Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography

Attention ASE Members:Visit www.aseuniversity.org to earn free continuing medical education credit through an online activity related to this article. Certificates are available for immediate access upon successful completion of the activity. Nonmembers will need to join the ASE to access this great member benefit!This document is endorsed by the following American Society of Echocardiography International Alliance Partners: Argentine Federation of Cardiology, Argentine Society of Cardiology, ASEAN Society of Echocardiography, Australasian Sonographers Association, British Society of Echocardiography, Canadian Society of Echocardiography, Chinese Society of Echocardiography, Department of Cardiovascular Imaging of the Brazilian Society of Cardiology, Indian Academy of Echocardiography, Indian Association of Cardiovascular Thoracic Anaesthesiologists, Indonesian Society of Echocardiography, InterAmerican Association of Echocardiography, Iranian Society of Echocardiography, Israel Work Group on Echocardiography, Italian Association of Cardiothoracic Anaesthesiologists, Japanese Society of Echocardiography, Korean Society of Echocardiography, National Society of Echocardiography of Mexico, Philippine Society of Echocardiography, Saudi Arabian Society of Echocardiography, Thai Society of Echocardiography, Vietnamese Society of Echocardiography. Visit www.aseuniversity.org to earn free continuing medical education credit through an online activity related to this article. Certificates are available for immediate access upon successful completion of the activity. Nonmembers will need to join the ASE to access this great member benefit! This document is endorsed by the following American Society of Echocardiography International Alliance Partners: Argentine Federation of Cardiology, Argentine Society of Cardiology, ASEAN Society of Echocardiography, Australasian Sonographers Association, British Society of Echocardiography, Canadian Society of Echocardiography, Chinese Society of Echocardiography, Department of Cardiovascular Imaging of the Brazilian Society of Cardiology, Indian Academy of Echocardiography, Indian Association of Cardiovascular Thoracic Anaesthesiologists, Indonesian Society of Echocardiography, InterAmerican Association of Echocardiography, Iranian Society of Echocardiography, Israel Work Group on Echocardiography, Italian Association of Cardiothoracic Anaesthesiologists, Japanese Society of Echocardiography, Korean Society of Echocardiography, National Society of Echocardiography of Mexico, Philippine Society of Echocardiography, Saudi Arabian Society of Echocardiography, Thai Society of Echocardiography, Vietnamese Society of Echocardiography. I.Introduction 3II.Nomenclature 4A.Image Acquisition Windows 4B.Scanning Maneuvers 5C.Measurement Techniques 5III.Instrumentation 5A.Two-Dimensional Imaging 51.Grayscale Maps 52.B-mode Colorization 63.Dynamic Range 64.Transmit Frequency 65.Harmonic Imaging 76.Sector Size and Depth 87.Transducer Beam Focus 88.Overall Gain and Time-Gain Compensation 89.Zoom/Magnification 810.Frame Rate 8B.Spectral Doppler 81.Velocity Scale 82.Sweep Speed 83.Sample Volume Size 104.Wall Filters and Gain 105.Display Settings 126.Pulsed-Wave Doppler, High–Pulse Repetition Frequency Doppler, and CW Doppler 127.Doppler Tissue Imaging 15C.Color Doppler Imaging 171.ROI and 2D Sector Size 172.Color Gain 173.Color Maps 174.Color Doppler Velocity Scale 17D.M Mode 181.Color M Mode 182.Steerable M Mode 18E.Electrocardiographic Setup 18IV.Two-Dimensional Imaging Protocol 23A.PLAX View 231.PLAX View: Left Ventricle 252.Right Ventricular Outflow Tract View 253.Right Ventricular Inflow View 25B.PSAX Views 25C.Apical Views 261.A4C View 262.Right Ventricle–Focused View 263.Apical Five-Chamber View 264.CS View 265.Two-Chamber View 306.Apical Long-Axis View (Three-Chamber View) 307.A4C and A2C Views Demonstrating the Atria and Pulvns 30D.SC Window and Views 311.SC Four-Chamber View 312.SC Short-Axis View 31E.SSN Long-Axis View 31V.Two-Dimensional Measurements 31A.PLAX View 311.Left Ventricle 312.Proximal RVOT 313.Anterior to Posterior LA Measurements 314.LVOT and Aortic Annulus 315.Asc Ao 32B.PSAX View 331.RVOT 332.PA 33C.Apical Views 331.LV Volume 33a.Biplane Disk Summation 33b.Three-Dimensional LV Volume 332.LA Volume 333.RV Linear Dimensions 334.RV Area 335.Right Atrial Volume 33D.SC Views 371.IVC 37VI.M-Mode Measurements 37A.TAPSE 37B.IVC 37C.AV 37VII.CDI 37A.RVOT, Pulmonary Valve, and PA 41B.RV Inflow and TV 41C.LV Inflow and MV 41D.LVOT and AV 42E.Aortic Arch 42F.Pulvns 42G.Hvns 42H.IVC 42I.Atrial Septum 42VIII.Spectral Doppler Imaging Measurements 42A.RVOT and Pulmonary Valve 43B.TV 43C.MV 43D.LVOT and AV 43E.Aortic Arch and Desc Ao 46F.Hvns 46G.Pulvns 46H.Tissue Doppler of the Mitral and Tricuspid Annuli 48IX.Additional Techniques 48A.Agitated-Saline Imaging 48B.UEA Imaging 491.Indications 492.Instrumentation and Administration 543.Image Acquisition 54C.Strain Imaging 54D.Three-Dimensional Evaluation of LV Size and Systolic Function 55X.The Integrated Complete Transthoracic Examination 55XI.The Limited Transthoracic Examination 55A.Pericardial Effusion 55B.LV Function 55C.Limited Right Ventricle and Pulmonary Hypertension 55XII.References 56XIII.Appendix: Additional Alternative Views 59A.PSAX Coronary Artery View 59B.RV A2C View 59C.SC SVC (Bicaval) View 59D.SC Abdominal Aorta 59E.Right Lateral Imaging of the IVC 59F.SC Short-Axis IVC 59G.SC Focused Interatrial Septum 59H.SC Short-Axis RVOT View 59I.SC Short-Axis Sweep from the Level of the Great Arteries through the Apex of the Heart 59J.Right Parasternal View of the Aorta 59K.SSN Innominate Veins 64L.SSN Short-Axis LA and Pulvn View (“Crab View”) 64M.Color M-Mode Flow Propagation 64