TTE Protocol Post LAAO or PFO/ASD

Setup

• Obtain height, weight, blood pressure on all patients
• Obtain ECG tracing
  • 3 beat loop
    • If HR > 100 bpm increase number of loops to 4 beats
    • If HR > 120 bpm increase number of loops to 5 beats

Warning: DO NOT ACQUIRE IMAGES WITHOUT AN ADEQUATE ECG TRACING

View	Modality	Image	#beats
1 Patient information page
		PARASTERNAL LONG AXIS
2	2D	PLAX depth 5 cm (adequate to visualize pericardial/pleural effusion or	3
3	2D	PLAX depth 2 cm (on axis for LV, measure EF)	3
4	Color	Mitral and aortic valve	3
5	2D	AoV (Zoom; optimize for LVOT measurement; should include both Ao root sinuses)	3 x2
6	2D	RV inflow- TV	3
7	Color	RV inflow- TV with color	3
8	CW	RV inflow- TR jet	3
9	2D	RV outflow PV	3
10	Color	RV outflow PV (focus on RVOT)	3
		PARASTERNAL SHORT AXIS
11	2D	AoV level, show TV, PV and left atrium	3
12	2D	Tricuspid valve	3
13	Color	TV, TR jet	3
15	CW	TR jet	3
16	Color	Color on Occluder (if ASD/PFO closure)
17	2D	Mid-pap level
		Apical 4-Chamber View
18	2D	Apical 4-Chamber (all 4 chambers)	3
19	2D	Apical 4-Chamber (LV focused- for biplane Simpson’s & RWMA)	3 x2
20	2D	Apical 4-Chamber Simpsons measurement
21	2D	LA measurement
22	Color	MV inflow Color	3
23	2D	Apical 4-Chamber LAA focused (If for LAAO)
24	Color	Apical 4 Chamber LAA focused color sweep (Nyquist <50 cm/s, increase color gain)	3
25	2D	RA measurement
26	2D	RV focused View	3
27	Color	RV focused (TV and TR jet)	3
28	CW	RV focused (TV and TR jet)	3
		Apical 5-Chamber View
29	2D	Apical 5-Chamber (all 5 chambers)	3
30	Color	Apical 5-Chamber (color box to display complete AR jet)	3
31	PW	Apical 5-Chamber PW of LVOT, optimize baseline	3
32	CW	Apical 5-Chamber AV CW	3
		Apical 2-Chamber View
33	2D	Apical 2-Chamber	3 x2
34	2D	Apical 2-Chamber Simpsons measurement
35	Color	Apical 2-Chamber focus on MV color	3
36	2D	LA measurement
37	2D	Apical 2-Chamber LAA focused (if for LAAO)
38	Color	Apical 2-Chamber LAAO focused color sweep (Nyquist <50cm/s, increase color gain)
		Apical 3-Chamber View
39	2D	Apical 3-Chamber (all 3 chambers)	3
40	Color	Apical 3-Chamber (color box to display complete AR jet)	3
41	Color	Apical 3-chamber color MV
		Subcostal
42	2D	Subcostal, 4-chamber
43	2D	Interatrial septum (zoom)
44	Color	Interatrial septum (zoom) Color Nyquist <50 cm/s (on device if applicable)	3 x2
45	2D	IVC and measurement
46*	Color	IVC and hepatic vein
		PISA- please consider for moderate or greater regurgitation; aliasing velocity 30-38 cm/s
		3D & 3D color- feel free to acquire; single beat and multi-beat acquisitions
		Anything more than mild valve disease use 3D protocol