TRANSTHORACIC ECHOCARDIOGRAM REPORT

Society of Cardiac Imaging Malaysia

Patient Name: .......................................................................................... Performed by:

RN / ID: ..........................................................................................
Date: .............................. Out Patient/Ward: ...........................
Indication: ..........................................................................................
Weight: ............. kg Height: ............. cm BSA: ............... Echo Machine:

LEFT VENTRICLE
Appointment Adhoc
Chamber Size: Normal Dilated D-Shape Image Quality: Fair Excellent

LVIDd: ............... cm LVIDs: ............... cm Poor

Blood Pressure: / mmHg
Ejection Fraction: Teichholz Simpsom’s (Biplane)
Heart Rate: ................... Bpm
EF: ................. % Eye Balling: .................%
ECG: NSR / AFL /AF / SVT / Vent. arrhythmias
Regional Wall Motion Abnormalities:

Normal Global Hypokinesia Regional Wall Segments

Mid Anteroseptum Basal Anteroseptum
Basal Anteroseptum
Hypokinesia .....................................................................................
Basal
Basal Anterior
Akinetic ............................................................................................ Inferoseptum

Dyskinetic ........................................................................................
Mid
Basal
Spontaneous Echo Contrast: Present Inferolateral Basal Inferolateral
Basal Anterolateral
Inferior
Basal
Apical
LV Clot: Nil Present Location: ............. Size: ......... cm2 Septum
Apical
Lateral
Inferolateral

Mid Mid
RIGHT VENTRICLE Inferoseptum Mid
Anterolateral
Anteroseptum
Mid
Basal Anterior
Chamber Size: Normal Dilated Anterolateral

Mid
Diameter: RVd1: .......... cm RVd2: ........... cm RVd3: .......... cm Basal Inferoseptum
Inferoseptum
Mid Mid
RVH: Nil Present, size: .......... cm Inferior
Mid
Anterolateral
Apical Apical
Inferior Inferolateral
Anterior
RV Systolic Function: TAPSE: .........cm FAC: .........% S´: .........cm/s Apical
Mid Apical
Septum
Inferior Mid Anterior
RIMP (TDI): ........... (N : < 0.54) RIMP (PW) : ........... (N : < 0.43) Anterior
Basal
Inferior Basal Apical Apical
PERICARDIUM Anterior Inferior Lateral

No PE Circumferential PE Loculated PE
Wall Motion Score :
Size: Small (<1cm) Moderate (1-2cm) Large (>2cm) Score Wall motion Endocardial motion Wall Thickening

Location: Anterior, size: ........ cm Lateral, size: ........ cm 1 Normal Normal Normal (>30%)
2 Hypokinetic Reduced Reduced (<30%)
RV Wall, size : ........ cm Posterior, size: …... cm
3 Akinetic Absent Absent
Cardiac Tamponade : None Present 4 Dyskinetic Outward Thinning

RV Collapsed RA Collapsed IVC Dilated, Not Collapsible

SEPTUM AO : PA
IVSd: .......... cm PWd: .......... cm Ratio: .............. : ............... (Eye Balling)
Normal Sigmoid Septum Symmetrical LVH Diameter: LVOT: .............. cm
Asymmetrical LVH SAM LVOTO, peak grad ….... mmHg Aortic Annulus: .............. cm

Inter-Atrial Septum: Intact Sinus Valsalva: .............. cm

PFO / ............... ASD : Left → Right / Right → Left / Left ↔ Right Sinotubular Junction: .............. cm

VSD (PM / SC / Muscular) PDA present Prox Ascending Aorta: .............. cm

27
 MITRAL VALVE AORTIC VALVE
Morphology: Normal Calcified AMVL / PMVL Morphology: Normal Trileaflet Bicuspid Prosthetic ...........
Thickened AMVL / PMVL Doming both Leaflet Thickened RCC/ NCC /LCC Calcified RCC/ NCC /LCC
Prolapsed ........ AMVL / PMVL Non-coapting Prolapsed RCC/ NCC /LCC Non-coapting
Immobile AMVL / PMVL Prosthetic (type) ........... Immobile RCC/ NCC /LCC Others : …………………..

Others : ………….............................................................…… Regurgitation (AR): Central Jet Eccentric Jet

Regurgitation (MR): Central Jet Eccentric Jet Severity: No AR Mild Moderate Severe

Severity: No MR Mild Moderate Severe By CFM

By CFM Pulmonary Vein Inflow reversal present Quantitative: P½t : …….... ms Jet Area/LVOT: …....…% VC: ……... mm

PISA Method: ERO: ……….. cm2 RV: ……….. ml

Quantitative: VC: ……….. mm MV Ann: ……….. cm
Doppler Volumetric Method: ERO: …..... cm2 RV: …..... ml RV : ….... %
PISA Method: ERO: ……….. cm2 RV: ……….. ml
Holodiastolic flow reversal present in Descending Aorta:
Doppler Volumetric Method: ERO: …..... cm2 RF: …..... % RV : ….... ml
End diastolic Flow Velocity: ……….. cm/s VTI: ……….. cm
Stenosis (MS) : Stenosis (AS) :
Severity: No MR Mild Moderate Severe
Severity: No MR Mild Moderate Severe
Coarctation of Aorta present
Quantitative: MVA (Planimetry): ……….. cm2 MVA (P½t): ……….. cm Quantitative: Vmax: ……….. m/s meanPG: ……….. mmHg

meanPG: …..…. mmHg PHT: ……... ms Wilkin’s Score: …… AVA (VTI): ……….. cm2 AVA (Planimetry): ……….. cm2
Aetiology : DVI: ……….. Acc Time: ……….. ms
Degenerative (MVP-FED) Degenerative (Barlow) Rheumatic Aetiology :
Degenerative(calcified) Rheumatic Prolapse
Endocarditis Functional Congenital Others(cleft)
Endocarditis Congenital Others(cleft)

TRICUSPIC VALVE PULMONARY VALVE

Morphology: Normal Calcified ATV / PTV / STV Morphology: Normal Thickened Calcified
Thickened ATV / PTV / STV Prolapsed ATV / PTV / STV Immobile Prolapsed Non-coapting
Immobile ATV / PTV / STV Non-coapting Others : ………….............................................................…..

Others : ………….............................................................……
Regurgitation (PR): No TR Mild Moderate Severe
Regurgitation (TR): Central Jet Eccentric Jet
Quantitative: PR Vmax: ……….. m/s PAEDP: ……….. mmHg
Severity: No TR Mild Moderate Severe
Pul Acc. Time: ……….. ms PV Diam: ……….. cm
By CFM Hepatic Vein Inflow reversal present
Stenosis (PS): No PS Present Vmax: ………... m/s
Quantitative: TR Vmax: ….…. m/s ePASP: ….…. mmHg TV Ann: …... cm
Aetiology :
Aetiology :
Degenerate Rheumatic Endocarditis PHTN
Endocarditis Functional Congenital Others(cleft)
Congenital Post-repair Others (functional)
Degenerative (MVP-FED) Degenerative (Barlow) Rheumatic

RIGHT ATRIUM LEFT ATRIUM INFERIOR VENA CAVA (IVC)

Normal Normal Collapsible (Sniff): >50% <50% Not Collapsible

Dilated, Area: ………. cm2 Dilated, Area: ………. cm2 Diameter: Normal Dilated Size: ................... cm

Volume: …......... ml estimated RAP: 3 mmHg 8 mmHg 15 mmHg

DIASTOLIC FUNCTION REMARKS :

Doppler Tissue Doppler Pulmonary Vein
………………………………………………………………
MV E Point: ...….. cm/s Septal E’: ...…..… Sys: ...….. cm/s
………………………………………………………………
MV A Point: ......... cm/s Lateral E’: ...…..… Dys: ......... cm/s
………………………………………………………………
MV D/Time: ...…..… ms E/E’: ...…..… A Rev: ...…..… ms
………………………………………………………………
A Duration: ...…..… ms A Dur: ...…..… ms
………………………………… ECHO verified by:
E/A Ratio: ...…….. ms Diastolic Dysfunction Grade
…………………………………
IVRT: ...…..… ms Normal Grade ll
…………………………………
Grade l Grade lII

28