NECTAR Study

Nectar Protocol – Imaging

Record: Study ID, Weight, Blood pressure at the time of ECHO, D1 or D4 on first image.

1)     Parasternal Long Axis View :

a. 2D-grayscale at Aorta-Mitral valve level

b. 2D-color at Aorta-Mitral valve level

c.  2D-grayscale of zoom of Aortic Valve (to measure LVOT)

d. 2D-colour on zoom of Aortic Valve

e. M-Mode at Left Atrium / Aorta junction for : LA/Ao ratio

f.   M-Mode at tip of mitral valve

g. 2D-grayscale of tricuspid valve (scan posteriorly)

h. 2D-color of tricuspid valve

                                               i. CW Doppler of tricuspid valve to obtain Tricuspid regurgitant jet if present.

i.   2D-grayscale sweep to RVOT

j.   2D-colour at RVOT

k.  2D-Zoom of Pulmonary valve

                                               i. PW-Doppler at RVOT

                                              ii. CW-Doppler through RVOT (especially for pulmonary insufficiency jet)

2) Parasternal short axis (PSAX) view:

a. 2D-grayscale at Pulmonary valve and Aortic valve level

b. 2D-Colour at Pulmonary valve and Aortic valve level

                                               i. PW-Doppler at RVOT

                                              ii. CW-Doppler at RVOT (especially for pulmonary insufficiency jet)

c.  M-Mode at left atrium – aorta junction

d. 2D-grayscal Sweep from aortic valve to LV apex

e. M-Mode at Tip of mitral valve in PSAX

f.   2D-grayscale view (at least 3 beats) at mid-papillary muscle level

3) Apical View

a. 2D-grayscale Apical 4 chamber view in 2D – LV focused with Left Atrium

b. 2D-colour over Mitral valve

c.  2D-grayscale Apical 4 chamber view in 2D – RV focused with Right Atrium

d. 2D-colour over Tricuspid valve

e. PW below the tricuspid valve for E/A velocities

f.   PW below the mitral valve for E/A velocities

g. CW-Doppler of tricuspid valve to obtain Tricuspid regurgitant jet – even if unavailable, please record so that we can do a systolic-diastolic time ratio.

h. Color on left atrium with low-velocity filter for pulmonary vein

                                               i. PW-Doppler in right upper pulmonary vein

i.   M-Mode in A4C for the Lateral wall of the RV to get TAPSE (line of interrogation should ideally cross the Apex).

j.   Apical 3 Chamber view of LV in 2D-grayscale

                                               i. Apical 3 chamber view in 2D-Color to see flow from mitral through Aortic Valve

1. PW at LVOT

k.  Apical 2 Chamber view of the LV in 2D in 2D grayscale (make sure to have all the LV walls)

4) Subcostal (if possible – difficult during pregnancy):

a. Subcostal long axis:

                                               i. 2D-grayscale and 2D color over the inter-atrial septum (for inter-atrial shunt)

b. Subcostal short axis:

                                               i. 2D-grayscale and 2D color over the inter-atrial septum (for inter-atrial shunt)

                                              ii. 2D-colour over the descending aorta

                                             iii. PW of the descending aorta.

                                             iv. 2D + Colour over IVC and subhepatic veins

5) Suprasternal notch:

a. PDA view with sweep: Colour and 2D

                                               i. PW and-or CW of the PDA flow

Shortened data collection anticipated:

1) LV Function / Dimensions:

a. LVO

                                               i. LVOT-VTI

                                              ii. HR

                                             iii. LVOT diameter

b. EDV, ESV and EF by Simpsons Biplane

c. A4C-EDV; A4C-ESV and EF by A4C only

d. LV-EDD and LV-ESD, Calculate Shortening Fraction

e. E of mitral valve; A of mitral valve.

2) RV Function:

a. TAPSE

b. RVO

                                               i. RVOT-VTI

                                              ii. HR

                                             iii. RVOT diameter

c. RV-FAC in A4C

                                               i. RV-EDA and RV-ESA

d. E of tricuspid valve, A of tricuspid valve.

3) Estimation of Pulmonary Pressure

a. Septal curve at peak of systole: Round, Flat, Bowing

b. Eccentricity Index at peak of systole

c. PAAT/RVET

d. TRJ velocity

e. PDA patency:

                                               i. Yes – No present

                                              ii. Directionality: Left to right, Bidirectional, Right to left.

                                             iii. Peak velocity gradient in systole.

                                             iv. Diameter in 2D (narrowest)

                                              v. Retrograde holodiastolic flow in post-ductal Aorta: yes-no

f.  Inter-atrial shunt:

                                               i. Yes – No present

                                              ii. Directionality: Left to right, Bidirectional, Right to left.