preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
Cardiac Measurements Guidelines | powered by EsaoteMIDEAS
Complete routine cardiac measurements Guidelines.
1) Left Ventricle:
a) Size: Dimensions or volumes, at end-systole and end-diastole
b) Wall thickness and/or mass: Ventricular septum and left ventricular posterior wall thicknesses (at end-systole and end-diastole) and/or mass (at end-diastole)
c) Function: Assessment of systolic function and regional wall motion. Assessment
of diastolic function
2) Left Atrium:
• Size: Area or dimension
3) Aortic Root:
• Dimension
4) Right Ventricle:
Size: Dimensions
Function: Systolic and diastolic function
RV & pulmonary hemodynamics
5) Right Atrium:
a) Size: Dimensions, area
b) RA pressure
6) Valvular Stenosis:
a) Valvular Stenosis: Assessment of severity, including trans-valvular gradient and area.
b) Subvalvular Stenosis: Assessment of severity, Including subvalvular gradient.
7) Valvular Regurgitation: Assessment of severity with semi-quantitative descriptive statements and/or quantitative measurements
8) Cardiac Shunts: Assessment of severity. Measurements of QP:QS (pulmonary-to systemic flow ratio) and/or orifice area or diameter of the defect are often helpful.
9) Prosthetic Valves:
a) Transvalvular gradient and effective orifice area
b) Description of regurgitation, if present
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
Our concepts of heart disease are based on the enormous reservoir of physiologic and anatomic knowledge derived from the past 70 years' of experience in the cardiac catheterization laboratory.
As Andre Cournand remarked in his Nobel lecture of December 11, 1956, the cardiac catheter was the key in the lock.
By turning this key, Cournand and his colleagues led us into a new era in the understanding of normal and disordered cardiac function in huma
Various coronary physiological measurements can be made in the cardiac catheterization laboratory using sensor-tipped guidewires; they include the measurement of poststenotic absolute coronary flow reserve, the relative coronary flow reserve, and the pressure-derived fractional flow reserve of the myocardium. Ambiguity regarding abnormal microcirculation has been reduced or eliminated with measurements of relative coronary flow reserve and fractional flow reserve. The role of microvascular flow impairment can be separately determined with coronary flow velocity reserve measurements. In addition to lesion assessment before and after intervention, emerging applications of coronary physiology include the determination of physiological responses to new pharmacological agents, such as glycoprotein IIb/IIIa blockers, in patients with acute myocardial infarction. Measurements of coronary physiology in the catheterization laboratory provide objective data that complement angiography for clinical decision-making
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
Cardiac Measurements Guidelines | powered by EsaoteMIDEAS
Complete routine cardiac measurements Guidelines.
1) Left Ventricle:
a) Size: Dimensions or volumes, at end-systole and end-diastole
b) Wall thickness and/or mass: Ventricular septum and left ventricular posterior wall thicknesses (at end-systole and end-diastole) and/or mass (at end-diastole)
c) Function: Assessment of systolic function and regional wall motion. Assessment
of diastolic function
2) Left Atrium:
• Size: Area or dimension
3) Aortic Root:
• Dimension
4) Right Ventricle:
Size: Dimensions
Function: Systolic and diastolic function
RV & pulmonary hemodynamics
5) Right Atrium:
a) Size: Dimensions, area
b) RA pressure
6) Valvular Stenosis:
a) Valvular Stenosis: Assessment of severity, including trans-valvular gradient and area.
b) Subvalvular Stenosis: Assessment of severity, Including subvalvular gradient.
7) Valvular Regurgitation: Assessment of severity with semi-quantitative descriptive statements and/or quantitative measurements
8) Cardiac Shunts: Assessment of severity. Measurements of QP:QS (pulmonary-to systemic flow ratio) and/or orifice area or diameter of the defect are often helpful.
9) Prosthetic Valves:
a) Transvalvular gradient and effective orifice area
b) Description of regurgitation, if present
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
Our concepts of heart disease are based on the enormous reservoir of physiologic and anatomic knowledge derived from the past 70 years' of experience in the cardiac catheterization laboratory.
As Andre Cournand remarked in his Nobel lecture of December 11, 1956, the cardiac catheter was the key in the lock.
By turning this key, Cournand and his colleagues led us into a new era in the understanding of normal and disordered cardiac function in huma
Various coronary physiological measurements can be made in the cardiac catheterization laboratory using sensor-tipped guidewires; they include the measurement of poststenotic absolute coronary flow reserve, the relative coronary flow reserve, and the pressure-derived fractional flow reserve of the myocardium. Ambiguity regarding abnormal microcirculation has been reduced or eliminated with measurements of relative coronary flow reserve and fractional flow reserve. The role of microvascular flow impairment can be separately determined with coronary flow velocity reserve measurements. In addition to lesion assessment before and after intervention, emerging applications of coronary physiology include the determination of physiological responses to new pharmacological agents, such as glycoprotein IIb/IIIa blockers, in patients with acute myocardial infarction. Measurements of coronary physiology in the catheterization laboratory provide objective data that complement angiography for clinical decision-making
Wellens syndrome. Wellens syndrome (also referred to as LAD coronary T-wave syndrome) refers to an ECG pattern specific for critical stenosis of the proximal left anterior descending artery. The anomalies described occur in patients with recent anginal chest pain, and do not have chest pain when the ECG is recorded.
Congenital defects can put a strain on the heart, causing it to work harder. To stop your heart from getting weaker with this extra work, your doctor may try to treat you with medications. They are aimed at easing the burden on the heart muscle. You need to control your blood pressure if you have any type of heart problem.
Changing your lifestyle can help control and manage high blood pressure. Your health care provider may recommend that you make lifestyle changes including:
Eating a heart-healthy diet with less salt
Getting regular physical activity
Maintaining a healthy weight or losing weight
Limiting alcohol
Not smoking
Getting 7 to 9 hours of sleep daily
CRISPR technologies have progressed by leaps and bounds over the past decade, not only having a transformative effect on
biomedical research but also yielding new therapies that are poised to enter the clinic. In this review, I give an overview of (i)
the various CRISPR DNA-editing technologies, including standard nuclease gene editing, base editing, prime editing, and epigenome editing, (ii) their impact on cardiovascular basic science research, including animal models, human pluripotent stem
cell models, and functional screens, and (iii) emerging therapeutic applications for patients with cardiovascular diseases, focusing on the examples of Hypercholesterolemia, transthyretin amyloidosis, and Duchenne muscular dystrophy.
A post-splenectomy patient suffers from frequent infections due to capsulated bacteria like Streptococcus
pneumoniae, Hemophilus influenzae, and Neisseria meningitidis despite vaccination because of a lack of
memory B lymphocytes. Pacemaker implantation after splenectomy is less common. Our patient underwent
splenectomy for splenic rupture after a road traffic accident. He developed a complete heart block after
seven years, during which a dual-chamber pacemaker was implanted. However, he was operated on seven
times to treat the complication related to that pacemaker over a period of one year because of various
reasons, which have been shared in this case report. The clinical translation of this interesting observation
is that, though the pacemaker implantation procedure is a well-established procedure, the procedural
outcome is influenced by patient factors like the absence of a spleen, procedural factors like septic measures,
and device factors like the reuse of an already-used pacemaker or leads.
Transcatheter closure of patent ductus arteriosus (PDA) is feasible in low-birth-weight infants. A female baby was born prematurely with a birth weight of 924 g. She had a PDA measuring 3.7 mm. She was dependent on positive pressure ventilation for congestive heart failure in addition to the heart failure medications. She could not be discharged from the hospital even after 79 days of birth, and even though her weight reached 1.9 kg in the neonatal intensive care unit. We attempted to plug the PDA using an Amplatzer Piccolo Occluder, but the device failed to anchor. Then, the PDA was plugged using a 4-6 Amplatzer Duct Occluder using a 6-Fr sheath which was challenging.
Accidental misplacement of the limb lead electrodes is a common cause of ECG abnormality and may simulate pathology such as ectopic atrial rhythm, chamber enlargement or myocardial ischaemia and infarction
A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D...Ramachandra Barik
Device closure of an eccentric atrial septal defect can be challenging and needs technical modifications to avoid unnecessary complications. Here, we present a case of a 45-year-old woman who underwent device closure of an eccentric defect with a large device. The patient developed pericardial effusion and left-sided pleural effusion due to injury to the junction of right atrium and superior vena cava because of the malalignment of the delivery sheath and left atrial disc before the device was pulled across the eccentric defect despite releasing the left atrial disc in the left atrium in place of the left pulmonary vein. These two serious complications were managed conservatively with close monitoring of the case during and after the procedure.
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...Ramachandra Barik
A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had a higher refractory period than the atrioventricular node.
Percutaneous balloon dilatation, first described by
Andreas Gruentzig in 1979, was initially performed
without the use of guidewires.1 The prototype
balloon catheter was developed as a double lumen
catheter (one lumen for pressure monitoring or
distal perfusion, the other lumen for balloon inflation/deflation) with a short fixed and atraumatic
guidewire at the tip. Indeed, initially the technique
involved advancing a rather rigid balloon catheter
freely without much torque control into a coronary
artery. Bends, tortuosities, angulations, bifurcations,
and eccentric lesions could hardly, if at all, be negotiated, resulting in a rather frustrating low procedural success rate whenever the initial limited
indications (proximal, short, concentric, noncalcified) were negated.2 Luck was almost as
important as expertise, not only for the operator,
but also for the patient. It is to the merit of
Simpson who, in 1982, introduced the novelty of
advancing the balloon catheter over a removable
guidewire, which had first been advanced in the
target vessel.3 This major technical improvement
resulted overnight in a notable increase in the procedural success rate. Guidewires have since evolved
into very sophisticated devices.
Optical coherence tomography-guided algorithm for percutaneous coronary intervention. Vessel diameter should be assessed using the external elastic lamina (EEL)-EEL diameter at the reference segments, and rounded down to select interventional devices (balloons, stents). If the EEL cannot be identified, luminal measures are used and rounded up to 0.5 mm larger for selection of the devices. Optical coherence tomography (OCT)-guided optimisation strategies post stent implantation per EEL-based diameter measurement and per lumen-based diameter measurement are shown. For instance, if the distal EEL-EEL diameter measures 3.2 mm×3.1 mm (i.e., the mean EEL-based diameter is 3.15 mm), this number is rounded down to the next available stent size and post-dilation balloon to be used at the distal segment. Thus, a 3.0 mm stent and non-compliant balloon diameter is selected. If the proximal EEL cannot be visualised, the mean lumen diameter should be used for device sizing. For instance, if the mean proximal lumen diameter measures 3.4 mm, this number is rounded up to the next available balloon diameter (within up to 0.5 mm larger) for post-dilation. MLA: minimal lumen area; MSA: minimal stent area;NC: non-compliant
Brugada syndrome (BrS) is an inherited cardiac disorder,
characterised by a typical ECG pattern and an increased
risk of arrhythmias and sudden cardiac death (SCD).
BrS is a challenging entity, in regard to diagnosis as
well as arrhythmia risk prediction and management.
Nowadays, asymptomatic patients represent the majority
of newly diagnosed patients with BrS, and its incidence
is expected to rise due to (genetic) family screening.
Progress in our understanding of the genetic and
molecular pathophysiology is limited by the absence
of a true gold standard, with consensus on its clinical
definition changing over time. Nevertheless, novel
insights continue to arise from detailed and in-depth
studies, including the complex genetic and molecular
basis. This includes the increasingly recognised
relevance of an underlying structural substrate. Risk
stratification in patients with BrS remains challenging,
particularly in those who are asymptomatic, but recent
studies have demonstrated the potential usefulness
of risk scores to identify patients at high risk of
arrhythmia and SCD. Development and validation of
a model that incorporates clinical and genetic factors,
comorbidities, age and gender, and environmental
aspects may facilitate improved prediction of disease
expressivity and arrhythmia/SCD risk, and potentially
guide patient management and therapy. This review
provides an update of the diagnosis, pathophysiology
and management of BrS, and discusses its future
perspectives.
The Human Developmental Cell Atlas (HDCA) initiative, which is part of the Human Cell Atlas, aims to create a comprehensive reference map of cells during development. This will be critical to understanding normal organogenesis, the effect of mutations, environmental factors and infectious agents on human development, congenital and childhood disorders, and the cellular basis of ageing, cancer and regenerative medicine. Here we outline the HDCA initiative and the challenges of mapping and modelling human development using state-of-the-art technologies to create a reference atlas across gestation. Similar to the Human Genome Project, the HDCA will integrate the output from a growing community of scientists who are mapping human development into a unified atlas. We describe the early milestones that have been achieved and the use of human stem-cell-derived cultures, organoids and animal models to inform the HDCA, especially for prenatal tissues that are hard to acquire. Finally, we provide a roadmap towards a complete atlas of human development.
The treatment of patients with advanced acute heart failure is still challenging.
Intra-aortic balloon pump (IABP) has widely been used in the management of
patients with cardiogenic shock. However, according to international guidelines, its
routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated
that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian
Association of Hospital Cardiologists, reviews the available data derived from clinical
studies. It also provides practical recommendations for the optimal use of IABP in
the treatment of cardiogenic shock and advanced acute heart failure.
Left ventricular false tendons (LVFTs) are fibromuscular
structures, connecting the left ventricular
free wall or papillary muscle and the ventricular
septum.
There is some discussion about safety issues during
intense exercise in athletes with LVFTs, as these
bands have been associated with ventricular arrhythmias
and abnormal cardiac remodelling. However,
presence of LVFTs appears to be much more common
than previously noted as imaging techniques
have improved and the association between LVFTs
and abnormal remodelling could very well be explained
by better visibility in a dilated left ventricular
lumen.
Although LVFTsmay result in electrocardiographic abnormalities
and could form a substrate for ventricular
arrhythmias, it should be considered as a normal
anatomic variant. Persons with LVFTs do not appear
to have increased risk for ventricular arrhythmias or
sudden cardiac death.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
2. First, ultrasound can be directed as a beam
and focused
It obeys the laws of reflection and refraction
It is poorly transmitted through a gaseous
medium and attenuation occurs rapidly,
especially at higher frequencies.
The amount of reflection, refraction, and
attenuation depends on the acoustic
properties of the various media through which
the ultrasound beam passes.
3. Within soft tissue, velocity of sound is
fairly constant at approximately 1,540
m/sec (or 1.54 m/msec, or 1.54 mm/µsec).
Wave length(in millimeters) = 1.54/f,
where f is the transducer frequency (in
megahertz).
4.
5. higher frequency ultrasound has less
penetration compared with lower
frequency ultrasound.
The loss of ultrasound as it propagates
through a medium is referred to as
attenuation.
Attenuation has three components:
absorption, scattering, and reflection.
Attenuation always increases with depth
and is also affected by the frequency and
6. Attenuation may be expressed as “half-
value layer”or “half-power distance”which
is a measure of the distance that
ultrasound travels before its amplitude is
decreased to one half its original value
As a rule of thumb, the attenuation of
ultrasound in tissue is between 0.5 and
1.0 dB/cm/MHz.
7.
8. The velocity and direction of the
ultrasound beam as it passes through a
medium are a function of the acoustic
impedance of that medium.
Acoustic impedance (Z, measured in
rayls) is simply the product of velocity (in
meters per second) and physical density
(in kilograms per cubic meter).
9. The phenomena of reflection and
refraction obey the laws of optics and
depend on the angle of incidence as well
as the acoustic mismatch.
Small differences in velocity also
determine refraction.
These properties explain the importance
of using an acoustic coupling gel during
transthoracic imaging.
This is primarily due to the very high
acoustic impedance of air.
10. Specular echoes are produced by reflectors
that are large relative to ultrasound
wavelength. Eg: endocardial and epicardial
surfaces, valves, and pericardium.
Targets that are small relative to the
wavelength of the transmitted ultrasound
produce scattering, and such objects are
sometimes referred to as Rayleigh scatterers.
Scattered echoes provide the substrate for
visualizing the texture of gray-scale images.
The term speckle is used to describe the
11.
12.
13.
14. Most commercial transducers employ
ceramics, such as ferroelectrics, barium
titanate, and lead zirconate titanate.
Dampening (or backing) material, which
shortens the ringing response of the
piezoelectric material after the brief
excitation pulse. An excessive ringing
response lengthens the ultrasonic pulse
and decreases range resolution.
At the surface of the transducer,
15. An important feature of ultrasound is the
ability to direct or focus the beam .
The proximal or cylindrical portion of the
beam is referred to as the near field or
Fresnel zone.
When it begins to diverge, it is called the
far field or Fraunhofer zone.
Maximizing the length of the near field is
an important goal of echocardiography.
16.
17. The ultrasound beam is both focused
and steered electronically, beam
manipulation can be achieved through
the use of phased array transducer.
By adjusting the timing of excitation and
adjustments in the timing allow the beam
to be steered through a sector arc,
resulting in a two-dimensional image.
electronic transmit focusing of the beam
18.
19. Focusing concentrates the acoustic
energy into a smaller area, resulting in
increased intensity .
By increasing beam intensity within the
near field, the strength of returning signals
is enhanced. An undesirable effect of
focusing is its effect on beam divergence
in the far field
20.
21. Intensity varies
across the lateral
dimensions of the
beam
It is customary to
measure the beam
width at its half
amplitude or intens.
At high gain settings,
the weaker portion of
the ultrasound beam
is recorded and
22.
23. Resolution has at least two components:
spatial and temporal.
Spatial resolution - smallest distance that
two targets can be separated .
Axial resolution
lateral resolution
24.
25. Commercial echographs have repetition
rates between 200 and 5,000 per second.
M-mode , pulse repetition rates of
between 1,000 and 2,000 per second are
used.
For two-dimensional imaging, repetition
rates of 3,000 to 5,000 per second are
necessary to create the 90-degree sector
scan.
Because all the pulses are devoted to a
26.
27.
28.
29. • Requires more than one position.
• Tilting pt to left improves ultrasound
windows.
• Rt lat decubitus-record aortic flow &
congen disease.
• Subcostal imaging
• Suprasternal notch
• Sitting position
30.
31.
32. • Mid portion & base of lv ,both leaflets of
MV ,AV ,AO root ,LA &RV.
• imaging plane is aligned parallel to long
axis of lv.
• Reduced endocardial definition & wall
motion analysis difficult.
• Medial angulation of the scan plane – RA
& RV seen.
33.
34.
35.
36.
37.
38. • one of the most important components of
quantitation of ventricular function.
• Qualitative and quantitative data derived from
echocardiography, e.g., LV dimensions and wall
thickness, can influence patient management and
serve as potent predictors of outcomes
• Chronic stable coronary artery disease, there is a
consistent relationship between heart size and
outcomes
• The same applies to patients without heart failure.
• Framingham Heart Study patients without a history
of heart failure or myocardial infarction, LV size (by
M-mode echocardiography) was an important
predictor of subsequent risk of heart failure.
39. • M-mode line perpendicular to long
axis of the heart and immediately
distal to the tips of the mitral leaflets
in thePLAX view
• diastolic measurements
septal wall thickness, the
LV internal diameter at end diastole
(LVIDd) and posterior wall thickness.
In systole, the LV systolic diameter(LVIDs)
40. • clockwise rotation of 90 degrees
• Pts lateral wall I placed to the observer”s
right
• LV is displayed as if viewed from apex
• Apical level
• Papillary muscle level -
• Mitral valve level- Precise recording of
mitral orifice in pts with MS.
41. -Basal level- aortic annulus, AV, coronory
ostia, LA, TV, RVOT, PV & prox pa.
-annulus
regarded as clock face- LMCA at 4 & RCA
at 11
-with slight superior angulation-bifurcation
of PA
42.
43.
44.
45.
46.
47. • Apical 4 chamber-After location of apical
window ,all 4 chambers are optimally
visualised when ful excursion of MV & TV
leaflets occurs & true apex is seen.
-false tendons of LV & moderator band
of RV are normal variants.
–crux of heart.
• Apical 5 chamber –tilt the transducer into
a shallower angle
48.
49.
50. • Apical 2 chamber- rotating the transducer
CCW approx 60 deg.
Similar orientation to RAO
angiographic view LA
APPENDAGE IS VIEWED.
• Apical long axis view –transducer rotated
CW 60 similar to PLAX.
LV walls &
ultrasound beam are parallel.
Quantifying aortic valvular & subvalvular
obstruction including HOCM.
51.
52.
53.
54. • beam is oriented perpendicular to long
axis of LV
• better endocardial definition
• septal defects are better delineated.
• Only view that visualises superior portion
of IAS
• proximity of RV free wallto the
transducer(pericardial tamponade)
• IVC & hepatic veins are viewed.
59. Tilting the plane far anteriorly
LVOT not seen
Trabeculated &outflow of RV, pulm valve, part of PA
60.
61.
62. • Depending on orientation of imaging
planeto arch
• PARALLEL- asc & des segments of aorta,
origin of innominate, lt cca, lt sca, rpa are
viewed.
• PERPENDICULAR- RPA & LA are viewed
63.
64.
65. • fractional shortening and EF
• Fractional shortening—the percentage change in
the LV minor axis in a symmetrically contracting
ventricle
• FS(%)= (LVIDd – LVIDs)/LVIDd × 100%
• FS = 25% – 45% (normal range)
• LV volumes by 2D:
1. Prolate ellipsoid method.
2. Hemi-ellipsoid (bullet) method.
3. Biplane method of discs (modified
Simpson’s)
82. • One of the most significant developments of
the last decades was the introduction of 3-
dimensional (3D) imaging and its evolution
from slow and labor-intense off-line
reconstruction to real-time volumetric imaging
• The major proven advantage of this
technique is the improvement in the accuracy
of the echocardiographic evaluation of
cardiac chamber volumes.
• Another benefit of 3D imaging is the realistic
and unique comprehensive views of cardiac
valves and congenital abnormalities
83. • The major breakthrough that allowed
quality real-time imaging was the
development of a microbeam former
• When the entire crystal of the transducer
head is sampled or covered with
elements, the transducer is a dense array
• The microbeam former is required for this
arrangement to provide a communication
of all of the approximately 3000 elements
to the ultrasound system
84.
85.
86. • Transducer design
• 2 D Matrix array of transducer elements
helps generate the third dimension
• The significant innovation that actually
allows steering is making the elements
electrically independent from each other
• This allows generating a scan line that
varies azimuthally and elevationally
87.
88.
89. • Modern 2D
transducers
therefore consist of
thousands of
electrically active
elements that steer
a scan line left and
right as well as up
and down
90. • Beam forming in three spatial dimensions
1. Beam forming constitutes the steering and focusing
of transmitted and received scan lines
2. Significant portion of the beam steering is done
within the transducer in highly specialized integrated
circuit
3. The main system steers at coarse angles, but the
transducer circuits steer in fine increments in a
process termed microbeam forming
4. Summing is the act of combining raw acoustic
information from each element to generate a scan
line and by summing these in a sequence (first in
the transducer and then subsequently in the system)
91. • There are two major black and white modes run
in an electronically steered 3D system
• Live mode where the system scans in realtime
three dimension
• Gating, this time only four to eight beats, allows
a technique to generate wider volumes while
maintaining frame rate
• 3 D modes
1.Live 3D mode–instantaneous
2.3D zoom–instantaneous
3.Full-volume–gated
4.3D color Doppler–gated
92. • Display of 3D information
1.A 3D data set consists of bricks of pixels
called volume elements or voxels
• A process known as cropping can be used
to cut into the volume and make some
voxels invisible
• 3D data sets of voxels are turned into 2D
images in a process known as volume
rendering
93. • All 3D echocardiography is subject to the
laws of physics.
• Artifacts such as ringing, reverberations,
shadowing, and attenuation occur in three
and two dimensions.
• . The constraints of a 3D image are
bounded by:
(1)Frame rate,
(2) 3D volume size,
(3) Image resolution.
94. • 1) Direct evaluation of cardiac chamber volumes without
the need for geometric modeling
• 2) Noninvasive realistic views of cardiac valves and
congenital abnormalities , helpful for showing a variety of
pathologies and assessing the effectiveness of surgical
or percutaneous transcatheter interventions
• 3) Direct3D assessment of regional LV wall motion
aimed at objective detection of ischemic heart disease at
rest and during stress testing ,as well as quantification of
systolic asynchrony to guide ventricular
resynchronization therapy
• 4) 3D color Doppler imaging with volumetric
quantification of regurgitant lesions shunts ,and cardiac
output
• 5) Volumetric imaging and quantification of myocardial
perfusion
95. • True myocardial motion occurs in three
dimensions, and traditional 2D scanning
planes do not capture the entire motion of
the heart
• Quantifying implies segmenting structures
of interest from the 3D voxel set
• 3D quantification of the left ventricle
typically employs a surface- rendered
mesh
• This allows accurate computation of
96.
97.
98.
99.
100. • Most studies have
been done on
mitral valve.
Understanding
about the mitral
valve annulus,
leaflet tethering,
tenting volumes
has improved with
the advent of 3 D
echocardiography
108. • B mode echoes from an interface
that changes position will be
seen as echoes moving towards
and away from the transducer.
• If a trace line is placed on this
interface and the resulting trace
is made to drift across the face of
109. • The resulting display shows
motion of a reflector over
distance and time – a distance
time graph
• The change in distance (dy) over
a period of time dt is represented
by the slope of the reflector line
of motion.
110. • If this motion pattern is obtained
on moving cardiac structures
then the resulting images
constitute M-mode
echocardiography.
• M-mode echocardiography is use
to evaluate the morphology of
structures, movement and
velocity of cardiac valves and
117. • The mitral valve has 2 leaflets –
anterior and posterior.
• Specific letters corresponding
to systole and diastole are
assigned to the m-mode
tracing of the mitral valve.
126. M-mode at the Mitral Valve
Amplitude Description
Normal
Value
EPSS Measure e point to septal
separation
< 5 mm
d-e Measures the maximum
excusion of the mitral valve
following diastolic opening.
17 to 30 mm
127. M-mode at the Mitral Valve
Slope Description Normal Value
d-e Measure rate of initial
opening of the mitral valve
in early diastole.
240 to 380
mm/s
e-f Measures the rate of early
closure of the mitral valve
following diastolic
opening.
50 to 180 mm/s
128. • Flail PMVL
• Fluttering of the AMVL
• Mitral Stenosis
• LA myxoma
142. • The aortic valve has 3 cusps –
right coronary, left coronary
and non-coronary cusps.
• The cusps imaged in the PLAX
view are the right coronary and
the non-coronary cusps.
143.
144. M-mode at the Aortic Valve
Coronary
cusp
Non-coronary cusp
Anterior aortic root
Posterior aortic root
Left Atrium
145. M-mode at the Aortic Valve
LA dimension
Cusp Separation
Aortic root
146. M-mode at the Aortic Valve
LA dimension
Cusp SeparationAortic root Measurements are made
from leading edge to
leading edge.