| • Guidelines for the clinical application of echocardiography have been formulated by the American College of Cardiology and the American Heart Association in collaboration with the American Society of Echocardiography. |
• To monitor normally occurring physiologic changes during the transitional circulation of the newborn.
• Helps define structural anomaly, if present.
• Helps determine hemodynamics and ventricular function.
• To assess the presence and degree of pulmonary artery hypertension in premature infants with respiratory failure related to lung disease.
• Doppler echocardiography can show ductal patency as well as amount and direction of shunting.
• Cyanosis in newborns without evidence of severe lung disease but whose chest radiograph, ECG, and extremity blood pressures are abnormal.
• Arrhythmias, nonimmune hydrops, and sepsis.
• Chromosomal abnormalities and certain extracardiac anomalies.
• Innocent heart murmurs do not warrant echocardiography.
• Still’s murmur.
• Flow murmur of the pulmonary artery.
• Peripheral pulmonic stenosis.
• Supraclavicular murmur.
• Systolic flow murmur.
• Maintain low threshold for obtaining echocardiogram in children with a murmur and abnormal results on accompanying studies (eg, ECG, chest radiograph).
• Diastolic murmur or gallop.
• Examples include Kawasaki disease, rheumatic fever, myocarditis, and endocarditis.
• Provides important information regarding the following:
• Chamber sizes.
• Valve and ventricular function.
• Pericardial involvement.
• Presence of intracardiac masses.
• Can also be used for serial evaluation throughout the disease process and to determine whether therapy is effective.
• To evaluate patients with connective tissue diseases, such as Marfan syndrome and Ehlers-Danlos syndrome, which are associated with valve prolapse, aortic root dilation, and dissection.
• To assess ventricular function in patients with certain neuromuscular disorders, such as Duchenne’s muscular dystrophy, that can affect the heart muscle.
• To assess left ventricular hypertrophy and dysfunction in children with chronic renal disease and long-standing systemic hypertension.
• To obtain baseline and serial echocardiograms to assess for cardiomyopathy in patients receiving chemotherapeutic agents, which can be cardiotoxic.
• Useful in additional disease processes including HIV, serial assessment for rejection in cardiac transplant patients, and screening of patients with a family history of cardiomyopathy.
• Newly diagnosed thromboembolic disease.
• Searches for sources of thrombus and potential intracardiac shunts.
• Routine transthoracic echocardiogram is often inconclusive and therefore, a contrast study may be necessary.
• If either study is inconclusive, a transesophageal echocardiogram may be necessary.
• Determines whether there is associated structural heart disease (eg, Ebstein’s anomaly, mitral valve prolapse, and cardiac tumors).
• Evaluates cardiac function (ie, myocarditis, cardiomyopathy).
• If tachycardia has been present for an extended period of time, an echocardiogram may help determine whether an intracardiac thrombus is present and if ventricular function is preserved.
• Chest pain is not an absolute indication for echocardiography, since < 5% of chest pain is cardiac in origin.
• Abnormal ECG or chest radiography in those rare patients with cardiac disease.
• Chest pain associated with exercise, a family history of hypertrophic cardiomyopathy or long QT syndrome.
• Syncope in children is most frequently vasovagal or neurogenic and does not require an echocardiogram.
• However, when syncope occurs during exercise, an echocardiogram can rule out an anomalous coronary artery or left ventricular outflow obstruction.
• Do not perform transesophageal echocardiogram in patients with the following:
• Esophageal obstruction or bleeding.
• Unrepaired tracheoesophageal fistula.
• Inadequate control of the airway.
• Relative contraindications to TEE include the following:
• Esophageal varices or diverticuli.
• Previous esophageal surgery.
• Coagulopathy.
• History of a cervical spine injury.
• Small patient size (< 3 kg).
• Transesophageal echocardiography may pose a risk because of its invasive nature.
• Hypoxia due to tracheal compression.
• Hypotension.
• Nonsustained ventricular tachycardia.
• Supraventricular tachycardia.
• Esophageal tear.
• Risks associated with sedation should also be considered.
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