Echocardiogrphy Instrumentasi and Color Doppler. 2023 Ir Cahyo

Instrumentation
&
haemodynamic,
Color Doppler
Ultrasound &
Echocardiography
DEMO Pulse Wave Doppler :
Instrumentation & hemodynamic in echocardiography
Color Doppler Ultrasound : Instrumentation & hemodynamic
10. Hemodynamic & Doppler

20. Keyboard: Gain, Velocity/ Scale
Time-scale, Reverse/ Invert
30. PW vs CW, Application & Calculation
40. Pulse Wave : 60. Echocardiography :
41. Sample Volume 61. Probes
42. Aliasing, Base Line, HPRF 62. VTI, Qp/ Qs, PISA, PHT
43. Angle : 30 up to 60 degree 63. Tekanan Intra Cardiac & PVR
64. TDI & MPI
50. Color Flow Mapping :
65. Audio
Color Bar type, Turbulence &
66. Parameters & Setting
Window (size & Position)
67. Cardiac B/M mode
Hemodynamic
Is the study of the physical principles of blood circulation
Kecepatan: max, rerata, change, distribusi

Densitas RBC
Percepatan
Tekanan & ∆P
Volume
Debit/ Vol. Flow
Jarak
Arah
→ Only blood ?
4
Doppler shift
11 10 9 8 7 6 5 4 3 2 1 0
11 10 9 8 7 6 5 4 3 2 1 0
Pada interval waktu yang sama kapal yang bergerak (kapal kedua) menerima jumlah gelombang yang lebih banyak.
Selisih jumlah gelombang/ detik kedua kapal ini disebut sebagai “doppler shift”
5
Doppler shift equation
fR
Moving interface “v”
∆f : f – fR : doppler shift
f : transmited ultrasound frequency
fR : receiving ultrasound frequency
v : velocity moving interface
C : velocity ultrasound
6
Doppler shift equation
Moving Interface
Semestinya pada sudut 900

tidak ada doppler shift, tetapi
pada prakteknya selalu saja
ada sebagian ultrasound
beam yang tidak tegak lurus
dengan arah gerak interface.
7
Doppler US in Echocardiography
Doppler imaging : color Doppler, power Doppler, TDI, pulsed
Doppler and continuous Doppler.
AUDIO
Color Flow Mapping
COLOR Power Doppler
Tissue doppler imaging

Doppler
Effect
Pulsed Wave Doppler
SPECTRUM
Continuous Wave Doppler
8

64. TDI & MPI
65. Audio
Keyboard : Gain & Velocity/ Scale
10
Gain :
G69 G48
11
Time Scale
Example : without time scale adjustment
Reverse/ Invert
14
Steering
This function is used to steer the ultrasound beam either left or right
of the perpendicular of the face of Linear probe. This allows a
decrease in the angle of insonation with respect to blood flow an
improves Doppler performance. This function is only available on flat
Linear probe.
before steering
Brachiocephalic artery → Brachial artery → Radial
& Ulnar artery 16

64. TDI & MPI
65. Audio
Continuous Wave Doppler Method
• The Method of the Image acquisition
- Two separate crystals :
One : continuously emitting ultrasound at a certain frequency
The other : continuously receiving the reflected ultrasound.
• All the red blood cells’ velocity Recording

- Not applying the sample volume theory
- Measuring velocity not at a certain depth, all the red blood cells’ velocity
in the ultrasound path is recorded.
Pulse Wave Doppler
• The Method of the Image acquisition
- A Single Crystal
- Similar to image acquisition in B-mode : Ultrasound is emitted from a single
crystal with a certain frequency and received from the reflected red blood
cells at any depth (sample volume)
• Sample volume : Detecting the moving red blood cells at any depth in applied.
• PRF : Pulse Repetition Frequency
Doppler Spectral Doppler : PW & CW
Calculation of Spectral Doppler Spectral
Pulse Wave : Continuous Wave :

➢ Max velocity : 2 m/s ➢ No limit of maximal velocity
➢ Advantages :
➢ Disadvantages :
anatomic location can be
range ambiguity
known
➢ Advantages : no aliasing
➢ Disadvantages : aliasing
➢ Clinical Application : ➢ Clinical Application :
• LVOT velocity (<1,6 m/s) & VTI • Peak-flow velocity & VTI
• Volume measurements • Valvular Pressure Gradient
• Diastolic function/ filing • Pressure Half Time
• Mitral in-flow velocity • Dynamic LVOT Gradient
• Pulmonary & Hepatic vein velocity
• Pulmonary Pressure
• Location of flow disturbance
• Mitral annulus velocity (TDI)
Spectral Doppler : PW & CW
Clinical Applications of Spectral Doppler
• Flow Dynamic Evaluation : Direction, Velocity, Pressure
- Flow velocity integral (VTI : Velocity Time Integral)
- Pressure Gradient : intra kardiak
- Pressure Half Time
- Acceleration
• Valvular Disease Evaluation
- Regurgitation : MR/TR/AR
- Stenosis : MS/TS/AS
- Valve area & V1/V2 ratio
• Shunt : VSD, ASD, PDA (Patent ductus arteriosa), Forament Ovale
prevalence : accounting for 5%–10% of all congenital heart disease
• Evaluation of the Ventricle Systolic & Diastolic function

• Intra Cardiac Pressure during Systolic & Diastolic
Comparison Table CW/ PW
CW Point of Comparison PW
Non-available Depth information Available
HIGH Accuracy LOW
Range of
Infinity Limited
velocity detection
Complexity
Simple Complex
in operation
22

64. TDI & MPI
65. Audio
Sample Volume
SPECTRAL
BROADENING
24
Stenosis Doppler Spectrum
Variance

64. TDI & MPI
65. Audio
Aliasing :
Aliasing in color Doppler
Color flow imaging denotes change in color. If blood flow with high
velocity (indicated red) moves away from the region of data
acquisition, the color will appear blue as the opposite direction.
Aliasing at color Doppler US may manifest as a mixture of colors.
28
Velocity control
Compare both 2 images. The right image with velocity 41m/s has only
red color mapping on the descending aorta and clear shape. On the
contrary, the left image with 9m/s has not only red color but also bright
blue color in same scanning condition like same size of color box, color
gain (50). It’s a form of aliasing. Therefore to get good color Doppler
image of fast blood vessels you have to increase “velocity” (PRF).
9cm/s
41cm/s
29
Base Line Spectrum Pulse Wave
30
Aliasing and Direction :
31
Beat frequency pada PW
To obtain beat frequency, it is
necessary that the received signals
from multiple pulses be mixed with
the reference signal.
The sample-and-hold circuit

assembles the values obtained from
multiple transmitted pulses to form
the beat frequency.
The beat pattern can be more clearly

delineated if more pulses are used,
which would require an increase in
the PRF.
The max. doppler shift fD that can be detected

is related to the PRF (Nyquist limit) :
32
Aliasing
Exp. : 13 sampling over 10 cycles
→ The actual beat frequency is misinterpreted.
This is called aliasing and it is also is not present in CW doppler.
Sampling rate requirement at least must be twice the max

frequency (Nyquist limit)
33
Without HPRF
HPRF :
(High Pulse Repetition Frequency)
Frequency)
With HPRF
34
Reverse flow and Aliasing
Reverse Flow Aliasing


64. TDI & MPI
65. Audio
Doppler angle & angle marker
50%
15% 2 v f `cos Ф.
∆f = -----------------
C
Ultrasound Gell
5%
4%
2%
0.4%
5 degree error
Cos 700 = 0,34202 Cos 400 = 0,76604

Cos 750 = 0,25882 Cos 450 = 0,70711
5-degree error cause 25% deviation 5-degree error cause 8% deviation
→ Keep working between 300 and 600

Angle :
Velocity
Velocity not speed !!

Tortuous RRA Insonation (angle):
39
Doppler Auto trace
Automatic Doppler Calculation : PI,RI,SD,PSV,EDV,Vmean
40

64. TDI & MPI
65. Audio
Color Bar
Nyquist Limit (doppler shift maximum)
Base Line/ Zero Velocity
Color Box
Color Bar/
Color Map
Negative Velocity -17 cm/ sec
Choosing Color Bar
There are 4 components of color :
1. Color ( Blue, Red, Yellow, Green)

→ indicating direction of flow
2. Saturation (Color + White)

Or by Changing the color from red to yellow
→ Indicating speed
3. Brightness
→ Indicating Blood cell density/ Gain level
4. Variance (Color adding, exp. Green and Yellow)

→ Indicating turbulence (velocity range)
Depth - Velocity
Color Box - Velocity
44

64. TDI & MPI
65. Audio
Probes :
 3D/ 4D Probes →
46
Jenis – jenis probe/ tranducer :
Linear scanning, dari
Linear array probe/ Sector scanning, dari
Electronic linear array Sector probe
Trapezoid scanning, dari Sector scanning, dari

Linear array probe Micro-convex probe
Convex scanning, dari IVUS

Convex probe Intra Vascular probe
Echo Probes (2-4 MHz for adult) :
Mechanical probe Micro Convex probe Phase Array probe
Pencil probe TEE 3,5 - 7,5 MHz IVUS : 25 – 80 MHz

B-mode Techniques & Evaluation
Cardiac window
4
1
2
3
Transesofageal ekokardiografi (TEE) :
Diindikasikan untuk keadaan2 sbb :
Menentukan sumber dari emboli pd jantung
Mendiagnosis/ menyingkirkan dugaan endokarditis
Memeriksa dugaan disfungsi katup prostetik
Menilai diseksi aorta
Menilai derajat keparahan regurgitasi katup
Mengkompensasi jendela akustik yang buruk
Mendeteksi lesi jantung kongenital
Bidang citraan transversal Bidang citraan longitudinal


64. TDI & MPI
65. Audio
VTI ( Velocity Time Integral) & SV
Continuity equestion :
LVOT current = AV current
CSA LVOT (cm2) = p (D/2)2
SV = CSA x DistanceVTI
→ As long as no REGURGITATION !!
AV : Aortic Valve
CSA : Cross Sectional Area
LVOT : Left Ventrical Outflow tract
Regurgitasi Aorta : RF : Regurgitant Fraction
→
VTI (Velocity Time Integral) & SV
Continuity equestion :
AV : Aortic Valve
LVOT current = AV current
CSA : Cross Sectional Area
CSA LVOT (cm2) = p (D/2)2 LVOT : Left Ventrical Outflow tract
SV = CSA LVOT x DistanceVTI

Qp/Qs :
A shunt can be quantified by measuring the flow ratio of the
pulmonary cardiac output (Qp) to the systemic cardiac output (Qs).
•Qp = RVOT VTI * π * (RVOT / 2)2

•Qs = LVOT VTI * π * (LVOT / 2)2
In normal conditions after birth, Qp/QS= 1
Qp/Qs > 1, indicating a left-to-right shunt.
Qp/Qs < 1, indicating a right-to-left shunt.
Congenital heart defects affect between 4 and 75 per 1,000 live births depending on how they are diagnosed.
Congenital heart defects (CHD), Cardiac shunting are :
- Atrial septal defects (ASD)

- Patent foramen ovale (PFO)
- Patent ductus arteriosus (PDA).
- Ventricular septal defects (VSD)
PISA, the proximal isovelocity surface area
Mitral Regurgitation measurement
PISA limitation :
The regurgitant orifice is rarely round. Thus

the PISA is not a perfect hemisphere.
Jets which are eccentric in origin

demonstrate a PISA that is not
hemispherical.
Motion of the annulus during systole

influences the calculation.
Measurement of the PISA radius is difficult.
Alignment with the direction of flow is

sometimes impossible.
Multiple jets are usually present.
Regurgitation is usually dynamic. Thus, the

mid-systolic frame might not be
representative of MR.
The method cannot be used in calcified and

prosthetic valves
Presure Half Time :
 Pressure half-time(PHT) is the time interval for the peak
pressure gradient to reach its half level.
 It is measured by precisely aligning the sample volume with the
blood flow that pass through the mitral valve and tracing the
spectrum.
Severity of mitral stenosis corresponding PHT value :
PHT 100 msec : light stenosis
PHT 200 msec : mid stenosis
PHT 300 msec : severe stenosis
Pressure by Bernoulli equation :

P = 4 V2 V : Velocity
Empiric : MVA = 220/ PHT
(220 msec equivalent to 1 cm2 valve area)

PHT is able to evaluate Aorta regurgitation
PHT = 0,29 DT
VM
PHT = ½ PM
VHT
4 V2HT = ½ 4 V2M
VHT = 0,7071 VM
PHT
DT

64. TDI & MPI
65. Audio
Tekanan Intra-kardiak
Tekanan Sistol Ventrikel Kanan :
Pd Regurgitasi Trikuspid : SPRV = Gradien Tekanan TV + PRA
Pd VSD : SPLV = SPRV + PGjet
Tekanan Diastol Ventrikel Kanan :

Pd Regurgitasi pulmonal : EDPPA = EDPRV + (VPA-EDP)2 x 4
Estimasi Resisitensi Vaskular Paru :

Pd Tricuspid Regurgitasi :
http://www.researchgate.net/post/What_are_the_methods_of_estimating_pulmonary_vascular_resistance_PVR_in_echocardiography_How_do_they_correlate_with_cath_estimated_PVR
Tekanan Atrium Kiri :

Pd Regurgitasi mitral : Tekanan Atrium Kiri = SBP - { 4 x (VMR)2}
Tekanan akhir-diastol Ventrikel kiri :

Pd Regurgitasi aorta : LVEDP = DBP – PGAR
LVEDP = DBP – 4 (Vmax)2
Pressure Gradient = 4 V2
Pulmonary artery
diastolic pressure :
Bernoulli equation :
P = 4 V2
The tracing reveals a diastolic jet with a peak velocity of about 2.9 m/sec an end diastolic
velocity of about 1.5 m/sec. At end-diastole, pulmonary artery pressure is approximately
equal to left atrial (or pulmonary capillary wedge) pressure. Also at diastole, right atrial and
ventricular pressures are approximately equal. Using the Bernoulli principle, the gradient
across the pulmonic valve (∆P) is given by ∆P = 4 *(1.5)2, which equals approximately
9 mm Hg. Since, at end diastole, pulmonary artery pressure equals right ventricular pressure
equals right atrial pressure (if there is no tricuspid stenosis, as specified in the question),
adding this gradient to right atrial pressure yields a useful estimate of pulmonary artery
diastolic pressure, which is approximately equal to left atrial pressure, by echocardiography.
→ Estimasi Resisitensi Vaskular Paru :
Pd Tricuspid regurgitasi :
Parastenal short axis

The normal pulmonary vascular resistance is 0.3-1.6 Wood Units.
Pulmonary Vascular Resistance (PVR)
PVR is sum of all opposing forces to blood flow through the pulmonary circulation
PVR then calculated as is SVR (ΔP/flow)
SVR : Systematic Vascular Resistence
PVR = (MPAP – LAP)/CO
Where: MPAP = mean pulmonary artery pressure

LAP = left atrial pressure or wedge pressure
CO = cardiac output
PVR is normally much lower than SVR as the pulmonary system is low pressure,
low resistance
Normal PVR = 1.6 mm Hg / L / min OR mm Hg.min/ L OR HRU OR Wood units
1.6 < PVR < 2.4 wood units → PH with low PVR
HRU : Hybrid Resistance units
https://media.lanecc.edu/users/driscolln/RT127/Softchalk/Heart_Perfusion/Heart_Perfusion7.html
https://en.wikipedia.org/wiki/Vascular_resistance http://cardiaccathpro.com/calculations_resistance.html
Pulmonary vein velocity :
+ Dari 4 vena pulmonal, vena pulmonal kanan atas paling jelas dengan
transthorakik echokardiografi
+ 5 mm SV, ditempatkan pada vena pulmnonal, 1 – 2 cm dari lubang
+ Doppler vena pulmonal digunakan untuk mengevaluasi bermacam

parameter: - Fungsi Diastol
- Tekanan pengisian ventrikel kiri
- Relaksasi
- Kekakuan miokard
Qualitative assessment Pulmonal Hypertention :
ASD patient with PH, CFM of artery pulmonal : red on mid-seistole → PVR increasing
PW spectrum artery pulmonal showing reverse flow, as qualitative PVR increasing

Tekanan Atrium Kiri :

Pd Regurgitasi mitral : Tekanan Atrium Kiri = SBP - { 4 x (VMR)2}
Peningkatan tekanan artrium kiri menggambarkan teknanan akhir diastole LVEDP.

Tekanan artrium kiri pertanda profil pengisian diastole LV, maka pengukuran tekanan atrium kiri menjadi
esensial untuk mengetahui secara dini kegagalan diastole.
Mitral regurgitasi 38-40% org sehat meski TRIVIAL (tdk penting)
Tekanan akhir-diastol Ventrikel kiri :

Pd Regurgitasi aorta : LVEDP = DBP – PGAR
LVEDP = DBP – 4 (Vmax)2
PGAR = Pressure Gradient Aorta Regurgitasi

LVEDP ↑ : akan menunjukan adanya gagal jantung kiri karena semisal gangguan otot jantung shg ketidak mampuan
memompa menunjukan stroke volume dan cardiac output menurun krn LEVDP yg meninggi.
http://angger-pratama-fkp12.web.unair.ac.id/artikel_detail-70142-Asuhan%20Keperawatan-
Asuhan%20Keperawatan%20Gagal%20Jantung.html
Intra Cardiac Pressure :
Pressure measurement Diastole Systole
Right Atrial 0-5 mmHg Jugular Vein Jugular Vein
Left Atrial 10 mmHg ? Mitral Regurgitation
Left Ventricle 80/120 mmHg Aorta Regurgitation SBP
Right Ventricle 5/25 mmHg Jugular Vein Tricuspid Regurgitation/ VSD
Systemic Arterial 80/120 SBP SBP

mmHg
Pulmonal Arterial 10/25 Pulmonal Regurgitation ?
mmHg
Left Atrial ↑: Dispnea/ keluhan nafas pendek → Kegagalan diastole

Kemungkinan katup Mitral stenosis
Pulmonal Arterial ↑ : Gejala peninggian tekanan di sirkulasi paru

Pulmonal valve desease indicator : kelainan vascular paru (kongesti/ penyumbatan)
PAPi (Pulmonal Artery Pulsatility index) = Pulse pressure Pulmonal/ right atrium pressure
Haemodinamic index yg berkorelasi dgn PH.
Sgt berkaitan dgn gagal Ventrikel kanan & fatality rate pasien.

64. TDI & MPI
65. Audio
TISSUE DOPPLER IMAGE
Makes it possible to measure velocities at any point of the ventricular wall

during the cardiac cycle
Doppler conventional was using high pass filter, wall motion would be eliminated.
TDI is allowing low velocity to be processed into auto-correlator without high pass filter.
72
TDI
PW Doppler TDI to analyze and quantify the speed of myocardial motion.
TDI can be used to assess the function of the left ventricular systole and diastole.
The placement of the sample volume at a certain point that represents the
dynamics of the geometric movement systole and diastole of the left ventricle,
such as the Mitral Annulus (septal).
Right Ventricle : Lateral Tricuspid Annulus
Diastole phase:
Fast charging period: E '
Charging atrium contraction: A '
Normal S’ = 9,7 ± 1,9 cm/ det
Index diastol Ʈ (miliseconds) :

Konstanta waktu relaksasi ventrikel kiri yg amat sensitif
untuk mengukur kinerja miokard saat relaksasi
Nilai Ʈ yg memanjang ditemukan pd gangguan relaksasi LV
yang berat.
Semakin kecil rasio E’/A’ semakin tinggi Ʈ
TDI M-mode vs Color M-mode
MPI : Myocardial performance index/ Tei Index
Mempresentasikan kinerja miokard baik pd saat sistol maupun diastol
IVCT : Isovolumic contraction time

IVRT : Isovolumic relaxation time
ET : Ejection time
LV ET normal 265-325 msec, RV : 280-380 msec
LV MPI normal 0.39 ± 0.05, RV MPI : 0.28 ± 0.04
MPI :
- Indeks pengukuran fungsi ventrikel nongeometrik.
- Berhubungan dgn P/ t.
- Salah satu akibat dr hipertensi pulmonal adalah
peningkatan MPI RV.
- MPI LV> 1,14 resiko 5 kali lipat terjadi transplantasi
/mortalitas dlm 2 thn rerata kedepan.
- Korelasi kuat dgn keluaran pasien gagal jantung
sistol.
- IVCT memanjang & ET memendek → disfungsi
myocard.
- IVRT memanjang → disfungsi diastol.

64. TDI & MPI
65. Audio
Keyboard of SA-6000C
77
1. The Doppler shifts from blood happen to be in the
human audible range.
2. Pitch increasing when velocity increase, wherever

the direction of blood flow, approach or away from
the transducer.
3. Spectrum above the baseline is fed to the right

speaker, below the baseline to the left speaker (if
INVERT is not enabled).
4. The human ear is no less sensitive than the

doppler spectrum, don’t ever turned off audio
- can tell the presence of blood flow even invisible
spectrum (such as the gain setting is too weak)
- help placement of cursor location & probe position
- The audio signal is crucial for "fine tuning" to give
the best spectral profile
- like when driving do not close our ears
5. If blood moving away from the transducer lowers

the frequency, why does it still sound higher pitch
on the ultrasound machine? → point 2.
78
1. Suara dengan nada tinggi mengindikasikan
stenosis
Suara dengan nada rendah mengindikasikan
regurgitasi
2. Lokasi sample volume :

Menyentuh ujung katup → berisik
Lokasi yang benar → harmonis, halus & jernih
tanpa bising
3. Suara melengking dapat ditimbulkan oleh gerakan

lambat dinding jantung → aktive-kan “Wall filter”
Suara “klik” artefak berkaitan dengan gerakan
katup.
4. Aliasing : sound coming from the incorrect speaker
5. Dengan audio dapat dibedakan :

+ Regurgitasi
+ Turbulensi
+ Aliran pulsasi rendah
+ Kebisingan dinding (wall noise)
+ Noise
79

64. TDI & MPI
65. Audio
Frame Average/ Persistence :
FA : Max FA : Min
Setting → prerprocessing : FA/ Persistence, DR, Edge Enhance, Harmonic,

Write zoom, Gain, TGC, Wall Filter, Sensitivity,
Chroma, Power output, Probe frequency
→ postprocessing : Window, Read zoom, Rejection, Post Gain

81
Harmonic Imaging
Contrast harmonic : Aliran koroner dalam lumen LAD, RCA & Cx artery
Doppler berwarna & PW, harmonik transtorasik dengan injeksi kontras i.v.
Penentuan CRF (case fatality rate) pada LAD lebih akurat & non invasive
Microbubbles 1-5 micron contrast agent was Echovist (Schering AG, Berlin)
DYPIRIDAMOLE (penghambat pembekuan) as VASODILATOR
LAD : Left anterior descendence

64. TDI & MPI
65. Audio
Cardiac B-mode
Clinical Applications of B-mode

• Cardiac Anatomy Direct Evaluation
• Assessment of Heart Shape & Size & Symmetry
• Cardiac Movement
• Cardiac volumes : LV/LA/RV/RA
• Effusion
• Mass :
Endocardium, Myocardium, Epicardium, Pericardium
B-mode Techniques & Evaluation
Cardiac window
4
1
2
3
Volume Flow study :
VS : Ventricular Septum
PW : Posterolateral Wall
Parasternal long axis view CS : Coronary Sinus
ARHWD, ARHWS : Anterior Right Heart Wall at Diastole and Systole

PRHWD, PRHWS : Posterior Right Heart Wall at Diastole and Systole
AIVSD, AIVSS : Anterior Interventricular Septum at Diastole and Systole
PIVSD, PIVSS : Posterior Interventricular Septum at Diastole and Systole
ENDOD, ENDOS : Endocardial Surface of Posterior Left Ventricular at
Diastole and Systole
EPID, EPIS : Epicardium at Diastole and Systole
Variable and Volume Flow Equations
LVEDV : Left Ventricle End Diastolic Volume
LVESV : Left Ventricle End Systole Volume
SV : Stroke Volume
SV = LVEDV - LVESV
SI : Stroke Index
SI = SV / Body Surface Area
CO : Cardiac Output
CO = SV x HR/1000
CI : Cardiac Index
CI = CO / Body Surface Area
SF : Shortening Fraction
SF = (LVDD-LVDS) / LVDD x 100
LVDD : Left Ventricle Diameter Diastole
EF : Ejection Fraction
EF = (LVEDV-LVESV) / LVEDV x 100
BSA = H0.725 x W0.425 x 0.007184 H: cm W: Kg BSA: m2

2D echo :
Auto boarder detection : Planimetri : short axis view
Exp. to calculate ventrikel volume Mitral valve area → Mitral stenosis

Cahyo Mulyanto – PT DINA MEDINDO
E-mail : dinamed@dnet.net.id
Toll Free : 08001821053
HP : 0816838911
Fax.: 021-8561168
Post : Cipinang Muara Raya 11
Jakarta 13420
90

Echocardiogrphy Instrumentasi and Color Doppler. 2023 Ir Cahyo

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Instrumentation

10. Hemodynamic & Doppler

Kecepatan: max, rerata, change, distribusi

Moving interface “v”

Semestinya pada sudut 900

COLOR Power Doppler

Tissue doppler imaging

10. Hemodynamic & Doppler

10. Hemodynamic & Doppler

• All the red blood cells’ velocity Recording

Pulse Wave : Continuous Wave :

• Evaluation of the Ventricle Systolic & Diastolic function

Non-available Depth information Available

HIGH Accuracy LOW

10. Hemodynamic & Doppler

10. Hemodynamic & Doppler

The sample-and-hold circuit

The beat pattern can be more clearly

The max. doppler shift fD that can be detected

This is called aliasing and it is also is not present in CW doppler.

Sampling rate requirement at least must be twice the max

Reverse Flow Aliasing

10. Hemodynamic & Doppler

Cos 700 = 0,34202 Cos 400 = 0,76604

→ Keep working between 300 and 600

Velocity not speed !!

10. Hemodynamic & Doppler

Base Line/ Zero Velocity

There are 4 components of color :

1. Color ( Blue, Red, Yellow, Green)

2. Saturation (Color + White)

4. Variance (Color adding, exp. Green and Yellow)

Color Box - Velocity

10. Hemodynamic & Doppler

Trapezoid scanning, dari Sector scanning, dari

Convex scanning, dari IVUS

Pencil probe TEE 3,5 - 7,5 MHz IVUS : 25 – 80 MHz

Bidang citraan transversal Bidang citraan longitudinal

10. Hemodynamic & Doppler

CSA LVOT (cm2) = p (D/2)2

Regurgitasi Aorta : RF : Regurgitant Fraction

SV = CSA LVOT x DistanceVTI

•Qp = RVOT VTI * π * (RVOT / 2)2

Congenital heart defects (CHD), Cardiac shunting are :

- Atrial septal defects (ASD)

Mitral Regurgitation measurement

The regurgitant orifice is rarely round. Thus

Jets which are eccentric in origin

Motion of the annulus during systole

Measurement of the PISA radius is difficult.

Alignment with the direction of flow is

Multiple jets are usually present.

Regurgitation is usually dynamic. Thus, the

The method cannot be used in calcified and

Pressure by Bernoulli equation :

Empiric : MVA = 220/ PHT

(220 msec equivalent to 1 cm2 valve area)

10. Hemodynamic & Doppler

Tekanan Diastol Ventrikel Kanan :

Estimasi Resisitensi Vaskular Paru :

Tekanan Atrium Kiri :

Tekanan akhir-diastol Ventrikel kiri :