2echocardiography 2009

8/14/2019 2ECHOCARDIOGRAPHY 2009

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EchocardiograpEchocardiograp

hyhy

Anatomy andAnatomy andpatologypatology

Dott. Mirco BaccinoDott. Mirco BaccinoCardiolo ia Os edale Santa CoronaCardiolo ia Os edale Santa Corona


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Echocardiography is a group ofEchocardiography is a group ofinterrelated applications ofinterrelated applications of

ultrasound to detect and checkultrasound to detect and check

dimension and movement of thedimension and movement of the


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ECHOCARDIOGRAPHYECHOCARDIOGRAPHY

Patients without well-knownPatients without well-known

cardiopathycardiopathy::The goal is to highlight aThe goal is to highlight acardiopathy in high riskcardiopathy in high risksubjectssubjects


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Patients withPatients with

well-knownwell-known

cardiopathycardiopathy

The goal is tohighlight theclinical patternand to check it


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Sensible parameters:Sensible parameters: -- morphology

morphology - ejection fractionejection fraction

-- contractilitycontractility - ventricular diameters- ventricular diameters - ventricular performance- ventricular performance

- flow calculations by- flow calculations byDopplerDoppler - regurgitations- regurgitations - gradients- gradients


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Coronary artery diseaseCoronary artery disease CardiomyopathiesCardiomyopathies

(dilated, hypertrophic,(dilated, hypertrophic,

restrictive, infiltrative)restrictive, infiltrative) HypertensionHypertension Congenital heart diseaseCongenital heart disease Valvular heart diseaseValvular heart disease Pericardial effusion andPericardial effusion and

tamponadetamponade EndocarditisEndocarditis


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ECHOECHO

Parasternal view (long andParasternal view (long andshort axis)short axis)

Apical viewApical view

Subxifoid viewSubxifoid view


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TransthoracicTransthoracic

echocardiography (B-modeechocardiography (B-mode

ed M-mode)ed M-mode)

Doppler examination (PW eDoppler examination (PW eCW)CW)

Doppler tissueDoppler tissue

characterization (TDI)characterization (TDI)

Stress testStress test

echocardiographyechocardiography

(dipiridamolo o(dipiridamolo o

dobutamine)dobutamine)


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WINDOWSWINDOWS WINDOWS


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Apical positionApical position

Four chambers viewFour chambers view


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Parasternal position longParasternal position long

axis viewaxis view


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Parasternal Short axisParasternal Short axis

viewview


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Subxiphoid positionSubxiphoid position


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Parasternallong axis view

POSTERIOR WALL

cx

ANTERIOR SEPT

iva


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Parasternal long axis view

Ventruclar values

Valvular diseaseCADCardiomyopathies

LVOT patologyHCMSub-ao stenosis

AORTA ASC.

AneurismiDissezione

Aortic valveStenosis

Regurgitation

Ventricular valuesSystemic Hyperthension

Aortic stenosisDiabetesHCM

Coronaryartery diseaseIva/cx

Left Atrium:Mitral disease

Left ventricular failurAtrial fibrillationMixoma

Mitral valveRegurgitationStenosis


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Parasternal short axis view-left ventricle

ANTERIOR WALLiva

LATERALWALLcx

POSTERIORWALL cx-cd

INFERIOR WALLcd

SEPTUM

ANTERIORiva

INFERIORcd


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Parasternal short axis view

ISCHEMIA check

in ECO STRESS

FLATTENING OF THE VENTRCIULAR SEPTUMIN PULMONARY HYPERTHENSION

AMI location

LEFT VENTRICULARVALUES


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Parasternal shot axis viewGreat vessel

AORTAN cuspidi (2d)Morfologia (2d)

Area planim. (2d)

TRICUSPIDVALVELeaflets (2d)Morphology (2d)Rigurgitation (color)

PAPs (cwd)ATRIAL SEPTUMMorfologia (2d)Movimento (2d)Shunt ?

EVDxMorfologia (2d)Dimensioni (m,2d)Cinesi (m,2d)

PULMONARYVALVEMorfologia (2d)Rigurgito (color)

PVR (pwd)

PULMONARYARTERYDimensioni (2d)Masse (2d)


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Parasternal short axis viewGreat vessel

AORTICVALVEStenosisRegurgitation ATRIAL SEPTUM

Oval fossa defectInteratrial seprum defects

RVOTFallotArrythmogenic RV

cardiomyopathyHomograft polmonarePre-RossTRYCUSPID

VALVERV Disfunctione

Ebstein PULMONARYARTERYPulmonaryEmbolismclots

FISTULA


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APICAL 4-5 CHAMBER VIEW

LATERAL WALL

cxmotion (m,2d)

SEPTUMcd, iva

motion (m,2d)


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APICAL 4-5 CHAMBERLV FUNCTIONSystolic/dyastolicRV MORPHOLOGY/FUNCTION

TRYCUSPID Valve andPuLMONARY HYPERTENSION

AORTIC ValvePATHOLOGY

HOCM

MITRAL valvePATHOLOGY

ISCHEMIA/AMISeptum-lateral wall

ATRIUMPATHOLOGY


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APICAL 2 CHAMBERANTERIOR WALLIva

INFERIORWALLCd

APICAL

WALLIva


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APICAL 2 CHAMBER ISCHEMIA/AMIAnterior-inferior

LV SYSTOLICFUNCTION


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Parasternal M-mode view


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Transesophageal


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Doppler CW e PWDoppler CW e PW


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DopplerDoppler

Pressure gradient by BernoulliPressure gradient by Bernoulliequation:equation:P = 4VP = 4V22

22

Continuity equation:Continuity equation:CSACSA22 = CSA= CSA11 * V* V11/V/V22


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MAJOR CORONARY ARTERIES AREAS OF OVERLAP


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IVACXCD

MAJOR CORONARY ARTERY


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PATHOLOGY


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Apical 4-5 chamber viewApical 4-5 chamber view

IVS BREACH


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IVS BREACH

TRYCUSPID ValveREGURGITATION

Patent FossaOvale

B. ISCHEMIAShunt

Biventricular acuteoverloaded

RV ACUTE OVERLOADED

MECHANICALCOMPLICATON


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Ventricular AneurysmVentricular Aneurysm


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Ejection fractionEjection fraction

Operator-

Dependent


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PRE POST

FAVORABLE REMODELING

CRT- remodelling -


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RESPONDER

30% = NO RESPONDER


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LEFT ATRIUM

MITRAL VALVESTENOSIS

MITRALREGURGITATION

ATRIAL COMPLIANCE ATRIAL FIBRILLATION

LEFT ATRIUM


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LEFT ATRIUM

ATRIAL

FIBRILLATIONCLOTS

ATRIUM DIMENSIONS

MAZE


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SPONTANEOUS ECHOCONTRAST

1 LOW FLOW

2 - CLOTS

VERY IMPORTANT TO DETECT

CLOTS IN LEFT ATRIUM


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CLOTS IN LEFT ATRIUMCLOTS IN LEFT ATRIUM

ETEETE

PARASTERNAL LONG AXIS VIEW Mitral Stenosis


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1. THICK LEAFLETS

2. ATRIUMEXPANSION

PARASTERNAL LONG AXIS VIEW

3. VALVE MELTING

Mitral Stenosis

PARASTERNAL SHORT AXIS VIEW Mit l St i


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PARASTERNAL SHORT AXIS VIEW

1. THICK LEAFLETS

2. MELTING

REDUCED VALVE AREA

Post-med

Ant-lat

Mitral Stenosis


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APICAL 4 CHAMBERS

1. SICK VALVE

2. LEFT ATRIUMEXPANSION

Mitral Stenosis


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E


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MITRAL STENOSIS

PARASTERNALSHORT AXIS VIEW

VALVE AREA

APICAL 4C

- DOPPLER AREA- GRADIENT

STENOSIS GRAVITY


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STENOSIS GRAVITYDoppler valve area and gradient

1. DOPPLER2. GRADIENT BY SOFTWARE

1. MVA2. PHT

3. DOPPLER VALVE AREA BY SOFTWARE

Mitral Stenosis

A ti St i


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Aortic Stenosis

GRADIENT VALVEAREA

PLANIMETRY CONTINUITY EQUATION

Apical 5cParasternal short axis view

GRADIENT A ti St i


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1. APICAL 5C

2. CWD LVOT

3. SISTOLIC SPEED-> Bernouillis Equation

GRADIENT

GRADIENT

bytrackball

Aortic Stenosis

VALVE AREA

Aortic Stenosis


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VALVE AREATT PLANIMETRY

base

apice

PARASTERNALSHORT AXIS VIEW

PLANIMETRY

Aortic Stenosis


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VALVE AREA GRAVITY


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VALVE AREA GRAVITY

AVA AVA Index

(cm2) (cm 2/m2) LIGHT > 1.5 > 0.9

MODERATE > 1-1.5 > 0.6-0.9

SEVERE < 1 < 0.6

Aortic Stenosis

A i S i


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Aortic StenosisAortic Stenosis


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Aortic StenosisAortic Stenosis

Aortic RegurgitationDIAGNOSIS


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rasternale asse lungo

DIASTOLICJET

apical 5C and

long axis view

Parasternal

short axisview

COLOR DOPPLER

Aortic RegurgitationDIAGNOSIS


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Aortic regurgitationAortic regurgitation


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i i iA ti R it ti


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Aortic RegurgitationAortic Regurgitation

DIAGNOSIS Mitral


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DIAGNOSIS

COLOR DOPPLER SISTOLIC JET:

Mitralregurgitation

APICAL 4C

PARASTERNAL LONG AXIS VIEW

DIAGNOSIS Mitral regurgitation


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DIAGNOSIS

IN NORMAL MORPHOLOGY TOO

NO NECESSARYBILLOWING

Mitral regurgitation

Mi l i iMit l it ti


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Mitral regurgitationMitral regurgitation

Mit l lMit l l


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Mitral prolapseMitral prolapse

SUBXIFOID VIEW


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SUBXIFOID VIEW

VEIN FlOW (pwd)

CAVA VEIN

Dimensions (m,2d)Variaz resp (m,2d)Masse (2d)

PERICARDIUMMorfology (2d)Effusion (2d)

ATRIAL SEPTUMMorfology (2d)Movement (2d)

SUBXIFOID VIEW EVDx


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SUBXIFOID VIEW

CAVA VEIN

Vein PressureEmbolismTumor

PERICARDIUMEffusion/clots

RV

FunctionDimensions

RV pathologyPulmonary embolism

ATRIALSEPTUMAneurysmDefectsShunts

SUBXIFOID VIEW


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CAVA VEIN INFERIORDiameter ATRIAL SEPTUM

Morfology

SUBXIFOID VIEW

SUBXIFOID VIEW


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SUBXIFOID VIEW

VOLUME

PERICARDIAL EFFUSION

Rv DIMENSIONS

RV

clots

VEIN RV MOVEMENT

CENTRAL VEIN PRESSURE


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IVC SNIFF RAP mm Hg

< 1.5 collasso 0-5

1.5-2.5 > 50% 5-10< 50% 10-15

> 2.5 < 50% 15-20> 50% > 20%

1) Subxifoid view diameters

DIMENSIONS - MOVEMENT TAPSE


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RIGHT VENTRICLEFUNCTIONTDI ANULUS TV

ITR

DIMENSIONS: edd > 3.5 cm TAPSE:


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RIGHT VENTRICULDISFUNCTION


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PULMONARY SYSTOLIC PRESSURE


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APICAL 4C VIEW CWD SPEED

APICAL 4C CWD

Arrhithmogenyc


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g ycardiomyopathy: MRI

1) EXPANSION 2) FAT WALL


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RIGHT DISFUNCTION


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RV EXPANSION - ATRIAL SEPTUM INCORRECT MOVEMENT


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RV PERFORMANCE


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TAPSE

1) m-MODE

TV ANULUS lat.

2) TDITV ANULUS lat.

PERFORMANCE: TAPSE


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NORMALE > 2 cm/secLIGHT DISFUNCTION 1.5-2 cm/sec

SEVERE DISFUNCTION < 1 cm/sec

PERFORMANCE: TDI


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> 12.7 cm/s > 12 cm/s

> 13 cm/s

NORMAL

LEFT VENTRICULELEFT VENTRICULE


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LEFT VENTRICULELEFT VENTRICULE

EXPANSIONEXPANSION

Mitral Valve VegetationsMitral Valve Vegetations


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Mitral Valve VegetationsMitral Valve Vegetations

Right Ventricle expasionRight Ventricle expasion


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Right Ventricle expasionRight Ventricle expasion

HOCMHOCM


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HOCMHOCM

Left VentricleLeft Ventricle


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HypertrophyHypertrophy

Left VentricleLeft Ventricle


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Left VentricleHypertrophyHypertrophy

Cardiac MassCardiac Mass


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C di MCardiac Mass


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Ventricular MixomaVentricular Mixoma


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Ventricular MixomaVentricular Mixoma

EbsteinEbstein


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EbsteinEbstein

Pericardial effusionPericardial effusion


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ETE Interatrium defectETE Interatrium defect


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ETE Interatrium defectETE Interatrium defect

TrydimensionalTrydimensionalE h di h


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EchocardiographyEchocardiography

TrydimensionalTrydimensional


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EchocardiogrphyEchocardiogrphy


E h di hE h di h


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E h di hE h di h


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Santa Corona HospitalSanta Corona Hospital


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Santa Corona HospitalSanta Corona Hospital


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2echocardiography 2009

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