- Echo Physics—The Basics
- Image Optimization
- Introduction to Echocardiography
- Basics of Color Flow Imaging and Doppler Echocardiography
- Mitral Valve and Mitral Stenosis
- Mitral Regurgitation
- Aortic Valve and Aortic Stenosis
- Aortic Regurgitation
- Pulmonary Valve
- Tricuspid Valve
- Pulmonary Hypertension
Echo Physics—The Basics
Slides 1 to 6
These slides depict the indications and the advantage of the sonography along with the great advances in the field. People have started with large machines occupying the whole room to now only handheld devices that can be carried in the pocket.
Slide 7
This slide illustrates how the idea of using ultrasound for evaluation of the heart came in the mind, from the use of sonar equipment in the ship. It was used to find the depth of the sea bed or locate the whales.
Slides 8 to 14
These slides discuss the basics of sound waves, there properties like wavelength and frequency, and the speed in various tissues.
Slides 15 to 17
These slides discuss the display of ultrasound in its three forms namely—A-mode, B-mode and the M-mode.2
Slides 18 to 24
These slides discuss the different ultrasound—tissue interactions, namely—the refraction, reflection, attenuation, scatter, etc.
Slides 25 to 28
These slides, all tell us about the different target tissue characteristics and the meaning or the terminologies used such as isoechoic, anechoic, hypoechoic, etc.
Slides 29 to 34
All these slides discuss the construction and the types of transducers that are used in ultrasonography, namely—the linear, convex and microconvex, etc.
Slides 35 to 38
These slides discuss the selection of the probe for particular examination and the choice of the frequency, the advantages and disadvantages of high and low frequency transducers.
Slides 39 to 42
All these slides discuss the different physical properties of the probe, such as the near and far zone, the focal point, the significance of the index mark.
Slides 43 and 44
These slides discuss the relation of the depth of the structure to the time and the use of TGC, i.e. time gain compensation.3
Slide 45
This slide discusses the details of harmonic imaging against the fundamental imaging.
Slides 46 to 54
These slides discuss in detail all about the types of resolutions, namely—axial, lateral, contrast and temporal. The importance and the methods of increasing the frame rate are also discussed.
Slides 55 to 59
These slides discuss the use of different adjustments in the machine such as zoom mode, the 2D color, dynamic range and screen display to have a good image.
Slides 60 and 62
These slides discuss the different filters used in normal and tissue Doppler imaging.
Slides 63 to 79
All these slides discuss in details the causes of artefacts, and method of overcoming them, like, the side lobe artefacts, near field clutter, enhancement, reverberation, the mirror image artefacts and electromagnetic artefacts.4
Image Optimization
Slides 1 to 3
These slides discuss the importance of a crisp, good esthetic image of the ultrasound.
Slide 4
This slide discusses in detail all the methods of acquiring a good esthetic image, as recommended by the American Society of Echocardiography (ASE).
Slides 5 to 7
These slides discuss the importance of imaging from the true apex and avoiding foreshortening.
Slide 9
This slide again guides us the as to the use of different available modalities in obtaining a good image.
Slides 10 to 15
These slides discuss the proper use of sufficient amount of jelly for examination along with the proper adjustments of the gains, and time gain compensation (TGC) for image optimization.
Slides 16 to 19
These slides discuss the proper use of focus, sector size, and sector movement along with proper depth for obtaining a good image.5
Slides 20 to 22
These slides discuss the use of zoom in mode as often as required along with the 2D color, called Chroma, and the screen display of the one-third to two-thirds type.
Slide 23 and 24
These slides enumerate all the Doppler settings that are a must to have the proper measurement of the velocities and gradients. These include filters, gains, scale, envelope sweep speed, etc.
Slides 25 to 29
These slides exemplify all the spectral Doppler settings that should be done, like the scale, envelope, and the sweep speed.
Slides 30 to 34
These slides discuss the adjustments that should be done for the evaluation of the color flow examination. Such as area of interest, gains, black white suppress, 2D gains, etc.
Slides 35 and 36
These slides enumerate all the Do's and Don'ts for acquitting a good image, such as minimizing translational motion, maximizing resolution, avoiding apical foreshortening, maximizing endocardial border and identifying the end diastole and systole.6
Introduction to Echocardiography
Slides 1 and 2
These slides give us an idea as to the inclusions in this presentation, like the position of patient, the different windows, M-mode, 2D echocardiography and the details of the structures seen in various windows.
Slides 3 to 5
These slides give us all the details of the modern measurement methodology.
Slides 6 to 9
These slides describe the positon of the patient, different echocardiographic windows and the different views in these windows.
Slides 10 to 13
These slides describe in details the position of the patient, the position of the probe, and the structures seen in the parasternal long axis view.
Slides 14 to 17
These slides describe the method, the wave forms with their physiological importance as seen in the M-mode examination at the mitral valve level.
Slides 18 to 21
These slides exemplify the M-mode examination at the aortic valve and left atrial level, with the normal values and some examples of abnormalities seen in this examination.7
Slides 22 to 24
These slides illustrate the method of examination of the LV by M-mode, with the normal values.
Slides 25 to 30
These slides describe the short axis view at the aorta and LA level, with all the structures, seen, along with the RA, PA, LA, to the coronaries.
Slides 31 to 33
These slides discuss and illustrate the parasternal short axis views at the mitral, papillary muscle and the apical level, and the different measurements taken in these vies along with the segments evaluated in these views.
Slides 34 to 41
These slides illustrate all the apical views along with the structures seen in these views the patient position, the method of imaging, along with certain abnormalities seen in these views, like the dilated coronary sinus.
Slides 42 to 45
These slides discuss the method of recording the subcostal views, the importance of these views, and most important the imaging of the inferior vena cava (IVC).
Slides 46 to 48
These slides show the method of obtaining the suprasternal view both the long and the short axis ones, along with the structures seen in these views.8
Slides 49 to 54
These last few slides demonstrate certain special views, that are taken in certain special conditions, for evaluation of specific structures, like the posterior tricuspid leaflet, the RA and the RV, the aortic flow.9
Basics of Color Flow Imaging and Doppler Echocardiography
Slides 1 and 2
These slides deal with the hemodynamic of the blood flow across all the valves.
Slides 4 to 6
These slides show the correlation of the flow patterns across each valve in relation to the electrocardiogram which is very important for the precise timing of the various events.
Slides 7 and 8
These slides enumerate the physical properties of color flow imaging.
Slide 9
This slide shows the flow across the pulmonary valve and the color coding as per the convention, with live videos.
Slide 10
This slide demonstrates the color flow across the left ventricular inflow and outflow.
Slides 11 and 13
These slides discuss the types of color flows, namely—laminar and turbulent, are discussed in these two slides.10
Slide 14
The slide shows the artefacts seen during color flow imaging.
Slides 15 to 19
These slides deal with the basic physical properties of Doppler, the Doppler principle and Doppler shift and the importance of the angle of the Doppler beam to the blood flow.
Slides 20 and 21
These slides stress the importance of being parallel to the blood flow as possible and the degree of error incurred if one does not align parallel to the flow.
Slides 22 to 24
These slides show the polarity of the spectrum across each valve, in normal and disease conditions.
Slides 25 and 26
These slides discuss the properties of two different modalities of Doppler namely— pulsed wave and continuous wave Doppler are discussed in detail.
Slides 27 and 28
Slide 29
This slide enumerates the various uses of pulsed and continuous Doppler are discussed in this slide. As in other modalities, the Doppler artifacts and the method to avoid them are shown.
Slide 30
As in the case of 2D echo and color flow imaging, certain artefact that are seen in Doppler echocardiography are shown.
Slides 31 to 33
These slides discuss the use of various Doppler modalities like the PW, CW and the color Doppler, and the normal velocities across all the valves.
Slide 34
This slide discusses the differences of the 2D verses the Doppler modalities.
Slide 35
This slide summarizes all the method of Doppler evaluation of the patient.
Slides 36 to 38
These slides discuss the Bernoulli's equation, the peak, mean gradients and VTI and their significance.12
Slides 39 to 44
These slides enumerated the views that are best for evaluation of the different valves, namely—mitral, aortic, tricuspid and the pulmonary. They also explain the view that are not useful for Doppler evaluation.
Slides 45 and 46
Mitral Valve and Mitral Stenosis
Slides 1 to 7
These slides illustrate the normal mitral valve anatomy, the recognition of the various scallops, and the zona coapta.
Slide 8
The closure pattern of the mitral valve leaflets in normal and various diseased conditions are illustrated in this slide.
Slides 9 to 11
These three slides show the 2D, M-mode and the spectral Doppler findings of a normal mitral valve.
Slides 12 and 13
These slide enumerate the various causes of mitral valve affections.
Slides 14 to 19
These slides illustrate the 2D appearance of the mitral valve in mitral stenosis, in the parasternal long, the parasternal short and the apical views. They also show the proper method of doing planimetry, and the Wilkin's scoring system of the mitral stenosis, so as to decide whether the valve is suitable for BMV or not. The method to see for chordal thickening is also shown.14
Slides 20 to 22
These slide discuss the M-mode evaluation of mitral stenosis, all the findings at the mitral and the aortic—LA level.
Slides 23 to 25
These slides discuss the color Doppler evaluation and findings in mitral stenosis.
Slides 26 to 29
These slides discuss the evaluation of the severity of mitral stenosis, particularly by planimetry, the method and the short comings of planimetry.
Slides 30 and 31
These two slides discuss the peak and mean gradients in mitral stenosis.
Slides 32 to 37
These slides discuss in detail about the pressure half time in mitral stenosis. Right from the method, the sky slope and the pressure half time in atrial fibrillation.
Slides 38 to 40
These slides discuss the area calculation of the mitral valve by continuity equation, along with its draw backs.15
Slides 41 to 42
These slides discuss the Pisa method of area calculation in mitral stenosis and the importance of a little exercise in cases of dilemma, between the symptoms and severity of the disease.
Slides 43 and 44
These two slides discuss the complications in a case of mitral stenosis, like the clot and smoke formation and the development of atrial fibrillation.
Slides 45 to 47
These slides illustrate the findings in mild, moderate and sever mitral stenosis.
Slides 48 to 53
These slides discuss in detail, the resent classification of the severity of mitral stenosis.
Slides 54 to 60
All these slides discuss to great length about the BMV, the feasibility, the contra-indications, the procedure, and the complications.
Slides 61 and 62
These slides discuss the algorithm, regarding the management of mitral stenosis of various grades.16
Mitral Regurgitation
Slides 1 to 4
These slides discuss the causes of mitral regurgitation, along with the types of regurgitation such as acute or chronic.
Slides 5 and 6
These describe the ASE, recommendations for the evaluation of severity of mitral regurgitation, and the specific, the supportive and the quantitative parameters.
Slides 7 to 11
These slides discuss in detail the color flow evaluation of mitral regurgitation, including the extent of jet into the LA, the jet area and the jet area to LA area.
Slides 12 and 13
These slides describe the method of measuring the vena contracta, with the advantages and the grading of the MR on the basis of vena contracta.
Slides 14 to 16
These sides illustrate the evaluation of the MR by the jet area and jet area to LA area, and also discuss the problems in eccentric jets.
Slides 17 to 20
Slides 21 to 23
These slides discuss the utility of continuous wave Doppler in evaluation of the severity of MR.
Slides 24 to 27
These slides describe in detail the use of volumetric method in evaluation of the severity of MR. The basic principle is the subtraction of the aortic or left ventricular outflow tract (LVOT) flow from the mitral flow to calculate the mitral regurgitant flow.
Slides 28 to 30
These slides describe and explain the principle of PISA, method for the evaluation of the severity of MR.
Slides 31 to 33
These slides discuss and summaries the findings in a case of sever MR, along with the limitations that should be kept in mind in evaluation of MR.
Slide 34
This slide gives us the algorithm, for the management of MR of various degrees.
Slides 35 to 40
These slides discuss the very common cause of MR, and that is mitral valve prolapse. The basic findings needed to diagnose MVP have been highlighted.18
Slides 41 to 44
These slides illustrate with videos some of the other causes of MR, such as flail leaflet, the inferior wall MI, and endocarditis.
Slides 45 to 47
These slides discuss and illustrate other mitral valve abnormalities such as mitral annular calcification and dilated cardiomyopathy.
Slides 48 and 49
These two slides show the congenital abnormalities of mitral valve such as the parachute MV and the submitral aneurysm.
Slides 50 to 52
Lastly, these slides illustrate the rare causes of mitral regurgitation such as the radiation fibrosis and the large left atrial myxoma obstructing the mitral valve.19
Aortic Valve and Aortic Stenosis
Slides 1 to 6
These slides illustrate the normal anatomy and the appearance of the aortic valve in various views, namely—the parasternal short axis, the long axis, the apical 3-chamber and the apical 5-chamber views. Mode at the aortic valve and left atrium level is discussed.
Slides 7 to 9
These slides enumerate the different causes and types of aortic stenosis.
Slides 10 to 16
These slides discuss in details the congenital valvar variety of aortic stenosis which include the unicuspid, bicuspid and the quadricuspid aortic valves. All are nicely illustrated by videos. Also, the proper diagnosis and care of the presence of raphe is discussed.
Slides 17 to 19
These slides discuss in details the 2D findings and evaluation of acquired variety of aortic stenosis, namely—the rheumatic and arteriosclerotic types.
Slides 20 to 23
These slides discuss and illustrate the findings in M-mode echocardiography. Including the eccentric closure in bicuspid AV and the aortic leaflet flutter in subaortic obstruction.
Slides 24 to 29
These slides discuss the complete, in detail evaluation of the aortic stenosis by Doppler echocardiography.
The velocities are discussed for the grading of severity of AS, and also the shape and density of the continuous wave Doppler in valvar and subvalvar aortic stenosis.20
Slides 30 to 37
These slides discuss the aortic valve area calculation by continuity equation. The proper procedure and the care to be taken in measuring the LVOT diameter and measuring the LVOT VTI are described and illustrated in detail.
Slides 38 to 41
These slides discuss the other methods of evaluation of the severity of AS and the area calculation such as the perimetry. The draw backs of 2D perimetry and the advantages of 3D perimetry are discussed.
Slide 42
This slide discusses and illustrates the aortic root evaluation and measurement in any aortic valve involvement.
Slides 43 to 46
These slides discuss in detail the latest ASE grading of aortic valve stenosis. The grade A to D are discussed in detail, and finally charted out.
Slides 47 to 49
These slides discuss and illustrate the different varieties of subvalvar aortic stenosis, such as the membranous and the ridge variety.
Slides 50 to 54
These slides discuss in detail the subvalvar variety of aortic stenosis, and namely—the commonest variety that is the hypertrophic cardiomyopathy. The M-mode findings are discussed in these cases. Also the differentiation of the AS jet from the MR and TR jet is discussed.21
Slides 55 to 58
These slides discuss the limitation and the precautions that should be taken in evaluation of aortic stenosis. The important one is the LV failure, where the gradients will be affected. The use of low dose dopamine in DSE is discussed.
Slides 59 and 60
These slides discuss the algorithm for the management of various grades of aortic stenosis as per the latest ASE guidelines.22
Aortic Regurgitation
Slides 1 and 2
These slides enumerate all the causes and the types of aortic regurgitation, namely— the valvular and aortic root and the acute verses chronic variety.
Slides 3 to 8
These slides discuss and illustrate all the varieties of aortic regurgitation, namely— the sclerotic, rheumatic, those due to bicuspid AV, the aortic root dilatation and the AR due to endocarditis and valvar prolapse.
Slides 9 to 12
These slides discuss the utility of M-mode in the evaluation of AR, where the findings, of early closure of MV, AML flutter, the LV size, all add to the evaluation of the severity of AR.
Slides 13 to 18
These slides discuss and illustrate in details the evaluation of AR by CFM, which is one of the main ways of evaluation of its severity. The extent of jet into the LV, the jet width to LVOT width and the jet cross- sectional area to aortic annular area are all discussed.
Slides 19 and 20
These slides discuss one of the specific criteria for evaluation of severity of AR and that is vena contracta. Its method and advantages.
Slides 21 to 26
These slides both discuss and illustrate the use of pulsed wave and continuous wave Doppler in AR. PW Doppler is not as useful as the CW Doppler. The CW Doppler PHT, deceleration slope, the intensity of the spectrum and the shape are all important parameters.23
Slides 27 and 28
These slides discuss the importance of LV dimensions, the VC jet width to LVOT width, and the flow reversal in the DAO for the evaluation of the severity of the AR.
Slides 29 to 33
These slides discuss the quantitative evaluation of AR, by the continuity equation. Just like the MR the regurgitant volume is the aortic flow minus the mitral flow. The PISA method is also discussed.
Slides 34
This slide summarizes the severity of AR on the basis of effective regurgitant orifice area (EROA), regurgitant volume and the regurgitant fraction.
Slides 35 and 36
These slides as in case of other valvular problems give the algorithm for the management of AR according to the latest ASE guidelines.24
Pulmonary Valve
Slides 1 to 5
These slides describe in detail the anatomy of the pulmonary valve in the various views such as the parasternal short axis (PSAX), the RV inflow and the RV outflow and the subcostal views.
Slides 6 and 7
These slides discuss in detail the M-mode of the pulmonary valve in normal conditions, and the different wave patterns seen.
Slide 8
This slide demonstrates the CFM in pulmonary stenosis and its importance.
Slides 9 and 10
These slides describe the method of measuring the PAT, i.e. the pulmonary acceleration time, and the values in health and disease.
Slides 11 to 15
These slides describe the M-mode and 2D echo findings in a case of pulmonary stenosis. Namely—the exaggerated A wave, and the anatomical appearance of the pulmonary valve.
Slides 16 to 18
These slides describe the color flow and the Doppler findings in a case of PS, and also the grading of the severity on the basis of the gradients.25
Slide 19
This slide describes the latest 2015 grading of PS according to the ASE Criteria.
Slides 20 and 21
These slides describe the causes of pulmonary regurgitation.
Slides 22 to 24
These slides describe the M-mode and the color flow findings in a case of pulmonary regurgitation.
Slides 25 to 27
These slides describe in detail the Doppler findings in PR, and also the advantage of determining the pulmonary artery mean and end diastolic pressure from the PR spectrum.
Slides 28 and 29
Tricuspid Valve
Slides 1 to 6
These slides describe in details the anatomical peculiarities of the tricuspid valve apparatus, right from the leaflets to cordae to the papillary muscles. The different views and the leaflets seen in those views are all described.
Slide 7
This slide describes the flow peculiarities of the tricuspid valve.
Slide 8
This slide enumerates all the tricuspid valve abnormalities.
Slides 9 to 11
These slides discuss the tricuspid stenosis, namely—the causes and the types.
Slides 12 to 14
These slides describe in detail the 2D and color flow findings in a case of TS.
Slides 15 and 16
These slides describe the grading of the severity of TS on the basis of the peak, mean gradients and also as per the latest ASE recommendations,27
Slides 17 and 18
These slides describe the causes of primary TR.
Slides 19 to 23
These slides describe and illustrate the different types of primary TR, both the acquired and the congenital variety, including rheumatic, endocarditis, prolapse, carcinoid syndrome and the Epstein's anomaly.
Slide 24
This slide enlists all the causes of secondary TR.
Slides 25 to 28
These slides illustrate and describe the 2D and color flow evaluation of tricuspid regurgitation. It also discusses the severity of TR on the basis of color flow mapping.
Slides 29 and 30
These slides describe the Doppler evaluation of TR, and the flow reversal in the hepatic veins.
Slides 31 to 34
Slides 35 and 36
These slides describe the algorithm for the management of TR, according to the latest ASE guidelines.29
Pulmonary Hypertension
Slides 1 to 3
These slides describe the anatomical and the physiological details of the pulmonary circulation, along with the peculiarities of the pulmonary flow.
Slides 4 to 6
These slides discuss in detail about the definition of pulmonary hypertension, the differences as regards to the capillary resistance and the pulmonary capillary wedge pressure. It also discusses the common causes of pulmonary hypertension.
Slides 7
This slide describes in detail the Dana Classification of pulmonary hypertension, into 5 groups.
Slide 8
This slide compares the old with the new classification and describes in details the pre- and post-capillary hypertension and the relation with the capillary resistance and the wedge pressure.
Slides 9 to 14
These slides describe in detail the 2D findings in a case of pulmonary hypertension namely—dilated RA and RV, dilated MPA, and the paradoxical IVS motion along with a dilated non-collapsing IVC.
Slides 15 to 17
Slides 18 to 22
These slides discuss and illustrate the Doppler evaluation of pulmonary hypertension, mostly the different methods, and the TR jet velocity, being the main method.
Slides 23 to 27
These slides discuss in details the reasons for using the IVC, to calculate the RA pressure. They also demonstrate the different IVC conditions.
Slide 28
This slide explains the importance of knowing the problems with free flow TR, where the velocity of TR may not correlate with the severity of pulmonary hypertension.
Slides 29 to 31
These slides discuss the other Doppler method of evaluation the PH, and that is the measurement of PAT, the pulmonary acceleration time. They also discuss and demonstrate the importance of the shape of the pulmonary systolic flow in evaluation of the PH.
Slides 32 to 34
These slides discuss the use of PR jet in the evaluation of the end diastolic and the mean pulmonary artery gradients. The mean TR velocity is also a method of calculating the mean pulmonary artery pressure.
Slides 35 and 36
These slides discuss how the pulmonary artery pressure may not be a prognostic marker, as it can be of the same value at two different stages of cardiac output.