Term
| What is the focus of pediatric echocardiograms? |
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Definition
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Term
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Definition
| A thin, linear, perforated, membrane like structure located in the area of the coronary sinus, which is observed to move freely within the RA |
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Term
| Persistent left subclavian |
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Definition
–The left subclavian vein or a branch of the left subclavian vein drains into the coronary sinus.
–The coronary sinus can be visualized in the left parasternal long axis and will appear as a large round chamber in the left AV sulcus. |
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Term
| Contrast injection where will result in normal flow route? |
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Definition
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Term
| Contrast injection where will result in opacification of the coronary sinus? |
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Definition
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Term
| Persistent right SVC (anomalous SVC) |
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Definition
–SVC drains into the LA
–Diagnosed using contrast injection with 4 chamber apical or subcostal, injection of contrast into either arm opacifies the LA then the LV with no contrast in the right heart |
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Term
| Anomalous pulmonary venous return |
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Definition
–One or more pulmonary veins empties into the RA, or a common pulmonary venous chamber located posteriorly to the LA and RA which then drains into the RA.
–Contrast injection will demonstrate abnormal flow through the common pulmonary venous chamber and the presence of an ASD.
–ASD will demonstrate abnormal Doppler flow patterns. |
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Term
| Differentiating a supravalvular membrane from a cortriatrium is based on what? |
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Definition
| how close the membrane is to the mitral valve. Supravalvular membranes are closer to the valve. |
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Term
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Definition
-narrowing of the pulmonary valve
-RV thickening
-Overriding AO
-VSD |
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Term
| What are the three types of mitral stenosis? |
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Definition
-Parachute deformity
-Anomalous mitral arcade deformity
-double orifice mitral valve
–Best visualized from the parasternal long axis, apical and subcostal windows
–Visualized from the apical four chamber or parasternal short axis |
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Term
| Parachute deformity of the mitral valve |
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Definition
| –Single papillary muscle receiving all chordae |
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Term
| Anomalous mitral arcade deformity |
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Definition
| –Multiple small papillary muscles receiving chordae |
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Term
| Double orifice mitral valve |
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Definition
| –Two Mitral valve openings with or without commissural fusion |
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Term
| Mitral valve hypoplasia and atresia |
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Definition
–Hypoplasia is a small annulus with small leaflets which severely obstructs blood flow.
–Atresia is the absence of a valve causes a complete obstruction between the LA and LV.
–Patients cannot survive without a communication between the atrium and ventricles (ASD and VSD).
–Patients with hypoplastic left heart syndrome usually have hypoplasia or atresia. |
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Term
| Patients with hypoplastic left heart syndrome usually have what? |
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Definition
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Term
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Definition
-Absence of a functional tricuspid valve
–Best examined from the subcostal or apical views.
–Contrast injection will show an ASD and VSD with blood flow from the RA to the LA to the LV to the AO and PA. |
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Term
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Definition
–Characterized by a downward displacement of the tricuspid valve.
–The right heart is broken down into the small physiological ventricle, atrialized ventricle, and large RA.
–May be associated with TR and an ASD.
–Tricuspid is late to close at end diastole with it trailing MV closure by up to 80 ms.
•2D apical is best view for diagnosis.
•Criteria for diagnosis is different.
–The Mayo clinic uses 8mm/M of BSA as diagnostic criteria.
–Feigenbaum uses 20 mm displacement.
•If anterior leaflet is tethered to the RV wall, valve replacement is in order. |
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Term
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Definition
•Best viewed in short axis.
•Anterior leaflet will have a gap or cleft.
•Usually not significant. |
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Term
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Definition
•The AV valve (usually tricuspid) has chords that attach on both sides of the septum.
•Must be associated with a VSD.
•Contrast injection will opacify the RA then RV and LV. |
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Term
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Definition
•RA empties into the LV and LA empties into the RV.
•The inflow tracks criss-cross.
•One mechanism for the correction of transposition of the great vessels. |
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Term
| What is the most common type of congenital AS? |
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Definition
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Term
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Definition
–A type of congenital AS; the most common of which is bicuspid aortic valve.
–Bicuspid AO is most common congenital defect.
–On M-mode eccentric closure of the valve is noted.
–Aorta must be interrogated from several windows to ensure maximum velocity is found. |
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Term
| Supravalvular aortic stenosis |
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Definition
–Parasternal long axis shows narrowing of the ascending aorta.
–Echocardiographic findings are the same as those seen with acquired stenosis. |
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Term
| Hypoplastic left heart syndrome |
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Definition
–The left side of the heart forms incorrectly so that the LV is hypoplastic, there is aortic atresia, and the AO is hypoplastic.
–This condition is not compatible with life. Surgery performed must be done immediately. |
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Term
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Definition
–The valve may be present but the aortic diameter is decreased.
–Best visualized in the parasternal short axis, long axis, and the suprasternal. |
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Term
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Definition
–The aorta ends completely in the arch after the carotid branch.
–Best visualized using the suprasternal view. |
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Term
Asymmetrical septal hypertrophy (ASH)
(Hypertrophic cardiomyopathy) |
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Definition
•genetically determined thickening of the IVS.
•IVS/LVPW ratio greater than 1.3 is diagnostic criteria for ASH.
•Septum thickness may increase to 20mm.
•Parasternal long axis and subcostal show the IVS the best due to the perpendicular relation of the structure to the beam.
•Improper angulation during the M-mode examination may lead to a false positive.
•The septum is often to seen have a "speckled" pattern, caused by areas of higher density muscle.
•ASH may be present without LVOT obstruction.
•Since it is a genetic disease the whole family should be studies if one member is diagnosed.
5/ |
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Term
| Idiopathic hypertrophic subaortic stenosis (IHSS) and hypertrophic obstructive cardiomyopathy (HOCM). |
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Definition
–Parasternal long axis and subcostal views show gross thickening of the septum and the LVPW.
–LVOT obstruction may be present, especially with the increased contractile state seen with exercise.
–Pulsed Doppler confirms the presence of AO/LVOT gradient.
–M-mode findings
•Systolic anterior motion (SAM) of the anterior mitral valve leaflet.
•Thick hypokinetic IVS.
•Reduced LV chamber size.
–Exaggerated LVPW motion to compensate for the hypokinetic septum. Partial closure of the aortic valve in mid-systole. |
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Term
| Atrial septal defects (ASD) categorized into what three types? |
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Definition
-Sinus venosus ASD
-Secundum ASD
-Primum ASD
•RVE, RAE, abnormal atrial septal motion and paradoxical septal motion are characteristic findings. Color Doppler is diagnostic |
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Term
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Definition
•Posterior portion of the septum
•Contributes to 15% of ASDs |
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Term
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Definition
•Patent foramen ovale
•Contributes to 70% of ASDs |
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Term
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Definition
•Anterior portion of the septum.
•2-D from the subcostal window is the best view for diagnosis with color flow or contrast study. |
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Term
| Ventricular septal defects |
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Definition
| •RVE, RAE, abnormal atrial septal motion and paradoxical septal motion are characteristic findings. Color Doppler is diagnostic |
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Term
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Definition
–A ventricular aneurysm can be a post-MI complication.
–Echo has become as good at diagnosis as cath lab information.
–Apical aneurysms are most common.
•The apical 2-chamber can be used to assess the anterior and posterior walls of the LV. When the aneurysm ruptures, it is often fatal. |
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Term
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Definition
–"Tet" is a combination of 4 cardiac defects all of which must be present for diagnosis.
•VSD
•Overriding AO
•RVOT obstruction (PS)
•RVH
•Parasternal long axis will show the overriding AO.
•Short axis view is used to detect the PS.
•Four chamber view allows assessment of chamber sizes.
•The RVH may cause paradoxical septal motion, RVE and RAE.
•M-mode can be used to diagnose the overriding AO. |
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Term
| Patent ductus arteriosus (PDA) |
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Definition
–PDA is a communication between the AO and the PA which is necessary for fetal circulation but should close within days after birth.
–It is located between the descending aorta and the LPA after bifurcation of the MPA.
•Suprasternal view is good for spectral and color diagnosis.
•Doppler criteria:
–Parasternal short axis can be used to detect turbulent flow in the PA. PI can cause turbulent flow in the PA so it must be ruled out.
–From the suprasternal notch, retrograde flow in the descending may be seen. This can be a finding with AI so it must be ruled out.
–Ascending AO flow will be normal.
–Spectral Doppler will show a turbulent flow pattern in systole and diastole. |
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Term
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Definition
–A single pumping chamber receives blood from both atria.
–A rudimentary hypoplastic ventricle may be seen with the functioning ventricle either left or right in morphology.
•Tricuspid atresia is similar but with it there will not be two functioning valves as is the case with a single ventricle.
•Often occurs with transposition of the great arteries.
•Short axis basal view will show the AO to be anterior and to the right of the PA. |
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Term
| Transposition of the great arteries is broken down into what 2 categories? |
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Definition
-Type D (Uncorrected)
-Type L (Corrected) |
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Term
Transposition of the great arteries
–Type D (Uncorrected) |
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Definition
•AO arises from the RV
•PA arises from the LV
•The patient must have a VSD, ASD, or PDA to sustain life.
•A balloon septostomy may widen an ASD in the case of the type D listed above. |
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Term
Transposition of the great arteries
–Type L (Corrected) |
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Definition
Two variations
-Criss cross AV valves
-Inversion of the ventricles |
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Term
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Definition
–One blood vessel arising from the ventricles.
–Patient will have a VSD and the blood vessel overrides both ventricles.
–The MPA, LPA or RPA usually exits the truncus posteriorly.
•Images from several views may be needed to establish the diagnosis. |
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Term
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Definition
–A congenital disorder of the connective tissue characterized by abnormal length of the extremities, fingers, toes, etc.
–Commonly affects the tunica media of the AO which weakens the vessel and may lead to dilation, degeneration, and possibly rupture.
•Parasternal long axis is usually a good view for assessment of the AO size and LA size.
•AI is a distinct possibility and should be carefully assessed. |
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Term
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Definition
–Coarctation is caused by a shelf like obstruction located in descending aorta just distal to the left subclavian artery.
–It can be visualized in using 2-D at the suprasternal notch.
•Parasternal long axis will show dilation of the ascending AO with prominent pulsation.
•Doppler examination shows high velocities in the descending AO distal to the narrowing |
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Term
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Definition
–One blood vessel arising from the ventricles.
–Patient will have a VSD and the blood vessel overrides both ventricles.
–The MPA, LPA or RPA usually exits the truncus posteriorly.
•Images from several views may be needed to establish the diagnosis. |
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Term
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Definition
–A congenital disorder of the connective tissue characterized by abnormal length of the extremities, fingers, toes, etc.
–Commonly affects the tunica media of the AO which weakens the vessel and may lead to dilation, degeneration, and possibly rupture.
•Parasternal long axis is usually a good view for assessment of the AO size and LA size.
•AI is a distinct possibility and should be carefully assessed. |
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Term
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Definition
–Coarctation is caused by a shelf like obstruction located in descending aorta just distal to the left subclavian artery.
–It can be visualized in using 2-D at the suprasternal notch.
•Parasternal long axis will show dilation of the ascending AO with prominent pulsation.
•Doppler examination shows high velocities in the descending AO distal to the narrowing |
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Term
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Definition
| –Distance between the valve leaflets during systole |
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Term
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Definition
| Percentage of blood the ventricle pumps out with each beat |
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Term
–Evaluate left ventricular function
–Preferred method in echocardiography |
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Definition
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Term
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Definition
–Amount of blood delivered to the systemic circulation
–Liters per minute |
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Term
| Stroke Volume calculation |
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Definition
•Subtract LV systolic volume cubed from LV diastolic volume cubed
•SV = (LVID3D – LVID3S) |
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Term
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Definition
| •Heart rate is calculated by dividing the R-R interval into 60,000 |
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Term
| Ejection fraction calculation |
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Definition
–Greater than 50%
–Percentage of blood the ventricle pumps out with each beat
•Assumes ventricle shaped like perfect circle
EF% = LVIDD – LVIDS
LVIDD
–Subtract the end systolic volume from the end diastolic volume
–Divide by the end diastolic volume |
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Term
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Definition
•Used to estimate left ventricular function
•Makes no assumptions as the shape of the ventricle
•It is a percentage of the changing ventricular dimensions
–FS% = (LVIDd^2 – LVIDs^2)/LVIDD |
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Term
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Definition
20mm - 37mm
-measured at end diastole
•First deflection of the EKG tracing
•Leading edge of anterior root to leading edge of posterior root |
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Term
| Aortic valve excursion measurement |
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Definition
15mm - 26mm
•Measurement of the distance between valve leaflets during systole
•Perpendicular to the leaflets
•As early during systole as possible |
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Term
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Definition
27mm - 40mm
•Measured at the end of ventricular systole
•Aortic root is at maximum anterior position
•Leading edge of posterior aortic root to the leading edge of the posterior left atrial wall |
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Term
Mitral valve measurements
•Views taken with M-mode curser passing through the mitral valve leaflets, Parasternal long axis orShort axis
•Tracing of mitral valve leaflets
–Opening / Closing
E Point Septal Separation (EPSS ) |
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Definition
2mm - 7mm
•Distance from the E point of the anterior mitral valve leaflet to the lowest point of the intraventricular septum
•Measurement:
–Straight up from the E point
–To the IVS of the mitral valve tracing
•Indicates: Left ventricular volume
•LV dilates , Mitral valve decreases motion, Low cardiac output states
•Mitral stenosis |
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Term
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Definition
18mm - 28mm
•Measures
–Distance of the anterior motion of the anterior leaflet of the mitral valve
–Measured straight up from the D point to the E point of the mitral valve tracing
•D-E amplitude decreases with Mitral valve stenosis |
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Term
| Left ventricular measurements |
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Definition
•Draw a vertical line from the Q wave of the QRS complex down through the entire M-mode tracings.
•The following measurements can be made along the vertical line
•Right ventricle
–19-26 mm
•Measure the inner dimension of the right ventricle |
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Term
| Intraventricular septum measurement |
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Definition
–7-11 mm
•Includes entire thickness of the septum
•Usually taken during diastole
•Systolic measurement may also be required |
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Term
| Left ventricular inner dimenson |
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Definition
–Diastolic
•40-57 mm
•Measure the inner dimension of the left ventricle |
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Term
| Left ventricular posterior wall |
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Definition
–7-11 mm
•Measure the thickness of the posterior wall
•The LVPW and IVS measurements should be approximately the same |
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Term
•Systolic measurements
•Left ventricular inner dimension |
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Definition
–20-40 mm
•Identify the greatest anterior motion of the posterior wall.
•Draw a vertical line from the point identified.
•Measure :
–Inner dimension during systole
–Pulmonic valve M-mode tracing |
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Term
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Definition
Downward motion caused by atrial contraction
•Coincides with the “A” point
•Mitral valve M-mode |
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Term
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Definition
•Represents onset of RV systole
•Valve opening |
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Term
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Definition
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Term
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Definition
| The valve begins to close |
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Term
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Definition
| Complete closure of the valve |
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Term
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Definition
| Bulging of the valve just prior to atrial contraction |
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Term
| M-Mode Aortic root measurement |
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Definition
| Measured off Q wave from the QRS of EKG |
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Term
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Definition
| Measure at the end of T wave |
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Term
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Definition
| measure AV opening from inner edge to inner edge of leaflets |
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