transthoracic echocardiography

 

outlines

- view of transthoracic echocardiography normal

- abnormal disease

 

view of transthoracic echocardiography

- parasternal long axis view

- parasternal short axis view

- subcostal view

- apical two chamber view

- apical four chamber view

- apical five chamber view

- suprasternal view

 

parasternal long axis view

- parasternal long axis view normal

parasternal long axis view normal

parasternal short axis view

- parasternal short axis view normal

- level of cut

parasternal short axis view normal

 

level of cut

- pulmonary artery

- level of aortic valve

- level of mitral valve

- level of papillary muscle

- left ventricle

subcostal view

- subcostal view normal

- estimate right atrial pressure from the IVC

subcostal view normal

 

estimate right atrial pressure from the IVC

apical two chamber view

- apical two chamber view normal

apical two chamber view normal

apical four chamber view

- apical four chamber view normal

apical four chamber view normal

apical five chamber view

- apical five chamber view normal

apical five chamber view normal

suprasternal view

- suprasternal view normal

suprasternal view normal

abnormal

- mitral stenosis

- mitral regurgitation

- aortic stenosis

- aortic regurgitation

- infective endocarditis

- tricuspid stenosis

- tricuspid regurgitation

- pulmonary regurgitation

- pulmonary hypertension

- prosthetic valve

- infective endocarditis

 

mitral stenosis

- mitral valve area

- mitral valve pressure

- severity of mitral stenosis

- imaging of mitral stenosis

mitral stenosis

mitral valve area

** วิธีการวัด

** ข้อเสียของการวัดวิธีนี้

 

mitral valve pressure gradient

** วิธีการวัด mitral valve pressure gradient

 

severity of mitral stenosis

- mitral valve area วิธีการคำนวณ

 

pressure half time

- definition of pressure half time

- severity by the pressure half time

definition of pressure half time

 

severity by the pressure half time

 

imaging of mitral stenosis

  A4C PSAX  
 

- diastolic doming of anterior leaflet

- thickening of the valve leaflets

- restricted opening of the valve

- dilatation of the left atrium

(mitral stenosis)

- color flow map of a stenotic mitral valve showing a "candle-flame" shaped jet

- PW doppler of mitral valve showing increased diastolic flow velocity

- showing reduced mitral valve orifice size

 
       

 

mitral regurgitation

- การวัด regurgitation ให้ดูอะไรบ้าง

- ทิศทางของ jet ในการบอก pathology

- severity of mitral regurgitation

- imaging of mitral regurgitaion

mitral regurgitation

การวัด regurgitation ให้ดูอะไรบ้าง

 

ทิศทางของ jet ในการบอก pathology

** mitral valve prolapse vs mitral valve rheumatic MR มีทิศทางของ jet ที่แตกต่างกัน

 

severity of mitral regurgitation

- color flow mapping

- PW doppler

 

imaging of mitral valve regurgitation

  A4C A5C PLAX PSAX combined method
 

- biatrial enlargement

(mitral valve regurgitation)

-Color flow: severe mitral regurgitation with an eccentric jet that is " wall hugging" and anteriorly directed (opposite the side of leaflet prolapse)

- color flow map of a regurgitant mitral valve showing a jet in the left atrium

- PW doppler of the mitral valve showing a MR flow signal in the left atrium

 

- greater > 2-mm prolapse of the posterior leaflet beyond the plane of the annulus

 

- color flow map of a regurgitant mitral valve showing a jet in the left atrium

 

 

 

 

           

 

aortic stenosis

- aortic valve area

- aortic valve pressure gradient

- imaging of aortic stenosis

- severity of aortic stenosis

aortic stenosis

aortic valve area

 

aortic valve pressure gradient

 

severity of aortic stenosis

aortic valve area opening

peak velocity and pressure gradient

 

imaging of aortic stenosis

pathology A4C A5C PLAX PSAX combined method
aortic stenosis  

- color flow map of stenotic aortic valve showing a jet in the proximal aorta

- PW doppler of aortic valve showing increased systolic flow velocity

 

rheumatic and calcified aortic stenosis : calcium deposits in the commissures resulting in commissural fusion

- calcification of aortic valve leaflets

rheumatic and calcified aortic stenosis : calcium deposits in the commissures resulting in commissural fusion

- showing calcification of aortic valve annulus

CW doppler

 
bicuspid aortic valve

 

 

 

 

 

 

 

 

 

 

tricuspid aortic valve

 

       

quadricuspid aortic valve

 

       

 

aortic regurgitation

- severity of aortic regurgitation

- echocardiographic sign of severe AR

- imaging of AR

severity of aortic regurgitation

 

aortic regurgitation

- echocardiographic sign of severe AR

- the ratio between width of AR jet and LVOT diameter indcates the severity of aortic regurgitation

- pressure half time and severity

- depth of jet

- deceleration rate

- PW doppler

 

imaging of AR

  A4C A5C PLAX PSAX combined method
aortic valve

PW

- rapid equilibration of aortic and left ventricular diastolic pressure with nearly equal to end-diastole

(aortic regurgitation)

 

 

- color flow map of the aortic valve show a regurgitant jet

- pressure half time

** the steeper slope of the continuous wave doppler of AR

- pressure half time and severity of AR

- aortic regurgitant jet that fills the entire left ventricular outflow tract, consistent with severe aortic regurgitation

- color flow map of the aortic valve show a regurgitant jet

- assessment of AR severity from the depth of jet

- jet width : the ratio between width of AR jet and LVOT diameter (severity of AR)

- jet height to LVOT height ratio

- vena contracta

- vena contracta interpretation

- effective regurgitant orifice area (EROA)

- M-mode for LVEDD and LVESD

- bicuspid aortic valve with moderate regurgitation

PLAX >>diameter

A5C >>TVI

A4C>>diameter

aortic aneurysm with AR    

the aortic wall is thin at the sinuses of the sinuses of Valssalva and aneurysmal dilatation results in AR

the aortic wall is thin at the sinuses of the sinuses of Valssalva and aneurysmal dilatation results in AR

 

 

tricuspid stenosis

- criteria for severe TS

tricuspid stenosis

criteria for severe TS

tricuspid regurgitation

- tricuspid regurgitation ดูอะไรบ้าง

- criteria for pathologic TR

- severity of tricuspid regurgitation

- pulmonary artery pressure

- TAPSE

- imaging of tricuspid regurgitation

tricuspid regurgitation ดูอะไรบ้าง

- severity

- assess pulmonary hypertension

- RV function

- LV function

- tricuspid annulus (normal tricuspid annulus 25-28 mm)

 

 

tricuspid regurgitation

- criteria for pathologic TR

 

severity of tricuspid regurgitation

-severity by color flow mapping

- severity by PW doppler

pulmonary artery pressure

- วิธีการคำนวณ pulmonary artery pressure ใน tricuspid regurgitation

วิธีการคำนวณ pulmonary artery pressure ใน tricuspid regurgitation

TAPSE

- TAPSE คืออะไร

- TAPSE มีหลักการวัดอย่างไร

- การแปลผล TAPSE

TAPSE คืออะไร

- tricuspid annular plane systolic excursion

 

TAPSE มีหลักการวัดอย่างไร

- เป็นการวัด right ventricular longitudinal / systolic function เป็นการวัด tricuspid lateral an

 

การแปลผล TAPSE

 

imaging of tricuspid regurgitation

  A4C A5C PLAX PSAX combined method
 

- infective endocarditis resulting in flail posterior mitral valve leaflet and tricuspid regurgitation before tricuspid valve annuloplasty

(tricuspid regurgitation)

- color flow map of a regurgitant tricuspid valve showing a jet in the right atrium

- vena contracta, regurgitant jeft area, jet area/RA area ratio

- CW doppler of the tricuspid valve showing TR flow signal in the right atrium

- tricuspid inflow velocity, right ventricular systolic pressure (RVSP)

- tricuspid annular plane systolic excursion (TAPSE)

 

- M mode scan of the ventricles showing diltation of the right ventricle and paradoxical moition of septum

 

 

 

 

 

 

           

 

pulmonary regurgitation

- severity of pulmonary regurgitation

- imaging of pulmonary regurgitation

severity of pulmonary regurgitation

- PR fraction

 

imaging of pulmonary regurgitation

  PSAX  
 

- a regurgitant jet in the RV outflow tract

 
     
   

pulmonary hypertension

- วฺิธีการวัด RVSP ใน pulmonary hypertension

- การประมาณ right atrial pressure

- severity of pulmonary hypertension

pulmonary hypertension

วฺิธีการวัด RVSP ใน pulmonary hypertension

 

การประมาณ right atrial pressure

 

severity of pulmonary hypertension

prosthetic valve

- การประเมิณ prosthetic valve ดูอะไรบ้าง

- normal paravalvular leak criteria

prosthetic valve

การประเมิณ prosthetic valve ดูอะไรบ้าง

 

normal paravalvular leak criteria

infective endocarditis

- imaging of infective endocarditis

 

infective endocarditis

- imaging of infective endocarditis

  PSAX PLAX A4C
mitral valve  

- a large, mobile vegetations attached to the anterior mitral valve leaflet

 
tricuspid valve

- small vegetation attached to the septal tricuspid leaflet with an echolucent area within the septal tricuspid leaflet (area of perforation)

(infective endocarditis)

 

- vegetation attached to the tricuspid valve causing severe TR

- mitral valve is densely calcified

aortic valve

- a large, septated abscess is seen adjacent to the aortic valve annulus

- a large mobile aortic valve vegetation

(infective endocarditis)

- large vegetation can be seen on the ventricular surface of both aortic valve leaflets

- dilated left ventricle, suggesting the presence of significant AR

- a larged vegetation attached to the aortic valve that prolapses into the LVOT in diastole

fungal endocarditis

- large vegetations are present on the aortic and mitral valves

- moderately to severe AR with an eccentric jet

 
pulmonic valve

- a vegetation is identified on the pulmonic valve

(infective endocarditis)