Cardiovascular Imaging Module II Vincent Brinkman, MD and Sharon Roble, MD Division of Cardiology The Ohio State University College of Medicine

Cardiovascular Imaging Module II  Describe the use of echocardiography with Doppler recordings in the diagnosis of congenital and valvular heart disease Note: All of the Cardiac Medical Illustrations were adapted from Patrick J. Lynch and C. Carl Jaffe, (Yale University, 2006) and used under their Creative Commons license.

2D Imaging  Provides information on structure and anatomy.

2D Imaging – Cardiac Function  Normal  Abnormal

3D Imaging

2D Imaging – Bicuspid Aortic Valve  Bicuspid aortic valve Normal

Bicuspid Aortic Valve - MRI

2D Imaging - Masses  Normal  Atrial Myxoma Left Ventricle Left Atrium

2D Imaging – Masses with MRI

Tissue Characterization – Myocardial Fibrosis Kim et al., NEJM 2000; 343: Myocardial Fibrosis

Doppler ECHO 3 m/s 6 m/s 3 m/s VelocityTime 3 m/s Pulse Wave Continuous Wave 6 m/s

Doppler ECHO Pulse region Pulse WaveContinuous Wave Velocity in the LVOT

Color Doppler Aortic Valve Mitral Valve Left Atrium Left Ventricle Red = Towards Blue = Away

Mitral Regurgitation  Normal  Mitral Regurgitation

Atrial Septal Defect Right Atrium Left Atrium Secundum ASD

ASD – Saline Contrast Study Right Atrium Left Atrium

Tricuspid Regurgitation Normal Pulmonary Hypertension & Tricuspid Regurgitation Right Ventricle Right Atrium Tricuspid Regurgitation

Pulmonary Hypertension Pressure 1 Pressure 2 Bernoulli’s Principle or Pressure Difference ≈ 4v 2

Bernoulli Equation Peak Velocity = 4 m/s ΔP = 4v 2 ΔP = 64mmHg (Normal RVSP is < 32mmHg)

Ventricular Septal Defect VSD Left Ventricle Right Ventricle VSD

Ventricular Septal Defect – Bernoulli’s Principle Peak Velocity = 4.3 m/s ΔP = 4v 2 ΔP = 74mmHg

Aortic Stenosis Left Ventricle Aortic Valve Aorta

Aortic Stenosis – Bernoulli Equation V = 4.4 m/s ΔP = 4v 2 ΔP = 77mmHg (Normal is < 10mmHg)

Aortic Stenosis – “Extra Credit”  How do we calculate the aortic valve area? Continuity Equation Area Out = (Velocity in) x (Area in) / (Velocity out) Continuity Equation or Flow In = Flow Out Simplified… Area IN x Velocity IN = Area OUT x Velocity OUT (Area IN x Velocity IN ) / Velocity OUT = Area OUT

Cardiac Imaging Summary  Cardiac imaging can be used to diagnose many conditions.  2D Echocardiography shows us anatomy, structure and function.  Cardiac MRI can also give us “tissue characterization.”  Color Doppler imaging shows us flow and can diagnose a variety of valvular and congenital abnormalities  Doppler ECHO gives us velocities and helps us to diagnose problems as well as calculate pressures and hemodynamics.

The End…

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