心脏超声术语及剖面图简介

Introduction to Digital Adult Echocardiography

Introduction / Definition of Terms

Introduction iii - ii

Abbreviations iii - iv

Definitions of terms iii - ix

Windows iii - xi

Introduction / Definition of Terms Introduction to Digital Adult Echocardiography Introduction

This guide is an introduction to transthoracic adult echocardiography for ultrasound

students, new sonographers, cardiovascular fellows, other physicians and health care

providers interested in echocardiography. It is meant as a beginner’s manual to help the

echocardiography student understand the basics of obtaining and interpreting images of

the adult heart. This guide will follow the digital image archiving protocol performed at

the University of Wisconsin Hospital and Clinics Adult echocardiography laboratory. It is

not meant to supplant the many excellent textbooks available on this subject.

The guide is set up as a step-by-step approach to performing complete evaluation of the

adult heart. An attempt will be made to keep to the basics. As each view is shown the

normal anatomy will be illustrated. The potential pitfalls and misdiagnoses will also be

outlined. As with all ultrasonography, the abnormal is frequently easy to differentiate

while the many variants of normal can present the greatest difficulty in interpretation. It

is hoped that this guide may assist in the development of the skills necessary to better

understand adult echocardiography.

At the University of Wisconsin Hospital and Clinics, the transthoracic echocardiogram

begins with entering patient data into the ultrasound machine, noting the indication for

the exam and obtaining a brief patient history. The echocardiographer is responsible for

obtaining and entering the following data:

1.Full name and sex.

2.Hospital number.

3.Height and weight (to calculate body surface area (BSA)).

4.Birthdate and age.

5.Referring physician and service/clinic.

6.Additional physician(s) that should receive a report.

7.Sonographer performing the study.

8.Activate the Digital Camtronics Image Archiving System. This is done by pushing

the left upper button on the Camtronics box attached to all machines on the left

hand side.

9.Recording systolic and diastolic blood pressure (echocardiographer is responsible

for taking blood pressure and recording on patient worksheet).

10.Recording heart rate on the patient worksheet after obtaining heart rate during

echocardiogram.

Introduction to Digital Adult Echocardiography Introduction / Definition of Terms Images obtained in the protocol are entered into the Camtronics Image Archiving

System as either cine clips or still frames. Still frames are used for display of scrolling

M-mode or Doppler data. Occasionally real-time scrolling data is recorded as

continuous data. Most 2-D information is in loops of 3-5 cycles; occasionally longer runs

are needed. Measurements done during the exam are captured as a frozen frame by

the Camtronics system as a still image.

For display of real-time 2-D or color Doppler images, cine loops of 3-5 beats are

recorded. This can be done manually using the Camtronics acquisition device. This

allows recording of the precise number of beats desired and gives full control over the

length of the loop, depending on pathology observed. For more routine imaging, a semi-

automatic ECG gated acquisition mode is recommended. This mode allows a

predetermined number of beats to be recorded with each loop initiated at the onset of

the QRS complex on the ECG monitor. The devise automatically stops recording after

the programmed number of beats is obtained. We recommend this recording mode for

most exams. It is the most memory-efficient and also increases the uniformity of the

study.

The single frame mode is best used in conjunction with the echo system’s cine loop

system. We display all 2-D measurements as a single frame. Similarly, we use the echo

system cine loop to acquire scrolling M-mode and Doppler data. We then select the best

single frame example, measure it, and record the tracing with measurement as a single

frame.

Introduction / Definition of Terms Introduction to Digital Adult Echocardiography Abbreviations

The following abbreviations will be used for the remainder of this text

Abbreviation Definition

2-D Two dimensional imaging

3-D Three dimensional imaging

A-Mode Amplitude mode

A Atrial diastolic velocity peak

A Area (seen in mathematical formulas)

APEX 2C Apical two chamber view

APEX 3C Apical three chamber view (also known as Apical Long axis)

APEX 4C Apical four chamber view

APEX 5C Apical five chamber view

AcT Acceleration time

AF Atrial fibrillation

AMVL Anterior mitral valve leaflet

Ant Anterior

Ao Aorta

AI Aortic insufficiency

AS Aortic stenosis

Asc Ascending

ASD Atrial septal defect

ASH Asymmetrical septal hypertrophy

ATVL Anterior tricuspid valve leaflet

AV Aortic valve

AVA Aortic valve area

AVR Aortic valve replacement

BAV Balloon aortic valvuloplasty

BP Blood pressure

BSA Body surface area

c propagation spee

d of sound in tissue

CAD Coronary artery disease

cath Cardiac catheterization

CBV Catheter balloon valvuloplasty

Ch Chordae

cm Centimeter

cm/s Centimeter per second

CO Cardiac output

Introduction to Digital Adult Echocardiography Introduction / Definition of Terms

Abbreviation Definition

Cont eq Continuity equation

cos Cosine

CS Coronary sinus

CSA Cross sectional area

Cx circumflex coronary artery

D Diameter

DA Descending aorta

dB Decibel

dP/dt Rate of change in pressure over time

E Energy

ECG Electrocardiogram

ED End-diastole

EDD End-diastolic dimension

EDV End-diastolic volume

EF Ejection fraction

epi epicardium

EPSS E-point of septal separation

ES End-systole

ESD End-systolic dimension

ESPVR End-systolic pressure-volume relationship

ESV End-systolic volume

ETT Exercise treadmill test

??Frequency shift

?Frequency

FL False lumen

Fn near zone

Fo resonance frequency (operating frequency)

Fs scattered frequency

FSV forward stroke volume

Ft transmitted frequency

Fx function

HCM hypertrophic cardiomyopathy

HPRF High pulse repetition frequency

HR Heart rate

HV Hepatic vein

I Intensity

Introduction / Definition of Terms Introduction to Digital Adult Echocardiography

Abbreviation Definition

IAS Interatrial septum

inf inferior

IV intravenous

IVC Inferior vena cava

IVCT Isovolumic contraction time

IVRT Isovolumic relaxation time

kHz Kilohertz

L Length

LA Left atrium

LAA Left atrial appendage

LAD Left anterior descending coronary artery

LAE Left atrial enlargement

LAO Left anterior oblique

lat Lateral

LAXX Parasternal long axis

LCC Left coronary cusp

LLD Left lateral decubitus

LMCA Left main coronary artery

LPA Left pulmonary artery

LSPV left superior pulmonary vein

LV Left ventricle

LVEDD Left ventricular end diastolic dimension

LV-EDP Left ventricular end diastolic pressure

LVESD Left ventricular end systolic dimension

LVH Left ventricular hypertrophy

LVI Left ventricular inflow

LVO Left ventricular outflow

LVOT Left ventricular outflow tract

M-mode Motion mode

MAC Mitral annular calcification

MB Moderator band

MI Myocardial infarction

MS Mitral stenosis

MV Mitral valve

MVA Mitral valve area

MVI Mitral valve insufficiency

Introduction to Digital Adult Echocardiography Introduction / Definition of Terms

Abbreviation Definition

Myx myxoma

NCC Noncoronary cusp

?P change in pressure

P Pressure

PA Pulmonary artery

pAn Pseudoaneurysm

PAP Pulmonary artery pressure

PD Pulsed Doppler

PDA Patent ductus arteriosis

PE Pericardial effusion

PEP Pre-ejection period

PISA Proximal isovelocity surface area

PM papillary muscle

PMVL Posterior mitral valve leaflet

post posterior

PI Pulmonary insufficiency

PRF Pulse repetition frequency

PRFR Peak rapid filling time

PS Pulmonary stenosis

PV Pulmonic valve

PTCA Percutaneous transluminal coronary angioplasty

PV Pulmonary vein

PVC Premature ventricular contraction

PWT Posterior wall thickness

Q Volume flow rate

Qp Pulmonic volume flow rate

Qs Systemic volume flow rate

r ventricular radius or correlation coefficient (depends upon

the context)

RA Right atrium

RAE Right atrial enlargement

RAO Right anterior oblique

RAP Right atrial pressure

RCA Right coronary artery

RCC Right coronary cusp

RF Regurgitant fraction

RJ Regurgitant jet

Introduction / Definition of Terms Introduction to Digital Adult Echocardiography

Abbreviation Definition

ROA Regurgitant orifice area

RPA Right pulmonary artery

RSPV Right superior pulmonary vein

RSV Regurgitant stroke volume

RV Right ventricle

RVE Right ventricular enlargement

RVH Right ventricular hypertrophy

RVI Right ventricular inflow

RVO Right ventricular outflow

RVOT Right ventricular outflow tract

SAM Systolic anterior motion

SAXX Parasternal short axis

SC Subcostal

SSN Suprasternal notch

ST Septal thickness

STJ Sinotubular junction

STVL Septal tricuspid valve leaflet

SV Stroke volume

SVC Superior vena cava

SWMA Segmental wall motion abnormality

T1/2Pressure half-time

T Thrombus

TEE Transesophageal echocardiography

TGA Transposition of the great arteries

TGC Time gain compensation

TI Tricuspid valve insufficiency

TL True lumen

TOF Tetralogy of Fallot

TPV Time to peak velocity

TS Tricuspid stenosis

TSV Total stroke volume

TTE Transthoracic echocardiography

TV Tricuspid valve

v Velocity

V Volume

Veg Vegetation

Introduction to Digital Adult Echocardiography Introduction / Definition of Terms

Abbreviation Definition

Vmax Maximum velocity

VSD Ventricular septal defect

VTI Velocity time integral

Z Acoustic impedance

Definitions of terms

Throughout the text we will use the following definitions for the terms that describe

movement:

?Angling

?Rotating

?Tilting

Angling

Refers to holding the transducer in the same position on the patient and changing the

angle of the transducer up or down, staying within the same axis plane in which you are

imaging (Figure 1 Angling).

Figure 1 Angling

Introduction / Definition of Terms Introduction to Digital Adult Echocardiography

Rotating

Refers to holding the transducer in the same position on the patient and turning the

orientation index marker clockwise or counterclockwise (another way to describe this

motion would be to pivot) (Figure 2 Rotating).

Figure 2 Rotating

Tilting

Refers to holding the transducer in one position and rocking one end of it up or down,

allowing the echocardiographer to cut the heart in a series of radial planes (Figure 3

Tilting).

Figure 3 Tilting

Introduction to Digital Adult Echocardiography Introduction / Definition of Terms Windows

The following windows will be used throughout this text:

?Parasternal Long Axis (abbreviated LAXX)

The window used to obtain long axis images of the heart is located along the left

sternal border. The parasternal long axis view images the heart along its longitudinal

axis. The patient is positioned in the left lateral decubitus position and the

transducer is placed in the left third or fourth intercostal space adjacent to the

sternum. The transducer orientation marker is directed towards the patient’s right

shoulder (see Figure 4).

Figure 4 IIllustration of the anatomy demonstrated in the parasternal long axis.

Introduction / Definition of Terms Introduction to Digital Adult Echocardiography

?Parasternal Short Axis (abbreviated SAXX)

The parasternal short axis views are obtained by rotating the transducer orientation

mark towards the patient’s left shoulder, (90 degrees clockwise from the LAXX

view). This window allows one to obtain images of the heart in cross section. By

changing rib interspaces or angling the transducer superiorly or inferiorly with the

orientation marker staying in the same place, one can demonstrate the heart in

short axis at different levels. For example, a superior plane in the SAXX view will

demonstrate the great vessels, an inferior view in the SAXX will demonstrate the LV

apex (Figure 5 a + b).

a b

Figure 5 a + b Illustrations of the anatomy demonstrated in the short-axis views -

parasternal short axis (a) and subcostal short axis (b).

Introduction to Digital Adult Echocardiography Introduction / Definition of Terms

?Apical (abbreviated APEX)

To best utilize this window, the patient is positioned in a steep left lateral decubitus

(LLD) position. The echocardiographer should palpate for the apical pulse which will

usually be found below and sometimes lateral to the left breast tissue. The

orientation marker is directed towards the patients left side at approximately the 4

o’clock or 5 o’clock position to demonstrate the four chambers of the heart. To obtain

the best apical image possible, special echocardiography beds with cut-out portions

are recommended. These special beds have a portion that drops out, allowing easy

access to the lateral aspect of the patient’s body without moving them out of the LLD

position. This may better allow you to evaluate the apex of the heart (Figure 6).

Figure 6 IIllustration of the anatomy demonstrated in the apical four-chamber view.

Introduction / Definition of Terms Introduction to Digital Adult Echocardiography

?Subcostal (abbreviated SC)

The patient is positioned supine when obtaining images of the heart from this

window. The legs are bent at the knees and the feet are placed flat on the table. By

bending the patient’s knees, the stomach muscles relax more allowing for easier

image acquisition. The transducer is placed just inferior to the sternum and the

orientation marker is directed towards the 3 o’clock position or the patient’s left side.

The patient may need to take a deep breath in for you to see the heart, or you may

need to move the transducer more inferior and to the right and angle up through the

left lobe of the liver to demonstrate the best image of the heart. The four chamber

view obtained from this position best demonstrates the atrial septum (Figure 7).

Figure 7 Illustration of the anatomy demonstrated in the subcostal four-chamber view

of the heart.

Introduction to Digital Adult Echocardiography Introduction / Definition of Terms

?Suprasternal Notch (abbreviated SSN)

The patient is again positioned supine and now has the neck extended to utilize this

window. This window is located just superior to the superior border of the sternum.

This window is used to obtain images of the aortic arch (Figure 8).

Figure 8 Illustration of the anatomy demonstrated in the suprasternal notch view.

Introduction / Definition of Terms Introduction to Digital Adult Echocardiography

?Right Parasternal (abbreviated RPS)

This view is primarily used with the pedof transducer to obtain ascending aorta

Doppler velocities. The patient is rolled into a right lateral decubitus position and

may even need to be rolled further into a RAO position to obtain the maximum

Doppler signal and velocity measurement. The pedof probe is placed next to the

sternum and between the third rib interspace. This position is the best for recording

the ascending aorta velocity because it places the transducer at the best angle to

sample flow in the ascending aorta and is the closest window to the aortic valve.

Figure 9 Diagram indicating the nomenclature to describe the locations on the body

from which echocardiographic studies can be obtained.