Licensure of the cardiac sonographer: an overview of issues and activities.

The impact of echocardiography on the continuum of cardiovascular health care is well established. Ongoing concerns regarding costs, accessibility, quality, and appropriateness of services rendered by practitioners of echocardiography have prompted various legislative proposals and regulatory policies from government, medical professional groups, and health plans. Specifically, there continues to be a drive to enact law for licensure of sonographers. These activities require continuing advocacy for the profession with active leadership. As part of its mission statement, the American Society of Echocardiography (ASE) states, "ASE strives to be a leader in public policy in order to create a favorable environment for excellence in the practice of echocardiography." As such, the ASE is committed to an increase in their interaction with legislators, payers, and policy makers. This article describes the historical perspective of state, federal, and provincial sonographer licensure issues to provide an understanding of the political perspectives.

Guidelines for cardiac sonographer education: recommendations of the American Society of Echocardiography Sonographer Training and Education Committee.

In 1992, the American Society of Echocardiography published a report of the Sonographer Education and Training Committee's recommendations for education of sonographers who perform echocardiographic procedures. Since the publication of the original document, there has been continual progress in technology with the development of more sophisticated diagnostic applications that allow more information to be obtained from echocardiographic procedures. These recent changes in the clinical application of echocardiography should be included in all cardiac sonographer education programs. The American Society of Echocardiography, a professional society that currently represents approximately 2500 cardiac sonographers, provides these updated guidelines.

Aortic regurgitation: a common complication after surgery for hypertrophic obstructive cardiomyopathy.

Surgical ventriculomyectomy and ventriculomyotomy by the aortic approach are safe and effective methods of relieving symptoms and obstruction to left ventricular outflow in patients with hypertrophic obstructive cardiomyopathy. With the addition of Doppler ultrasound to the routine follow-up assessment of these patients an unexpectedly high occurrence of aortic regurgitation was found in the postoperative patients. Because aortic regurgitation has been reported to rarely accompany this condition, 67 patients with hypertrophic obstructive cardiomyopathy were studied clinically and with Doppler echocardiography for the presence and severity of aortic regurgitation. Severity of the regurgitation was quantitated by pulsed or color Doppler echocardiography according to the length and width of the regurgitant jet in at least two views. In 37 patients with hypertrophic obstructive cardiomyopathy who did not undergo surgery, aortic regurgitation was detected in only 1 (3%) by Doppler ultrasound and in none clinically. In 52 patients who did undergo surgery and were studied a mean of 7.8 years postoperatively, aortic regurgitation of trivial to moderate degree was common, being detected in 28 (54%) by Doppler ultrasound and in 6 (12%) clinically. In a subgroup of 22 patients who were studied preoperatively and again early postoperatively (mean 6 weeks), new aortic regurgitation was found in 8 (36%) and was graded as trivial in all. Aortic regurgitation is a common complication related to ventriculomyectomy and ventriculomyotomy in patients with hypertrophic obstructive cardiomyopathy. Although initially trivial, the regurgitation may progress in severity over time. The regurgitation has been well tolerated in all patients studied to date.

Fetal cardiac tumor: a prenatal echocardiographic marker for tuberous sclerosis.

Auscultation of a fetal bradyarrhythmia led to the prenatal echocardiographic detection of an intracardiac tumor. After birth the diagnosis of tuberous sclerosis was established. Therapeutic implications for current and future pregnancies, when a fetal cardiac tumor is found, are discussed.

Quantitative two-dimensional echocardiographic assessment of fetal cardiac growth.

High-resolution, real-time cardiac imaging and Doppler measurements of blood flow have the potential of extending the fetal cardiovascular profile beyond heart rate monitoring alone. The development of normal standards is a prerequisite to the application of these capabilities. To quantify fetal cardiac growth and explore the potential applications, we performed real-time, two-dimensional echocardiography in a cross-sectional study of 75 normal pregnancies from 17 to 40 weeks gestation. Left and right ventricular, left and right atrial, and aortic root measurements were obtained. Regression analysis showed that the best correlation for ventricular and aortic dimensions with gestational age or biparietal diameter was a straight line (y = mx + b). Ten normal fetuses were then serially monitored. Cardiac dimensions fell within the confidence range of the regression models, and most cases exhibited similar growth slopes. Finally, five abnormal cases were studied to demonstrate the use of these data in diagnosing altered cardiac structure and function.