AE Lab 1.6 — 2D & M-Mode Measurements

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10 Terms

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PLAX - Diastole

Measurements must be perpendicular to chamber walls
End-diastole: onset of the QRS, first frame after MV closure or frame in which the cardiac chamber is largest
- All valves closed
Taken at the MV leaflet tips
**If there is a sigmoidal septum, move towards apex to avoid it
**Do not include RV in IVS

IVSd
LVIDd
LVPWd

<ul><li><p><span style="background-color: transparent;">Measurements must be perpendicular to chamber walls</span></p></li><li><p><span style="background-color: transparent;"><strong>End-diastole</strong>: onset of the QRS, first frame after MV closure or frame in which the cardiac chamber is largest</span></p><ul><li><p><span style="background-color: transparent;">All valves closed </span></p></li></ul></li><li><p><span style="background-color: transparent;">Taken at the MV leaflet tips</span></p></li><li><p><span style="background-color: transparent;">**If there is a sigmoidal septum, move towards apex to avoid it</span></p></li><li><p><span style="background-color: transparent;">**Do not include RV in IVS</span></p></li></ul><p></p><ul><li><p><span style="background-color: transparent;">IVSd</span></p></li><li><p><span style="background-color: transparent;">LVIDd</span></p></li><li><p><span style="background-color: transparent;">LVPWd</span></p></li></ul><p></p>

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PLAX - Systole

Measurements must be perpendicular to chamber walls
End-systole: frame after AV closure or the time in when cardiac chamber is smallest, around the T wave
- All valves closed
Taken at the MV leaflet tips
LVIDs

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Zoomed AV

Measurements must be perpendicular to LVOT walls taken inner edge to inner edge
Mid-systole: AV open
LVOT: should be taken 5-10 mm proximal to the annulus
- AoV open

LVOT
Aortic Annulus

<ul><li><p>Measurements must be perpendicular to LVOT walls taken inner edge to inner edge</p></li><li><p><strong>Mid-systole</strong>: AV open </p></li><li><p>LVOT: should be taken 5-10 mm proximal to the annulus</p><ul><li><p>AoV open </p></li></ul></li></ul><p></p><ul><li><p>LVOT</p></li><li><p>Aortic Annulus</p></li></ul><p></p>

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Zoomed Aortic Root

Normal Aortic size in the adult:
- Ao root < 4.0 cm
- Ascending Ao < 3.7 cm
- Descending Aorta < 2.8 cm
***These values can vary considerably depending on age, gender, and body habitus***

Measurements must be perpendicular to aorta walls taken leading edge to leading edge
End-diastole: onset of the QRS or frame before AV opens
- Right before AV opens

Aortic Sinus/Sinus of Valsalva
STJ
Ascending Aorta

<ul><li><p>Normal Aortic size in the adult:</p><ul><li><p>Ao root < 4.0 cm</p></li><li><p>Ascending Ao < 3.7 cm</p></li><li><p>Descending Aorta < 2.8 cm</p></li></ul></li><li><p>***These values can vary considerably depending on age, gender, and body habitus***</p></li></ul><p></p><ul><li><p>Measurements must be perpendicular to aorta walls taken leading edge to leading edge</p></li><li><p><strong>End-diastole</strong>: onset of the QRS or frame before AV opens</p><ul><li><p>Right before AV opens </p></li></ul></li></ul><p></p><ul><li><p>Aortic Sinus/Sinus of Valsalva</p></li><li><p>STJ</p></li><li><p>Ascending Aorta</p></li></ul><p></p>

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High PLAX Asc Aorta

Measurements must be perpendicular to aorta walls taken leading edge to leading edge
End-diastole: onset of the QRS or frame before AV opens
Ascending Aorta

<ul><li><p><span style="background-color: transparent;">Measurements must be perpendicular to aorta walls taken <strong>leading edge to leading edge</strong></span></p></li><li><p><span style="background-color: transparent;"><strong>End-diastole</strong>: onset of the QRS or frame before AV opens</span></p></li><li><p><span style="background-color: transparent;">Ascending Aorta</span></p></li></ul><p></p>

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Ao measurements

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IVC Diameter

Measurement must be perpendicular to IVC walls and taken inner edge to inner edge
~1-2 cm proximal to IVC/RA junction
Measured when IVC is at its maximum/biggest dimension
IVC normal size is < 2.1 cm

<ul><li><p><span style="background-color: transparent;">Measurement must be perpendicular to IVC walls and taken <strong>inner edge to inner edge</strong></span></p></li><li><p><span style="background-color: transparent;">~1-2 cm proximal to IVC/RA junction</span></p></li><li><p><span style="background-color: transparent;">Measured when IVC is at its <strong>maximum/biggest dimension</strong></span></p></li><li><p><span style="background-color: transparent;">IVC normal size is < 2.1 cm</span></p></li></ul><p></p>

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A4CH RV Focused TAPSE (tricuspid annular planar systolic excursion) Measurement

M-mode cursor should be aligned along the RV free wall as perpendicular to the lateral tricuspid annulus as possible (and as parallel as possible to movement of the TV annulus)
Measure leading edge of TV annulus from end-diastole toward the apex at end-systole
Normal TAPSE value >1.7 cm otherwise systolic dysfunction

<ul><li><p><span style="background-color: transparent;">M-mode cursor should be aligned along the RV free wall as perpendicular to the lateral tricuspid annulus as possible (and as parallel as possible to movement of the TV annulus)</span></p></li><li><p><span style="background-color: transparent;">Measure <strong>leading edge</strong> of TV annulus from <strong>end-diastole</strong> toward the apex at <strong>end-systole</strong></span></p></li><li><p><span style="background-color: transparent;">Normal TAPSE value >1.7 cm otherwise systolic dysfunction</span></p></li></ul><p></p>

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IVC Sniff Test

M-mode cursor is placed through the IVC ~1-2 cm distal from the hepatic vein, then have the patient perform a sniff maneuver
IVC diameter should be ≤ 2.1cm

<ul><li><p><span style="background-color: transparent;">M-mode cursor is placed through the IVC ~1-2 cm distal from the hepatic vein, then have the patient perform a sniff maneuver</span></p></li><li><p><span style="background-color: transparent;">IVC diameter should be ≤ 2.1cm</span></p></li></ul><p></p>

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Protocol

PLAX
- IVSd
- LVIDd
- LVPWd
- LVIDs
PLAX (m-mode)
- LV (@MV tips)
- MV (@MV tips)
- AV (@AV tips)
Zoomed AV
- LVOT diameter
- Ao Annulus
- Ao Sinus
- Ao STJ
Asc Ao
A4C
- TAPSE
SUBX
- IVC diameter
- IVC m-mode sniff

bonus

LV M-Mode (at MV leaflet tips)
- IVSd
- LVIDd
- LVPWd
- LVIDs
AV M-Mode (aortic leaflet tips)
- Aortic diameter (QRS, leading to leading)
- LA diameter (just after T wave, biggest LA, leading to leading)