Echocardiograp

hy

Anatomy and
patology
Dott. Mirco Baccino
Cardiologia Ospedale Santa Corona
Echocardiography is a group of
interrelated applications of
ultrasound to detect and check
dimension and movement of the
 ECHOCARDIOGRAPHY

- Preceded by
clinical
estimation
- EKG
- Specific
issues
- Targets ECHO
 ECHOCARDIOGRAPHY

 Patients without well-known

cardiopathy:
The goal is to highlight a
cardiopathy in high risk
subjects
 ECHOCARDIOGRAPHY

Patients with
well-known
cardiopathy

The goal is to
highlight the
clinical pattern
and to check it
 ECHOCARDIOGRAPHY
 Sensible parameters:
 - morphology
 - ejection fraction
 - contractility
 - ventricular diameters
 - ventricular performance
 - flow calculations by
Doppler
 - regurgitations
 - gradients
 ECHOCARDIOGRAPHY
 Coronary artery disease
 Cardiomyopathies
(dilated, hypertrophic,
restrictive, infiltrative)
 Hypertension
 Congenital heart disease
 Valvular heart disease
 Pericardial effusion and
tamponade
 Endocarditis
 ECHO

 Parasternal view (long and

short axis)
 Apical view

 Subxifoid view
 ECHOCARDIOGRAPHY
 Transthoracic
echocardiography (B-mode
ed M-mode)
 Doppler examination (PW e
CW)
 Doppler tissue
characterization (TDI)
 Stress test
echocardiography
(dipiridamolo o
dobutamine)
WINDOWS WINDOWS
 Apical position
Four chambers view
Parasternal position long
axis view
Parasternal Short axis
view
Subxiphoid position
Parasternal
long axis view
ANTERIOR SEPT
iva

POSTERIOR WALL
cx
Parasternal long axis view
Ventruclar values LVOT patology AORTA ASC.
Valvular disease HCM Aneurismi
CAD Sub-ao stenosis Dissezione
Cardiomyopathies
Aortic valve
Stenosis
Regurgitation

Ventricular values Left Atrium:

Systemic Hyperthension Mitral disease
Aortic stenosis Left ventricular failure
Diabetes Mitral valve Atrial fibrillation
HCM Regurgitation Mixoma
Coronary
Stenosis
artery disease
Iva/cx
Parasternal short axis view-left ventricle
ANTERIOR WALL
ANTERIOR iva
SEPTUM iva
LATERAL
INFERIOR WALL
cd cx

POSTERIOR
WALL cx-cd

INFERIOR WALL
cd
Parasternal short axis view

ISCHEMIA check
in ECO STRESS
AMI location

LEFT VENTRICULAR
VALUES
FLATTENING OF THE VENTRCIULAR SEPTUM
IN PULMONARY HYPERTHENSION
Parasternal shot axis view PULMONARY
VALVE
Great vessel Morfologia (2d)
EVDx Rigurgito (color)
Morfologia (2d) PVR (pwd)
Dimensioni (m,2d)
Cinesi (m,2d)
PULMONARY
ARTERY
TRICUSPID Dimensioni (2d)
VALVE Masse (2d)
Leaflets (2d)
Morphology (2d)
Rigurgitation (color)
PAPs (cwd)
ATRIAL SEPTUM
AORTA Morfologia (2d)
N° cuspidi (2d) Movimento (2d)
Morfologia (2d) Shunt ?
Area planim. (2d)
Parasternal short axis view
Great vessel RVOT
Fallot
Arrythmogenic RV
cardiomyopathy
Homograft polmonare
TRYCUSPID Pre-Ross
VALVE
RV Disfunctione
Ebstein PULMONARY
ARTERY
Pulmonary
Embolism
clots
AORTIC FISTULA
VALVE
Stenosis
Regurgitation ATRIAL SEPTUM
Oval fossa defect
Interatrial seprum defects
APICAL 4-5 CHAMBER VIEW
SEPTUM
cd, iva LATERAL WALL
motion (m,2d) cx
motion (m,2d)
 APICAL 4-5 CHAMBER
LV FUNCTION
RV MORPHOLOGY/FUNCTION Systolic/dyastolic

ISCHEMIA/
AMI
Septum-lateral wall

MITRAL valve
PATHOLOGY

TRYCUSPID Valve and

PuLMONARY HYPERTENSION
ATRIUM
AORTIC Valve PATHOLOGY
PATHOLOGY
HOCM
APICAL 2 CHAMBER
ANTERIOR WALL
APICAL Iva
WALL
Iva

INFERIOR
WALL
Cd
APICAL 2 CHAMBER ISCHEMIA/AMI
Anterior-inferior

LV SYSTOLIC
FUNCTION
B-mode ed M-mode
M-mode
Parasternal M-mode view
Transesophageal
Doppler CW e PW
 Doppler

 Pressuregradient by Bernoulli
equation: ΔP = 4V22

 Continuity
equation:
CSA2 = CSA1 * V1/V2
MAJOR CORONARY ARTERIES AREAS OF OVERLAP
MAJOR CORONARY ARTERY

IVA
CX
CD
PATHOLOGY
Apical 4-5 chamber view
 MECHANICAL IVS BREACH
COMPLICATON

Biventricular acute
overloaded

Patent Fossa
TRYCUSPID Valve Ovale
REGURGITATION

RV ACUTE OVERLOADED B. ISCHEMIA

Shunt
Ventricular Aneurysm
Ejection fraction

Operator-
Dependent
Ejection fraction
 CRT
- remodelling -

PRE POST

FAVORABLE REMODELING
RESPONDER

30% = NO RESPONDER
PULMONARY ARTERIAL PRESSURE
2. SPEED
(m/sec)

1. CWD on TRR

3. PRESSURE GRADIENT SOFTWARE

Equazione di
Bernouilli 4. PLUS 10 mmHg
modificata

apical 4C view
LEFT ATRIUM

Valore normale
Indicizzato
< 25 cmq

50 ml about
LEFT ATRIUM

MITRAL VALVE MITRAL

STENOSIS REGURGITATION

ATRIAL COMPLIANCE ATRIAL FIBRILLATION

LEFT ATRIUM

ATRIUM DIMENSIONS

ATRIAL
FIBRILLATION CLOTS

MAZE
SPONTANEOUS ECHOCONTRAST

1 – LOW FLOW

2 - CLOTS

VERY IMPORTANT TO DETECT

CLOTS IN LEFT ATRIUM
ETE
PARASTERNAL LONG AXIS VIEW Mitral Stenosis

1. THICK LEAFLETS

2. ATRIUM
EXPANSION

3. VALVE MELTING
PARASTERNAL SHORT AXIS VIEW Mitral Stenosis

1. THICK LEAFLETS

2. MELTING

Post- Ant-
med lat

REDUCED VALVE AREA

APICAL 4 CHAMBERS Mitral Stenosis

1. SICK VALVE

2. LEFT ATRIUM
EXPANSION
GRAVITY

Mitral Stenosis
RV FUNCTION

STENOSIS DEGREE

PULMONARY
PRESSURE
LEFT ATRIUM VOLUME
MITRAL STENOSIS

PARASTERNAL APICAL 4C
SHORT AXIS VIEW

VALVE AREA
- DOPPLER AREA
- GRADIENT
STENOSIS GRAVITY
Doppler valve area and gradient Mitral Stenosis

1. DOPPLER
2. GRADIENT BY SOFTWARE

1. MVA
2. PHT
3. DOPPLER VALVE AREA BY SOFTWARE
 Aortic Stenosis

GRADIENT VALVE AREA

PLANIMETRY CONTINUITY
EQUATION

Apical 5c
Parasternal short axis view
GRADIENT Aortic Stenosis

2. CWD LVOT

1. APICAL 5C
by
3. SISTOLIC SPEED
-> Bernouilli’s Equation
trackball
GRADIENT
 Aortic Stenosis
VALVE AREA
TT PLANIMETRY

PARASTERNAL
SHORT AXIS VIEW

base

PLANIMETRY

apice
 Aortic Stenosis
VALVE AREA
TEE PLANIMETRY

VALVE AREA BY PLANIMETRY

 VALVE AREA GRAVITY

Aortic Stenosis
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
Aortic Stenosis
 DIAGNOSIS Aortic Regurgitation

COLOR DOPPLER

arasternale asse lungo

apical 5C and Parasternal

long axis view short axis
view
DIASTOLIC JET
Aortic regurgitation
Aortic regurgitation
Aortic Regurgitation
DIAGNOSIS Mitral
COLOR DOPPLER SISTOLIC JET: regurgitation

APICAL 4C

PARASTERNAL LONG AXIS VIEW

DIAGNOSIS Mitral regurgitation

IN NORMAL MORPHOLOGY TOO

NO NECESSARY
BILLOWING
Mitral regurgitation
Mitral prolapse
SUBXIFOID VIEW

VEIN FlOW (pwd)

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

ATRIAL SEPTUM
PERICARDIUM Morfology (2d)
Morfology (2d) Movement (2d)
Effusion (2d)
SUBXIFOID VIEW EVDx
RV pathology
Pulmonary embolism

CAVA VEIN
Vein Pressure
Embolism
Tumor

ATRIAL RV
PERICARDIUM Function
Effusion/clots SEPTUM
Aneurysm Dimensions
Defects
Shunts
 SUBXIFOID VIEW

CAVA VEIN INFERIOR

Diameter ATRIAL SEPTUM
Morfology
SUBXIFOID VIEW
PERICARDIAL EFFUSION

Rv DIMENSIONS

VEIN
RV MOVEMENT

VOLUME RV
clots
CENTRAL VEIN PRESSURE

1) Subxifoid view diameters

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%
DIMENSIONS - MOVEMENT TAPSE

ITR
RIGHT VENTRICLE
FUNCTION
TDI ANULUS TV
DIMENSIONS: edd > 3.5 cm TAPSE: <1.5 cm: moderata
<1.0 cm: severa

RIGHT VENTRICUL
DISFUNCTION ITR: 3-4

TDI: S < 8 cm/s

ARRHITHMOGENIYC CARDIOMYOPATHY

RVOT > 30 mm Aneurysm

PULMONARY SYSTOLIC PRESSURE

APICAL 4C CWD

APICAL 4C VIEW CWD SPEED’

Arrhithmogenyc
cardiomyopathy: MRI

1) EXPANSION 2) FAT WALL

ARRHYTHMOGENIC CARDIOMYOPATHY

ANEURYMS
 RIGHT DISFUNCTION
RV EXPANSION - ATRIAL SEPTUM INCORRECT MOVEMENT
 PULMONARY HYPERTENSION

1) CWD trans-tricuspid valve

2) GRADIENT
trans-tricuspid valve

3) PVC

PAPs = gradient + pvc

30-40: lieve
40-50: moderate
> 50: severe
RV PERFORMANCE

1) m-MODE 2) TDI
TV ANULUS lat. TV ANULUS lat.

TAPSE
PERFORMANCE: TAPSE

NORMALE > 2 cm/sec

LIGHT DISFUNCTION 1.5-2 cm/sec
SEVERE DISFUNCTION < 1 cm/sec
PERFORMANCE: TDI

> 13 cm/s

> 12.7 cm/s > 12 cm/s

NORMAL
LEFT VENTRICULE
EXPANSION
Mitral Valve Vegetations
Right Ventricle expasion
HOCM
Left Ventricle
Hypertrophy
Left Ventricle
Hypertrophy
Cardiac Mass
Cardiac Mass
Ventricular Mixoma
Ebstein
Pericardial effusion
Pericardial effusion
Pericardial effusion
Pericardial effusion
Pericardial effusion
Pericardial effusion
Pericardial effusion
ETE - Clots in right
atrium
ETE – Interatrium defect
 Trydimensional
Echocardiography
 Trydimensional
Echocardiogrphy
 Trydimensional
Echocardiography
 Trydimensional
Echocardiography
Santa Corona Hospital