Transthoracic Echocardiography

A. 이동 (movement)
기울임
(tilting)
C. 경사 (angulation)
회전
(rotation)
Terminology

Anatomy of Echo

Echo Window
1. Parasternal
2. Apical
3. Subcostal
4. Suprasternal notch

Basic views of Echocardiography
Apical view
Subcostal view
Suprasternal view

Basic views of Echocardiography

Parasternal long axis view

Parasternal long axis view

Parasternal short axis view

Parasternal Short Axis view
PSAX- AV level
PSAX- Mid
PSAX- MV base
PSAX- Apex

Parasternal short axis view

Short axis view of aorta

Short axis view of aorta

Apical 4 chamber view

Apical 4 chamber view

Apical long axis view

Apical 2 chamber view

Apical 2 chamber view

Subcostal view

Subcostal view

Suprasternal notch view

Suprasternal notch view

Measurement of Cardiac Chambers

▶ Considering cardiac cycle
: sinus rhythm
: Multiple beats should be used in AF
: Avoid PVC or PAC
(avoided in the post-ectopic beat in PACs or PVCs)
▶ Quantification
: Mildly or moderately or severely abnormal
General principles

Respiration (at end-expiration)
Image at minimum depth necessary
Highest possible transducer frequency
Adjust gains, dynamic range, transmit
Frame rate ≥ 30/s
Harmonic imaging
B-color imaging
General principles

Factors affecting image quality
Tester factors
technique
knowledge
experience
Machine factor
Depth
Gain
Frame rate
Resolution
Power
Compression
Dynamic range
Persistence
Focusing
Artifacts, etc
Patient factors
Hemodynamic stability
Body shape
Combined disease

2D Image Optimization

2D Image Optimization

Measure LV dimension

Measure LV volume

Measure LV mass

PLAX, PSAX view
End of mitral leaflet
2D or M-mode
End diastole, systole
- multiple beat
Measure LV dimension & thickness

LV M-mode
EDD
ESD

LV M-mode

Oblique parasternal images를 피한다.
LV 2D

Normal LV size

LV volume
▶ Manual measurements
: Mid-papillary short axis view , A4C, and A2C view
: Trace endocardial border
▶ End diastole
: QRS starting point, pre-MV closure, or biggest dimension during cardiac cycle
▶ End systole
: Pre-MV opening, or smallest dimension during cardiac cycle

LV volume measure
End diastole
End systole
A2C
A4C
LVEF=22%

LV mass calculation
A2
A1
Am
Am = A1 – A2

Normal LV mass

Measure LA size
▶ LV end systole, maximal LA size
▶ Avoid foreshortening of LA
▶ LA length in true long axis of the LA
▶ Excluded pulmonary veins and LAA

▶ Measured from the leading edge of the posterior aortic wall to the leading edge of the posterior LA wall
- measure end systole
Measure LA size

A4C
A2C
LA volume = 8/3 π [ (A1) (A2) / (L) ]
※(L) is the shortest of either the A4C or A2C length
LA size measure: Area-Length Method

A4C
A2C
LA size measure
: Modified Simpson’s Method

Normal LA size

RV size measure
Apical 4-chamber view, at end diastole
RV diameter < LV diameter

At end diastole, PSAX
Measure RVOT, PA diameter

Normal RV, RVOT, PA diameter