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Echocardiography - PowerPoint PPT Presentation


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Echocardiography. Doppler Echocardiography. PLAX View. Normal LV Inflow. Aortic Regurgitation. Normal Outflow. Mitral Regurgitation. RVIT View. Tricuspid Valve – Normal Flow. Tricuspid Stenosis. Tricuspid Regurgitation. Tricuspid Valve - PWD. Tricuspid Inflow. E velocity. cm/s.

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echocardiography

Echocardiography

Doppler Echocardiography

slide12

Tricuspid Inflow

E velocity

cm/s

slide13

Tricuspid Inflow

cm/s

A velocity

slide15

Tricuspid Inflow

cm/s

Deceleration time

doppler stroke volume calculation
Doppler Stroke Volume Calculation
  • Assumption used for measuring SV using Doppler are:
  • Accurate cross-sectional flow area measurement.
  • Laminar Flow.
  • Spatial ‘flat’ flow velocity profile.
  • Parallel intercept angle between Doppler beam and
  • direction of blood flow.
  • 5. Velocity and diameter measurements are made at the
  • same anatomic site.
stroke volume at tricuspid valve
Stroke Volume at Tricuspid Valve

SV = CSA x VTI

SV = π (D)² x VTI

4

SV = 0.7855 D² x VTI

slide26

Tricuspid Regurgitation

cm/s

TR Peak Velocity

slide27

Tricuspid Regurgitation

RVSP = SPAP = 4 (TRjet)² + RAP

slide30

Tricuspid Stenosis

Deceleration Slope

cm/s

Deceleration Time

stroke volume at pulmonic valve
Stroke Volume at Pulmonic Valve

SV = CSA x VTI

SV = π (D)² x VTI

4

SV = 0.7855 D² x VTI

slide46

Pulmonic - PWD

Acceleration time

slide48

Pulmonic Valve - PWD

MPAP = 80 – 0.5 x Acceleration Time

Normal MPAP = 9 to 18 mmHg

slide51

Pulmonic - CWD

Peak Velocity

slide53

Pulmonic - CWD

PR – Peak Velocity

PR- EDV

slide54

Pulmonic Pressure

PA-EDP = 4( PR-EDV )² + RAP

Normal Value is 4 to 12 mmHg

MPAP= 4(PR pk)²

Normal Value is 9 to 18 mmHg

slide60

Mitral Inflow

Peak Velocity

cm/s

slide62

Mitral Stenosis

Deceleration Slope

cm/s

Deceleration Time

mva calculation
MVA Calculation

PHT (ms) = DT (ms) x 0.29

MVA (cm2) = 220 / PHT

MVA (cm2) = 751/ DT

slide67

Mitral Regurgitation

cm/s

VTI MR

MR Peak Velocity

slide68

Mitral Regurgitation

Aliasing

Velocity

Radius, r

slide69

Mitral Regurgitation

ERO mm² = 6.28 x r² + aliasing velocity

MR peak velocity

RV (cc) = ERO cm²x MRVTI cm

slide70

Evaluation of LV Systolic Function

Mitral Regurgitation Jet

When Mitral regurgitation is present the CW Doppler velocity curve indicates the instantaneous pressure difference between the left ventricle and left atrium.

slide71

Evaluation of LV Systolic Function

The slope of the mitral regurgitant jet velocity can be quantitated as the rate of change in pressure over time (dP/dt) by measuring the time interval between the mitral regurgitant jet velocity at 1 and 3 m/s.

slide72

Evaluation of LV Systolic Function

At each velocity, the corresponding pressure gradient is 4v squared per Bernoulli.

dP/dt = [ 4 (3) (3) – 4 (1) (1)]

Time interval

= 32 mmHg

Time interval

Thus a longer time interval indicates a depressed dP/dt and thus a decreased LV systolic function.

slide73

Evaluation of LV Systolic Function

dP/dT

dt

1 m/s, 4 mmHg

dP

3 m/s, 36 mmHg

slide74

Evaluation of LV diastolic Function

-dP/dT

dt

1 m/s, 4 mmHg

dP

3 m/s, 36 mmHg

stroke volume at mitral valve
Stroke Volume at Mitral Valve

SV = CSA x VTI

SV = π (D)² x VTI

4

SV = 0.7855 D² x VTI

slide80

Mitral Inflow

E velocity

cm/s

slide81

Mitral Inflow

cm/s

A velocity

slide83

Mitral Inflow

cm/s

A dur

slide84

Mitral Inflow

cm/s

Deceleration time

slide85

Mitral Inflow

E velocity

cm/s

A velocity

A dur

IVRT

Deceleration time

slide88

Pulmonary Venous Flow

cm/s

S velocity

slide89

Pulmonary Venous Flow

cm/s

D velocity

slide90

Pulmonary Venous Flow

cm/s

AR velocity

slide92

Pulmonary Venous Flow

cm/s

S velocity

D velocity

AR velocity

AR dur

slide96

Tissue Doppler

cm/s

E’ velocity

slide97

Tissue Doppler

cm/s

A’ velocity

slide98

Tissue Doppler

cm/s

A’ velocity

E’ velocity

slide101

Propagation Velocity

Propagation Velocity, Vp

stroke volume at tricuspid valve109
Stroke Volume at Tricuspid Valve

SV = CSA x VTI

SV = π (D)² x VTI

4

SV = 0.7855 D² x VTI

slide115

Tricuspid Regurgitation

cm/s

TR Peak Velocity

slide116

Tricuspid Regurgitation

RVSP = SPAP = 4 (TRjet)² + RAP

slide119

Tricuspid Stenosis

Deceleration Slope

cm/s

Deceleration Time

slide121

Tricuspid Inflow

E velocity

cm/s

slide122

Tricuspid Inflow

cm/s

A velocity

slide124

Tricuspid Inflow

cm/s

Deceleration time

slide131

Outflow – LVOT - PWD

Closing Click

Peak Velocity

stroke volume at lvot
Stroke Volume at LVOT

SV = CSA x VTI

SV = π (D)² x VTI

4

SV = 0.7855 D² x VTI

slide136

Outflow – Aortic - PWD

Opening click

Peak Velocity

pwd evaluation
PWD Evaluation

The Pulse wave Doppler should be moved from

along the LVOT into the Aorta to identify the

site of obstruction.

slide139

Outflow – Aortic - CWD

Mean velocity

Closing click

Opening click

Peak velocity

slide145

Aortic Regurgitation

Deceleration time

aortic regurgitation146
Aortic Regurgitation

PHT (ms) = DT (ms) x 0.29