Adult Echocardiography Technical Data Worksheet Name: Indication: Technical comments: MR #: Date: Done by:

P a r a s t e r n a l L AX AoV: LA: MV: LVOT: TV: (pw) E: Comment: Comment: Comment: cm. m/s VSD: A: m/s m/s ____________

Ap i c a l 4 C h a m b e r MV: E/A ratio: MR V-max: PHT: TV: V-max: m/s _____________ msec MVA ______ cm2 m/s m/s cm % RV: cm

TR V-max:

Mod Simpsons EF: V-max: TR _____________ LA: cm RA:

P a r a s t e r n a l S AX TV: E: m/s A: m/s m/s m/s ____________

Ap i c a l 5 C h a m b e r LVOT: (pw) AoV (cw): AI: V-max: m/s

PV:

TR V-max: m/s V-max: ____________ PI :

_____________

V-max: m/s ___________cm2 V-max: m/s PHT: ___________ msec

AoV: MV: LV: Effusion: MV:

Comment: Comment: Comment: MV:

Ap i c a l 2 - C h a m b e r V-max: MR V-max: Comment: cm cm cm cm Ap i c a l 3 - C h a m b e r MV: V-max: MR V-max: V-1 (pw) : Ao Valve Area: AI: V-max: m/s m/s m/s m/s ___________ V-2 (cw) : cm2 PHT: msec m/s m/s m/s ____________

M -M o d e : Ao / L A, R V / L V Ao: LA: ACS: MV D-E: MV E-F: Comment: MV-EPSS: RVd IVSd LVd AoV: LVPWd LA: IVSs LVs ACS: LVPWs EF: FS: CI: Comment:

cm/sec cm cm cm cm cm cm cm cm % % L/min/m
2

Subcostal IVC: VSD: Effusion: Comment: cm Hepatic Veins: ASD: cm

Sup r a ste rn al
AoV: Dissection: V-max: m/s

Technical data and commentary only; this document does not constitute a formal medical impression or final report.