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Basic Echocardiography Modes and Modalities

Basic Echocardiography Modes and Modalities. Echocardiography. Echocardiography is the application of ultrasound to evaluate cardiac anatomy and physiology. There are several different ways that ultrasound is used in echocardiography to assess cardiac structure/function.

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Basic Echocardiography Modes and Modalities

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  1. Basic Echocardiography Modes and Modalities

  2. Echocardiography • Echocardiography is the application of ultrasound to evaluate cardiac anatomy and physiology. • There are several different ways that ultrasound is used in echocardiography to assess cardiac structure/function. • These different ways (or modalities) will be discussed in the following slides.

  3. Echocardiography • The standard/basic modalities that are commonly used in echo are: • 2-Dimensional or “real-time” echo • M-Mode or “motion mode” echo • Color doppler echo, and • Spectral doppler echo

  4. 2-Dimensional Echocardiography

  5. 2-Dimensional Echo • Ultrasound waves are generated by the transducer and penetrate into the soft tissue. • Each tissue density interface within the body reflects part of the ultrasound wave back to the transducer. • The ultrasound platform forms an image based upon the arrival time and intensity of the returned ultrasound wave. • In 2 dimensional echocardiography, each image is formed from a single fan shaped slice of returning ultrasound. • Images are formed rapidly, allowing “real-time” motion of cardiac structures to be displayed.

  6. 2-Dimensional Echo Right Ventricle (RV) Interventricular Septum (IVS) Left Ventricle (LV) • This is a (static image) cross section of the heart obtained from the left parasternal border (parasternal short axis). • Imagine the heart cut in half at it’s midsection along the short axis (ventricular level). • Displayed in this view: • RV • IVS • LV

  7. 2-Dimensional Echo • To the left is a “real time” 2-dimensional image of the heart from the parasternal short axis view. • Note how in systole, the walls of the left ventricle thicken and contract in unison, and the cavity size (dark area) decreases. This is an example of normal systolic function. • The two lateral structures within this cavity are the papillary muscles of the left ventricle (part of the mitral apparatus).

  8. 2-Dimensional Echo • The following slides are examples of normal anatomy and cardiac function in “real time” 2-dimensional echocardiography (echo). • These views are a sample of the most common views that you will see in echo. • Each new view will be prefaced by a static image that defines cardiac anatomy.

  9. 2-D Echo (Parasternal Long Axis) RV LV Apex IVS LV Aortic Valve Mitral Valve Left Atrium • The parasternal long axis view is obtained from the left sternal border. • Displayed in this view: • RV • IVS • LV • Aortic Valve (AV) • Mitral Valve (MV) • Left Atrium (LA)

  10. 2-D Echo (Parasternal Long Axis) • To the left is a “real time” clip of the parasternal long axis view • Note that walls of the left ventricle (IVS and LV posterior wall - bottom) contract simultaneously and with equal thickening of the myocardium (heart muscle). • In diastole, the mitral valve is open, in systole the mitral valve is closed. • Conversely, in diastole – the aortic valve is closed, and in systole the aortic valve is open.

  11. 2-D Echo (Parasternal Short Axis) • This is a (static image) cross section of the heart obtained from the left parasternal border (parasternal short axis). • Imagine the heart cut in half at it’s midsection along the short axis (ventricular level). • Displayed in this view: • RV • IVS • LV RV IVS LV

  12. 2-D Echo (Parasternal Short Axis) • To the left is a “real time” 2-dimensional image of the heart from the parasternal short axis view. • This view is a perpendicular view of the parasternal long axis view • In this view, the right ventricle normally presents as a concave attachment (upper left) to the left ventricle

  13. 2-D Echo (Parasternal Short Axis)

  14. 2-D Echo (Parasternal Short Axis)

  15. 2-D Echo (Apical 4 Chamber) • As it’s name would imply, this is a view that displays all 4 chambers of the heart. • This view is obtained with the transducer placed at the 4-6th left intercostal space (imaging from the apex) • The apex of the heart is displayed at the top of the image (ventricles on top, atria on the bottom) • Note how the left heart structures are displayed to the right and vice versa. IVS LV RV MV TV RA LA

  16. 2-D Echo (Apical 4 Chamber) • To the left is a “real time” clip of the apical 4 chamber view • Note that walls of the left ventricle (IVS and LV lateral wall – far right) contract simultaneously and with equal thickening of the myocardium (heart muscle). • In diastole, the mitral valve is open, in systole the mitral valve is closed.

  17. 2-D Echo (Apical 5 Chamber) • The apical 5 chamber is a slight modification (anterior angulation) from the apical 4 chamber. • This view brings into view the left ventricular outflow tract and the aortic valve. • The right side of the heart is somewhat obscured by the angle of transducer orientation. Left Ventricular Outflow Tract (LVOT) LV MV AV LA

  18. 2-D Echo (Apical 5 Chamber) • In this view the mitral and aortic valves are visualized • Note again that in diastole, the mitral valve is open, in systole the mitral valve is closed. • Conversely, in diastole – the aortic valve is closed, and in systole the aortic valve is open.

  19. Motion Mode (M-Mode) Echocardiography

  20. Motion Mode (M-Mode) • One of the first types of echocardiography • M-Mode imaging utilizes a single “ice-pick” sector of the “real-time” image to display cardiac motion with a (significantly) more rapid frame rate across time. • Depth is displayed on the y-axis, and time is displayed on the x-axis.

  21. Motion Mode (M-Mode) • To the left is displayed a 2-D image of a parasternal short axis view. • The red line represents the user defined “sampling line” for the display of motion (m-mode) • Note that the line sampled cuts through (or displays) in order from top to bottom: • RV freewall • IVS • LV posterior wall

  22. Motion Mode (M-Mode) • In M-Mode, the motion of all cardiac structures along the sample line is displayed over time (left to right) • Systole and Diastole are evident by the decrease in LV cavity size. • The motion of the IVS and LV Posterior wall are synchronous in contraction.

  23. Color Flow Doppler Echocardiography

  24. Color Flow Doppler • Utilizing the measured frequency shifts of blood flow though the heart as sampled by ultrasound (i.e. Doppler Shift), blood flow direction and velocity can be obtained. • Color (flow) doppler echocardiography assigns a color to the blood flow within a sampled area. • Blood flow is assigned a color based upon 2 factors • Flow direction • Flow velocity

  25. Color Flow Doppler • In color doppler echocardiography, a “color scale” is utilized. This scale determines the color of the blood flow sampled and is typically displayed in the upper left or right of the imaging screen. • To the left is a typical color scale. Blood that is traveling toward the transducer (or top of image) is coded red and blood traveling away from the transducer (or bottom of image) is coded blue. • Each direction has shades at their extreme ends to depict a higher velocity of flow. The numbers (56cm/sec in this example) represent the higher ends of flow velocity.

  26. Color Flow Doppler • To the left is an example of color flow doppler. • This apical 5 chamber view in diastole shows the mitral valve open and blood flowing into the LV and toward the top of the image (labeled red). • The highest velocity of the mitral inflow can be identified by it’s yellow hue (as indicated by the color scale in the top right) • Note the sample area is outlined by a light blue box. LV LA

  27. Color Flow Doppler • This is the same apical 5 chamber view in systole. • Note how the blood leaving the left ventricle through the LVOT is coded blue. • Also of note is a small amount of mitral regurgitation. This is displayed as a blue signal that is passing though the closed mitral valve during systole. LV LA

  28. Color Flow Doppler • This is the real time clip that demonstrates color flow doppler interrogation of the mitral and aortic valves (apical 5 chamber view) • Again, in systole, note that there is a small amount of blue color flowing retrograde into the left atrium. This is mild mitral regurgitation.

  29. Color Flow Doppler • To the left is another example of color doppler interrogation from the apical 4 chamber view. • In systole, note again - that there is a mitral regurgitation. During systole there should be no blue signal present in the left atrium. This is classified as moderate mitral regurgitation.

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