1. Mostafa Eladawy MD,AFSA Basics of Echocardiography

4. Ultrasound principles

5. Penetration depth and resolution Factors affecting ultrasound transmission: cycle length: (wavelength λ [mm]) frequency: (frequency f [Hz]) Speed: (propagation velocity c [m/s]) in the respective medium The relationship of these parameters is described by the wave equation: c = λ × f λ = c / f longer wavelengths penetrate further than shorter wavelengths Image resolution cannot be greater than one wavelength the higher the ultrasound frequency, the better the image resolution

6. Types of resolution Axial resolution Lateral resolution Elevational resolution

7. Modes 1-A mode 2-B mode 3-M mode 4-2D Echogenicity

8. Doppler principles Christian Doppler

9. The difference between the emitted frequency and the received frequency is called: Doppler shift (fd ) Blood flow V = fd × c/2 × f0 × cos α For practical application in Doppler echocardiography: the emitted frequency (f0) is known and the velocity of sound (c/2) is constant at 1540 m/s. Therefore, the velocity causing the Doppler shift can be calculated by: V = fd × cos α

10. PRF (or scale)

11. Nyquist limit Nyquist Limit = Pulse Repetition Frequency / 2

12. 1-PW 2-CW 3-CFM Angle of beam

13. Pressure or pressure gradient?

14. ∆P = P 2 -P 1 = 4(V 2 2 – V 1 2 )

15. Transducers

18. Manipulation of TEE probe

19. . The ASE/SCA 20 Views for a Comprehensive TEE Exam

20. Left Ventricle function FS = EDD-ESD EDD FAC = EDA-ESA EDA EF = EDV-ESV EDV

21. Left ventricle function Simpson mode M-mode 2D Eye balling TEI index

22. Regional wall motion

23. ME 4 chamber view

24. Trans gastric view

25. Right ventricle Size Contractility

26. Rt Atrium

27. LT atrium

28. LV filling pressure

29. Mitral valve leaflets

30. Mitral valve Stenosis 1-gradient 2-planimetry 3-pressure half time

31. Regurgitation 1-PISA 2-vena contracta 3-jet area 4-Regurgitant fraction 5-Indirect indices

32. Aortic valve Stenosis 1-gradient 2-planimetry

33. Regurgitation 1-PISA 2-jet area 3- vena contracta 4-Indirect indices

34. Tricuspid valve Stenosis Regurgitation

35. Pulmonary valve Stenosis Regurgitation

36. Pulmonary pressure

37. Pulmonary veins

38. Shunts

39. Ascending aorta and LVOT

40. Descending aorta

41. IVC and hepatic veins

42. Recent adavances 3D echo (live and offline)

43. TDI Speckle Tracking: non-Doppler, angle- independent quantification of myocardial deformation, by tracking the displacement of the speckles during the cardiac cycle, strain and the strain rate can be measured offline.

44. Recommended books 1-Practical approach to transesophageal echocardiography(Perrino) 2-Core topics in echocardiography (Rob Fenneck) 3-Atlas of multiplane transesophageal echocardiography (Martin Dunitz) 4-transesophageal echocardiography in anesthesia and intensive care (BMJ) 5-Pocket atlas of echocardiography (Thieme) 5-Essential echocardiography (Humana press)

45. Questions??