Protocol (Parasternal)

PLAX beginning to LVIDd-LVIDs

• 2D max depth to visualize any possible effusions

• 2D normal depth — highest window possible

• 2D measurements- frame of IVS, LVID, PW at end-diastole at the MV tips

• 2D measurement- frame of LVID at end-systole at MV tips

What to do in PLAX if aligned properly?

Obtain M-Mode imaging of:

• Left ventricle

• Mitral valve

• Aortic valve

When and how is IVS measured?

• Interventricular septal thickness (end-diastole)

• Inner edge to inner edge

IVS measurement

0.6 - 1.1 cm

When and how is LVIDd measured?

• Left ventricular internal dimesion (end-diastole) at mitral valve leaflet tips

• Inner edge to inner edge

LVIDd measurement

3.4 - 5.6 cm

When and how is PW measured?

• Posterior wall thickness (end-diastole)

• Inner edge to inner edge

PW measurement

0.6 - 1.1 cm

When and how is LVIDs measured?

• Left ventricular internal dimesion (end-systole) at mitral valve leaflet tips

• Inner edge to inner edge

LVIDs measurement

2.3 - 4.0 cm

PLAX mitral valve

• 2D of mitral valve in Zoom/RES

• Color Doppler loop of mitral valve

• Color Doppler loop of mitral regurgitation vena contracta, if present — use Zoom/RES

When and how is LVOT measured?

• Early-systole at leaflet insertion

• Inner to inner edge

LVOT measurement

2.0 - 2.2 cm

PLAX aortic valve/aorta

• 2D of aortic valve in Zoom/RES

• Color Doppler loop of aortic valve in Zoom/RES, if aortic insufficiency is present

• 2D measurement of annulus in Zoom/RES at mid-systole (inner edge)

• 2D measurement- frame of aorta (sinuses) in Zoom/RES at end-diastole (leading edge to leading edge)

• 2D of ascending aorta (separate) in Zoom/RES at end-diastole (leading edge to leading edge)

Aorta measurement

2.1 - 3.9 cm

When and how is annulus measured?

• Between hinge points of AV leaflets (early to mid-systole)

• Inner edge to inner edge

Annulus measurement

1.4 - 2.6 cm

When and how is aortic root measured?

• Aortic root at the Sinus of Valsava (end-diastole)

• Leading edge to leading edge

Aortic root measurement

2.1 - 3.5 cm

When and how is STJ measured?

• Sinotubular junction (end-diastole)

• Inner edge to Inner edge

Sinotubular junction measurement

1.7 - 3.4 cm

When and how is ascending aorta measured?

• End-diastole

• Leading edge to leading edge

Ascending aorta measurement

2.1 - 3.4 cm

PLAX left atrium

• 2D of the left atrium in Zoom/RES

• 2D measurement- frame of left atrium at end-systole (inner edge to inner edge)

When and how is the LA measured?

• Left atrium (end-systole)

• Leading edge to leading edge

Left atrium measurement

2.3 - 3.9 cm

PLAX RVIT

• 2D RVIT (no left-sided structures should be visualized) - use Zoom/RES as needed for endocarditis

• Color Doppler loop of RVIT

• Continuous-wave Doppler frame of tricuspid regurgitation if present

PLAX RVOT

• 2D RVOT

• Color Doppler loop

• Pulsed-wave and continuous Doppler frame, if needed

PSAX aortic valve

• 2D at aortic valve level

• 2D valve in Zoom/RES demonstrating three leaflets

• Color Doppler loop of aortic valve

PSAX AVL tricuspid valve

• 2D of tricuspid valve - use Zoom/RES with highest resolution setting as needed for endocarditis

• Color Doppler loop of tricuspid valve

• Continous-wave Doppler frame of tricuspid regurgitation if present

PSAX AVL pulmonic valve

• 2D of the pulmonic valve and pulmonary artery (with branches) - use Zoom/RES with highest resolution setting, as needed for endocarditis

• Color Doppler loop of pulmonic valve

• Pulsed-wave Doppler frame of RVOT (before the pulmonic valve)

• Continous-wave Doppler frame of the pulmonic valve

PSAX left ventricular views

• 2D of the left ventricle at the mitral valve level (basal level)

• 2D of the left ventricle at the papillary muscle level

• 2D of the left ventricle below the papillary muscles (apex)