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 [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 = f = 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 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
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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)
