1. Basic Echo
As I understand it…
Dr Claudia Wong

2. Types of Ultrasound
M-mode
2D echocardiography
Doppler

3. M-mode
M is for motion
A single beam in an ultrasound scan can be used to produce an M-mode picture, where movement of a structure such as a heart valve can be depicted in a wave-like manner.
Because of its high sampling frequency (up to 1000 pulses per second), this is useful in assessing rates and motion

4. M-mode

5. 2D Echocardiography
The principle of ultrasound reflection off cardiac structures to produce images of the heart

6. 2D Echocardiography

7. Doppler
Describes the change in frequency due to relative motion between
Wave source (Echo probe)
Receiver (Echo probe)
Reflector (RBCs)

8. Principles we should know
Doppler principle
Bernoulli principle
Hydraulic principle
Continuity principle

9. Doppler

10. Doppler
Θ < 20, such that cos Θ ~ 1

11. Bernoulli Principle

12. Hydraulic Principle

13. Continuity Principle
Whatever flows in must flow out

14. Doppler Using these principles, we can determine Pressure Flow
Velocity
Volume

15. Particular Doppler Terms We Should Know
Colour wave doppler
VTI (velocity time integral)
TDI (tissue doppler imaging)
Pulsed wave doppler
Continuous wave doppler

16. Colour wave doppler

17. Particular Doppler Terms We Should Know
Colour wave doppler
VTI (velocity time integral)
TDI (tissue doppler imaging)
Pulsed wave doppler
Continuous wave doppler

18. Velocity Time Integral (VTI or TVI)
TVI (cm) = area under velocity curve & is equal to the sum of velocities (cm/s) during ejection time

19. Particular Doppler Terms We Should Know
Colour wave doppler
VTI (velocity time integral)
TDI (tissue doppler imaging)
Pulsed wave doppler
Continuous wave doppler

20. Tissue Doppler Imaging (TDI)
Tissue tracking or displacement is the integral of tissue velocity over a given time.
It represents the distance a region of interest moves relative to its original location.

21. Particular Doppler Terms We Should Know
Colour wave doppler
VTI (velocity time integral)
TDI (tissue doppler imaging)
Pulsed wave doppler
Continuous wave doppler

22. Tissue Doppler

23. Transthoracic Echo 4 standard views Parasternal long axis
Parasternal short axis
Apical
Subcostal

24. Parasternal long axis

25. Parasternal short axis

26. Apical

27. Subcostal

28. Clinical Applications
RVSP
Mitral stenosis
Aortic stenosis
Stroke volume
Mitral regurgitation
Diastolic dysfunction

29. R Ventricular Systolic Pressure
RVSP from tricuspid jet
= tricuspid gradient
∆ P = 4 (V2 – V1)2 + RAP
RAP
RAP
IVC
Collapse
0-5
>1.7
>50%
6-10
<1.7
11-15
<50%
16-20
Nil

30. Mitral Stenosis Direct measurement of MVA
Using M-mode + 3D echo
Peak mitral diastolic velocity
Continuous wave doppler
Mean pressure gradient and TVI
MVA
Pressure half-time method
MVA = 220/PHT
Continuity equation + PISA method

31. Mitral stenosis

32. Mitral stenosis Severity Severity MVA (cm2) Mean Gradient (mmHg)
PASP (mmHg)
Mild
>1.5
<5
<30
Moderate
5-10
30-50
Severe
<1.0
>10
>50

33. Aortic stenosis Velocity Pressure gradient Area
Using Doppler + VTI for peak velocity
Pressure gradient
Using Bernoulli principle P = 4V2
Area
Using Continuity principle
AVA = (LVOTA x LVOT TVI)/AV TVI
LVOT / AVA velocity ratio
Based on Continuity principle

34. Aortic stenosis

35. Aortic stenosis Severity peak aortic valve velocity >4.5 m/s
mean pressure gradient >50 mmHg
AVA < 0.75 cm2
LVOT/AV TVI <0.25

36. Stroke volume
Using the hydraulic principle

37. Mitral regurgitation
Uses continuity principle – whatever flows in must flow out
Q1=Q2
CSA1 x V1= CSA2 x V2

38. Mitral regurgitation
We compare LVOT SV vs. MV SV

39. Mitral regurgitation Severity Severity Volume (mL) Mild 30 Moderate
30-44
Moderate - Severe
45-59
Severe 60

40. Diastolic dysfunction
4 stages
Normal
Delayed
Pseudonormal
Restrictive

41. Diastolic dysfunction
Looks at several factors
MIF = Mitral inflow
E = early diastolic mitral inflow velocity
A = late diastolic mitral inflow velocity
e’ = early diastolic mitral annulus velocity
DTI = Doppler tissue imaging

42. Diastolic dysfunction
Mitral inflow

43. Diastolic dysfunction

44. Diastolic dysfunction

45. Diastolic dysfunction
Normal
Delayed
Pseudo-normal
Restrictive
E/A
1-2
<0.75
>2
DTI
>240
<150
E/e’ ≤8
range
≥15