Methods

It is critical that users apply the same measurement methodolgy as used in the generation of the reference values. For the most part (except where otherwise noted), measurements included herein abide by the recent ASE Pediatric Guidelines .

Briefly, the following principles apply:

M-Mode:
Measurements are made using the "leading edge to leading edge" convention.
2D:
Measurements are made from the endocardial surfaces; vascular diameters use the "inner edge to inner edge" convention, measuring perpendicular to the vessel wall.

Details

The following list provides technical detail for individual site measurements:

RV End Diastolic Dimension (M-Mode)
Units: mm
View: parasternal
Timing: diastole
Where to measure: RV free wall to RV septal surface
Left Atrial Diameter (M-Mode)
Units: mm
View: parasternal
Timing: systole
Where to measure: AP diameter at level of aortic root
Interventricular Septum, Diastole (M-Mode)
Units: mm
View: parasternal
Timing: diastole
Where to measure: RV endocardial surface to LV endocardial surface
LV End-Diastolic Diameter (M-Mode)
Units: mm
View: parasternal
Timing: diastole
Where to measure: posterior septal surface to anterior surface of posterior wall; excluding papillary muscles
LV Posterior Wall, Diastole (M-Mode)
Units: mm
View: parasternal
Timing: diastole
Where to measure:
Interventricular Septum, Systole (M-Mode)
Units: mm
View: parasternal
Timing: systole
Where to measure:
LV End-Systolic Diameter (M-Mode)
Units: mm
View: parasternal
Timing: systole
Where to measure:
LV Posterior Wall, Systole (M-Mode)
Units: mm
View: parasternal
Timing: systole
Where to measure:
LV Mass (M-Mode)
Units: g
View: parasternal
Timing: diastole
Where to measure: see: IVSd, LVEDD, and LVPWd
Left Atrial Diameter (2D)
Units: mm
View: parasternal
Timing: systole
Where to measure: largest A-P diameter
LA Major Diameter (2D)
Units: mm
View: A4C
Timing: systole
Where to measure: maximal distance from the center of the mitral annulus to the center of the superior LA wall, parallel to the interatrial septum
LA Minor Diameter (2D)
Units: mm
View: A4C
Timing: systole
Where to measure: maximal distance from the atrial septum to the lateral atrial wall
LA Area (2D)
Units: cm^2
View: A4C
Timing: systole
Where to measure: endocardial surface, from the lateral aspect of the mitral annulus to the septal aspect, excluding the pulmonary veins and appendage
Mitral Valve, Lateral (2D)
Units: mm
View: A4C
Timing: diastole
Where to measure: leaflet hingepoints
Mitral Valve, Antero-Posterior (2D)
Units: mm
View: PLAX;
Timing: diastole
Where to measure: leaflet hingepoints
LV Major, End-Diastole (A4C) (2D)
Units: mm
View: A4C;
Timing: diastole
Where to measure: basal border (line connecting the MV annular hinge points) midpoint to the apical endocardium
LV Area, End-Diastole (A4C) (2D)
Units: mm
View: A4C;
Timing: diastole
Where to measure: LV endocardial borders (excluding the papillary muscles)
LV Major Diameter, End-Systole (A4C) (2D)
Units: mm
View: A4C;
Timing: systole
Where to measure: basal border (line connecting the MV annular hinge points) midpoint to the apical endocardium
LV Area, End-Systole (A4C) (2D)
Units: mm
View: A4C;
Timing: systole
Where to measure: LV endocardial borders (excluding the papillary muscles)
LV Major Diameter, End-Diastole (A2C) (2D)
Units: mm
View: A2C;
Timing: diastole
Where to measure: basal border (line connecting the MV annular hinge points) midpoint to the apical endocardium
LV Area, End-Diastole (A2C) (2D)
Units: mm
View: A2C;
Timing: diastole
Where to measure: LV endocardial borders (excluding the papillary muscles)
LV Major Diameter, End-Systole (A2C) (2D)
Units: mm
View: A2C;
Timing: systole
Where to measure: basal border (line connecting the MV annular hinge points) midpoint to the apical endocardium
LV Area, End-Systole (A2C) (2D)
Units: mm
View: A2C;
Timing: systole
Where to measure: LV endocardial borders (excluding the papillary muscles)
Aortic Valve Annulus (2D)
Units: mm
View: PLAX
Timing: systole
Where to measure: leaflet hingepoints
Left Main Coronary Artery (2D)
Units: mm
View: PSAX
Timing: maximum diameter
Where to measure:
Left Anterior Descending Coronary Artery (2D)
Units: mm
View: PSAX
Timing: maximum diameter
Where to measure:
Circumflex Coronary Artery (2D)
Units: mm
View: PSAX
Timing: maximum diameter
Where to measure:
Proximal Right Coronary Artery (2D)
Units: mm
View: PSAX
Timing: maximum diameter
Where to measure:
Mid Right Coronary Artery (2D)
Units: mm
View: PSAX
Timing: maximum diameter
Where to measure:
Distal Right Coronary Artery (2D)
Units: mm
View:
Timing: maximum diameter
Where to measure:
Sinus of Valsalva (2D)
Units: mm
View: PLAX
Timing: systole
Where to measure: largest diameter of sinus
Sinus of Valsalva (d) (2D)
Units: mm
View: PLAX
Timing: diastole
Where to measure: largest diameter of sinus
Sino-Tubular Junction (2D)
Units: mm
View: PLAX
Timing: systole
Where to measure: where the aortic sinuses end and the aorta becomes a tubular structure.
Sino-Tubular Junction (d) (2D)
Units: mm
View: PLAX
Timing: diastole
Where to measure: where the aortic sinuses end and the aorta becomes a tubular structure.
Ascending Aorta (2D)
Units: mm
View: PLAX or high RSB
Timing: systole
Where to measure: at the level of the RPA
Ascending Aorta (d) (2D)
Units: mm
View: PLAX or high RSB
Timing: diastole
Where to measure: at the level of the RPA
Proximal Transverse Arch (2D)
Units: mm
View: SSN
Timing: systole
Where to measure: between RCCA and LCCA
Distal Transverse Arch (2D)
Units: mm
View: SSN
Timing: systole
Where to measure: between LCCA and LSA
Aortic Isthmus (2D)
Units: mm
View: SSN
Timing: systole
Where to measure: narrowest segment distal to LSA
Descending Aorta (2D)
Units: mm
View: SSN
Timing: systole
Where to measure: immed. beyond isthmus
Abdominal Aorta (2D)
Units: mm
View: SUBC
Timing: systole
Where to measure: at level of diaphragm
Inferior Vena Cava (2D)
Units: mm
View: SUBC Sagittal
Timing: diastole
Where to measure: just below diaphragm
RA Major Diameter (2D)
Units: mm
View: A4C
Timing: systole
Where to measure: maximal distance from the center of the tricuspid annulus to the center of the superior RA wall, parallel to the interatrial septum
RA Minor Diameter (2D)
Units: mm
View: A4C
Timing: systole
Where to measure: maximal distance from the atrial septum to the lateral atrial wall
RA Area (2D)
Units: cm^2
View: A4C
Timing: systole
Where to measure: endocardial surface, from the lateral aspect of the tricuspid annulus to the septal aspect, excluding the SVC, IVC, and RA appendage
Tricuspid Valve, Lateral (2D)
Units: mm
View: A4C
Timing: diastole
Where to measure: leaflet hingepoints
Tricuspid Valve, Antero-Posterior (2D)
Units: mm
View: PLAX
Timing: diastole
Where to measure: leaflet hingepoints
RV Basal Diameter (2D)
Units: mm
View: A4C
Timing: diastole
Where to measure: maximal distance from RV free wall to septum, parallel to annulus, basal 1/3rd of RV
RV Mid-Cavitary Diameter (2D)
Units: mm
View: A4C
Timing: diastole
Where to measure: RV free wall to septal endocardium, parallel to annulus, midway between annulus and apex
RV Length (2D)
Units: mm
View: A4C
Timing: diastole
Where to measure: midpoint of TV annulus to RV apex
RV Length, End-Systole (2D)
Units: mm
View: A4C
Timing: systole
Where to measure: midpoint of TV annulus to RV apex
RV Anteroinferior Basal Diameter (2D)
Units: mm
View: PLAX
Timing: diastole
Where to measure: maximal diameter at the basal third of the RV cavity from its anterior to inferior walls while maintaining a parallel orientation with the annulus.
RV End-Diastolic Area (A4C) (2D)
Units: cm^2
View: A4C
Timing: diastole
Where to measure: RV endocardial border (include trabeculations within the area)
RV End-Systolic Area (A4C) (2D)
Units: cm^2
View: A4C
Timing: systole
Where to measure: Rotated CCW from traditional A4C; RV endocardial border (include trabeculations within the area)
RV Fractional Area Change (A4C) (2D)
Units: %
View: A4C
Timing: n/a
Where to measure: (EDA - ESA) / EDA
RV End-Diastolic Area (RV 3C) (2D)
Units: cm^2
View: RV A3C
Timing: diastole
Where to measure: Rotated CCW from traditional A4C; RV endocardial border (include trabeculations within the area)
RV End-Systolic Area (RV 3C) (2D)
Units: cm^2
View: RV A3C
Timing: systole
Where to measure: RV endocardial border (include trabeculations within the area)
RV Fractional Area Change (A3C) (2D)
Units: %
View: A3C
Timing: n/a
Where to measure: (EDA - ESA) / EDA
RV Global FAC (2D)
Units: %
View: Apical
Timing: n/s
Where to measure: (FAC (A4C) + FAC (A3C) / 2
Tricuspid Annular Plane Systolic Excursion (M-Mode)
Units: mm
View: A4C
Timing: systole
Where to measure: M-Mode through the lateral aspect of the tricuspid annulus while maintaining vertical alignment with the apex
RV Peak Longitudinal Strain (A4C) (STE/Strain)
Units: %
View: A4C
Timing: systole
Where to measure: peak longitudinal strain, RV lateral wall endocardial border, average of the basal, middle, and apical segments
RV Peak Longitudinal Strain (A3C) (STE/Strain)
Units: %
View: A3C
Timing: systole
Where to measure: peak longitudinal strain, average of inferior/anterior wall segments, from the lateral basal attachment of the TV to just before the pulmonary valve attachment at the infundibulum
RV Global Peak Longitudinal Strain (STE/Strain)
Units: %
View: Apical
Timing: n/a
Where to measure: (RV PLS (A4C) + RV PLS (A3C))/2
Pulmonary Valve Annulus (2D)
Units: mm
View: PSAX
Timing: systole
Where to measure: leaflet hinge points
Main Pulmonary Artery (2D)
Units: mm
View: PSAX
Timing: systole
Where to measure: between the pulmonary sinotubular junction and bifurcation
Right Pulmonary Artery (2D)
Units: mm
View: PSAX
Timing: systole
Where to measure: immediately beyond bifurcation
Left Pulmonary Artery (2D)
Units: mm
View: PSAX
Timing: systole
Where to measure: immediately beyond bifurcation
LA Volume (2D)
Units: ml
View: A4C
Timing: systole
Where to measure:
LV End-Diastolic Volume (2D)
Units: ml
View: apical or subcostal
Timing: diastole
Where to measure:
LV End-Systolic Volume (2D)
Units: ml
View: apical
Timing: systole
Where to measure:
LV Mass (2D)
Units: g
View: parasternal, apical
Timing: diastole
Where to measure: see components: PSAX Epi area, PSAX endo area, LV Major
MV E (Doppler)
Units: cm/s
View: apical
Timing: diastole
Where to measure: peak early diastolic mitral inflow, PW sample volume at leaflet tips
MV A (Doppler)
Units: cm/s
View: apical
Timing: diastole
Where to measure: peak late diastolic mitral inflow, PW sample volume at leaflet tips
MV E/A ratio (Doppler)
Units:
View: apical
Timing: diastole
Where to measure:
TV E (Doppler)
Units: cm/s
View: apical
Timing: diastole
Where to measure: peak early diastolic tricuspid inflow, PW sample volume at leaflet tips
TV A (Doppler)
Units: cm/s
View: apical
Timing: diastole
Where to measure: peak late diastolic tricuspid inflow, PW sample volume at leaflet tips
TV E/A ratio (Doppler)
Units:
View: apical
Timing: diastole
Where to measure:
LV TDI E' (Doppler)
Units: cm/s
View: apical
Timing: diastole
Where to measure: peak early diastolic annular velocity
LV TDI A' (Doppler)
Units: cm/s
View: apical
Timing: diastole
Where to measure: peak late diastolic annular velocity
LV TDI S' (Doppler)
Units: cm/s
View: apical
Timing: systole
Where to measure: peak systolic annular velocity
Septal TDI E' (Doppler)
Units: cm/s
View: apical
Timing: diastole
Where to measure: peak early diastolic annular velocity
Septal TDI A' (Doppler)
Units: cm/s
View: apical
Timing: diastole
Where to measure: peak late diastolic annular velocity
Septal TDI S' (Doppler)
Units: cm/s
View: apical
Timing: systole
Where to measure: peak systolic annular velocity
RV TDI E (Doppler)
Units: cm/s
View: apical
Timing: diastole
Where to measure: peak early diastolic annular velocity
RV TDI A (Doppler)
Units: cm/s
View: apical
Timing: diastole
Where to measure: peak late diastolic annular velocity
RV TDI E/A Ratio (Doppler)
Units:
View: apical
Timing: diastole
Where to measure:
RV TDI S (Doppler)
Units: cm/s
View: apical
Timing: systole
Where to measure: peak systolic annular velocity
TV E/e' (Doppler)
Units:
View: apical
Timing: diastole
Where to measure:
Pulmonary Artery Acceleration Time (Doppler)
Units: msec
View: PSAX
Timing: systole
Where to measure: onset of flow to peak velocity
Mean Longitudinal Strain (STE)
Units: %
View: apical
Timing: systole
Where to measure:
Basal Mean Circumferential Strain (STE)
Units: %
View: PSAX
Timing: systole
Where to measure:
Mid Mean Circumferential Strain (STE)
Units: %
View: PSAX
Timing: systole
Where to measure:
Apical Mean Circumferential Strain (STE)
Units: %
View: PSAX
Timing: systole
Where to measure:

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