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How to write Pediatric Echo Report

Pediatric Echocardiography Introductory Course

Dr. Ahmed AbdElSamad Elhewala

Lecturer of Pediatrics – Faculty of Medicine -Zagazig University

zagPediatrics@gmail.com

Understanding the Echocardiogram

New

M-Mode2D

PW

CW

Echocardiography

2D Echocardiography

M-Mode Echocardiography

The M-mode ( 1-Dimension ) a single beam of ultrasound is transmitted and structure along its path reflect sound back to transducer. It was the first ultrasound modality to record display moving echoes from the heart and thus the motion could be interpreted in terms of myocardial and valvular function even it can help in studying arrhythmias. The M-modes were originally recorded without access to 2-dimensional images.

M-Mode Echocardiography

PW & CW Echocardiography

Pulsed Wave ( PW ) has the ability to detect the velocity and direction of blood at a certain point ; sampled volume.

Continuous Wave ( CW ) has the ability to detect velocity and direction of blood detected along line of measuring ;multiple sample volume

Pulsed wave can only measure low velocities up to 1.5 m/sec , CW has range ambiguity

Pressure gradient can be calculated from measured velocity

P=4 (V) 2

PW & CW Echocardiography

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How to write Pediatric Echo Report

1.Descritpion of cardiac lesion

2. Measurement of cardiac chambers & Vessels

3. Evaluation of valves & gradients

4.Evaluation of cardiac functions

6.Conclusion and Recommendation

5.Wall motion abnormalities ,Pericaridum & masses

1-Description of Cardiac lesion

Segmental Approach

Situs ( S or I or A)

Position of the Apex ( Dextrocardia or Dextroposition)

Position of the Ventricles( D or L)

Atrio-ventricular connection

Ventriculo-arterial connection

Relationship of the great vessels

Segmental Approach

Segmental Approach

Segmental Approach

Cardiac Position & Orientation Position of the heart in the chest with regard to itslocation, and the orientation of its apex. Location of the heart in the chest:1. Levoposition - to the left2. Mesoposition - central3. Dextroposition - to the right Cardiac orientation is the base to apex orientation of theheart:1. Levocardia - apex directed to the left of the midline2. Mesocardia - apex oriented inferiorly in the midline3. Dextrocardia - apex directed to the right of the midline

Segmental Approach

Segmental Approach

Atrial Morphology The right and left atria are identified morphologically bytheir respective atrial appendages and veins emptyinginto them. The RA receives IVC, SVC and coronary sinus. The LA receives all 4 pulmonary veins. The RA has a triangular, broad based, anteriorappendage while the LA has a narrow, fingerlikeposterior appendage. The septum secundum (limbus of the fossa ovale) lies onthe RA side. The septum primum (flap) lies on the LAside. The Crista Terminalis is in the RA. LA is smoothwith fewer trabeculations. Almost invariably 2 atria are present although sometimesthere may be a common atrium if the IAS is absent.

Segmental Approach

Identifying the right and left ventricle and its relationship to each other ( right and left hand rule)

Segmental Approach

Identifying the right and left ventricle and its relationship to each other ( right and left hand rule)

Segmental Approach

Concordant or DiscordantConnections Connection : refers to the sequence of anatomicstructures. Normally, RA is connected to RV by means ofTV. RV is then connected to the PA by means of the PV.Therefore, there are atrio-ventricular connections andVentriculo-arterial connections to identify. Concordance: describes the relationship between thevarious chambers, valves, and great vessels. In thenormal heart all the connections and relationships in theanatomic sequence are concordant. Discordance : describes abnormal relationships betweenthe various chambers and great vessels.

Segmental Approach

Segmental Approach

AV Connection/Alignment AV Concordance AV Discordance Tricuspid Atresia Mitral Atresia Common AV Valve Overriding AV Valve Straddling AV Valve Double Inlet Ventricle

Segmental Approach

Segmental Approach

Arterial Morphology The definition of an aortais an artery that gives riseto the coronary arteriesand the brachiocephalicvessels. In contrast the pulmonaryartery branches into twobut does not give rise toany vessels.

Segmental Approach

Ventriculo-Arterial ConnectionConcordant or Discordant When the aorta is connected to the LV and thepulmonary artery to the RV the connection is describedas concordant. If the aorta is connected to the RV and the pulmonaryartery to the LV then the connection is discordant. Thisis most commonly seen in transposition of the greatarteries (TGA)

Segmental Approach

Concordant or Discordant

Double outlet Ventricle

Single outlet

Segmental Approach

Segmental Approach

Segmental Approach

2.Measurement of cardiac chambers

Origin RPA= 0.5cmBSA=0.4m2

Z - score

Z score= -3.5

M-Mode Echocardiography

Measurement of Vessels

Aorta

3.Evaluation of valves & gradients

Every Valve should be evaluated by 2D echocardiographic examination , then by color then by pulsed and continuous wave doppler.

Tricuspid regurge maximal pressure gradient can help estimate pulmonary artery systolic pressure

Pressure gradient across shunts should be measured

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4.Evaluation of cardiac functions

Can be qualitative , semiquantitative or quantitative

Evaluation of systolic and diastolic functions of right and left ventricles

5.Wall motion , pericardium ,masses

Any wall motion abnormality should be described if dyskinetic as in aneurysm or hypokinetic as in ischemia or akinetic as in cases with infarction

Pericardial effusion should be identified and if there is tamponade

Any cardiac mass should be descriped , its location, attachment , size and relation to valves and vessels , what due you suspect ? Is it thrombus , tumour or vegetations

6.Conclusion & Recommendation

Should be in clear words stating the diagnosis , determining different lines of management .

Does the case need admission ? Is there need for emergency treatment ;

medical as prostin or surgical ? If surgery is recommended , when you

expect the surgery will be done?All this should be also explained to the

parents.

Important Items (ASE)

Full name of the patient in clear words

Age of the patient

Date of the study

Imaging window visibility

Name of study performer and signature

Refering physician and reason of referral

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Dr. Ahmed AbdElSamad Elhewala

zagPediatrics@gmail.com