is m-mode obsolete in the 4-d era? - · m-mode echocardiography high sampling rate (>1000/sec)...
TRANSCRIPT
THORAXCENTRE
Is M-mode obsolete in the 4-D era?
J. Roelandt
Thoraxcentre, ErasmusMC, Rotterdam,NL
M-mode echocardiography
High sampling rate (>1000/sec)Motion pattern analysis
A t i t t tAccurate important measurements
Timing of eventsTiming of events
Rapidly occurring eventsap d y occu g e e ts
Intermittent/transient events
This patient has dyspnoea and a prosthetic mitral valve.Is there obstruction of the valve?Is there obstruction of the valve?
A. YesA. YesB. NoC. No way to tellD. All of the above
This patient has dyspnoea and a prosthetic mitral valve.Is there obstruction of the valve?
Answer:
Is there obstruction of the valve?
Answer:B. No
Note the rapid posterior Movement of the LA wall with rapid LV filling(LA emptying)
Marked LA dilation in pt with MSMarked LA dilation in pt with MS
IVR Normal IVR:
80±12 msec
IVR: 60 msec
80±12 msec
Note absence of early diastolic rapid ventricular fillingNote absence of early diastolic rapid ventricular filling and short IVR.
Normal mechanical valve Stenotic mechanical valve
Normally acceleration and decelaration are sharp and rapid. Note blunting of valve excursion on the right.
MV prosthetic dysfunction
What is the diagnosis?
A. AV dissociationB. Atrial dissociationC AV blockC. AV blockD. All of the above
What is the diagnosis?
A. AV dissociationB. Atrial dissociationC AV blockC. AV blockD. All of the above
What is the diagnosis?
ANSWER D All f th bANSWER: D - All of the above
While the ECG shows AV dissociation and AV block, the MV echo suggests timed LA contractionthe MV echo suggests timed LA contraction.
The atria are therefore dissociated.
44-year-old woman referred for evaluation of shortness of breathshortness of breath
What is the cause of the wall motion abnormality?a - Ischemic cardiomyopathyb Conduction abnormalityb - Conduction abnormalityc - Myocarditisd - other?
What is the diagnosis?
ANSWER: C MyocarditisANSWER: C - Myocarditis
What is the diagnosis?
A. RV volume overloadB. Left bundle branch blockC Constricti e pericarditis
JR/1160
C. Constrictive pericarditisD. All of the above
Dip – 40 ms after onset QRS
JR/1160
ANSWER: B – Left bundle branch block
What is the diagnosis?
What is the diagnosis?
INSP EXPINSP EXP
ANSWER: Constrictive pericarditis
Constrictive pericarditis: hemodynamics
240 msec290 msec
PR - AC Interval
NL > 60 msNL > 60 ms
EPSS Distance
NL < 17 mm
JR/1155
JR/1344
Athletic teenager with loud 3rd heart sound
WPW syndrome (type A)
Note pre excitation (contraction) of the posterior wallNote pre-excitation (contraction) of the posterior wall
Pulmonic valve M-Mode
37 y.o. woman withdyspnea and systolicmurmur.
Diagnosis?:A Valvular PSA. Valvular PSB. Pulmonary HtnC. Constrictive
pericarditisD. Cannot tell
ANSWER:
B. Pulmonary Htn
Note the absence ofA-dip in spite of NSRand also the “flying W” pattern
Paradoxical IVS motion Differential diagnosis (1)Differential diagnosis (1)
Increased RV internal dimension (>30mm)Increased RV internal dimension ( 30mm)1. Normal septal thickening (>30%)
RV V l l dRV Volume overload Primary pulmonary hypertension
2. Reduced septal thickening (<30%)Coronary artery disease Dilated cardiomyopathy y p y
JR/1161
Paradoxical IVS motionDifferential diagnosis (2)Differential diagnosis (2)
Normal RV internal dimension (<30mm)1 N l t l thi k i ( 30%)1. Normal septal thickening (>30%)
Postoperative patientsAc te RV ol me o erloadAcute RV volume overload Constrictive pericarditis Pericardial effusionPericardial effusionIV conduction abnormalities (WPW syndrome)
2 Reduced septal thickening (<30%)2. Reduced septal thickening (<30%)Coronary artery diseaseLBBBLBBB Cardiomyopathic ASH
JR/1162
Reasons to use M-mode EchocardiographyReasons to use M mode Echocardiography
Better estimation of time intervalsMotion patterns of normal and abnormal structuresIdentify high frequency motionIdentify high frequency motionEvaluation of PHT even in the absence of TR/PRMechanism of paradoxical pulse and tamponadeB tt l ti f th ti l f tiBetter evaluation of prosthetic valve functionDiagnose arrhythmias (sometimes better than ECG…)Better understanding of LA hemodynamicsSimple evaluation of dyssynchronyColor M-mode for timing and flow propagation
Many thanks!