1、 Chapter 2： ECHOCARDIOGREAPHY 1.Normal Echocardiography Technology of Echocardiography Basic Technology： Transthoracic：M-Mode，2-D, Doppler Transesophygeal: Everyday, OR Technology of EchocardiographyOthers:Real time 3-D ECHOSTRESS ECHODoppler Tissue Image,DTIAcoustic Quantification,AQColor Kinesis,

2、CKIntravascular/intracardiacMyocardial contract echocardiography, MCE Stran rate: 心臟的位置心臟的位置The heart is in the left side of the middle mediastinumValvesChambers and SeptumParasternalApicalSubcostalSupersternal Echocardiographic views Parasternal Long- Axis View: Orienting the plane of sound along O

3、rienting the plane of sound along the major axis of the heart, form the major axis of the heart, form the patients left hip to the right the patients left hip to the right shoulder.shoulder. Anatomy Four Chambers: Walls： Atria wall: 23mm Right Ventricular wall: 35mm Left Ventricular wall: 811 mmHear

4、t Valve: Mitral Valve, Tricuspid Valve Aortic valve, Pulmonary Valve Parasternal Long-axis view Rotating the transducer 900 clockwise from the parasternal long-axis view (2) Parasternal short-axis view: Short axis view at the MV level Left ventricle : Circle Right ventricle : Crescent shape MV: Fish

5、 month at diastolic Line at systolicApical 4 chamber view 4 chamberMV, TVAtrial SeptumVentricular Septum (3)心尖四腔心切面心尖四腔心切面 Apical 5 chamber view The sound plane tilted anteriorly SupraternalView Subcostal View M-mode M-mode Color Doppler Color coded Red、Blue、 Green Red: Blood flow toward the transdu

6、cer Blue: Blood flow away from the transducer Green:Turbulence, The velocity is proportional to the brightness of the color Spectral Doppler (PW & CW) Vertical = Velocity, Horizontal: TimeAbove Baseline = Toward to transducerBelow Baseline = Away from transducerEAEAMitral Valve & Tricuspid V

7、alvePW Waveform 肺動脈瓣血流肺動脈瓣血流Pulmonary Valve FlowAotic Valve color Doppler & PW waveformLeft ventricular systolic function Left Ventricular Volume（EDV，ESV） Stroke Volume （SV） Ejection Fraction （EF） Shortening Fraction：（：（SF） Cardiac output （CO） Cardiac index （CI） Rheumatic Heart diseaseMitral Val

8、ve Stenosis (MS)Mitral Valve Efficiency (Regurgitation) (MR)Aortic Valve Stenosis (AS)Aortic Valve Regurgitation (AR) Mitral Stenosis The edges of the leaflets are rolled The edges of the leaflets are rolled and gnarled. and gnarled. The The chordae tendinae chordae tendinae can also be can also be

9、thickened, tethered, and shortened. thickened, tethered, and shortened. Small Small mitral mitral valve area.valve area. MS 2. 2. “Great Wall - battlements”Great Wall - battlements” 3. 3. Enlarged left atria and right Enlarged left atria and right ventricle ventricle 4. 4. Narrowed, High velocity fl

10、ow Narrowed, High velocity flow with bright yellow and blue with bright yellow and blue 5. 5.Thrombus in left atria or Thrombus in left atria or left atria appendage. (TEE) left atria appendage. (TEE)二、風濕性心臟病二、風濕性心臟病 MSMSMSMSBattlementsMSMSAtria Fibrillation Small anatomic areaMV area = 220/PHT Spon

11、taneous contractThrombiMitral Regurtgitation 1. MV / Chordae thickened, redundant, calcification, leaflet leak, prolapse, poor coaptation during systole 2. High-velocity mosaic (mainly blue regurgitaion jet Seen in systole. 3. Left atria and ventricle overloaded. Dilated LA and LV Valve leaflets thi

12、ckened and Valve leaflets thickened and domed, immobile with small domed, immobile with small opening opening PoststenoticPoststenotic dilation of the dilation of the ascending aorta. ascending aorta. Thickened LV wallThickened LV wall High-velocity, mosaic (mainly blue) High-velocity, mosaic (mainl

13、y blue) across AV . The flow Velocity across AV . The flow Velocity 2 2m/sm/s Aortic StenosisASAS AV leaflets Thickened, Redundant, AV leaflets Thickened, Redundant, and leak, and leak, prolapseprolapse, poor , poor coaptation coaptation in diastole in diastole Dilated LVDilated LV CDFI: Diastolic h

14、igh-velocity CDFI: Diastolic high-velocity mosaic flow in LVOT mosaic flow in LVOT CW: Diastolic Flow can be used for CW: Diastolic Flow can be used for quantification quantificationAortic RegurgitationLeak in diastoleAR3、Coronary Artery Disease(Atherosclerosis ) 1. Regional LV wall motion abnormali

15、ty Dyskinesis、Akinesis, Paradoxical motion 2. LV aneurysms：Mostly apex, Anterior wall with a paradoxical motion 3. Coronary arteries narrowing. Septum ThinSeptumAneurysm in apexCKCK：Regional Regional dyskinesisdyskinesisNormal LM and bifurcationStress EchoLV Contract 4、 Pericardial Effusion(PCE) Ech

16、o free space (Clear space,black) in pericardiumPCEPCE5、 Congenital Heart Disease Ventricular septal defect (VSD) Atrial septal defect (ASD) Patent ductus ateriosus (PDA) Tetralogt of Fallow (TOF) VSD Dilated LV, LA Dilated LV, LA Ventricular Ventricular septal septal defect seendefect seen Left to r

17、ight shunting across the Left to right shunting across the ventricular septum. ventricular septum. CWCW：High-velocity systolic flow High-velocity systolic flow above the baseline above the baseline PDA Dilated LV,LAPDA can be seen connecting the main PA (bifurcation, LPA) and the DAOMosaic (Mainly r

18、ed) flow in PA from DAOHigh-velocity Continuous flow seen above baseline ASD Dilated RA,RV and PA Dilated RA,RV and PA DefectDefect L-R shunting Flow through the L-R shunting Flow through the ASD in both systole and ASD in both systole and dastoledastole Contrast Echo: Contrast Echo: noncontrastnonc

19、ontrast- - containing blood passes across ASD containing blood passes across ASD TetralogyTetralogy of of FallotFallot） Include Pulmonary Include Pulmonary stenosis stenosis (RVOTO), (RVOTO), VSD, Overriding Aorta and RV hypertrophy.VSD, Overriding Aorta and RV hypertrophy. EchoEcho： Dilated and ove

20、rriding Aorta Dilated and overriding Aorta Malalignment Malalignment VSD VSD RVOTORVOTO RV hypertrophyRV hypertrophy R-L shunting in systoleR-L shunting in systole L-R shunting in diastoleL-R shunting in diastole High-velocity flow across RVOTHigh-velocity flow across RVOTAOLVLARVRL shuntingRL shunt

21、ingOverriding aortaTOFRVOTO Can be find in any of the cardiac Can be find in any of the cardiac chamber, but mostly in LA chamber, but mostly in LAGenerally attached to the lower Generally attached to the lower atrial atrial septum by a stalk that septum by a stalk that permits the tumor to move within permits the tumor to move within the the atrial atrial cavity.cavity.The tumor The tumor prolapses prolapses through and through and occludes the MV occludes the MV 6. 6. Cardiac TumorCardiac Tumor（MyxomaMyxoma） LA myxomaLA myxoma Asymmetrical ventricular Asymmetrical ventricular