ABC | Volume 113, Nº1, July 2019

Statement Position Statement on Indications of Echocardiography in Adults – 2019 Arq Bras Cardiol. 2019; 113(1):135-181 Table 22 – Recommendations of transthoracic echocardiography in patients with bicuspid aortic valve and ascending aorta dilatation Recommendation Class of recommendation Level of evidence Assessment of aortic root and ascending aorta diameter in patients with bicuspid aortic valve I B Annual reassessment of size and morphology of the aortic root and ascending aorta in a patient with a bicuspid aortic valve and aortic diameter between 4.0 and 4.5 cm, if the size remained stable within the first 6-month interval after the first exam I B Six-monthly reassessment of the aortic root and ascending aorta size and morphology in a patient with a bicuspid aortic valve and one of the following criteria: aortic diameter > 4.5 cm; rapid increase in aortic diameter (> 0.3 cm); family history of aortic disease in a first degree relative; or if it is the first examination to detect aortic dilatation I B Table 23 – Recommendations of stress echocardiography in aortic regurgitation 153 Recommendation Class of recommendation Level of evidence Stress echocardiography in asymptomatic or marked AR with doubtful symptoms to evaluate exercise- induced symptoms and functional capacity IIa B Stress echocardiography in moderate AR with evident or doubtful symptoms to confirm and exclude other causes IIa B Echocardiography under stress with exercise or with dobutamine when there is a discrepancy between the severity of AR to the transthoracic echocardiography and clinical symptoms, to better quantify the AR III C AR: aortic regurgitation. Table 24 – Recommendations of transesophageal echocardiography in aortic regurgitation* 153 Recommendation Class of recommendation Level of evidence Discrepancy between qualitative and quantitative parameters of transthoracic echocardiography and/or between echocardiography and clinical evaluation regarding the severity of AR I B Confirm the presence, etiology and severity of acute AR if the transthoracic echocardiography is of limited, doubtful or inconclusive quality I B In patients with a bicuspid aortic valve to assess the diameter of the aortic root and ascending aorta when the transthoracic image is suboptimal I B *3D, if available. AR: aortic regurgitation. Table 25 – Recommendations of the echocardiography in tricuspid valvulopathy Recommendation Class of recommendation Level of evidence 2D TTE is recommended to confirm diagnosis, to assist in identifying the etiology and mechanisms of tricuspid lesions, to determine severity, to assess pulmonary pressure, as well as the dimensions of the cardiac cavities and the right ventricle function and to characterize any associated cardiac disease on the left side I B TEE (with 3D if available) may be used for more detailed assessment of valve morphology, mechanisms and Doppler quantification if the TTE is of limited, doubtful or inconclusive quality, or there is a discrepancy between the clinical data and the echocardiographic findings I B 3D TTE (in optimal windows) can be used to assess systolic and diastolic volumes and RV systolic function in patients with marked TR (stages C and D) IIb B TEE (2D or 3D) for assessing the systolic function of the RV in marked TR III C TTE: transthoracic echocardiography; 2D: two dimensional; TEE: transesophageal echocardiography; 3D: three dimensional; RV: right ventricle; TR: tricuspid regurgitation. 157