Basic Echocardiography

Andre H Simarmata
Pre Test
Ekokardiografi adalah teknik modern
yang memungkinkan dokter memeriksa
jantung tanpaharus memasukkan
selang atau kabel ke dalam tubuh atau
jaringan tubuh pasien. Teknik
inimemakai prinsip dasar gelombang
suara ultra, yaitu suara dengan
frekuensi yang sangattinggi, dari 1-10
MHz (megahertz).
 Fungsi ?
•Mengetahui fungsi jantung sistolik maupun
diastolik
•Mengetahui apakah ada penyakit jantung
bawaan
•Mengetahui apakah ada thrombus di jantung
•Mengetahui apakah ada area Hipokinetik
•Mengetahui Dimensi Ruang Jantung
•Mengetahui katup2 jantung
•Mengetahui Penyebab gangguan
Hemodinamik
 Topics
• History
• Basic Concepts
• What will we see?
• Adult Heart Disease
• Congenital Heart Disease
HISTORY
1950’s

1970 2009

1963
BASIC CONCEPTS
 Basic Concepts*
• Ultrasound  Freq of Sound ≥ 20 kHz
• Echo uses freq 1,5 MHz – 7.5 MHz

*. Kaddoura S. Echo made easy. [2nd ed. Edinburgh ; New York: Churchill Livingstone; 2009
 Hypo & hyperechoic structures
• US pass easily through fluids.
– Poor: bone & air.

• Hypoechoic structure: “black regions”

– Blood, pericardial effusion, pleural effusion.

• Hyperechoic structure: “gray regions”

– Myocardium, valves, vessel walls, masses,
thrombi, vegetations.
Echo Window
 Mode
• Two-dimensional (2D)
imaging
• M-mode imaging
• Doppler imaging (CW,
PW, Colour Flow)
 Mode
• Two-dimensional (2D)
imaging
• M-mode imaging
• Doppler imaging (CW,
PW, Colour Flow)
 Mode
• Two-dimensional (2D)imaging
• M-mode imaging
• Doppler imaging (CW, PW, Colour
Flow)
– Separate crystal exists for
receiving and emitting
ultrasound
– Records all velocities along the
path of the US beam.
 Mode
• Two-dimensional (2D)imaging
• M-mode imaging
• Doppler imaging (CW, PW, Colour
Flow)
– The same crystal receives and emits
the ultrasound
– PWD records flow velocity from a
specific location.
 Mode
• Two-dimensional (2D) imaging
• M-mode imaging

• Doppler imaging (CW,

PW, Colour Flow)

BART :
Blue – Away
Red – Toward
WHAT WILL WE SEE ???
Parasternal Long-Axis View (PLAX) – 2D
16-Segment model of LV Myocardium
PLAX – M-Mode (Ao Level)
PLAX – M-Mode ( MV Level)
 PLAX – M-Mode (LV Level)

• Wall Thickness
• Ejection Fraction
 PLAX – M-Mode (LV Level)
• Wall Thickness  Left Ventricular
Hypertrophy (LVH)
– Concentric Hypertrophy
• chronic pressure overload  ventricular chamber
radius not change  wall thickness greatly increases
ventricle becomes "stiff"  diastolic dysfunction
– Eccentric Hypertrophy
• volume and pressure overload  chamber radius &
wall thickness increased
 PLAX – M-Mode (LV Level)
• Ejection Fraction
– Basic Measurement

– Teichholz Correction

 Do not use if there is a regional wall movement

impared
PLAX – Doppler Mode (Colour Flow)
Parasternal Short-Axis View (PSAX) – Aortic Valve Level
2D
PSAX – Aortic Level – Colour Flow
PSAX– Mitral Valve Level – 2D
PSAX– Mitral Valve Level – M-Mode
PSAX– Papillary Muscle Level – 2D
PSAX– Papillary Muscle Level – M-Mode
Apical View 4 Chamber – 2D
Apical View Long Axis – 2D
 Apical View 4 Chamber – 2D
Ejection Fraction (Simpson’s Method)
Apical 4 Chamber View – Doppler Mode (PW)
to assess Dyastolic Function
Apical 4 Chamber View – Tissue Doppler Imaging (TDI)
to assess Dyastolic Function
 Left ventricular Diastolic function*

*. Sherif F; et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography. European Journal of
Echocardiography (2009) 10, 165–193
 Apical 4 Chamber View – RV Function
Tricuspid Annular Plane Systolic Excursion (TAPSE)
Subcostal View
Suprasternal View
ADULT HEART DISEASE
Coronary Artery Disease
Valvular Heart Disease - MS
Valvular Heart Disease
MS + Thrombus
Valvular Heart Disease - MR
Valvular Heart Disease - TR
Valvular Heart Disease - AR
Valvular Heart Disease - AS
Pericardial Disease – Pericarditis
Constrictiva
Cardiac Tumor – LA Myxoma
Anurisma Aorta Asc
Effusion - Pericardial
Effusion - Pleural
CONGENITAL HEART DISEASE
 Atrial Septal Defect

Small Moderate Large

Size (mm) <6 6 to < 12 ≥ 12
 Ventricle Septal Defect

Small Moderate Large

Compared to the < 1/3 1/3 – 2/3 > 2/3
size of Ao Root
Tetralogy of Fallot
3D Echo
Post Test
 References
• Members C, Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, et al. ACC/AHA/ASE
2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article.
Circulation. 2003 September 2, 2003;108(9):1146-62.
• Kaddoura S. Echo made easy. [2nd ed. Edinburgh ; New York: Churchill Livingstone; 2009.
• Feigenbaum H, Armstrong WF, Ryan T. Feigenbaum's echocardiography. 6th ed. Philadelphia:
Lippincott Williams & Wilkins; 2005.
• Meyer RA. History of Ultrasound in Cardiology. Journal of Ultrasound in Medicine. 2004 January 1,
2004;23(1):1-11.
• Moss AJ, Allen HD. Moss and Adams' heart disease in infants, children, and adolescents : including
the fetus and young adult. 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins; 2008.
• Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for
the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009
Mar;10(2):165-93.
• Møller JE, Hillis GS, Oh JK, Reeder GS, Gersh BJ, Pellikka PA. Wall motion score index and ejection
fraction for risk stratification after acute myocardial infarction. American Heart Journal.
2006;151(2):419-25.
• Klein P, Holman ER, Versteegh MIM, Boersma E, Verwey HF, Bax JJ, et al. Wall motion score index
predicts mortality and functional result after surgical ventricular restoration for advanced ischemic
heart failure. Eur J Cardiothorac Surg. 2009 May 1, 2009;35(5):847-53.