Download Click here for handout

11/19/2009
Advances in Cardiac Imaging
Grand Round
Department of Internal Medicine
Division of Cardiology
Lucien Abboud , MD
December 1st 2009
Case 1
Pseudoaneurysm of
Saphenous Venous Grafts
1
11/19/2009
2
11/19/2009
Case 2
Thrombus In Transit
SYSTOLE
RV
TV
RA
3
11/19/2009
DIASTOLE
IVC
TRICUSPID REGURGITATION JET
4
11/19/2009
Complex architecture
AIUM “ American Institute of Ultrasound in Medicine”
5
11/19/2009
50 years Later
Successful Imaging modalities
• Accurate Diagnosis
• Ability to assess flow and
hemodynamic variables
• Ability of risk
stratification.
• Provide clinical outcome
and prognostic data.
• Safe and Cost effective.
Piezoelectric Crystals
• The origins of medical
diagnostic ultrasound and
echocardiography date back
to the discovery of
piezoelectricity in 1880 by
Pierre and Jacques Curie
• A piezoelectric disk generates
electricity when deformed.
6
11/19/2009
Sergei Y. Sokolov
Father Of Ultrasound Technology
1928 : at the Electrotechnical
Institute of Leningrad, he used
Ultrasound technology used for
the development of Sonar.
Flaw detection devices 1942
• Floyd Firestone at the
University of Michigan
received a patent for a similar
device in 1942 for the
detection of flaws in
industrial metals.
Floyd A. Firestone
1953
Cardiologist Inge Edler
7
11/19/2009
Ultrasound
cardiography (or UCG)
Inge Edler
Hellmuth Hertz
with their first
Siemens
machine .
The picture above: The very first
recording of the ultrasound echo
from the heart.
Inge Edler and Hellmuth Hertz
presenting the poster on the
1977 symposium on
Echocardiography in the
University Hospital in Lund.
8
11/19/2009
"Father of Echocardiography"
quantitative assessment of left-ventricular dimensions.
Why named Echocardiography ?
•
UCG Ultrasound Cardiography.
•
Then Dr. Feigenbaum borrowed the
Ultrasonogram from the neurology
department ( Echoencephalography) and
started acquiring images of the heart, so
he called this modality Echocardiography.
9
11/19/2009
Early 1980’s
Higher Frequency
better Image resolution
Phased array transducer
Real Time 2D Echocardiography
1976
10
11/19/2009
Christian Andreas Doppler
(1803 - 1853)
11
11/19/2009
Daniel Bernoulli
1700-1782
• Change in pressure across a
small orifice is proportional
to the square of the velocity
of the fluid flowing through
the orifice
12
11/19/2009
LIV HATLE MD
13
11/19/2009
3D echocardiography
• Better assessment of Ejection fraction.
• More accurate Cardiac chamber
quantification.
• Overcome the Foreshortening of the Left
ventricle in the conventional 2D
echocardiography.
• Better assessment of Valvular heart disease.
14
11/19/2009
Real Time 3D and 4D
echocardiography
15
11/19/2009
16
11/19/2009
1816
Rene--Theophile
Rene
Theophile--Hyacinthe Laennec
1967
David Littmann
2009
Cardiac CT
angiography
17
11/19/2009
J Am Coll Cardiol 2006;48:1896–1910
Beyond CAD
Assessment of LV systolic function
Calcium score assessment
Anomalous coronary arteries
Post-CABG
Pulmonary veins anatomy prior to EP ablation
therapy.
• Aortic Dissection
• LV thrombus and other cardiac masses evaluation.
• Pericardial disease
•
•
•
•
•
Assessment of LV systolic function
18
11/19/2009
Calcium Scoring
Pulmonary Vein anatomy
19
11/19/2009
The Future of Cardiac imaging
Widely Available ( Cardiac CT , Cardiac MR, 3D echo) .
Easy and fast acquisition
Safety , less radiation/contrast exposure.
Digital data can be accessed from any secured
internet access.
• Much easier way of comparison with previous
studies.
• Improve electronic medical records
• Early diagnosis of disease => major role in preventive
medicine.
•
•
•
•
Future Cardiac Imaging Lab
Thank you
Questions ?
20