SARABI Study

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.

                                              ii. PW Doppler at inflow portion for E/A

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)

l. Right parasternal ascending aorta view (B-mode).

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. 2D-colour sweep from aortic valve to LV apex over interventricular septum

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

                                              ii. PW Doppler at inflow portion for E/A

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

g. 2D-grayscale view (at least 3 beats) at mitral valve level

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

i.   2D-grayscale view (at least 3 beats) at LV apex 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.   Tissue Doppler Imaging (TDI)

                                               i. TDI on RV free wall below the tricuspid valve

                                              ii. TDI on LV free wall below the mitral valve

                                             iii. TDI of septum below the attachment of mitral valve

k. 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

2. PW in cavity to measure the isovolumetric relaxation time (inside cavity in A3C)

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

m. Colour over Mitral Valve

                                               i. PW below Mitral Valve in A2C

n. 3D LV volume, 3D RV volume

                                               i. Capture using High Volume Capture

                                              ii. Capture using 4 beat acquisition

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

                                              v. PW of the subhepatic veins

5) Suprasternal notch:

a. Aortic Arch in 2D-grayscale and 2D-color

                                               i. PW in Ascending Aorta

                                              ii. PW in Descending Aorta

b. Branch Pulmonary artery (Moustache view)

                                               i. 2D-grayscale and 2D-Color

1. PW in LPA and in RPA if possible