Recommendations for Quantification Methods During the Performance of a Pediatric Echocardiogram: A Report From the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council
2010; Elsevier BV; Volume: 23; Issue: 5 Linguagem: Inglês
10.1016/j.echo.2010.03.019
ISSN1097-6795
AutoresLeo Lopez, Steven D. Colan, Peter C. Frommelt, Gregory J. Ensing, Kathleen Kendall, Adel K. Younoszai, Wyman W. Lai, Tal Geva,
Tópico(s)Congenital Heart Disease Studies
ResumoAccreditation StatementThe American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The American Society of Echocardiography designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.ARDMS and CCI recognize the ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers.The American Society of Echocardiography is committed to ensuring that its educational mission and all sponsored educational programs are not influenced by the special interests of any corporation or individual, and its mandate is to retain only those authors whose financial interests can be effectively resolved to maintain the goals and educational integrity of the activity. Although a monetary or professional affiliation with a corporation does not necessarily influence an author's presentation, the Essential Areas and policies of the ACCME require that any relationships that could possibly conflict with the educational value of the activity be resolved prior to publication and disclosed to the audience. Disclosures of faculty and commercial support relationships, if any, have been indicated.Target AudienceThis activity is designed for all cardiovascular physicians and cardiac sonographers with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, intensivists, and other medical professionals with a specific interest in cardiac ultrasound will find this activity beneficial.ObjectivesUpon completing the reading of this article, participants will better be able to:1.Review the techniques for optimizing imaging and quantifying cardiac structures in the pediatric population.2.Explain the importance of adjusting measurements of cardiovascular structures for the effects of body size.3.Identify the pediatric quantification protocols for the pulmonary veins, systemic veins, atria and atrioventricular valves.4.Recognize and apply the recommended echocardiographic methods for the evaluation of left and right ventricular size and systolic function.5.Define the optimal views and the appropriate anatomic sites for correct measurement of the proximal ascending, proximal and distal arch, and descending aorta.6.Employ appropriate transducer position and Doppler technique for the anatomic and hemodynamic interrogation of the aorta and aortic valve and the pulmonary artery and the pulmonary valve.Author DisclosureThe authors of this article reported no actual or potential conflicts of interest in relation to this activity.The ASE staff and ASE ACCME/CME reviewers who were involved in the planning and development of this activity reported no actual or potential conflicts of interest: Chelsea Flowers; Rebecca T. Hahn, MD, FASE; Cathy Kerr; Priscilla P. Peters, BA, RDCS, FASE; Rhonda Price; and Cheryl Williams.The following members of the ASE Guidelines and Standards Committee, JASE Editorial staff and ASE Board of Directors reported no actual or potential conflicts of interest in relation to this activity: Deborah A. Agler, RCT, RDCS, FASE; J. Todd Belcik, BS, RDCS, FASE; Renee L. Bess, BS, RDCS, RVT, FASE; Farooq A. Chaudhry, MD, FASE; Robert T. Eberhardt, MD; Benjamin W. Eidem, MD, FASE; Gregory J. Ensing, MD, FASE; Tal Geva, MD, FASE; Kathryn E. Glas, MD, FASE; Sandra Hagen-Ansert, RDCS, RDMS, MS, FASE; Rebecca T. Hahn, MD, FASE; Jeannie Heirs, RDCS; Shunichi Homma, MD; Sanjiv Kaul, MD, FASE; Smadar Kort, MD, FASE; Peg Knoll, RDCS, FASE; Wyman Lai, MD, MPH, FASE; Roberto M. Lang, MD, FASE; Steven Lavine, MD; Steven J. Lester, MD, FASE; Renee Margossian, MD; Victor Mor-Avi, PhD, FASE; Sherif Nagueh, MD, FASE; Alan S. Pearlman, MD, FASE; Patricia A. Pellikka, MD, FASE; Miguel Quinones, MD, FASE; Brad Roberts, RCS, RDCS; Beverly Smulevitz, BS, RDCS, RVS; Kirk T. Spencer, MD, FASE; J. Geoffrey Stevenson, MD, FASE; Wadea Tarhuni, MD, FASE; James D. Thomas, MD; Neil J. Weissman, MD, FASE; Timothy Woods, MD; and William A. Zoghbi, MD, FASE.The following members of the ASE Guidelines and Standards Committee, JASE Editorial staff and ASE Board of Directors reported a relationship with one or more commercial interests. According to ACCME policy, the ASE implemented mechanisms to resolve all conflicts of interest prior to the planning and implementation of this activity. Theodore Abraham, MD, FASE receives honoraria and research grant support from GE Healthcare. Patrick D. Coon, RDCS, FASE is on the speaker's bureau for Philips Medical. Victor G. Davila-Roman, MD, FASE is a consultant for St. Jude Medical, AGA Medical, Medtronic, CoreValve, Boston Scientific Corporation, and Sadra Medical. Elyse Foster, MD receives grant support from Abbott Vascular Structural Heart, EBR Systems, Inc., and Boston Scientific Corporation. Julius M. Gardin, MD, FASE is a consultant/advisor to Arena Pharmaceuticals. Jeffrey C. Hill, BS, RDCS, FASE receives grant/research support from Toshiba America Medical Systems and Philips; is a consultant to Medtronic; and is on the speaker's bureau for Philips. Martin G. Keane, MD, FASE is a consultant/advisor to Pfizer, Inc. and Otsuka Pharmaceuticals. Gilead I. Lancaster, MD, FASE owns stock in, and is a consultant/advisor to, Cardiogal. Jonathan R. Linder, MD, FASE is a consultant/advisor to VisualSonics. Carol C. Mitchell, PhD, RDMS, RDCS, RVT, RT(R), FASE is a speaker and consultant for GE Healthcare. Marti McCulloch, MBA, BS, RDCS, FASE is a speaker for Lantheus and advisor/consultant for Siemens. Tasneem Z. Naqvi, MD, FASE is a consultant/advisor to Edwards Lifesciences and St. Jude Medical, and receives grant support from Medtronic and Actor Medical. Kofo O. Ogunyankin, MD, FASE is on the speaker's bureau for Lantheus. Vera Rigolin, MD, FASE is on the speaker's bureau for Edwards Lifesciences and St. Jude Medical. Lawrence G. Rudski, MD receives grant support from Genzyme and owns stock in Abbott Labs, Hospira, Johnson and Johnson, and Medtronic. Stephen G. Sawada, MD owns stock in GE Healthcare. Alan D. Waggoner, MHS, RDCS is a consultant/advisor for Boston Scientific Corporation and St. Jude Medical, Inc.Estimated Time to Complete This Activity: 1.5 hours The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The American Society of Echocardiography designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. ARDMS and CCI recognize the ASE's certificates and have agreed to honor the credit hours toward their registry requirements for sonographers. The American Society of Echocardiography is committed to ensuring that its educational mission and all sponsored educational programs are not influenced by the special interests of any corporation or individual, and its mandate is to retain only those authors whose financial interests can be effectively resolved to maintain the goals and educational integrity of the activity. Although a monetary or professional affiliation with a corporation does not necessarily influence an author's presentation, the Essential Areas and policies of the ACCME require that any relationships that could possibly conflict with the educational value of the activity be resolved prior to publication and disclosed to the audience. Disclosures of faculty and commercial support relationships, if any, have been indicated. This activity is designed for all cardiovascular physicians and cardiac sonographers with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, intensivists, and other medical professionals with a specific interest in cardiac ultrasound will find this activity beneficial. Upon completing the reading of this article, participants will better be able to:1.Review the techniques for optimizing imaging and quantifying cardiac structures in the pediatric population.2.Explain the importance of adjusting measurements of cardiovascular structures for the effects of body size.3.Identify the pediatric quantification protocols for the pulmonary veins, systemic veins, atria and atrioventricular valves.4.Recognize and apply the recommended echocardiographic methods for the evaluation of left and right ventricular size and systolic function.5.Define the optimal views and the appropriate anatomic sites for correct measurement of the proximal ascending, proximal and distal arch, and descending aorta.6.Employ appropriate transducer position and Doppler technique for the anatomic and hemodynamic interrogation of the aorta and aortic valve and the pulmonary artery and the pulmonary valve. The authors of this article reported no actual or potential conflicts of interest in relation to this activity. The ASE staff and ASE ACCME/CME reviewers who were involved in the planning and development of this activity reported no actual or potential conflicts of interest: Chelsea Flowers; Rebecca T. Hahn, MD, FASE; Cathy Kerr; Priscilla P. Peters, BA, RDCS, FASE; Rhonda Price; and Cheryl Williams. The following members of the ASE Guidelines and Standards Committee, JASE Editorial staff and ASE Board of Directors reported no actual or potential conflicts of interest in relation to this activity: Deborah A. Agler, RCT, RDCS, FASE; J. Todd Belcik, BS, RDCS, FASE; Renee L. Bess, BS, RDCS, RVT, FASE; Farooq A. Chaudhry, MD, FASE; Robert T. Eberhardt, MD; Benjamin W. Eidem, MD, FASE; Gregory J. Ensing, MD, FASE; Tal Geva, MD, FASE; Kathryn E. Glas, MD, FASE; Sandra Hagen-Ansert, RDCS, RDMS, MS, FASE; Rebecca T. Hahn, MD, FASE; Jeannie Heirs, RDCS; Shunichi Homma, MD; Sanjiv Kaul, MD, FASE; Smadar Kort, MD, FASE; Peg Knoll, RDCS, FASE; Wyman Lai, MD, MPH, FASE; Roberto M. Lang, MD, FASE; Steven Lavine, MD; Steven J. Lester, MD, FASE; Renee Margossian, MD; Victor Mor-Avi, PhD, FASE; Sherif Nagueh, MD, FASE; Alan S. Pearlman, MD, FASE; Patricia A. Pellikka, MD, FASE; Miguel Quinones, MD, FASE; Brad Roberts, RCS, RDCS; Beverly Smulevitz, BS, RDCS, RVS; Kirk T. Spencer, MD, FASE; J. Geoffrey Stevenson, MD, FASE; Wadea Tarhuni, MD, FASE; James D. Thomas, MD; Neil J. Weissman, MD, FASE; Timothy Woods, MD; and William A. Zoghbi, MD, FASE. The following members of the ASE Guidelines and Standards Committee, JASE Editorial staff and ASE Board of Directors reported a relationship with one or more commercial interests. According to ACCME policy, the ASE implemented mechanisms to resolve all conflicts of interest prior to the planning and implementation of this activity. Theodore Abraham, MD, FASE receives honoraria and research grant support from GE Healthcare. Patrick D. Coon, RDCS, FASE is on the speaker's bureau for Philips Medical. Victor G. Davila-Roman, MD, FASE is a consultant for St. Jude Medical, AGA Medical, Medtronic, CoreValve, Boston Scientific Corporation, and Sadra Medical. Elyse Foster, MD receives grant support from Abbott Vascular Structural Heart, EBR Systems, Inc., and Boston Scientific Corporation. Julius M. Gardin, MD, FASE is a consultant/advisor to Arena Pharmaceuticals. Jeffrey C. Hill, BS, RDCS, FASE receives grant/research support from Toshiba America Medical Systems and Philips; is a consultant to Medtronic; and is on the speaker's bureau for Philips. Martin G. Keane, MD, FASE is a consultant/advisor to Pfizer, Inc. and Otsuka Pharmaceuticals. Gilead I. Lancaster, MD, FASE owns stock in, and is a consultant/advisor to, Cardiogal. Jonathan R. Linder, MD, FASE is a consultant/advisor to VisualSonics. Carol C. Mitchell, PhD, RDMS, RDCS, RVT, RT(R), FASE is a speaker and consultant for GE Healthcare. Marti McCulloch, MBA, BS, RDCS, FASE is a speaker for Lantheus and advisor/consultant for Siemens. Tasneem Z. Naqvi, MD, FASE is a consultant/advisor to Edwards Lifesciences and St. Jude Medical, and receives grant support from Medtronic and Actor Medical. Kofo O. Ogunyankin, MD, FASE is on the speaker's bureau for Lantheus. Vera Rigolin, MD, FASE is on the speaker's bureau for Edwards Lifesciences and St. Jude Medical. Lawrence G. Rudski, MD receives grant support from Genzyme and owns stock in Abbott Labs, Hospira, Johnson and Johnson, and Medtronic. Stephen G. Sawada, MD owns stock in GE Healthcare. Alan D. Waggoner, MHS, RDCS is a consultant/advisor for Boston Scientific Corporation and St. Jude Medical, Inc. Estimated Time to Complete This Activity: 1.5 hours Introduction 466Optimization Techniques in Imaging and Doppler Evaluation 466Principles and Methods for Adjusting Measurements of Cardiovascular Structures for the Effects of Body Size 467Pediatric Quantification Protocols 468Pulmonary Veins, Systemic Veins, and Atria 468Atrioventricular Valves 470Left Ventricle 475Right Ventricle 481Ventricular Outflow Tracts and Semilunar Valves 484Aorta, Coronary Arteries, and Pulmonary Arteries 487Conclusions and Limitations 490References 490
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