Echocardiogram Report (Pediatric Transthoracic)

Patient Name: [Patient name]

MRN: [Medical record number]

DOB / Age at Study: [Date of birth / Age at time of study]

Sex: [Sex]

Study Date/Time: [Date and time of study]

Location: [Facility/department/location]

Study Type: [Comprehensive / Focused]

Ordering Clinician: [Name, credentials]

Sonographer: [Name, credentials]

Interpreting Physician: [Name, credentials]

Height: [Height in cm, or "Not recorded"] Weight: [Weight in kg, or "Not recorded"] BSA: [BSA in m², or "Not recorded"]

BP: [Blood pressure in mmHg, or "Not recorded"] HR: [Heart rate in bpm, or "Not recorded"] O2 Sat: [Oxygen saturation %, or "Not recorded"]

Indication

[Clinical context and primary indication] (Include pertinent cardiac diagnoses, relevant surgical or interventional history, and specific clinical questions. Format as 1 short paragraph or 3–5 bullets. Omit non-cardiac history unless directly relevant to interpretation.)

Technique & Quality

• Modalities performed: [2D / M-mode / Color Doppler / Spectral Doppler / Tissue Doppler / 3D / Strain / Contrast / Other] (Select all that apply.)
• Patient cooperation/positioning: [Cooperation level, sedation if used, positioning constraints]
• Overall image quality: [Excellent / Good / Fair / Poor]
• Specific limitations: [Acoustic windows, motion/arrhythmia, postsurgical changes, body habitus, lung artifact, other] (List pertinent limitations; omit if none.)

Impact statement: Limitations affect assessment of: [Structures/parameters affected, or "None"]. (For focused studies, state structures not evaluated and reason.)

Findings

(Use segmental approach. Document findings only if adequately visualized. If a structure is not well visualized or not evaluated, state explicitly. Do not imply normality for structures not assessed.)

• Cardiac position and situs: [Position and visceroatrial situs]
• Systemic venous return: [SVC/IVC continuity, anomalous return if present] [Adequately visualized / Not well visualized]
• Pulmonary venous return: [Number/pattern of pulmonary veins, drainage] [Adequately visualized / Not well visualized]
• Atria and atrial septum: [Atrial size, septal patency/defects, shunt direction if present] [Adequately visualized / Not well visualized]
• Atrioventricular valves: [MV/TV morphology, regurgitation/stenosis severity] [Adequately visualized / Not well visualized]
• Ventricles: [Size, wall thickness, systolic function, regional wall motion] [Adequately visualized / Not well visualized]
• Ventricular septum: [Integrity, defects, shunt direction/magnitude if applicable] [Adequately visualized / Not well visualized]
• Outflow tracts: [LVOT/RVOT obstruction, malalignment] [Adequately visualized / Not well visualized]
• Semilunar valves: [AoV/PV morphology, regurgitation/stenosis severity] [Adequately visualized / Not well visualized]
• Great arteries: [Aortic arch sidedness/patency, coarctation, pulmonary artery size/branching] [Adequately visualized / Not well visualized]
• Ductus arteriosus: [Patent / Closed, shunt direction, gradient] (Include if clinically relevant.)
• Coronary artery origins: [Right/left origin and proximal course] [Adequately visualized / Not well visualized]
• Pericardium: [Effusion, thickness, hemodynamic impact if present]
• Other findings: [Masses, thrombi, devices, postoperative anatomy] (Only if applicable.)

Measurements

(Include only measurements obtained. Report units, Z-scores where available, and interpretation based on pediatric norms.)

Chambers & Dimensions

Parameter	Value (units)	Z-score	Interpretation
[LA dimension/volume]	[value]	[Z]	[Normal / Abnormal]
[LV dimensions (LVIDd/LVIDs/EF/FS)]	[value]	[Z]	[Normal / Abnormal]
[RV dimensions/function (TAPSE/FAC)]	[value]	[Z]	[Normal / Abnormal]
[Wall thickness (IVS/LVPW)]	[value]	[Z]	[Normal / Abnormal]

Valves & Great Vessels

Parameter	Value (units)	Z-score	Interpretation
[Aortic annulus / sinuses / STJ]	[value]	[Z]	[Normal / Abnormal]
[Pulmonary valve annulus]	[value]	[Z]	[Normal / Abnormal]
[Ascending aorta / arch / isthmus]	[value]	[Z]	[Normal / Abnormal]
[Main/branch pulmonary arteries]	[value]	[Z]	[Normal / Abnormal]

Doppler & Hemodynamics

Parameter	Value	Derived Data	Interpretation
[TR jet velocity]	[m/s]	[RVSP estimate]	[Normal / Elevated]
[Mitral inflow E/A, E/e']	[values]	[Diastolic function assessment]	[Normal / Abnormal]
[Aortic valve velocity/gradient]	[m/s, mmHg]	[Peak/mean gradient]	[Severity]
[Pulmonary valve velocity/gradient]	[m/s, mmHg]	[Peak/mean gradient]	[Severity]
[Shunt velocities (VSD/ASD/PDA)]	[m/s]	[Gradient, Qp:Qs if calculated]	[Direction/magnitude]

RV systolic pressure estimate: [Value mmHg] (Method: [TR velocity / VSD gradient / septal geometry], assumed RAP: [value mmHg]). (Include only if estimated.)

Impression

1. [Segmental diagnosis summary using standardized congenital nomenclature]
2. [Hemodynamic findings: obstruction severity, regurgitation severity, shunt direction/magnitude, ventricular function]
3. [Other findings impacting management] (Include only if applicable.)
4. [Limitations affecting interpretation] (Include only if clinically material.)

Comparison: [Compared with prior study dated YYYY-MM-DD: interval changes] (If none available: "No prior study available for comparison.")

Recommendations: [Additional imaging or follow-up if study limitations affect safety-critical diagnoses] (Omit if none.)

Critical Findings Communication

(Include only if critical or unexpected finding identified, or if institutional policy requires attestation when none present.)

• Critical finding(s): [Description of critical/unexpected finding]
• Clinician notified: [Name, role]
• Date/Time of notification: [YYYY-MM-DD HH:MM]
• Method: [Phone / In-person / Secure message / EMR alert]
• Attestation: [If no critical findings and policy requires: "No critical or unexpected findings requiring immediate communication."]

Authentication

Interpreting Physician: [Name, credentials]

Signature: [Electronic signature]

Date/Time of Final Report: [YYYY-MM-DD HH:MM]