Basic Concepts in Doppler Echocardiography: Methods of clinical applications based on a multi-modality Doppler approach

253 Pages·1987·14.473 MB·English

by  James V. Chapman (auth.), J. V. Chapman, A. Sgalambro (eds.)

I
BASIC CONCEPTS IN DOPPLER ECHOCARDIOGRAPHY
DEVELOPMENTS IN
CARDIOVASCULAR MEDICINE
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BASIC CONCEPTS IN DOPPLER
ECHOCARDIOGRAPHY
Methods of clinical applications
based on a multi-modality
Doppler approach
edited by
J.V. CHAPMAN
SonotronlDiasonics, Rotterdam, The Netherlands, and Department oj
Ultrasonology, University Medical Center, Henri Mondor, Paris, France
A. SGALAMBRO
Department oj Non-Invasive Cardiology,
Civic Hospital oj Codogno, Milano, Italy
1988 MARTINUS NIJHOFF PUBLISHERS 1Ir...
lIiII
a member of the KLUWER ACADEMIC PUBLISHERS GROUP
DORDRECHT I BOSTON I LANCASTER •
Distributors
jor the United States and Canada: Kluwer Academic Publishers, P.O. Box 358,
Accord Station, Hingham, MA 02018-0358, USA
jor the UK and Ireland: Kluwer Academic Publishers, MTP Press Limited,
Falcon House, Queen Square, Lancaster LA 1 1R N, UK
jor all other countries: Kluwer Academic Publishers Group, Distribution Center,
P.O. Box 322, 3300 AH Dordrecht, The Netherlands
Library of Congress Cataloging in Publication Data
Basic concepts in Doppler echocardiography.
(Developments in cardiovascular medicine)
Includes index.
1. Doppler echocardiography. I. Chapman, J.V.
n. 5galambro, A. Ill. Series. [DNLM: 1. Echocardi
ography--methods. WI DE997VME / WG l4l.5.E2 B306]
RC683.5.U5B36 1987 616.1'207543 87-20423
ISBN-13: 978-94-010-7995-2 e-ISBN-13: 978-94-009-3329-3
001: 10.1007/978-94-009-3329-3
Copyright
© 1987 by Martinus Nijhoff Publishers, Dordrecht. Reprinted 1988.
Softcover reprint of the hardcover 1s t edition 1988
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, mechanical,
..
photocopying, recording, or otherwise, without the prior written permission of
the publishers,
Martinus Nijhoff Publishers, P.O. Box 163, 3300 AD Dordrecht,
The Netherlands.
PREFACE
Basic Concepts in Doppler Echocardiography
The objective of this textbook is to offer a detailed yet concise overview of the various
applications of Doppler echocardiography. The fundamental principles of pulsed mode,
continuous mode, and color flow mapping are fully explained as well as the clinical
applications of each modality in the evaluation of various cardiac pathologies. A copious
amount of figures and illustrations is included so that the reader is able to follow the
discussions in the text by referring to the appropriate case studies. The emphasis of this
book is focused upon the practical Doppler examination. The sections on theoretical
considerations are therefore brief but comprehensive, while the didactic sections concentrate
upon how to perform and interpret the clinical examination. The instrumentation of the
Doppler system is also discussed so that the physician or technologist can acquire a basic
understanding of how the Doppler system actually functions.
CONTRmUTORS
Bjorn AJ.Angelsen Dr.Tech.
Professor of Biomedical Engineering
University of Trondheim
Trondheim , Norway
Phillip Brun M.D.
Director of Research
Department of illtrasonology
University Medical Center, Henri Mondor
Paris , France
Albert Meguira M.Sc.
Biomedical Engineer
Sonotron / Diasonics
Paris , France
and the
Department of illtrasonology
University Medical Center, Henri Mondor
Paris , France
Andreas Strauss M.D.
Department of illtrasonology
University Medical Center, Henri Mondor
Paris France
Sandra Yanushka B.Sc.
Clinical Specialist
Clinical Applications Department
Sonotron / Diasonics
Rotterdam, The Netherlands
ACKNOWLEDGMENTS
We are indebted to several persons who offered their time and expertise, making this book
possible. The implementation of Doppler ultrasound encompasses many disciplines, and these
people represent a great storehouse of technical and clinical knowledge. We would like to extend
our thanks to Terje Skjaerpe M.D. , University of Trondheim, for his contribution in the
sections on aortic valve area and right ventricular pressures. David T. Linker M.D. , also from
the University of Trondheim , was a constant source of clinical and technical insight, especially in
the area of pediatric Doppler echocardiography . Part of this book was based on an instruction
manual prepared with Ben Delemarre M.D. from the Academic Medical Center, Amsterdam.
And finally we would like to thank Kjell Kristoffersen Dr.Tech. ,head of research and
development for Vingmed Inc.,Norway, whose ability to explain technically difficult issues was
always appreciated.
I would like to acknowledge that case studies and clinical
data where obtained at the following institutions:
Department of Ultrasound
C.H.U. Henri Mondor
University of Paris,
France
Department of Cardiology
Civic Hospital of Codogno, Milano,
Italy
Section of Cardiology Regional Hospital and
Institution of Biomeaical Engineering
University of Trondheim,
Norway
Department of Cardiology
Academic Hospital Leiden,
The Netherlands
Department of Cardiology
Academic Medical Center Amsterdam,
The Netherlands
CONTENTS
CHAPTER 1 • BASIC PRINCIPLES ................................................. 1
Sound Wave Propagation .............................................................................. 1
The Ultrasound Beam .................................................................................. 4
The Doppler Effect. ..................................................................................... 6
Pulsed Doppler .......................................................................................... 8
High Pulse Repetition Mode ......................................................................... 12
Continuous Wave Doppler. .......................................................................... 14
Color Flow Mapping .................................................................................. 19
CHAPTER 2 • ON THE DESIGN OF A COLOR FLOW
IMAGING SYSTEM ......................................................................... 30
Technical Problems with Color Flow Imaging .................................................... 30
Scan methods .......................................................................................... 31
Phased Annular Array ................................................................................ 36
CHAPTER 3 • INTRACARDIAC FLOW DYNAMICS .................... 37
Entrance Flow ......................................................................................... 38
Pulsatile Flow ........................................................................................ 40
Turbulant Flow ........................................................................................ 41
Cardiac Output Measurement. ....................................................................... 45
CHAPTER 4 • THE NORMAL EXAMINATION ............................. 56
The Imaging Windows ............................................................................... 56
Characteristics of Normal Intracardiac Flows ...................................................... 66
CHAPTER 5 • APPLICATIONS IN ACQUIRED
HEART DISEASE ............................................................................. 83
Determination of the Pressure Gradient. ............................................................. 83
Aortic Stenosis ......................................................................................... 85
Mitral Stenosis ......................................................................................... 97
Tricuspid Stenosis ................................................................................... 111
Pulmonary Stenosis ................................................................................. 112
Aortic Insufficiency .................................................................................. 116
Mitral Insufficiency .................................................................................. 136
Pulmonary Insufficiency ............................................................................ 148
Tricuspid Regurgitation ............................................................................. 155
Prosthetic Valves ..................................................................................... 170
Obst ructive Cardiomyopathy ........................................................................ 190
Dilated Cardiomyopathy ............................................................................ 195
CHAPTER 6 • DOPPLER ULTRASOUND IN
CONGENITAL HEART DISEASE ................................................ 203
The Pulmonary to Systemic Flow Ratio .......................................................... 203
Ventricular Septal Defect. ........................................................................... 206
Atrial Septal Defect .................................................................................. 209
Patent Ductus Arteriosus ......................................................................... , .. 212
Estimation of Systolic Pulmonary Artery Pressure .............................................. 222
Obstructive Lesions ................................................................................. 228
IND EX ............................................................................................ 244
CHAPTER 1
BASIC PRINCIPLES
James V. Chapman
Ultrasound is a term used to describe acoustic waves of higher frequency
than audible sound. The best known traditional a~plication of ultrasound in
cardiology is two-dimensional echocardiography. fn this modality, reflected
sound from tissue interfaces is used to construct an image of the cardiac
structures under investigation. Doppler ultrasound uses the backscattered
signals from moving red blood cells to measure blood flow velocity.
The use of Doppler ultrasound to measure flow velocity began at
~proximately the same time as the use of ultrasound for diagnostic imaging.
Continuous wave Doppler instruments were initially used for the qualitative
assessment of peripheral vascular blood flow. Pulsed Doppler instruments
were later developed in order to study flow in a localized region. These
devices were employed in the study of intra-cardiac blood flow, SInce flow in a
specific chamber or vessel could be investigated.
This introductory chapter will explain the basic principles of pulsed and
continuous wave Do~pler ultrasound. A brief review of ultrasound physics
and terminology is arso included. Several ultrasound terms may De used
interchangeably in the current medica1literature, and a common vocabulary is
establisheo in this chapter in order to avoid ambiguity.
Sound Wave Propagation
In the Doppler ultrasound examination, a piezoelectric crystal is used to
transmit and receive the acoustic signal as in imaging modalities. The
piezoelectric crystal is said to function as a transducer, because it converts
variations of one quantity to those of another quantity. For imaging
applications, the piezoelectric crystal or element converts the electrical energy
of a sinusoidal waveform to mechanical energy, and vice versa. The crystarI S
composed of a synthetic mixture of lead titanate and lead zirconate. In
response ~o an applie~ voltage, the c.rystal is rapidly de.formed. Suc~ rapid
deformatIOn results In the productIOn of an alternatIng pressure In the
surrounding medium which propagates as a sound wave.
Fig. 1-1. Wavelength. The wavelength is defined as the length of space over which
consecutive pressure maxima or pressure minima occur.
1
Fig. 1-2. Specular reflection (A) occurs when the wavelength is small in comparison with
the boundry surface. Backscattering occurs when the reflector area is small in comparison
with the ultrasonic wave length.
,-(-------.....I) )))
Fig. 1-3 The Doppler shift.
Fig. 1- 4. Effect of angle correction. A represents the true peak velocity recorded in the
ascending aorta; B demonstrates the introduced error in the estimation of the flow velocity by
overestimation of the beam-to-flow angle.
2