Table 4. Recommendations for echocardiography in infants, children and adolescents^9,12,16–18 .

Recommendations	Recommendation class	Evidence level
Pathological heart murmur or other evidence of cardiac abnormality	I	C
Anomaly of heart position or site	I	B
Cardiomegaly on radiological chest examination or abnormal findings suggestive of heart disease	I	B
Abnormal electrocardiogram	I	B
Immediate preoperative assessment for heart surgery	I	C
Change in clinical status of patient with known heart disease	I	B
Morphological and functional assessment during the postoperative period after heart surgery	I	C
Family history of heart disease transmitted genetically	I	B
Neuromuscular disease with myocardial involvement	I	B
Signs and symptoms of infectious endocarditis	I	A
Signs and symptoms of heart failure	I	A
Palpitations without other symptoms, benign family history, and normal electrocardiogram	IIb	C
Palpitations with family history of arrhythmia, sudden death, or cardiomyopathy.	I	B
Palpitations in patient with known cardiomyopathy	I	B
Palpitations with abnormal electrocardiogram or known ion channel defects	IIa	C
Asymmetry of peripheral pulses	I	A
Syndrome associated with cardiovascular disease; genotype positive for cardiomyopathy; chromosome anomaly associated with cardiovascular disease	I	B
To determine the appropriate timing of clinical or surgical treatment in patients with known heart disease	I	B
Selection, placement, patency, and monitoring of endovascular devices	I	A
Identification of intracardiac and intravascular shunts before, during, and after interventional percutaneous cardiac catheterization	I	A
Prolonged fever, without apparent cause, in a patient with congenital heart disease	I	A
Functional murmur in an asymptomatic patient	IIb	C
Retarded growth in the absence of specific clinical abnormality	IIb	C
Atypical angina, identified as of musculoskeletal origin in an asymptomatic patient	III
Syncope with abnormal electrocardiogram, exercise-related syncope	I	A
Syncope with family history of cardiomyopathy or sudden death	I	A
Neurocardiogenic (vasovagal) syncope	IIa	C
Effort angina or angina at rest with abnormal electrocardiogram	I	B
Angina associated with fever or use of illicit drugs	IIa	B
Presumably innocent murmur with signs and symptoms of heart disease	I	C
Central cyanosis	I	A
Chest wall deformity and preoperative scoliosis	IIb	C
Extracorporeal life support: initiation, maintenance, and weaning	I	B
Previous normal echocardiography with change in cardiovascular status and/or new family history suggestive of hereditary heart disease	IIa	C
Abnormal cardiac biomarkers	I	B
Hemoglobinopathies	I	B
Connective tissue diseases (Marfan, Loeys, Dietz, and others)	I	B
Muscular dystrophy	I	B
Autoimmune diseases	I	B
Arterial hypertension	I	A
Stroke	I	B
Metabolic, mitochondrial, or storage disease	I	B
Family history of cardiovascular disease: sudden death before 50 years of age, connective tissue diseases (Marfan or Loeys Dietz syndromes), idiopathic arterial hypertension	IIa	C
Family history of cardiovascular disease: hypertrophic cardiomyopathy, nonischemic dilated cardiomyopathy, hereditary pulmonary arterial hypertension	IIa	B