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ESC Textbook of Cardiovascular Imaging - sample

Discover the ESC Textbook of Cardiovascular Imaging 2nd edition

standardized data

standardized data acquisition in transthoracic echocardiography 15 Fig. 1.15 Standardized grey-scale apical 2-chamber view during systole (a) and diastole (b), as well as the corresponding colour-coded images during systole (c) and diastole (d). Additional comments in the text. and inter-atrial septum, the cardiac crux, the septal and the anterior leaflet of the tricuspid valve, the inflow tract of the right ventricle, the free right ventricular wall and the left and right atrium. It is essential that the origin of the anterior mitral leaflet and the septal leaflet of the tricuspid valve is almost at the same point near the cardiac crux. The standardized 4-chamber view does not show parts of the left ventricular outflow tract or the longitudinal sectional plane of the coronary sinus. The apical 4-chamber view is used for visual assessment of global and regional left ventricular function in the inferoseptal and lateral regions of the left ventricular wall and for the morphological evaluation of the central mitral valve. Using the 2- and 4-chamber views, quantitative assessment of left ventricular function is performed by left ventricular volume analysis and determination of left ventricular ejection fraction using the Simpson’s rule. It is recommended to check the

16 chapter 1 conventional echocardiography—basic principles Fig. 1.16 Standardized grey-scale apical 4-chamber view during systole (a) and diastole (b), as well as the corresponding colour-coded images during systole (c) and diastole (d). Additional comments in the text. longitudinal length of the ventricle at end-diastole in both views before starting planimetry. If, for example, the longitudinal length of the 4-chamber view is more shortened than 10 mm in comparison to the 2-chamber view, it is obvious that the 4-chamber view has to be foreshortened. The colour-coded 4-chamber view ( Fig. 1.16c–d) is necessary for characterization of the defect localization in mitral valve regurgitation and for semiquantification of the tricuspid valve regurgitation by its vena contracta ( Fig. 1.17a–c; Fig. 1.17d–f). For complete semiquantification of tricuspid valve regurgitation its vena contracta has to be additionally measured in the apical right ventricular inflow tract view derived by tilting the apical long- axis view to the medial regions ( Fig. 1.17g–i). In the presence of turbulences at the tricuspid valve, the continuous wave Doppler spectra over the tricuspid valve have to be documented. The continuous wave Doppler spectrum over the tricuspid valve is necessary for estimating the right ventricular systolic pressure according to the simplified Bernoulli equation, which corresponds to the systolic pulmonary pressure if no pulmonary stenosis is present. Furthermore, the maximum velocity of tricuspid valve regurgitation is necessary for estimation of the pulmonary valvular resistance. The 4-chamber view is also used for the acquisition of the pulsed tissue Doppler spectra for the calculation of E/E′. The sample volume is positioned at the basal inferoseptal and lateral myocardium near the mitral annulus ( Fig. 1.18a–d). E′ for calculation of the E/E′- ratio is the mean E′ of both values determined at the basal inferoseptal and lateral left ventricular wall. The 4-chamber view is also used

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