Recommended Echocardiography Protocol
Protocol forTransthoracic Echocardiogram (TTE)
Length of clips: 2 cardiac cycles if in sinus rhythm
Parasternal Long Axis View
2D parasternal long axis at increased depth to visualize extra cardiac structures. CLIP.
If pericardial effussion is present, may give hints as to the underlying pathology. Measure pericardial effusion thickness. CLIP.
When directly visualized, the normal pericardium is no more than 1 to 2 mm in thickness.
If calcific pericardial disease is present, ultrasound shadowing may occur and again give hints as to the underlying pathology. Measure pericardial thickness. CLIP.
Parasternal long axis view at 2/3 of screen without color (descending thoracic aorta not necessary). CLIP.
Zoom Parasternal long axis of Aortic Valve and Mitral Valve. CLIP.
Parasternal long axis with color through Aortic Valve and Mitral Valve. CLIP.
Zoom Left Ventricular Outflow Tract and measure diameter. CLIP.
M-Mode of Aortic Valve and Left Atrium, freeze frame. CLIP.
M-Mode of Left Ventricle and Right Ventricle, freeze frame (cursor through chordae tendinae). CLIP.
Identify abrupt relaxation of the posterior wall with flattening of endocardial motion during diastole.
Identify abnormal septal motion (Represent with early diastolic notching followed by paradoxical and then normal motion of the ventricular septum). Annotate as “abnormal septal motion”. CLIP.
M-Mode measurement if cursor is perpendicular to long-axis of left ventricle. If not, please proceed to 2D measurement. CLIP.
Total clips: 8
2D Measurement if M-mode cursor not perpendicular
Parasternal long axis view with 2D measurements in end diastole while image is frozen (measure interventricular septal thickness, left Ventricular internal dimension in diastole, posterior wall thickness). CLIP.
Parasternal long axis view with 2D measurements in systole while image is frozen (measure left ventricular internal dimension in systole). CLIP.
Total clips: 2
Right Ventricular Inflow View
Right Ventricular Inflow and Tricuspid Valve without color (include Right Ventricular anterior wall motion if possible. CLIP.
Right Ventricular Inflow and Tricuspid Valve with color. CLIP.
Continuous wave Doppler of Tricuspid Regurgitant jet, measure peak velocity for Right Ventricular systolic pressure (freeze image). CLIP.
Total clips 3
Parasternal Short Axis View
Short axis view at the base of heart to include Aortic valve, Tricuspid valve and Pulmonic valve if possible. CLIP.
Short axis view of Pulmonic Valve and Pulmonary Artery without color (demonstrate bifurcation if possible and assess size relative to aorta). CLIP.
Short axis of Pulmonic Valve and Pulmonary Artery with color. CLIP.
Continuous wave and Pulse wave Doppler of Pulmonic Valve and Pulmonic Insufficiency jet. CLIP.
Zoom Short axis view of Aortic Valve without color. CLIP.
Zoom Short axis view of Aortic Valve with color. CLIP.
Tricuspid Valve without color. CLIP.
Tricuspid Valve with color. CLIP.
Continuous wave Doppler of Tricuspid Regurgitation jet, measure peak velocity for Right Ventricular systolic pressure. CLIP.
Short axis view of Left Ventricle at mitral valve level without color to assess RWMA. CLIP.
Short axis view of Left Ventricle at mid papillary muscle level without color to asses RWMA. CLIP.
Short axis view of Left Ventricular apex. CLIP.
Zoom Short axis view of Mitral valve without color. CLIP.
Zoom Short axis view of Mitral valve with color. CLIP.
Total clips: 15
Apical 4 Chamber
4 Chamber view without color. CLIP.
Apical 4 chamber optimizing the both atria for volume tracing. Measure right and left atrial areas and volumes (using A-L method) at end-systole. CLIP.
M-mode at tricuspid annulus for TAPSE. CLIP.
Measure TDI S’ velocity at tricuspid annulus. CLIP.
4 chamber view with color of Tricuspid Valve. CLIP.
Continuous wave Doppler of Tricuspid Regurgitation jet, measure peak velocity for Right Ventricular systolic pressure. CLIP.
4 Chamber view with color through Mitral Valve. CLIP.
Continuous Wave and Pulse Wave Doppler through Mitral Valve tips with measurement of E velocity, A velocity, E/A ratio and deceleration time. Valsalva maneuver if E/A >1. CLIP.
4 Chamber view with TDI color in frame rate range of 150-220.CLIP.
TDI Pulse Wave Doppler at Mitral valve septal CLIP and lateral annulus CLIP to obtain e’, a’ and s wave, E/e’.
Zoom Left Ventricle optimizing endocardium. (Trace Left Ventricle endocardium in diastole CLIP and systole CLIP using single plane method to determine Left Ventricular ejection fraction).
Zoom LV apex for apical thrombus without color and with color. Adjust focus length.CLIP
Total clips: 16
Apical 5 Chamber
5 Chamber view without color. CLIP.
5 Chamber view with color through Aortic Valve. CLIP.
Continuous wave Doppler demonstrating Aortic Insufficiency envelope. CLIP.
Continuous wave Doppler demonstrating Aortic Valve stenosis. CLIP.
Pulse wave Doppler of Left Ventricular outflow. CLIP.
Total clips: 5
Apical 2 Chamber
2 Chamber view without color. CLIP.
2 Chamber view with color through Mitral Valve. CLIP.
Zoom Left Ventricle. CLIP.
Total clips: 3
Apical Long Axis
Long axis view without color. CLIP.
Long axis view with color through Aortic Valve and Mitral Valve. CLIP.
Continuous wave Doppler through mitral valve. CLIP.
Continuous wave Doppler through Aortic Valve. CLIP.
Total clips: 4
Subcostal View
4 Chamber view without color. CLIP.
4 Chamber view with color at IAS. CLIP.
Inferior vena cava and Hepatic veins without color. CLIP.
M-mode of IVC with measurements with and without sniff. CLIP.
Total clips: 4
Suprasternal Notch
Aortic arch without color. CLIP.
Aortic arch with color. CLIP.
Total clips: 2
Grand total clips: 62
Compulsory parameters for report:
1. LV dimensions systole/diastole
2. LV volume in diastole
3. LV wall thickness diastole
4. LVEF
5. Regional wall motion abnormalities (17 segment model)
6. Grade of diastolic function
7. Comment on apical clot
8. RV size
9. RV systolic function
10. TAPSE
11. PW S’
12. Volume of left atrium
13. Volume of right atrium
14. E vel, A vel, Dt, E’, E/E’, E/A, E/A Valsalva
15. Mitral valve comment
16. Aortic valve comment
17. Tricuspid valve comment
18. Pulmonary valve comment
19. Comment on IVS
20. Comment on IAS
21. Comment on pericardium
22. IVC diameter and est RAP
23. Est PAP
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