Echocardiography (M-mode, 2D, Doppler) in children aged 4–17 years

Echocardiography is a non-invasive ultrasound examination of the heart performed in children and adolescents aged 4 to 17 years. The examination combines M-mode, 2D echocardiography, and Doppler assessment to evaluate the structure and function of the heart, its chambers and valves, as well as blood flow through the heart and major vessels.

Depending on the clinical indication, echocardiography can help identify or monitor congenital and acquired cardiac abnormalities and assess cardiac function.

Indications

• heart murmur or other abnormalities detected during auscultation;
• chest pain or discomfort;
• palpitations or a sensation of an irregular heartbeat;
• difficulty breathing, particularly during physical activity;
• unusual fatigue or reduced exercise tolerance;
• episodes of dizziness or loss of consciousness;
• elevated blood pressure;
• suspected congenital heart defects;
• monitoring of a previously diagnosed heart condition;
• assessment following certain infections or diseases that may affect the heart, as recommended by a doctor;
• monitoring of cardiac structure and function over time;
• cardiological assessment before participating in sports, when recommended by a doctor;
• other indications determined by a pediatrician or cardiologist.

Procedure

The child lies on the examination table, usually on their back or slightly turned onto the left side. A special gel is applied to the chest, after which the doctor moves the ultrasound transducer over different areas of the chest to obtain the required images.

2D echocardiography is used to assess cardiac structures, M-mode evaluates their dimensions and movement, while Doppler assessment evaluates the direction and characteristics of blood flow through the heart chambers and valves and, when necessary, the major vessels.

The examination is painless and does not use ionizing radiation. The child may be asked to change position or briefly hold their breath for a few seconds at certain points during the examination.

The duration varies depending on the child's age, ability to cooperate, and the complexity of the examination.

Limitations

• image quality may be affected by the child's position and ability to remain still;
• crying, frequent movement, or difficulty controlling breathing may make it harder to obtain optimal images;
• some cardiac structures or vessels may be difficult to visualize depending on individual anatomical features;
• echocardiography does not replace other cardiac investigations when these are indicated;
• results are interpreted in the context of symptoms, clinical examination findings, and other available investigations.

Advantages

• non-invasive and painless method;
• does not use ionizing radiation;
• allows real-time assessment of cardiac structure and function;
• combines 2D imaging, M-mode, and Doppler assessment in a single examination;
• allows assessment of blood flow and heart valve function;
• can be repeated and used for follow-up monitoring;
• suitable for children and adolescents;
• generally does not require sedation or anesthesia in children who are able to cooperate with the examination.

Contraindications

Echocardiography has no absolute contraindications.

If there are skin lesions, significant tenderness, or other conditions that make contact between the transducer and the chest difficult, the child's position or examination technique may need to be adapted.