1. ECHO SCREENING CLINICAL SESSION
RHD Education Workshop 2017:
ECHO SCREENING CLINICAL SESSION
Michael Cursaro – Royal Adelaide Hospital

2. Role of echo in rhd SCREENING TO IDENTIFY PRE-CLINICAL DISEASE
ASSESS VALVE MORPHOLOGY
ASSESS DEGREE OF STENOSIS
SEVERITY OF REGURGITATION
DETERMINE SUITABILITY FOR VALVULOPLASTY
ASSIST IN TIMING OF SURGERY
MONITOR COMPLICATIONS
(such as pulmonary hypertension, thrombus, etc)

3. Screening for rhd:
“HAND offers a significant improvement over auscultation for
the diagnosis of RHD…”
“Sensitivity and positive predictive value of cardiac auscultation compared with echocardiography is poor… More than 50% of children with abnormal echocardiography
results did not have a murmur detected, and more than 90% of murmurs heard
were false positives.”

4. Screening for rhd: Who to screen? What age? How often?
SACRHD (South Australian Rheumatic Heart Disease) PROJECT
Targeted echo screening using portable equipment
APY Lands, Port Augusta, Port Pirie, Coober Pedy, Ceduna and Metropolitan areas
1808 Aboriginal children
Children identified with a heart condition (Rheumatic and Congenital) were referred for further investigation/treatment.

5. Screening in apy lands

6. Screening in apy lands
Screened 292 school children at 8 community schools from Pipalyatjara to Iwantja

7. rhd vS normal echo *Mitral stenosis +/- regurgitation – most common ++
Aortic valve involvement
Tricuspid valve involvement

8. rhd vS normal echo

9. Screening protocol Settings: Harmonics OFF
Our protocol included additional images to exclude common CHD.

10. Criteria: definite vs borderline

11. Criteria: definite vs borderline

12. Criteria: definite vs borderline

13. When mitral stenosis present: measure mitral valve area
2D/3D Planimetry
Doppler
(Only 2D data available in echo screening)

14. When mitral stenosis present: measure mean gradient and pressure half time

15. Measure:
Ejection fraction
LA volume
Pulmonary artery pressure

16. LIVE ECHO