TTE Protocol Post MV TEER/ TMVI

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 measurements	3
	4	2D	AV color	3
	5	2D	AoV (Zoom; optimize and measure for LVOT measurement; should include both Ao root sinuses)	3 x2
	6	Color	MV sweep	5 x2
	7	3D	X-plane through MV leaflet tips	3
	8	3D Color	X-plane with color MV leaflet tips	3
	9	3D	PLAX MV 3D	3
	10	3D Color	MV 3D w/ color
			3D beats should be set to 1 beat and Density set to LOW
			3D beats should be set to 6 beats and Density set to LOW
			3D beats should be set to 6 beats and Density set to HIGH, adjust depth at lat/elev plane sizes to keep frame rates as close to 10Hz or above as possible
	11	2D	RV inflow- TV	3
	12	Color	RV inflow- TV with color	3
	13	CW	RV inflow- TR jet	3
	14	2D	RV outflow PV	3
	15	Color	RV outflow PV (focus on RVOT)	3
			PARASTERNAL SHORT AXIS
	16	2D	MV level, if MV TEER show tissue bridge	3
	17	Color	MV level color sweep	5 x2
	18	Color	MV level color X-plane to show jet (s)	3
	19	3D	PSAX MV 3D
	20	3D Color	MV 3D w/ color
			3D beats should be set to 1 beat and Density set to LOW
			3D beats should be set to 6 beats and Density set to LOW
			3D beats should be set to 6 beats and Density set to HIGH, adjust depth at lat/elev plane sizes to keep frame rates as close to 10Hz or above as possible
	21	2D	Tricuspid valve	3
	22	Color	TV, TR jet	3
	23	CW	TR jet	3
	24	2D	Pulmonic valve	3
	25	Color	PV, RVOT, PR jet	3
	26	2D	LV pap level	3
	27	M-mode	LV m-mode	3
			Apical 4-Chamber View
	28	2D	Apical 4-Chamber (all 4 chambers)	3
	29	2D	Apical 4-Chamber (LV focused- for biplane Simpson’s & RWMA)	3 x2
	31	2D	Simpsons measurement
	32	2D	Apical 4-Chamber (MV focused)	3
	33	2D	MV color sweep	5X2
	34	Color	Mitral valve inflow VTI	3
	35	3D	PLAX MV 3D without color	3
	36	3D	MV 3D w/ color
			3D beats should be set to 1 beat and Density set to LOW
			3D beats should be set to 6 beats and Density set to LOW
			3D beats should be set to 6 beats and Density set to HIGH, adjust depth at lat/elev plane sizes to keep frame rates as close to 10Hz or above as possible
	37	PW	RUPV PW
	38	2D	RV focused View	3
	39	M-mode	TAPSE
	40	PW TDI	S’
	41	2D	FAC
	42	Color	RV focused (TV and TR jet)	3
	43	CW	RV focused (TV and TR jet)	3
			Apical 5-Chamber View
	47	2D	Apical 5-Chamber (all 5 chambers)	3
	48	Color	Apical 5-Chamber (color box to display complete AR jet)	3
	51	PW	Apical 5-Chamber PW of LVOT	x2
	52	CW	Apical 5-Chamber CW of AV	x2
			Apical 2-Chamber View
	53	2D	Apical 2-Chamber	3
	54	2D	Apical 2-Chamber (LV focused-for biplane Simpsons and RWMA	3 x2
	55	2D	Simpsons measurement
	56	2D	Apical 2-Chamber (Focus on MV)
	57	Color	Apical 2-Chamber MV sweep	5 x2
	58	3D Color	Apical 2-Chamber X-plane on MR jet (s)	3
	59	CW	Apical 2-Chamber CW MV VTI
			Apical 3-Chamber View
	60	2D	Apical 3-Chamber (all 3 chambers)	3
	61	Color	Apical 3-Chamber (color box to display complete AR jet)	3
	62	PW	Apical 3-Chamber PW of LVOT	x2
	63	CW	Apical 3-Chamber AV CW	x2
	64	Color	Apical 3-Chamber MV color sweep	5 x2
	65	CW	Apical 3-Chamber CW MV VTI
			Subcostal
	66	2D	Subcostal, 4-chamber
	67	Color	Interatrial septum Color sweep (zoom)
	68	2D	IVC
	69	Color	IVC and hepatic vein
	70	Color	IVC sniff with diameter
			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
			If MV TEER is moving rocking back and forth with the leaflet motion and a large degree of MR contact ML to look over images, this could be a SLDA
			If MV mean gradient is >10 mmHg or effusion greater than baseline contact ML