ASE

American
Society
of
Echocar di ogr aphy
Hear t & Ci rrul ul i on Ul t rasound
Speci al i st s
-
Guidelines for Chamber
Quant i i i cat i nn
Adapted
from:
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Peilikka PA.
Plcard MH, Roman MJ, Seward J, Shanew|se J, Solomon S.
Spencer KT, St. John Sutton M.Slewarl W.
Recommendations for Chamber Qua nml c a t i on. J Am Soc
Echocardiogr (Dec. 05).
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Sym
mli.\r.
LVDi|Tl!l'IS'Ol1S
Measurement of left ventricular end-diastolic diameter
(EDD)
and
end-systolic
diameter
(ESD)
from
M-mode,
guided by
a
parasternal
short axis
image (upper left)
to
optimize
medial-
lateral beam orientation.
WOMEN MEN
Li n e a , Method
l Reference
Mitdly Moderat el y SevereIy\
Reference
Mildly Moderat el y Severel y
at
Range
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Abnom|aILbnormaI
Range
Abnormal Abnormal Abnormal
LV3gf;g>)jr_f,y,@'='l
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23. 1
| _v mass
=
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(1_o4[(Lv|na
+
P wr a
+
svvTd)3
_
(Lviod)
+
0.69
Lv
m---/BsA<g/f-#tif
43-95
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2122
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2149
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Hi -an zeci ml l mm l l l i mni l i l d . s p f n l i m
2-Dmeasurements for LVvolume calculations
using
the
biplane
method of
discs,
inthe
apical
four-chamber
(A4C)
and
apical
two-chamber
(A2C)
views at end diastole
(LV EDD)
and
at
end-systole (LV ESD).
LVEDD LVESD
A4C
A2C
Ejection
fraction
=
(EDV
-
ESV)/EDV
WOMEN and MEN
il Reference
Mildly Moderately
M i g 1;
Range
Abnormal Abnormal
Severely
Abnormal
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Spet i nl i st s
Two methods for
estimating
LV
length (AL)
formula andthe
from short axis
(len)
and
apical
echo views.
b =- L
Am
=
A,
_
A,
LVMass
(AL)
=
1.05
{[5/6 A1(a+d+t) ]
-
[5/6 A2(a+d) ]}
_
<13
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|v|ass(TE)~14o5 n{(b+i)2 [2/3 (a+1)
+d
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if
[ 2/3
a+d
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Q
WOMEN
1
MEN
a
ll Range
Abnormal Abnormal
Ahnoml al g Range
bnormal Abnormal Ahnormal
.
2Dmethod
\Re|erence
Mildly Moderat el y
Severe|y%ReferencekMiIdly
Moderately Severely
LVHHSS/B5Al9lm)1 44B8 89-100101-112 2113 50-102 03-115117-130 2131
Where Al =total LV
area;
A2
=
LV
cavity
area, Am
=
myocardial
area, a is the
long
or
semi-major
axis from widest minor axis radius to
apex,
b is the short-
axis radius
(back
calculated from the shon-axis
cavity area),
and d is the
truncated
semimajor
axis from widest short-axis diameter to mitral annulus
plane. Assuming
a circular area, the radius
(b)
is
computed
and mean wall
thickness
(t )
derived from the short-axis
epicardial
and
cavity
areas.
vNvvl.mch0.org
Guidelines for Chamber Quant i cat i on
Page
4 of 9
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X Fr l mc n r d i o g r a p h y
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AQE
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mvm x, r:m~u1min rl l rmmm
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Gu\ de(| nes for Chamber Quanh cat ron Page
5 of 9
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Society
uf
Ec h o c a r d i o g r a p h y
Heart arc u m/ f u m" Ul rmmund
spmarms
1,
f / ,
lm
Area-length
method
using
the
apical
four-chamber
(A4C)
and
apical
two-chamber
(A2C)
views at ventricular
end-systole
(maximum
LA
size).
The
length (L)
is measured from the back
wall tothe line across the
hinge points
of the mitral valve. The
shorter
(L)
from either the A40 or A2C is used in the
equation.
Biplane
method of
discs,
using
the
apical
four-chamber
(A4C)
and
apical
two-chamber
(A2C)
views at ventricular
end-systole
(maximum
LA
size).
Left Atrial
Volume =
8/311
[(A1)(A2)/(L)]
*
:.';~:llWl@
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ASE
Amcricatx
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l a w : to Ci rful ari vn Ui rmwund
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I
Aortic Root Measurements
Measurement of aortic root diameter at the sinuses of
Valsava from 2-D
parasternal long-axis image. (Top)
95% condence intervals for aortic root diameter at the
sinuses ot Valsalva based on
body
surface area in: children
and adolescents
(A),
adults
aged
20 to 39
years (B),
and
adults
aged
40
years
or more
(C). (Bottom)
y
=
1.92
+ 0.74x
SEE
=
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4. 4
r=o.4o
p<o.ooos
4. 0
3. 6
3. 2
2 . s
2. 4
1. 6 2. 0 2. 4
y
=1.02 + 0.98x
SEE
=
0.18
r =0. 93
p < o . o o 0 5
. . . I . . | . . . | . \ _
0.4 0.8 1.2 1. 6 2.0
y
=
0.97 +1. 12x
SEE
=
0.24
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r =0. 71
p
< 0. 0005
3. 8
3. 4
3. 0 B
2. 6
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. i . . . | _ _
1. 6 2.0 2. 4
Body
Surface Area
(m2)
Adapted
from: Roman
MJ,
Devereux
RB,
KramerFox R.
O'Lough|in
J. Two~dimensionaI
Echocardiographic
Aortic Root Dimensions in Normal Children and Adults. AmJ Cardiol
1989;64:507-512 (with permission).
S nuses of Va sa va
(cm)
.~ N .~ N s-=
N O & Q N
_
at
www.asecho.org
Guidelines for Chamber Quant i cat i on
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American
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Hen r i srCi rcul at i on Ul t rasound
Speci al i st s
Guidelines for t he Evaluation of Valvular
Regurgilation
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Adapted
from:
Zoghbl
WA, Ennquez-Sarano
M. Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P,
noCM, Qumone s MA. Fiakowski H, Slewarl WJ.
Waggener A, Weissman NJ.
Flecommendatlons for Evaluation of The Severity ol Native Valvular
Flegurgitation
with
Two~DimensaonaI and Doppler Echocardiography. J AmSoc Echocardlogr. 2003 Ju|;16(7):777-802.
Flecomrnendahons endorsed
by
t he American
College
ol
Cardiology,
the American Hearl Association,
and the
European Society
ol
Cardiology Working Group on
Echocardiography.
iidstar ordering
lniormatlon and lull tex! of ASE guideline
documents available at:
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2006 The American Society
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Doppler
Desc Aorta
-
PW
Severe
AR
Color
Doppler,
continuous wave, and pulsed
wave
(PW) Doppler recording
of ow
in the
descending
aorta in mild and severe aortic
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H/
Echocar di ogr aphy
H u n & C i m m n i n n U l r mmu mi
speci al i st s
Echocardiographic
Assessment of Valve
Adapted
from:
Baumgartner H, Hung J, Bemleio J, Chambers JB, Evangelism A,
Gnfn BP, lung B, Otto CM, Pellikka PA, Qui r i one s M.
Echocardiographic
Assessment 0( Valve Stenosis: EAEIASE Recommendations for Clinicai Practim.
Eur J
Echocardiogr
and J Am Soc Echocxardiogr
2009.
I
&
ASEr;:;':_~,r:s;f..r;f Annum' @
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2009 The American
Society
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M s m m m l o f w m
Stenosis
Page
1 : # 6
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ASE
Amer i can
Society
of
lichnLardiogi' aphy

He1rt&r Ci rcul at i on
Ultrr1sn|1ndSpeci'nlisI5
Findings indicative of
hemodynamically si gni cant t ri cuspi d
st e nosi s
l
s peci nc Findings
Mean pressure gradi ent
l
l zsmmng
inow time
velocity integral
>60 cm
l
Ti/2
z190 ms
valve area
by c ontinuity e qua tion

5 1 c m
supportive Findings
Enlarged right
atrium 2 moderate
Dilated interior vena cava
,_
Stroke volume derived from left or right ventricular
outow. in t he
presence
of more t han mild
tricuspid
regurgitation, the derived vatve area will be underestimated.
Nevertheless u value s 1cm im lies a s' nicant
P 'Q
hemodynamic
burden
Imposed byt he combined lesion.
.
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Grading
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Pulmonary
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Peak
veinciiy
< 3 3-4 >4
(rn/si
Peak
gr a die nt
<
36 36 to 64 >54
(mm Hg)
Aliasing
ol velocities at Continuous wave
Doppler
the level oft he
pulmonary acrossthe
pulmonary
valve
valve in
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for AS
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wats
recordi ng
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Data
s l e ms n t
Recor ding
M9 a s u r l ms n !
LVCT
diameter
2Dpsi - ssmnsi l o n g
a xi s vi ew.
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Zoom m o d e ,
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Mig-sysmln.
Parallal a nd
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valve or ll t h e sitll of
ve loc ity measur ement
( i l l IBXK).
Di l me l e r I5 u i e d t8
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CSA.
| _ v o ' r
vsionny
Pu| l8d WIVB Doppla r .

Apiesi i ong
ms or s-cnunzm
viaw.
snr npi s vsi ums pssmansa
-
j ust
on Lv s i a n orva lve an d
move d car eiuily into t he LVOT
If r squi r sa nooma i n la mina r
nowcurve.
VloCiIy
ba se l i ne and S t a l l
a dj ust a d
lo mi l i mi z e S i l l nf
ve loc ity
C u r v e .
Time me
( swe e p s p u n )
100mm/S.
Law wsu mm
se ni ng.
s r n o mh
vsliwsf y
survs with a
w | | da ned p i l l (
i n d I
nsrmw va ioc iiy range
ai pe a k
ve loc ity.
Ma ximum
m u n i t y
ir om
peak
of de nse
velocity
curvs.
VT! t r i t l d from
r noanl
mu n i t y .
As in
vsi sc ny
CW D b p p l l l ldldlcltd
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t uns uumr ) .
ui um pu n n u s i i s wi ndows
(mg. npic a l, supr a st nma l .
'
r igm paraseemai, sic ) ,
Ds creas s guns, i nc r sa se
-
wi l l Elini, - l dj ui l b l $ | | n
a n d SGH!(U o p l l mi l a
si gnsi .
-
Gr ay mai n s p s s u s i di spl a y
wim upnnusn
mmscan.
vsl a c i i y rnnge an d bs s ni i ns
aa|uud
so wsl wi t y signa l
-
El s but "H5 ms d i a l
sc a le .
Ma ximum
velocity
an
penn
of asnse
Vl| 0Ci! y C u r v e .
Avc id I vbiil i n d
nne i i n u r
si gnsi s.
VTI h ' l CQ d om
num
msgs
nf mme
si gna l
curve.
msn
grsaxsm
\ ' : a| \ | | l l 0d 'P0111
: mmvuocny
nurvn.
Ruper t window
where maximum
VQIDCIW ohllinc d.
Valve
anammy _
Parasternal l ong a nd Shnr t
~
a xi s vie ws.
Zuom mode .
1.
ide ntif y
numbe r ai
iesnsxs in
s y s m i s
rapns if p res n n i .
As s e s s i n n e r
mommy a nd
s mnni i s s nr s l f usion.
A s s s s s waive
saicincation.
1 ,
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ASE
American
Society
of
Echocar di ogr aphy
Haar t & Ci rcul at i on Ul t rasound
Speci al i st s
Measures of AS
severity
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by
Doppler-echocardiography
Units
Formula I
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Cutoff
roy Concept
Severe
Adva
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AS
jet
mls
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Direct
measurement i n c r e a s e s as
st e nosi s
V
. _
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efy
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Dlrect
measurement of
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e
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Volume ow
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all
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a
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ASE
Amer i can
Society
of
1 Echocar di ogr aphy
`
H e m ercm u l u m m u l r mr mr a
spmarrsrs
Echocardiographic
Evaluation of
or
LVDiastolic Function
Adapted
lrom.
Nagueh
SF.
Appleton
CP. Glllebert TC, Marino PN. Oh JK. Smlsetn OA, Waggener/XD, Flacnskampl FA,
Recommendations for the Evaluation of Left Ventricular Dlastolrc Function
by Echocardiography,
Eur J
Ecnocarcirogr
and J Am Soc
Echocardiogr
2009
LVand LAPressures in Normal
and Abnormal Diastolic Function
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information and full text ot ASE
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U l r l i l c h a o l g
Design and illustration by
medmovie.com
Copyright
2009 The American Society
of
Echocardiography
www.asecho.ofg Echocardiographic
Evaluation of LVDiastolic Function
Page
1 ot 8
ll
ia
ASE
American
Society
of
Echocar di ogr aphy
He u n sf Ci rcul uri on Ul rmsound
s p n i a l i n x
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Evaiudion of Prosthetic Vllhrn with
Echocardiography
and
Dapplor
Uiimmmnd
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Adapied from
Zughbi
WA. Chambers JB, Dumesnrl JG, Foster E, Gottdiener JS. Grayburn PA, Khandheria BK,
Levine RA, Marx GFI, Miiief FA,
Nakatani S, Ouinones MA, Fiakowski H, Rodriguez LL, Swamrnathan M, WaggonerAD.
Weissman NJ, Zabalgoiiia M,
Recommendations for Evaluation oi Prosthetic Valves with
Echocardiography
and
Doppler Ultrasound,
J AmSoc
Echocardxogr
2009 Sept . 22(9) 975-1014
This ASE
guideline
document was endor sed
by
the Arriencan
Coliege
ol
Cardiology Foundation, Amencan Heart Association,
European Association or
Echocardiography.
a
registered
branch oi
European Society
of Cardioiogy,
Canadian Socieiy oi Echocardiography,
and
Japanese Society
oi
Echocardiography.
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lniormailon and fulltext oi ASE
guideline
documents available al : www. asecho. org
by
modmoviacom
Copyright
2009 The American Society
of
Echocardiography
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Date, type,
and size of
replacement
valve
Height, weight,
and
body
surface area
Symptoms
and related
clinical
Endings
Blood
pressure
and heart rate
Motion of leaets or occluder
Structure and
integrity
of valve
and
sewing ring
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Imaging
of t he valve
Doppler echocardiography
of t he valve Contour of the
jet velocity signal
Peak
velocity
and
mean
gradient
Velocity-time integral (VTI)
of
the
jet
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index
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Pressure half-time
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mitral and
tricuspid
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Effective orice area
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Presence, location,
and
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VTIWVNTI we
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Pressure half-time
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Poss'
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>
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ol the
parameters
listed are normal or abnormal, respectively.
W
Slightly higher
cut-offs are seen in some
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parameters
are
also abnormal in the
presence
of
signiicant prosthetic
mitral
regurgitation.
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pr ost het i c
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map
Peak
velocity through
the
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or
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through
a
homograft
Increase
in
peak velocity
on serial
studies
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`
Hear t Alt Ci rcul at i on Ul l rasound
Speci al i st s
Guidelines for t he
Echocardiographic
Assessment of t he
Right
Heart in Adults
Adapt ed lr om, Fiudski LG Lai WW. Alalo J. Hua L Haridscriumaolier MD. Charidrasekarari K. Solomon SD,
Louie EK. Schiller NB Guidelines ior the
Echocardiograptirc
Assessment ol the
Right
Heart in Adults
A
Report
from t he American
Society
ol
Echocardiography
J Arri Soc
Echocardiogr
20i 0; 23' 685-713.
&
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Guidelines tor the
Echocardiographic
Ir.,,.`f..`..t;.Qf..{, Assessment of the
Right
Heart in Adults
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ordering
information and lull text of ASE
guideline
document s available at: www.asecho.org/guidelines
The information on these
pages
does riot constitute the
oiierlrig
of medical advice by ASE.
and should not be used as the sole basis to make medical
pract i ce
decisions.
Design
and illustration
by
medmovi ecom e`
Copyright
2010 The American Society
oi
Echocardiography
Guidelines for the
Echocaidiographic
Wwwasecho
"9
Assessment ofthe
Right
Heart in Adults
page
1 of 8
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/ / / / / / / / / / / / / / / / / / / / / 4 / / / / / / / / / / / / / / f / / / / / / J a / / % y % : : < : : : , / :
A. RVBasal
(RVD1)
>
4.2 cm
RVMid
(RVD2)
>
3.5 cm
RV
Longitudinal (RVD3)
>
8.6 cm
B. RVOT PLAX
proximal
>
3.3 cm
C, RVOT PSAX distal
>
2.7 cm
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of the
right
atrium
(RA)
is
performed
from the
plane
of the
tricuspid
annulus
(TA), along
the
interatrial
septum (IAS), superior
and antero-lateral walls of the RA.
The RA
major
dimension is
measured from the TAcenter to
the
superior
RAwall, and the RA
minor dimension is measured
from the anterolateral wall tothe
IAS, as indicated
by
the
yellow
arrows.
Variable
RA
Major
Dimension
RAMinor Dimension
RA
End-Syslolic
Area
Inferior vena cava
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view.
Measurement of the IVC. The
diameter
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is measured
perpendicular
to the
long
axis of
the IVC at end
expiration, just
proximal
to the
junction
of the
hepatic
veins that lie
approximately
0.5-3.0 cm
proximal
to the ostium of the
right
atrium
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>5.3 cm
>4.4 cm
>18 cm?
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D
adapted
from Assessment of the
Right
Ventricle
by Echocardiography:
APrimer for Cardiac
Sonographers,
J AMSoc
Echocardiogr
2009; 22:776-792.
Variable Abnormal
A. TAPSE <1_6 cm
B_
Pulsed
Doppler peak velocity
at the annulus
(S')
<10 cm/s
C. FAC
(%)
<35%
DA
Puised
Doppler
|v|P| >o.4o

E. Tissue
Doppler
MPI >O.55

it
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mPAP
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4(Ear|y
PI
ve|ocity)2
+
RAP
'
mPAP
=
1/3sPAP
+
2/3 dPAP
SPAP
=
artery pressure
V
mPAP
=
79
-
0. 45 x Acceleration Time mPAP
=
'
artery
Abnormal 2 25mm
Hg
d p / x p
=
artery
dPAP
=
4(End
Pr
ve|ocny>2
+
RAP
RAP
=
Right
atrial pressure
id
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Page
7 of 8
ASE
Amer i can
Society
of
Echocar di ogr aphy
H e m : at r i i r f ul mnn 1/ Irmmund
s peci al i s t s
Right
Atrial Putnam
Estimation of RA
pressure
onthe basis of IVC diameter and
collapse
Variable Normal Intennediate
High
(0-5 (3) mmHg) (
5-10
(8) mmHg) (15 mmHg)
IVC diameter $2. 1 cm S 2.1 cm >2.1 cm >
2_1 Cm
Collapse
with sniff >50% <50% >50%
<
50%
Secondary
-
Restrictive
tilling
indices of
-
Tricuspid
EIE >6
elevated RA
-
Diastolic ow
pressure predominance
inHV
"
Ranges
are
provided
for low and intermediate
categories;
however, for
simplicity,
a
mid-range
value of 3
mmHg
for normal and 8
mmHg
for
intermediate are
suggested.
Intermediate
(8mmHg)
RA
pressures may
be
downgraded
tonormal
(3 mmHg)
ifno
secondary
indices of elevated RA
pressure
are
present, upgraded
to
high
ifminimal
collapse
with sniff
(<35%)
and
secondary
indioes of elevated RA
pressure
are
present,
or left as 8
mmHg
ifuncertain.
lVC
=
Inferior vena
cava; RA=Right
atrium; HV=
Hepatic
veins
E:A E:E' Deceleration Time Additional
Findings
Normal 0.8-2.1 <6 >120ms
-
:'|:;;;n
<o.a <6 >120ms
`
Diastolic ow
predominance
in
HV
Late diastolic
antegrade
ow
in PA
Pseudonormal 0.8-2.1 >6 >120ms
Restrictive >2.1 >6 <120ms
Guidelines lor the
Echocardiographic
P 8 O' 8
wWwa5eCh'r9
Assessment of the
Right
Heart inAdults
age
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ASE
American
Society
of
fr
; Echocar di n ra h
, _ _
, :mm .rl r: i mi rmi n n 1/ r r msmmd
s p r mi l i m
Parameters for Evaluation of the
Severity
of Prosthetic Aortic Valve
Regurgitation
Parameters
Valve structure and motion
Mechanical or
Bioprosthetic
Structural
parameters
LVsize
Doppler
Parameters
(Qualitative
or Semi-
Quantitative)
Jet width incentral
jets
LVO
diameter)
-
Color*
Jet
density
-
CW
Jet deceleration rate
(PHT, ms)
-
CW
LVO ow
compared
to
pulmonary
ow
-
PW
Diastolic ow reversal in the
descending
aorta
_
PW
Doppler
Parameters
(Quantitative)
Regurgitant
Volume
Regurgilant
Fraction
Mild Moderate
Usually
normal Abnormal iv
Normal or
mildly
Norma'
dilated o
Intermediate,
(26%
-
64%)
Dense
Narrow,
(s 25%)
Incomplete
or
faint
Slow
(> 500)
Slightly
increased
Absent or brief
early
diastolic
Variable
(200-500)
Intermediate
Intermediate
<
30 ml/beat 30
-
59 ml/beat
<
30% 30
-
50%
Severe
Abnormal ~v
Dilated o
Large,
(265%)
Dense
St eep
(<200)
Greatly
increased
Prominent,
holodiastolic
3 60 ml/beat
3 50%
WAbnomiel mecnenloel valves; eg, immobile oocluder (valvular regurgitation),
denisoenoe orrocking (paravslvular
regurgitation);
Abnormal
biological
valves:
eg.
Leatlet thickening
or
pml apee (vat/utar),
dehisoenoe or
rocking
(pafavalvular regurgitation)

Parameter applicable to oentraljets

and is less accurate ineccentric
jets; Nyquist
limit ot50-60 cmls

lrmuenosd
by
LVcompliance
Gt
Applies
to chronic, late
postoperative
ARInthe absence of other
etlologles I
CW= continuous wave
Doppler;
LV
=
tell ventricle; LVO
=
left ventricular outowtract; PHT
=
pressure halt-lime;
PW=
'
pulsed
weve
Doppler.
r
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SE
American
Society
uf
Echocar di ogr aphy
Hear t & Ci rcul at i on Ul t rasound
Speci al i st s
Nonnali
Doppler Echo0amiogmphlc
Values for
Selected Prosthetic Aortic Valves
mx
gnaum
nun
gmnm :ummanna
Vllvi
ATSAP
Billallll
Bjofk-Shllly
Smgle ultmg
disc
Carponthv Edwards
Shndl l i
Sbmedpomme
Hancock 1|
Slsnled poraine
lhtronlc Fmu t y h
Slsnhess
I kdf mnlc H111
sn-lg/e :ming
msc
namanm u l e
s l e m amum
sunenum
caga-1
mu
81Jude Msdlcal
Ragem
Biloansl
Sl Judo llodlcal Standard
5119809!
Sl hl dl l l t dl t zl l
Sfenlhss
\
\~
S i n
9 1 2 5 8 5
21
23
25
27
19
21
23
Z5
27
29
21
23
25
29
19
21
23
25
27
21
23
25
27
21
23
25
27
29
23
24
26
27
29
19
21
23
25
27
19
21
23
25
27
29
21
Z3
25
27
29
(MMM)
21.42 4.2
15.72 8.3
15.1 2 5.5
38. 92119
2852111
23.7201
43.5 2 12.7
27.72 7.6
28.9 2 7.5
24.0 2 7.1
22.1 2 8.2
34.0 2 13.0
22.0 2 5.3
15.2 2 1.5
11.0240
25.9 2 10.5
26.9 2 8 9
17 1 2 7.0
15.92 9.7
23.52110
22. 52100
32 6 2 12B
34.1 Q 10 :1
31.3 Q 9.0
30 B2 6 3
29. 0Q 9. 3
20.5 2 120
15.62 9.4
12.82 6 B
11 7 2 6.8
7.9 2 5.5
42.0 Q 10.0
25 7 2 9 5
21.8 2 7.5
15, 9 1 7.3
137 2 4. 1
13.5Q 5.8
22.6 2 14.5
16.22 9.0
12.7 Q 11.2
10.1 2 5 8
1. 1Q 4.4
1IM\H1l)
21U2 1.8
11.12 3.5
10.524. 5
7.52 3.1
5. 022.0
21.0 2 3.4
15.72 5 3
13.02 5.0
10.02 2.0
25.6 2 8.0
17.32 6.2
16.12 6.2
12.92 4.5
12.12 5.5
9.92 29
14.52 4.1
16.62 8.5
10.82 2.8
8.22 17
13.023.9
9.12 5.1
8.1Q 4.6
5 3 2 3.1
4.6 2 3,1
14.1 2 5 9
13.52 4.9
9. 5 2 4.3
5.7 2 5.0
14.22 5.0
13.72 4.5
11.72 5 1
1042 4.3
11.12 4.3
22.02 9.0
22.12 7.5
19.72 6.1
10.52 3.7
16. 32 5.5
11.0x 4 B
8.0 24.8
6.93 3.5
5.6 2 3.2
3.5 2 1 7
24.52 5.8
15.2 2 5 0
13.4 2 5.5
11.02 5.3
8.4 2 3.4
7.0 2 1.7
10.72 7.2
6.2 2 4.7
5. 324.1
5.02 2.9
4.1 2 2.4
aral emf)
1 2 2 0 . 3
1.320 3
1 . 7 Q0 . 4
2. 0206
2. 1Qo. A
1 . 1 Q0 . 3
1 . 3 2 0 3
1. 5204
1. 6203
0. 9202
1520.3
1720. 5
1320.5
2. 3205
2.0205
1 3 2 0 .4
13 20.4
1520. 4
18 20.2
1.420.3
1 1 2 0 . 5
2.1s0.5
2520.1
1.120.2
1.4204
1. 5! 0. 5
1. 9202
1420.4
1. 5204
1 , 8 2 0 . 5
1920. 1
2.1202
1 , 1 2 0 . 2
1.12 0 3
1 , 6 2 0 . 4
2.0207
2.3209
2520.5
3320.5
1.52111
1.42 0 4
1.5 2 0 4
1.92115
2 5 20.4
2. 8205
1.3 2 0 6
1320.6
1 8 2 0 . 5
1020.3
2. 4Q0. 8
Pa ge z of e
,_
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4
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Mild Moderate Severe
`
`
p e n m e l e r s
;
\ LVsize
Prosthetic valve ra
i
Doppler
Parameters
~\
\
\ l
`
"
Culorlloyyjatareawm \
,
\
Flow
convergence

f
,lei
density
-CW
Jet contour -CW o

l
5
"
P\ilmbnary~vennus
llow
Quant i t at i ve Parameters
vCwl<rth(cm)
\
_A RyVol(ml/beat)
`\`
RF
{%}
EROA
(cmz)
_
`
\"`
"` \ `\`\"`"" \1"`
` \ `
\`
`
\\\= ;
l
y
\\\\\\\\\\\\\\\\\\\\\\\~\\\\\\~\\~\\\\\\\\\\\\\\\\\ we \\~\\\\\\l\\\\\\\\l \~\\\\\\
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\\
\\\
i
pl
\
ASE
American
Society
of
Echocar di ogr aphy
He l m sf ci rml mi mi vzrmsmma
s p m n l i m
'
Normal Normal or dilated
Usually
normal Abnormal Y
\
Small, central
jel
(usually
<
4cm1
<>f<2o% ofux
V""
e
area)
Intermediate
Dense
Noorminimal
incomplete
or
faint
Parabolic
Usually parabolic
SY**M e l
<
0.3 0.3-0.59
<
30 30-59
<
30 3049
<
0.20 0.20-0.49
`
l
ll\
\\
\
\
V'
// 1 j
i
f
/
/
W
w a d e
,/"/
1
;~

e`:f;;,w
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,~
"
V.

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/ /
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.

sf~~:''iJ~,'<~f</1;' . l l
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\
\\\ \ \
x
l/,;;,,//J;
ly {/WV
,I
'fIf\>f"~
'
33:."/P 2
/\/iw
\ ,
Usually
dilated '
\
_ \ i
Large eenlraljet
\
`
f
lusually
>
a
em
or
nf
\l\

\
49% e l m
area)
or
~
variable sizewal#
;
ilpirlgingijet
;
_
swimi\ginl.A~
,
y
Large 1
Danse
`_
5
////'//2,//?/////,,}7/
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-

triangular ,
Syslollc
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2 9, 6 _
l
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Normal
Doppler
Echocardiograploy
Values
for Selected Prosthetic Mitral alves
Valve
sji-m<sn|ay
manmrm
Tilting
disc
Curbomodics
Bileaei
cnrwmar-
sauna
Stented
biopmsfhesis
Cl rpomi or- Edwards
partcardlal
Stented Bioplusthesis
Nlncock I or not
lpsslsd
Stenled blopmsihesis
Mldtronic- Hall
Ti/ring dim:
Ihdt ronk: lntlm Porclm
Slsnted biopruslhssis
Omniclrbon
Tilting
disc
SI Judn llldical
Bileallot
St arr- Edwards
Caged
ball
S i n
23
25
27
29
31
23
25
27
29
31
33
27
29
31
33
27
29
31
33
27
29
31
33
27
29
31
29
31
33
35
23
25
27
29
31
33
23
25
27
29
31
26
215385
Mun gradi ent
P u k
voloclty
Pr assun Effective orlco
(mmHg) (mls)
lull-time
(ms)
: r u
(cm*)
5.0
5.572 2.3
4.53 2 2.2
4.26 2 1.6
4.9 2 1.6
3.6 2 0.6
3.46 2 1.03
3, 39 2 0.97
3.32 2 0.87
4.B 2 2.5
8.02 2.0
4.7 2 2.0
4.4 2 2.0
6.0 2 3.0
3.6
5.25 2 2.36
4, 05 2 0.83
1.0
5.02 2.0
2.46 2 0.79
4.86 2 1.69
3.87 2 2.0
3.5 2 0.51
4.2 2 1.44
4.0 2 1.3
3.2 2 1, 77
8.0
6.05 2 1.81
4.89 2 2.05
4.93 2 2 16
4.18 2 1.4
4 , 0 2 2 0
4.0
2.52 1.0
5.0 2 1.82
4.15 2 1.8
4.46 2 2.22
10 0
7.0 2 2.75
6.99 at 2.5
5.08 2 2.5
5.0
1.9
1.820.3
1. 72 0_4
1 6 2 0 . 3
17 2 0.3
1.920.1
1.320.1
1.61 20. 3
1. 52203
1 . 6 1 2 0 2 9
1. 5202
1.720.3
1. 752027
1.5-120.15
1.6
1.672 0.3
1.532 0,1
0.0
1.4
1 . 5 7 2 0 1
1. 452012
1. 62012
1 , 6 2 0 . 2 6
1 . 4 2 0 2 4
1. 3205
1.77 2 0.24
1.632 0.36
1.562 0.27
1.32 0 23
1.5
13421. 12
1.61 20. 29
1. 572029
15920. 33
1 7 2 0 . 3
1 7 2 0 . 3
12627
9 3 2 8
89220
88217
92224
93212
9 8 2 2 8
92214
9 2 2 1 9
93212
100
110215
90211
80
115220
9 5 2 1 7
90212
78
69215
77217
102215
105233
120240
134231
160
7 5 2 4
75210
8 5 2 1 0
74213
125225
110225
2. 92 0.8
2. 92 0.75
2.32 0.4
2, 821. 14
1.3 20. 5
1. 5202
1. 6202
1 , 9 2 0 . 2
1.0
1.352 0.17
1.672 0.17
1.752 0.24
2.03 2 0.32
1.4
1.9 2 0.57
1 65 2 0.4
1.982 0.4
2.6
P399
4016
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ASE
Amer i can
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1/
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ASE
Amer ican
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n e a r / .Q Ci rmi ai rvn i / zrmmund s p e n zi m
Tricumirt
lt
s
t
S
i
\
\
\
\
Echocardiographic
and
Doppler
Parameters r
Used in
Grading Severity
of
t
Prosthetic
Tricuspid
Valve
Regurgitation
t
Parameters Mild Moderate Severe
Usually
normal Abnormal or
Valve structure valve
Qggizggglgr
Valve
\
dehisoence
Jet area
by
color
Doppl er - _
1
central
jets only (cm2)
<5 5 10 MO
VCWidth
(Cm)
Q
Not dened
Zlct gened,
but
Jet
density
and contour
by Incomplete
or Dense, variable
CW
Doppler
faint, parabolic
contour
Normal or _ _ H I 1 I'
Doppler systolic hepatic
ow
bmmed
Blunted
F;/3;?
U 'C
2
RA/RV/IVC Normal* Dilated
Markedly
dilated
g
>
0.7 \
Dense with
early
peaking
'
If noother reason ior dilatation
Q For a valvular TR
jet, extrapolated
from native TR; unknown cuvosfor paraval vul ar
TR,

i
RA
=
right atrium; RV
=
right ventricle; IVC
=
inferior vena cava; VC
=
vena contracts,
t
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Evaluation of Prosthetic Valves Page
5 of 6
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