Cardiac ultrasound protocols

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1 Cardiac ultrasound protocols IDEXX Telemedicine Consultants Two-dimensional and M-mode imaging planes Right parasternal long axis four chamber Obtained from the right side Displays the relative proportions of all four chambers Displays the geometry of the left ventricle Subjective assessment of left ventricular function Evaluate mitral valve morphology If perpendicular to the screen, can be used for M-mode evaluation Two-dimensional measurement of the left atrium Left and right ventricles (LV/RV) Left and right atria (LA/RA) Mitral valve anterior and posterior leaflets Tricuspid valve Pericardium Right pulmonary vein Visualize interventicular and interatrial septum

2 Right parasternal long axis inflow/outflow Obtained from the right side Left ventricular inflow and outflow tract morphology Subjective assessment of left ventricular function Evaluate for systolic anterior mitral valve movement (SAM) Left ventricular outflow tract lesions (subaortic, aortic, supraortic) Aortic valve movement Left ventricle (LV) Mitral valve leaflets anterior and poster leaflets Left atrium (LA) Visualize chordae tendineae of the mitral valve Left ventricular outflow tract and aortic valve (AO) Right main pulmonary artery (RPA) Variable right ventricle and right atrial views (angle dependent) (RA/RV)

3 Right parasternal short axis papillary muscle level Obtained from the right side Evaluate left ventricular wall thickness Evaluate left ventricular wall motion Evaluate papillary muscle size and position Standard position for M-mode evaluation of the left ventricle Estimate right ventricular size and function Right ventricle (RV) Left ventricle (LV) Left ventricular papillary muscles anterior (APM) and posterior (PPM) Pericardium

4 Right parasternal short axis mitral valve level Obtained from the right side Evaluate left ventricular wall thickness Evaluate left ventricular wall motion Evaluate mitral valve morphology and movement Standard position for M-mode evaluation of the mitral valve Right ventricular outflow tract (RVO) Left ventricle (LV) Left ventricular outflow tract (LVO) Mitral valve anterior leaflet (AMV) and posterior leaflet (PMV) Pericardium

5 Right parasternal short axis left atrium/aorta Obtained from the right side Evaluate left atrial size Evaluate aortic valve morphology and movement Evaluate tricuspid valve and right ventricular outflow tract Standard position for M-mode and two dimensional measurement of the left atrium and aorta (LA/AO) Right ventricle (RV) Left atrium (LA) Aortic aorta Aortic valve cusps NC, LC, RC Pulmonic valve (PV) Tricuspid valve (TV) Pericardium

6 Right parasternal short axis right ventricular outflow tract Obtained from the right side Evaluate the right ventricular outflow tract, including Doppler evaluation Evaluate the right atrium and tricuspid valve Minimizes the left atrium Identify any pulmonary artery abnormalities Evaluate the pulmonic valve morphology and movement Visualize heartworms if present Right ventricle (RV) Right atrium (RA) Tricuspid valve (TV) Pulmonary artery (PA) Pulmonic valve (PV) Aorta Left atrium (minimized)

7 Left apical four chamber Obtained from the left side Relative comparison of the left and right heart to subjectively evaluate size and function Evaluate mitral valve morphology and motion Evaluate tricuspid valve morphology and motion Doppler evaluation for atrioventricular valve regurgitation (color and spectral) Doppler evaluation of ventricular filling used to estimate ventricular diastolic function Evaluate pulmonary veins and flow Right ventricle (RV) and right atrium (RA) Left ventricle (LV) and left atrium (LA) Mitral valve anterior and posterior leaflets Tricuspid valve septal and free wall leaflets Pulmonary veins

8 Left apical five chamber Obtained from the left side Evaluation of the left ventricular inlet and outflow Evaluate mitral valve morphology and motion Doppler evaluation for mitral valve regurgitation (color and spectral) Doppler evaluation of the left ventricular outflow tract (color and spectral) Right ventricle (RV) and right atrium (RA) Left ventricle (LV) and left atrium (LA) Mitral valve anterior and posterior leaflets Aorta and left ventricular outflow tract (AO)

9 Standard M-mode echocardiographic views M-mode left ventricular papillary muscle level Obtained from the right-sided short-axis or long-axis views Evaluate left ventricular wall thickness and systolic function Evaluate right ventricular size and wall motion Left ventricular walls left ventricular free wall and interventricular septum Left ventricular internal dimensions Right ventricular internal dimension

10 M-mode mitral valve level Obtained from the right-sided short axis or long axis outflow tract view Evaluate mitral valve motion throughout the cardiac cycle Evaluate for systolic anterior mitral valve motion Anterior mitral valve leaflet (AML) Posterior mitral valve leaflet (PML) Left ventricular walls

11 M-mode left atrium/aorta level Obtained from the right-sided short-axis or long-axis outflow tract view Evaluate the opening of the aortic valve and dimensions of the aorta Evaluate left atrial size more accurate in cats with this method and should not be used in dogs Aorta Aortic valve systole and diastole Left atrium The above imaging views represent a standard two-dimensional and M-mode evaluation. Additional views may be included to highlight specific anatomic details. All two-dimensional still images should be scrolled to the most diastolic frame possible prior to submission. Short video clips (3 5 seconds) of the above imaging planes can also be submitted and permit more accurate interpretation of regional systolic dysfunction, valve motion, and subtle abnormalities. (Clips should be submitted of individual imaging views, not the entire study.) Additional Doppler echocardiographic references can be given upon request.

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