7th NTCM

May 11th 2012

Role of
Echocardiography in
Various Clinical Settings
Andre Ketaren, MD

Department of Cardiology and Vascular Medicine, Medical

Faculty
University of Sumatera Utara / H. Adam Malik General
Hospital
Medan 2012

Echocardiography
Examination of the heart by using
ultrasound to assess cardiac
anatomy and function
Ultrasound no radiation highly
safe for patients (including pregnant
women)

History of Ultrasound and

Echocardiography
1700s, Spallanzani: bats were navigated by means of echo reflections using
inaudible sound
1800s, Doppler: pitch of sound wave varied if the source of the sound was
moving
1880, Curie & Curie: piezoelectric crystal
1912, Richardson: echo technique to detect underwater objects
1941, Dussik: ultrasound in medical diagnosis
1950, Keidel: transmit US through the heart and record the effects on the
other side of the chest
1953, Hertz & Edler: pulse-reflected US to examine the heart
1950s: Doppler technique
1960s: M-mode recorder
1960s: 2D echo
1970s: Color Doppler
1970s: TEE
1990s: 3D echo

M-mode

2D
Color
Doppler

3D

Tissue
Doppler

Doppler

Dimension of heart chambers

Left Ventricle Contractility

Global LV contractility Ejection
Fraction
M-mode method
2D method
Simpsons method
3D method

Right Ventricle Contractility

Global RV
contractility
Tricuspid annular
plane systolic
excursion (TAPSE)
Fractional area
change (FAC)

Myocardial contractility
Regional wall motion abnormality

Diastolic function
Symptoms of heart failure with normal
ejection fraction Diastolic
dysfunction??

Examination of Cardiac Valves

Mitral regurgitation

Normal mitral valve

Mitral stenosis

Examination of Cardiac Valves

Severity of
valvular lesion
decision for
intervention

Examination of Cardiac Valves

Examination of Prosthetic
Valves

Type of prosthetic valve

(mechanical/bioprosthetic, cage ball/
monoleaflet/bileaflet, previous post
op echo data)
Movement of the prosthetic valves
Significant leakage
Obstruction (orifice area and
pressure gradient)
Thrombus formation

Examination of Prosthetic
Valves

Mechanical mitral prosthesis

Mechanical valve leakage

Examination of Prosthetic
Valves

Mechanical valve prosthesis with thrombus

Intracardiac masses

Myxoma

Thrombus

Pericarditis & Pericardial

Effusion

Congenital Heart Disease

Atrial septal defect

Ventricular septal defect

Transesophageal
Echocardiography

Semi-invasive method
Superb clarity and
resolution
Relatively easy to
perform &
uncomplicated
Capable of providing
unique insight into
cardiothoracic
structures

Transesophageal
Echocardiography

Indications:
Intracardiac thrombus (source of
emboli & AF)
Suspected endocarditis
Valvular disease (native and
prosthetic)
Congenital heart disease
Evaluation of aorta
Intracardiac mass
Intraoperative evaluation

Transesophageal
Echocardiography

Three Dimensional Echocardiography

Assessment of chamber volumes
Anatomy of cardiac valves
Valve area in patient with valvular
stenosis

Three Dimensional
Echocardiography

Three Dimensional Echocardiography

Lung Ultrasound

Gargani. Cardiovascular Ultrasound 2011, 9:6

Lung Ultrasound

Gargani. Cardiovascular Ultrasound 2011, 9:6

Lung Ultrasound
A: Normal M-mode of the lung
B & C: Stratosphere sign (pneumothorax)

Gargani. Cardiovascular Ultrasound 2011, 9:6

Limitations & Pitfalls

Poor echo window
Doppler measurements are angledependent
Artefacts due to ultrasound physics
Ultrasound = energy heating

Conclusion
Echocardiography is an important
diagnostic tool in cardiovascular
medicine aiding in diagnosing,
excluding differential diagnosis,
deciding further step in patient
management.
High safety (no radiation) safe for
pregnant women.
Basic clinical skills (anamnesis,
physical examination) are mandatory
prior to echocardiography

Thank
you