Cardiovascular Imaging Module II

Vincent Brinkman, MD and

Sharon Roble, MD

Division of Cardiology

The Ohio State University

College of Medicine

Cardiovascular Imaging Module II

Describe the use of echocardiography with Doppler recordings in the diagnosis of congenital and valvular heart disease

Note: All of the Cardiac Medical Illustrations were adapted from Patrick J. Lynch and C. Carl Jaffe, (Yale University, 2006) and used under their Creative Commons license.

2D Imaging

Provides information on structure and anatomy.

2D Imaging – Cardiac Function

Normal Abnormal

3D Imaging

2D Imaging – Bicuspid Aortic Valve

Bicuspid aortic valve Normal

Bicuspid Aortic Valve - MRI

2D Imaging - Masses

Normal Atrial Myxoma

Left VentricleLeft Ventricle

Left AtriumLeft Atrium

2D Imaging – Masses with MRI

Tissue Characterization – Myocardial Fibrosis

Kim et al., NEJM 2000; 343: 1445-1453

Myocardial Fibrosis

Doppler ECHO

3 m/s

6 m/s

3 m/sV

elo

cit

y

Time

3 m/s

Pulse Wave

Continuous Wave

6 m/s

Doppler ECHO

Pulse region

Pulse WaveContinuous Wave

Velocity in the LVOT

Color Doppler

Aortic Valve

Mitral Valve

Left Atrium

Left Ventricle

Red = Towards Blue = Away

Mitral Regurgitation

Normal Mitral Regurgitation

Atrial Septal Defect

Right Atrium

Left Atrium

Secundum ASD

ASD – Saline Contrast Study

Right Atrium

Left Atrium

Tricuspid Regurgitation

Normal

Pulmonary Hypertension & Tricuspid Regurgitation

Right Ventricle

Right Atrium

Tricuspid Regurgitation

Pulmonary Hypertension

Pressure 1

Pressure 2

Bernoulli’s Principle

or

Pressure Difference ≈ 4v2

Bernoulli Equation

Peak Velocity = 4 m/sΔP = 4v2

ΔP = 64mmHg(Normal RVSP is < 32mmHg)

Ventricular Septal Defect

VSD

Left Ventricle

Right Ventricle

VSD

Ventricular Septal Defect – Bernoulli’s Principle

Peak Velocity = 4.3 m/sΔP = 4v2

ΔP = 74mmHg

Aortic Stenosis

Left Ventricle

Aortic Valve

Aorta

Aortic Stenosis – Bernoulli Equation

V = 4.4 m/sΔP = 4v2

ΔP = 77mmHg(Normal is < 10mmHg)

Aortic Stenosis – “Extra Credit”

How do we calculate the aortic valve area?

Continuity Equation

Area Out = (Velocity in) x

(Area in) / (Velocity out)

Continuity Equationor

Flow In = Flow Out

Simplified… AreaIN x VelocityIN = AreaOUT x VelocityOUT

(AreaIN x VelocityIN) / VelocityOUT = AreaOUT

Cardiac Imaging Summary

Cardiac imaging can be used to diagnose many conditions.

2D Echocardiography shows us anatomy, structure and function.

Cardiac MRI can also give us “tissue characterization.” Color Doppler imaging shows us flow and can diagnose

a variety of valvular and congenital abnormalities Doppler ECHO gives us velocities and helps us to

diagnose problems as well as calculate pressures and hemodynamics.

Cardiovascular Imaging Part 2 Quiz

The End…

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