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No method of evaluating transthoracic echocardiograms (TTE) image quality (IQ) has been validated. Furthermore, structural echo lab elements impacting IQ are unknown. We sought to develop and validate a TTE IQ grading tool and determine patient and echo lab features associated with IQ. Ten pediatric echo labs each submitted 50 consecutive new patient TTEs without complex heart disease. For each study, 3 sonographers independently rated IQ and performed routine measurements. IQ scoring used the American College of Cardiology Quality Network (ACC QNet) tool plus a novel Likert scale component. IQ scores were validated against the ability to make measurements and, when all measurements were made, variation between sonographers. After validation, patient and lab factors, from a previously published survey, associated with improved TTE IQ were determined by linear regression. Total IQ score (R 2  = 0.64), ACC QNet (R 2  = 0.29) and the Likert component (R 2  = 0.52) correlated with the total number of measurements made (p < 0.001). For the 236 (52%) TTEs with all measurements, the Likert scale component (OR 0.9, 95% CI 0.82-0.99, p = 0.037) was associated with lower measurement variability. Factors significantly associated with worse IQ scores were higher patient weight, performance by a traveling sonographer, lower annual and inpatient TTE volume, less dedicated teaching/administrative sonographer time, and full-day sessions for reading physicians. A novel TTE IQ scoring tool was created and validated for pediatric TTE. Modifiable structural components of echo labs associated with TTE IQ were identified. This novel IQ tool should guide IQ beyond the ACC QNet score., Competing Interests: Declarations. Conflict of interest: Garick Hill served as a consultant for Ultragenyx. Ethical Approval: Not applicable. Consent to Participate: Not applicable., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Right ventricular dilation is a common complication after tetralogy of Fallot (TOF) repair. Traditional echocardiographic assessments are imprecise due to the RV's location and complex geometry. We propose a novel echocardiographic measurement: RV apical flattening (RVAF) as a screening tool to help identify subjects with severe RV dilation. Patients with repaired TOF who had both echocardiograms and CMR's within 6-month interval at our institution were included in the study. The RVAF was measured in the four-chamber echocardiographic view as the minor length of RV cavity at the level of RV apical endocardium. Subjects were divided into two groups (group I: RVEDVi ≥ 150 ml/m(2) and group II; RVEDVi < 150 ml/m(2)). Echocardiogram and CMR data were compared between groups. A total of 75 subjects were included in the study. Mean age was 12.8 ± 3.6 years. Group I had 36 subjects, and group II had 39 subjects. The mean RVAF was significantly higher in group I (2.7 ± 0.5 cm) compared with group II (1.7 ± 0.4 cm; p < 0.001). There was significant correlation between RVAF and RVEDVi (r = 0.81; p < 0.001). By ROC analysis, an RVAF cutoff value of 2.0 cm had 94 % sensitivity and 77 % specificity in identifying severe RV dilation (area under the curve 0.95). RVAF is a simple and effective echocardiographic screening tool to help identify severe RV dilation. In conjunction with other 2D echocardiographic parameters, this technique would help further refine echocardiography-guided patient selection for timing of CMR and pulmonary valve replacement.

Stainless steel embolization coils (SSEC) have been used for over four decades for vascular occlusion. Recently, the safety of these coils in a magnetic resonance environment has been called into question, with important ramifications for thousands of patients with existing coils in place. We performed a retrospective chart review at five tertiary care pediatric centers evaluating all children and young adults with implanted SSEC who underwent magnetic resonance imaging (MRI). Data reviewed included demographics, coil implantation, MRI studies, and follow-up evaluations. Complications such as heating, discomfort, or device migration were specifically sought. Two hundred and ninety-seven patients with implanted SSEC underwent 539 MRI examinations. The median age at SSEC implantation was 2.3 years (1 week-23.2 years). The MRI studies were performed a median of 7.4 years (4 days-23.1 years) after implantation. No patients experienced any reported complications associated with their MRI examinations during the study or at median follow-up post-MRI of 4.8 years (1 day-23 years). In this large, retrospective review of patients with implanted SSEC undergoing MRI, there were no reported adverse events. These findings support the recent change by Cook Medical Inc. of their standard embolization coils from a designation of magnetic resonance unsafe to conditional.