CHAPTER 4: Echocardiographic Imaging

STANDARD IMAGING

• The quality of echocardiographic images can vary widely from patient to patient.

• It is both operator and patient dependent.

• A standardized imaging approach is important to achieve study to study reproducibility.

• In order to obtain proper images, ultrasound must get around bone and lung tissue, and reach the heart.

Source

• Tajik AJ, Seward JB, Hagler DJ, et al. Two-dimensional real-time ultrasonic imaging of the heart and great vessels. Technique, image orientation, structure identification, and validation. Mayo Clin Proc. 1978;53:271–303.

PARASTERNAL LONG AXIS VIEW (PLAX)

• Parasternal images are best obtained with the patient in the left lateral decubitus position.

• Imaging advantages of the lateral decubitus position:

  • - The heart moves away from under the sternum.

  • - The rib interspaces separate more.

  • - An ultrasound pathway around lung tissue becomes available.

  • - The long axis view is parallel to the long axis of the heart.

• The major cardiac structures (possible abnormal findings in parentheses) in this view are:

  • - The proximal ascending aorta, and a peephole view of the descending aorta behind the heart (aneurysm, dissection flap, atherosclerotic plaque).

  • - The aortic valve (bicuspid valve, aortic valve endocarditis, calcification or thickening).

  • - The left atrium (dilatation, sphericity, elongation, systolic expansion, myxomas).

  • - The mitral valve, chordae, and papillary tips (prolapse, systolic anterior motion, rheumatic doming, endocarditis, annular calcification).

  • - The basal and mid-left ventricular septum and inferolateral wall (basal septal hypertrophy, wall motion abnormalities).

  • - Pericardium and pericardial space (effusion, pleuro/pericardial thickening is only rarely measurable when there is fluid on both sides of the pericardium).

  • - Coronary sinus (dilates when there is a left superior vena cava).

Source

• Reynolds T, Abate K, Abate J. “Rib-hooks,” “pressure points,” and “hugs”: technical hints for improving two-dimensional echocardiographic imaging. J Am Soc Echocardiogr. 1993;6:312–318.

RIGHT VENTRICULAR FOCUSED VIEW

• The right ventricular focused apical four-chamber view is used to perform linear measurements of the right ventricle.

• Technique:

  • - Transducer is pointed medially toward the tricuspid valve.

  • - Left ventricular apex is kept in the same position.

  • - Mitral annulus is moved over to the side.

  • - Tricuspid annulus is moved toward the center of the image.

• Measurements:

  • - Basal right ventricular cavity diameter (maximum short-axis length of the basal right ventricular cavity, in the mid portion ...