Download Basic Veterinary Echocardiography

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Basic Veterinary Echocardiography
The Subject for a Radiologist?
Daniel A. Feeney DVM, MS
Professor of Veterinary Radiology
College of Veterinary Medicine
University of Minnesota
Transducer Configuration
What is Echocardiography?
• High Hz Sound
– TRANSMITTED
– REFLECTED
– TRANSLATED into time-associated image
(graphic 2-D)
Goals of Current Discussion
• COMPARE Echocardiography to Survey &
Contrast Radiography
• Introduce BASIC Technical Aspects of
Echocardiography
• Introduce ELEMENTARY Interpretive Principles
of Echocardiography
• Focus on Diagnoses for the GENERALIST
• Radiologist doing echocardiography =
plumber doing neurosurgery?
Justification for Echocardiography
• Shortcomings of Survey Radiography
–
–
–
–
–
–
hypertrophy vs. dilation
no information cardiac function
no information on valves
no information on internal cardiac anatomy
miss masses (pericardial sac or heart)
pleural fluid problems
Justification for Echocardiography
Justification for Echocardiography
• Shortcomings of Contrast Radiography
(particularly angiography)
• Shortcomings of Contrast Radiography
(particularly angiography)
– contrast media risk
– nonselective angiography +/- for shunts
– selective angiography
 invasive
 anesthesia risk
 specialized equipment
– pericardial sac procedures (e.g.
pneumopericardiogram)
 invasive
 anesthesia risk
 embolism & hemorrhage risk
Justification for Echocardiography
Applications of Echocardiography
•
•
•
•
•
•
noninvasive
no contrast media risk
sector scanners applicable for general abdomen, etc.
hypertrophy vs. dilation
quantitate cardiac function
find masses in the pericardial sac or heart (not
100%)
• no pleural fluid problems
• information on internal cardiac anatomy
& valves
• determine size and quantitate function of cardiac
chambers
• identify intracardiac or pericardial sac masses (or
vegetations)
• non-invasively reevaluate indices of cardiac function
after Rx
• clarify origin of pleural fluid
Technical Considerations
Technical Considerations
• Windows
– [R, 4-5] parasternal intercostal (M-mode standard)
– [L, 3-4] cranial parasternal intercostal
– [L, 5-6] caudal parasternal intercostal (apical)
• Transducer Configuration/Frequency (Hz)
– “inline” configuration
– Use Hz that will put area of interest in focal zone
of transducer
 horses/cattle 2.25-3.5 MHz
 medium/large dogs 3.5-5.0 MHz
 small dogs/cats 5.0-7.5 MHz
Technical Considerations
Cardiac Notch
• Cardiac Anatomy vs. Ultrasound Display Modes/Views
From:
Boon J, Wingfield WE & Miller Cw:
Echocardiographic Indices in the Normal Dog.
Vet Radiol 24:214-221, 1983.
M-mode
Real-time, sector, 2D*
* Two-dimensional Views





Technical Considerations
R parasternal long axis
R parasternal short axis
L (cranial parasternal long axis
L (caudal) [apical] parasternal long axis
L parasternal short axis
Anatomy
• Cardiac Anatomy vs. Ultrasound Display
Modes/Views
– “M-mode easiest method by which to obtain
cardiac dimension.”
– “The 2-D is generally superior in identification of
cardiac masses, atrioventricular septal defects,
regional wall disorders and heartworms.”
(Bonagura, O’Grady & Herring: VCNA(SA) 15:1177, 1985)
Anatomy
Basics of Interpretation
• What Parts Have You Identified (is the study
complete)?
– Valves
 aortic semilunar (M-mode & 2-D)
 mitral (M-mode & 2-D)
 pulmonic (2-D)
 tricuspid (M-mode & 2-D) [BEST-LCrP/S L-A
or LCrP/S S-A]
Basics of Interpretation
• What Parts Have You Identified (is the study
complete)?
– Chambers
 left atrium (M-mode & 2-D)
 left ventricle (M-mode & 2-D)
 right ventricle (M-mode & 2-D)
 right atrium (2-D) [BEST-LCaP/S L-A (apical)
view]
Technical Considerations
Basics of Interpretation
• What Parts Have You Identified (is the study
complete)?
– Miscellaneous Structures
 chordae tendinae (M-mode & 2-D)
 pericardium (M-mode & 2-D)
 papillary muscles (M-mode & 2-D)
 endocardium (M-mode & 2-D)
Making Sense of M-mode
• Contrast Echocardiography
– Use of saline, green dyes, aggregated albumen, etc.
to create echogenic fluid or bubbles which will
flow with the blood and identify its course
– Use for identifying shunts
From:
Feigenbaum H:
Echocardiography (3rd edition)
Lea & Febiger, Philadelphia, 1981.
Long-axis, RL
From:
Thomas WP:
Two-dimensional, Real-time
Echocardiography in the Dog –
Technique & Anatomic Validation.
Vet Radiol 25:50-64, 1984
Long-axis, RL
From:
Thomas WP:
Two-dimensional, Real-time
Echocardiography in the Dog –
Technique & Anatomic Validation.
Vet Radiol 25:50-64, 1984
Long-axis, RL
Doppler: Duplex/Color-flow
RL Long Axis (loop)
Short-axis, RL
From:
Thomas WP:
Two-dimensional, Real-time Echocardiography
in the Dog – Technique & Anatomic
Validation. Vet Radiol 25:50-64, 1984
Short-axis, RL
From:
Thomas WP:
Two-dimensional, Real-time Echocardiography
in the Dog – Technique & Anatomic
Validation. Vet Radiol 25:50-64, 1984
Short-axis, RL
From:
Thomas WP:
Two-dimensional, Real-time Echocardiography
in the Dog – Technique & Anatomic
Validation. Vet Radiol 25:50-64, 1984
Short-axis, RL
4-chamber, LR/M-mode, RL
4-chamber, LR
Basics of Interpretation
• Are These Structures Basically Normal?
–
–
–
–
–
? chambers conspicuously dilated or compromised
? contractility = 30%, rate & rhythm
? any percardial fluid [vs. pleural fluid]
? any masses or vegetations
? CVC persistently dilated, 4-5 level hepatic vein
branches seen
– ? obvious spontaneous contrast in the
chambers
Basics of Interpretation
• On Further Practical Scrutiny, Are They Sill
Normal?
– ? is ECG normal
– ? is mitral valve motion normal [AMV = “M”]
– ? paradoxical septal motion
Basics of Interpretation
• On Further Practical Scrutiny, Are They Sill
Normal?
– Relevant Generalities
• right ventricular free wall = 1/3-1/2 as thick as
ventricular free wall in small animals (Bonagura,
Herring: VCNA(SA) 15:1195, 1985)
• excessive “E-point” [1st hump of AMV’s “M”] to
septal separation consider left ventricular dilation
or failure (Bonagura, O’Grady &
Herring: VCNA(SA) 15:1208, 1985)
Basics of Interpretation
• Relevant Referenced Normal Parameters By
Species
– Dog-many dimensions proportional to body size1
– Cat-only weak relationship between dimensions & body
size2
– Horse-most dimensions not specified as varying with
breed/size3
1
2
3
Basics of Interpretation
• Relevant Referenced Normal Parameters By
Species
– “There is good agreement between 2-D & M’moade
indices of heart size except for the left atrial side,
whick is measurably larger within 2/d.”4
4
Bonagura, Herring: VCNA(SA) 15:1995, 1985
Bonagura, O’Grady & Herring: VCNA(SA) 15:1208, 1985
Boon, Wingfield & Miller: Vet Radiol 24:214, 1983
O’Grady, Bonagura, Powers & Herring: Vet Radiol 27:34, 1986
Bonagura, O’Grady & Herring: VCNA(SA) 15:1208, 1985
Bonagura, Herring & Welker: VCNA(SA) 2:311, 1985
Basics of Interpretation
Canine Measurement Scheme
• Measurement Standardization  that used for
humans:
Sahn DJ, DeMaria A, Kisslo J, et.al.: Circulation 58:1072-1083, 1978.
[M-mode Echocardiography]
Henery WL, DeMaria A, Gramiak R, et.al.: Circulation 62:212-217,
1980 [2-D Echocardiography]
– Leading edge method
– Systolic measurements  “nadir of septal motion”
– Diastolic measurements  “onset of the QRS
complex”
Boon J, Wingfild WE & Miller CW:
Echocardiographic Indices in the Normal Dog
Vet Radiol 24:214-221, 1983
Canine Measurement Scheme
Bonagura JD, O’Grady MR & Herring DS:
Echocardiography – Principles of Interpretation
Vet Clin North Am (SA) 15:1177-1194, 1985
Canine Dilatory Cardiomyopathy
Canine Dilatory Cardiomyopathy
Canine Dilatory Cardiomyopathy &
L Atrial Clot
Feline Hypertrophic Cardiomyopathy
Feline Hypertrophic Cardiomyopathy
Feline Dilatory Cardiomyopathy
Feline Dilatory Cardiomyopathy
Pericardial Infusion Bullet
Pericardial Infusion Bullet
Pericardial Fluid + Masses (clots)
Endocarditis (cow)
Heartbase Mass
Heartbase Mass
Mitral Endocardiosis
fD =
2v (cos
c
4-Chamber, Mitral Regurgitation
) fT
FLOW
2
High-resistance
Arterial Flow
Low-resistance
0
Doppler Principle
BASELINE
Respiratory/Cardiac Periodicity
2
Venous Flow
Long Axis, Mitral Regurgitation
Mitral Regurgitation
Endocarditis (aortic valve)
Aortic Stenosis
Valvular/Subvalvular
VSD (foal)
Sublumbar Lymphadenopathy
Invasive Retroperitoneal Mass