volume by area-length method using the apical four-chamber and two chamber views

·         2D/color flow imaging of mitral valve

·         2D/color flow imaging of tricuspid valve

·         2D/color flow imaging of aortic valve/LVOT

·         Pulsed wave Doppler of mitral inflow

·         Pulsed wave Doppler of pulmonary veins

·   Doppler tissue imaging of medial and/or lateral mitral annulus and lateral tricuspid annulus.  There are circumstances when this may not be performed (e.g. regional wall motion abnormalities, significant calcification, valvular prostheses)

·         PW Doppler of left ventricular outflow tract

·         CW Doppler of mitral valve (if mitral valve disease is present)

·    CW Doppler of aortic valve (if velocity ³ 2.0 m/sec, measure three signals, otherwise measure one)

·         CW Doppler of tricuspid valve

·         Strain data acquisition if clinically indicated

·         3D volumetric ejection fraction if clinically indicated

      Subcostal View

·                2D imaging in long and short axes of left and right atria and ventricles

·               2D/color flow imaging of atrial septum

·               Color flow imaging of tricuspid valve (if indicated)

·               2D imaging of inferior vena cava/hepatic veins

·       2D imaging of aorta (pulsed wave Doppler of the aorta is done in most, but not all, cases)

      Suprasternal Notch

·   2D long axis of aortic arch.  Short axis may be acquired if clinically indicated for assessment of aorta, left atrium and pulmonary veins

·         PW or CW Doppler of descending thoracic aorta