BASIC ECHOCARDIOGRAPHY : PW AND CW MODE Muhadi... · Understand normal and simple abnormal findings...
Transcript of BASIC ECHOCARDIOGRAPHY : PW AND CW MODE Muhadi... · Understand normal and simple abnormal findings...
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BASIC
ECHOCARDIOGRAPHY :
PW AND CW MODE
Muhadi
Cardiology Div, Dept of Internal Med , Faculty of Medicine, Univ of Indonesia,
Cipto Mangunkusumo National General Hospital
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ObjectivesTransthoracal Echocardiography (TTE)
Understand normal and simple abnormal
findings in PW and CW mode
echocardiography
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The Modalities of Echo
The following modalities of echo are used clinically:
1. Conventional echo
Two-Dimensional echo (2-D echo) :
anatomical assessment, valvular movement, RWMA
Motion- mode echo (M-mode echo) :
motion assessment over time, distance or depth measurement
2. Doppler Echo
All modalities follow the same principle of ultrasound
Differ in how reflected sound waves are collected and analysed
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Echo machine
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Doppler Echocardiography
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Doppler Echocardiography
Konsep echocardiografi doppler adalah menangkap
sinyal yang dipantulkan oleh sel darah merah, sehingga
dapat ditentukan adanya aliran darah, arah kecepatan,
dan karakteristik aliran.
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Doppler Echocardiography
Dikenal 2 modalitas doppler yaitu :
Doppler spectrum (spectral doppler), terdiri
dari :
1. PW ‘pulsed wave doppler’
(doppler gelombang pulsasi)
2. CW ‘continuous wave doppler’
(doppler gelombang kontinu)
CF ‘Color flow doppler’ ‘Color flow mapping’
(CFM)
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Doppler equation
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Estimation of blood flow velocity is dependent on
incident angle between ultrasound beam and
blood flow
Angle Cosine Percentage error
0 1 0
10 0.98 2
20 0.94 7
30 0.87 13
60 0.5 50
90 0 100
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Spectral analysis
Positive doppler shift-flow towards transducer
Traditionally displayed above
baseline
Negative doppler shift-flow away from
transducer
Displayed below zero baseline
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ECHO dynamic assessment
• 2D image : • anatomical assessment, valvular movement, RWMA
• M mode :
• motion assessment over time, distance or depth measurement
• CW and PW : • haemodynamic assessment, calculate velocity, then
pressure gradients
• CFM :
• both haemodynamic and anatomical information
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PW
Dengan PW transmisi sinyal gelombangsuara dikirim dalam bentuk pulsasi (‘pulse’).
Dapat dilakukan pemeriksaaan pada area tertentu dari suatu area aliran denganmenggunakan yang disebut ‘sample volume’, yang merupakan marka daridaerah yang diinginkan, pada alatekokardiografi ditandai dengan dua garissejajar.
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Sample Volume
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PW
Informasi yang dapat diperoleh berupa
:
Pengukuran fungsi diastolik
Pengukuran isi sekuncup dan curah
jantung
Pengukuran area mitral atau orifisium
aorta
Mengukur besarnya shunt
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Pengukuran fungsi diastolik LV
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Pulsed Wave (PW) for inflow pattern
(MV)
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LV-DIASTOLIC FUNCTION
Oh JK; Echo manual, 2007
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Continuity equation
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The Continuity Equation
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Pengukuran isi sekuncup dan curah
jantung melalui Aortic Valve flow danMitral Valve flow
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VELOCITY TIME INTEGRAL
(VTI)
Aliran darah bersifat pulsatif maka
perhitungan volumetric flow kompleks karena
kecepatan tidak konstan.
Karena itulah diambil pengukuran VTI
VTI = area under curve (cm/sec) X sec
Mengukur jarak yang ditempuh sel darah
pada setiap siklus jantung
VTI = “stroke distance”
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VELOCITY TIME INTEGRAL (VTI)
VTI diperoleh dengan cara mengikuti ujung
spektrum kecepatan
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CW
Transmisi gelombang suaraberlangsung secara kontinu, sehingga spektrum lebih luas darisemua area yang dilewatigelombang suara.
Gelombang kontinu dapatmenangkap aliran darah kecepatantinggi dengan baik tanpa terjadialiasing, yaitu suatu keadaangambar doppler terputus akibatterlampauinya batas maksimalkecepatan yang dapat diukurdengan doppler.
CW sangat bermanfaat utkmenangkap sinyal dari aliranfrekuensi tinggi seperti stenosis katup, dan pengukuransemikuantitatif dari regurgitasi.
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VTI CW Doppler in TR
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Apa pentingnya kecepatan aliran darah ?
Pressure Gradient
The modified Bernoulli equation is applied to
convert velocity to pressure
Pressure gradients are useful for assessment of
severity
of valvular stenosis and estimation of intracardiac
pressures .
Pressure gradients commonly determined by
Doppler include :
1) Maximum instantaneous pressure gradient
2) Mean pressure gradient
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Severity of AS by PG
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MS : MV Pressure Gradient
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Pressure Half Time (PHT)
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Pressure Half Time (PHT)
Severity AR PHT
MILD > 550 msec
MODERA
TE
300-550 msec
SEVERE < 300 msec
AR MS
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CF/CFM
Prinsip CFM adalah sama dengan PW tetapimenangkap sinyal pada beberapa titik sepanjanggaris penyitraan.
Dengan kesepakatan diberi warna merah utkaliran darah yang mendekati transducer danwarna biru yang menjauhi transducer “BART system” (Blue Away Red Towards Transducer)
Pada keadaan tertentu dimana aliran bersifatturbulen terjadi campuran warna merah dan biruatau mosaik
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CFM
Informasi yang diperoleh :
Menentukan arah dan waktu aliran
Menentukan sifat aliran laminar atau
turbulen
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Color Flow Mapping in
MR
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Colour Flow Doppler in MR
Severity of
MR
LVOT jet width
Mild < 25 % of LVOT
Moderate 25-65 % of LVOT
Severe > 65 % of LVOT
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Severity of AR LVOT jet width
Mild < 25 % of LVOT
Moderate 25-65 % of LVOT
Severe > 65 % of LVOT
Colour Flow Doppler in AR
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Colour Flow Doppler in TR
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KESIMPULAN
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TERIMA KASIH