How to write Pediatric Echo Report?

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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_at_gmail.com
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Understanding the Echocardiogram
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2D Echocardiography
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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.

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M-Mode Echocardiography
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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
• P4 (V) 2

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PW CW Echocardiography
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Follow ASE Guidlines
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How to write Pediatric Echo Report
1.Descritpion of cardiac lesion
6.Conclusion and Recommendation
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1-Description of Cardiac lesion
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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

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Segmental Approach
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Segmental Approach
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Segmental Approach
Cardiac Position Orientation ? Position of the
heart in the chest with regard to its location,
and the orientation of its apex. ? Location of
the heart in the chest 1. Levoposition - to the
left 2. Mesoposition - central 3. Dextroposition
- to the right ? Cardiac orientation is the base
to apex orientation of the heart 1. Levocardia -
apex directed to the left of the midline 2.
Mesocardia - apex oriented inferiorly in the
midline 3. Dextrocardia - apex directed to the
right of the midline
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Segmental Approach
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Segmental Approach
Atrial Morphology ? The right and left atria are
identified morphologically by their respective
atrial appendages and veins emptying into them. ?
The RA receives IVC, SVC and coronary sinus. ?
The LA receives all 4 pulmonary veins. ? The RA
has a triangular, broad based, anterior appendage
while the LA has a narrow, fingerlike posterior
appendage. ? The septum secundum (limbus of the
fossa ovale) lies on the RA side. The septum
primum (flap) lies on the LA side. The Crista
Terminalis is in the RA. LA is smooth with fewer
trabeculations. ? Almost invariably 2 atria are
present although sometimes there may be a common
atrium if the IAS is absent.
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Segmental Approach
Identifying the right and left ventricle and its
relationship to each other ( right and left hand
rule)
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Segmental Approach
Identifying the right and left ventricle and its
relationship to each other ( right and left hand
rule)
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Segmental Approach
Concordant or Discordant Connections ? Connection
refers to the sequence of anatomic structures.
Normally, RA is connected to RV by means of TV.
RV is then connected to the PA by means of the
PV. Therefore, there are atrio-ventricular
connections and Ventriculo-arterial connections
to identify. ? Concordance describes the
relationship between the various chambers,
valves, and great vessels. In the normal heart
all the connections and relationships in
the anatomic sequence are concordant. ?
Discordance describes abnormal relationships
between the various chambers and great vessels.
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Segmental Approach
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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
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Segmental Approach
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Segmental Approach
Arterial Morphology ? The definition of an
aorta is an artery that gives rise to the
coronary arteries and the brachiocephalic vessels.
? In contrast the pulmonary artery branches into
two but does not give rise to any vessels.
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Segmental Approach
Ventriculo-Arterial Connection Concordant or
Discordant ? When the aorta is connected to the
LV and the pulmonary artery to the RV the
connection is described as concordant. ? If the
aorta is connected to the RV and the
pulmonary artery to the LV then the connection is
discordant. This is most commonly seen in
transposition of the great arteries (TGA)
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Segmental Approach
Concordant or Discordant Double outlet
Ventricle Single outlet
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Segmental Approach
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Segmental Approach
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Segmental Approach
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2.Measurement of cardiac chambers
Z - score
Origin RPA 0.5cm BSA0.4m2
Z score -3.5
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M-Mode Echocardiography
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Measurement of Vessels
Aorta
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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

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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

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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.

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Important Items (ASE)
Full name of the patient in clear words
Name of study performer and signature
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Thank You !

• Dr. Ahmed AbdElSamad Elhewala

zagPediatrics_at_gmail.com