Final Feigenbaum’s Echocardiography DIGITAL

Feigenbaum’s Echocardiography

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Feigenbaum’s Echocardiography

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FIGURE 5.4. Doppler tissue imaging of the lateral annulus performed in two patients. The upper panel was recorded in a patient with normal systolic function and an ejection fraction of 60%. Notice the S wave of 9 cm/s. Also noted are the diastolic e ′ and a ′ velocities. The lower panel was recorded in a patient with a dilated cardiomyopathy and ejection fraction of 27%. Notice the annular systolic velocity of 4 cm/s consistent with reduced global function. annular velocity (Fig. 5.4). In a uniformly contracting ventricle, annular systolic velocity is a marker of global le ventricular func- tion. Annular velocity data also play a major role in assessment of diastolic function, as discussed in Chapter 6. Indirect M-Mode Markers of Left Ventricular Function Several indirect signs of le ventricular systolic dysfunction can be noted on M-mode echocardiography. ese include an increased

FIGURE 5.3. Apical view recorded in two patients demonstrates the measurement of the descent of the base with M-mode echocardiography. The M-mode interrogation beam has been directed from the apex of the heart through the lateral annulus. A: Note the approximate 1.6 cm of annular motion toward the apex in systole. B: Recording in a patient with severe systolic dysfunction reveals substantially decreased annular motion of < 1.0 cm in systole. is technique is rarely used today, having given way to direct measures of ventricular volume and ejection fraction. is same principle is used in Doppler tissue imaging of the annulus for determination of systolic velocities and excursion of the mitral annulus as a marker of ventricular function. Doppler tissue imaging relies on adjustment of Doppler gains and lters to selec- tively record velocities from within the myocardium itself rather than the blood pool. A sample volume can be placed within the mitral annulus and quantitative information extracted regarding annular excursion and global systolic function.

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FIGURE 5.5. M-mode echocardiograms recorded in two patients with significant systolic dysfunction. A: An E-point septal separation (EPSS) of 1.2 cm (normal, < 6 mm). B: Recording in a patient with more significant left ventricular systolic dysfunction in which the EPSS is 3.0 cm. Also note the interrupted closure of the mitral valve with a B bump (top), indicating an increase in the left ventricular end-diastolic pressure.

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