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The American Society of echocardiography ASE provides

The nomenclature Guidelines for echocardiographic measurements

Why is it critical for sonographers to stay up-to-date with the ASEguidelines?

Because ASE guidelines change Over time

It is important to understand what happens in diastole and systole

In order to perform proper echo measurements

Most measurements are taken

At the very end of each part of the cardiac cycle that we are looking at

When measuring it is important to be consistent with

The edges conversion

Trailing edge to leading edge

Typically used for internal dimensions (inner edge to inner edge )

Leading edge to leading edge

Typically use for external dimensions or specific structures like the aorta

Leading edge to trailing edge

Less common but refers to outer edge to outer edge

END DIASTOLE

The point in which cardiac cycle when the left ventricle is at its largest

What is closed at end diastole

The mitral valves in the aortic valve are closed

Which ventricle is the smallest at end diastole

Left atrium

What is the characteristic of the LV walls in end diastole?

The LV walls are thinner than in systole

What is the orientation to find end diastole?

The measurement cursor must be perpendicular to the long axis of the LV to avoid over estimation

What is the location of END DIASTOLE

Measurements are typically placed in the Level of the mitral valve leaflet tips

What is the timing of END DIASTOLE

Scroll to the first video frame immediately after the mitral Leaflet closure

If the mitral motion is not visible

The peak of the R wave on the EKG can approximate end diastole Ensuring that this is before the AV opens

What is the image optimization ofend diastole?

The chamber should be viewed along its center axis to maximize dimension

What is the convention of end diastole

Use the inner edge to inner edge, (blood tissue interface )for most internal chamber measurements

The diameter of the aortic root is the maximum diameter of the

Sinus of Val Silva obtained from the parasternal long access which depicts that aortic root and proximal descending aorta

Measurements should be made in the view that depicts the

Maximum aortic diameter perpendicular to the axis of the aorta

presumed aorta view measurements should be made from

Leading edge to leading edge

At which point of the cardiac cycle, should the measurements for long axis of the Aorta be taken

End diastole

Why are the measurements of long AXIS Of the aorta at end diastole So critical

Because the aortic root is prone to dilation

How do you manipulate the probe in order to go from PLAXLV To PLAX aorta

Slide the probe up anteriorly on the chest by approximately one intercostal space

What is considered the most standard anatomical measurement location for determining overall aortic size?

At the aortic root ( Sinus of Val Salva

What is the specific edge to edge used when taking the aortic measurements?

Measure from leading edge to leading edge

Which means outer edge of the anterior aortic wall to the inner edge of the posterior aortic wall

normal range for aortic annulus For men

2.9 cm + or - 3 centimeters

Normal range of aortic anulus in females

2.6 cm + or - 3 cm

Normal range for sinuses Valsalva in men

3.7 cm + or minus 3

What is the normal range of sinuses of Valsalva in females?

3.3 cm + or - 3 cm

What is the normal range for the Sino tubular junction in men?

3.2 cm + or - 3

What is the normal range for Sino tubular junction in females?

2.9 cm + or - 3 cm

What is the normal range for proximal ascending aorta in males?

3.5 cm + or - 3 cm

What is the normal range for proximal ascending aorta in females?

3.2 cm + or - 3 cm

Where Measurements at the long axis of the aorta are done at end diastole

LVOT aortic ANNULus Sinuses of Valsalva Sno tubular junction, ascending aorta

What is the anatomical description of LVOT

It is the tunnel of muscle and tissue leading out of the left ventricle into the aorta

At which specific point in the cardiac cycle Must LVOT be measured?

Mid SYSTOLE

Why is measuring specifically at mid SYSTOLE absolutely necessary

It must be measured in order to calculate the stroke volume accurately

How is LVOT measure measured

Measure from inner to inner edge

What are the two specific anatomical landmarks used to determine inner to inner edge measurements for LVOT

From the septal endocardium to the anterior mitral leaflet hinge point

What is the precise distance range from the aortic valve ORIFICE where the LOVT measurement should be taken

Within 0.5 cm to 1.0 cm

Why does small error in the LVOT diameter LVOTd Measure measurement lead to a massive error in the final calculations

Because the LVOT measurement is squared in the continuity equation

What critical clinical calculation is heavily impacted by an error in the LVOT measurement

The calculation of the aortic valve area

What is the dangerous clinical consequence or potential misdiagnosis that can result from inaccurate LVOT measurement

Potentially the severity of aortic stenosis

What specific ultrasound view and adjustment should be used to measure the aortic valve ANNULus

A zoomed view of the aorta in PLAXLV View

At which point in the cardiac cycle should the aortic ANNULUS Be measured

Mid SYSTOLE

What rule Is applied when measuring aortic valve ANNULUS

Measure measured from inner edge to inner edge

What specific anatomical landmarks defined the endpoint for measuring aortic valve ANNULUS

The rights and the non-coronary cusps insertion points

How should the measurement line be oriented relative to be outflow tract?

It is essential to measure perpendicular

Why must the measurement line be strictly perpendicular?

To ensure accurate, not oblique cross-section

What is the Primary pitfall that causes under or overestimation of the aortic valve ANNULUS size

Miss identifying the hinge points of the coronary CUSPS

What is the clinical consequence of Miss identifying the cusp hinge Points

It can lead to significant sizing Errors

What should the state of the left ventricle cavity be during normal end SYSTOLE

It should be at a smallest

Which two valves should be closed during end SYSTOLE

Both the mitral and the aortic valve

What is the state of the left atrium during end SYSTOLE

It is at its largest

How do the left ventricle walls during end SYSTOLE compared to how they look during diastole

The LV walls are thicker than in diastole

What is the anatomical level used to measure END SYSTOLE

At the same level used for diastole Specifically at the mitral valve leaflet tips

To maintain consistency across cardiac cycles, which heartbeat should you use to measure END SYSTOLE

Measure it at the same heartbeat that was used to find END diastole

What is the physical control on the ultrasound machine machine used to navigate the clip and precisely locate END SYSTOLE

Scroll with the track ball

Which specific frame or point should the LV END Systolic Dimension be obtained

And the smallest cavity dimension

In terms of bowel movement, which frame usually represents the exact moment of END SYSTOLE

Usually, the frame proceeding initial early diastolic opening of the mitral valve

Where should the measurement cursor be placed relative to the mitral valve leaflet

Just distal to the mitral valve tips

You must ensure your end systolic measurement is taken before what event happens in the next cardiac cycle

Before mitral valve opens for the next cycle

If an EKG traced is available, what specific electrical marker Signals ENDSYSTOLE

At the end of the T wave

Even though EKG can help, what skill should you master independently?

Learning to To find ENDSYSTOLE visually without relying on the EKG trace

What are the four anatomical measurements That are needed to be made In PLAX LV At END SYSTOLE

IVS END Systolic Thickness

LVIDs

LVPW END Systolic thickness

LA Diameter

What specific edge to edge convention is used when measuring LVIDs

Trailing edge to leading edge, which is just below the mitral valve leaflet tips

Why is ENDSYSTOLE Specifically chosen as the critical time to measure the left atrium

Because when it is at as largest value as it acts as a reservoir during ventricular Sicily

How should the measurement line be physically Orientated relative to the structure of the left atrium

Measure perpendicular to the long AXIS

What an atomic level or marker should the LA measurement Be placed

At the level of the aortic sinuses

What is the edge to edge rule used to measure La diameter?

Measure from inner to inner edge

What are the two exact wall boundaries used When perform performing the inner to inner edge, LA Movement

From posterior aortic wall to posterior atrial wall

Obtaining a proper LA measurement is absolutely necessary for diagnosing What condition?

left atrial enlargement

LA enlargement is the key clinical marker for which two major medical risks

Cardiovascular risk and atrial fibrillation

How do you measure RVIDd

Inner to inner edge

What is normal range for RVIDd For both men and women

2.0 - 3.0 cm

How to measure IVSd

Tissue interface to tissue interface

Normal range for IVSd for men

0.6– 1.0 cm

Normal range for IVSd for women

0.6–0.9 cm

How to measure and exact location for LVIDd

Inner to inner edge, measured below mitral valve

Normal range for LVIDd For men

4.2–5.8 cm

Normal range for LVIDd For women

3.8–5.2 cm

How is the LVPW Of the LV measured at END diastole

Tissue to tissue interface

Normal range for LVPW of the LV In males

0.6–1.0 cm

Normal range for LVPW of the LV For women

0.6–0.9 cm

How to measure aortic root at sinus of the Salva

Outer edge to inner edge

Normal range for aortic root sinus Salva in men

3.0–3.7 cm

Normal ranges for aortic rule at sinus of Valsalva in females

2.7–3.3 cm

How to measure and locate LVIDs

Inner to inner edge below the Mitral valve

Normal range for LVIDs In men

2.5–4.0 cm

Normal range for LVIDs In Women

2.2–3.5 cm

how is the left atrium measured

Outer To inner edge

Normal range for LA in men

3.0–4.0 cm

Normal range for LA In females

2.7–3.8 cm

How to get and location of LVOT diameter

Inner to inner edge from the septal endocardium to anterior mitral leaflet hinge point

Normal range LVOT diameter in men

2.0–2.4 cm

Normal range LVOT diameter in females

1.8–2.2 cm

How to get an exact location for aortic valve ANNULUS

Inner to inner edge, right and non-coronary cusp insertion points

Normal range aortic valve ANNULUS in men

2.0–2.9 cm

Normal range for aortic valve ANNULUS in females

1.9–2.6 cm