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Mostafa Eladawy MD,AFSA Basics of Echocardiography

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Ultrasound principles

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Penetration depth and resolution Factors affecting ultrasound transmission: cycle length: (wavelength λ [mm]) frequency: (frequency f [Hz]) Speed: (propagation velocity c [m/s]) in the respective medium The relationship of these parameters is described by the wave equation: c = λ × f λ = c / f longer wavelengths penetrate further than shorter wavelengths Image resolution cannot be greater than one wavelength the higher the ultrasound frequency, the better the image resolution

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Types of resolution Axial resolution Lateral resolution Elevational resolution

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Modes 1-A mode 2-B mode 3-M mode 4-2D Echogenicity

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Doppler principles Christian Doppler

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The difference between the emitted frequency and the received frequency is called: Doppler shift (fd ) Blood flow V = fd × c/2 × f0 × cos α For practical application in Doppler echocardiography: the emitted frequency (f0) is known and the velocity of sound (c/2) is constant at 1540 m/s. Therefore, the velocity causing the Doppler shift can be calculated by: V = fd × cos α

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PRF (or scale)

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Nyquist limit Nyquist Limit = Pulse Repetition Frequency / 2

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1-PW 2-CW 3-CFM Angle of beam

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Pressure or pressure gradient?

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∆P = P 2 -P 1 = 4(V 2 2 – V 1 2 )

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Transducers

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Manipulation of TEE probe

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. The ASE/SCA 20 Views for a Comprehensive TEE Exam

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Left Ventricle function FS = EDD-ESD EDD FAC = EDA-ESA EDA EF = EDV-ESV EDV

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Left ventricle function Simpson mode M-mode 2D Eye balling TEI index

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Regional wall motion

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ME 4 chamber view

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Trans gastric view

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Right ventricle Size Contractility

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Rt Atrium

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LT atrium

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LV filling pressure

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Mitral valve leaflets

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Mitral valve Stenosis 1-gradient 2-planimetry 3-pressure half time

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Regurgitation 1-PISA 2-vena contracta 3-jet area 4-Regurgitant fraction 5-Indirect indices

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Aortic valve Stenosis 1-gradient 2-planimetry

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Regurgitation 1-PISA 2-jet area 3- vena contracta 4-Indirect indices

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Tricuspid valve Stenosis Regurgitation

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Pulmonary valve Stenosis Regurgitation

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Pulmonary pressure

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Pulmonary veins

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Shunts

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Ascending aorta and LVOT

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Descending aorta

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IVC and hepatic veins

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Recent adavances 3D echo (live and offline)

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TDI Speckle Tracking: non-Doppler, angle- independent quantification of myocardial deformation, by tracking the displacement of the speckles during the cardiac cycle, strain and the strain rate can be measured offline.

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Recommended books 1-Practical approach to transesophageal echocardiography(Perrino) 2-Core topics in echocardiography (Rob Fenneck) 3-Atlas of multiplane transesophageal echocardiography (Martin Dunitz) 4-transesophageal echocardiography in anesthesia and intensive care (BMJ) 5-Pocket atlas of echocardiography (Thieme) 5-Essential echocardiography (Humana press)

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Questions??

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