Discover the ESC Textbook of Cardiovascular Imaging 2nd edition
standardized data acquisition in transthoracic echocardiography 17 Fig. 1.17 The colour-coded 4-chamber view for qualitative and semiquantitative analysis of tricuspid valve regurgitation during systole (a) and diastole (b). The continuous wave Doppler spectrum of tricuspid valve regurgitation is given in (c). For semiquantification of moderate and severe tricuspid valve regurgitation two views are necessary. In an example of a combined tricuspid valve disease the colour-coded 4-chamber view is displayed during systole (d) and diastole (e), as well as the view of the right ventricular inflow tract by medial tilting from the apical long-axis view during systole (g) and diastole (h). In both views the vena contracta of a tricuspid valve regurgitation has to be determined for semiquantification during systole. The corresponding continuous wave Doppler spectra of the tricuspid valve regurgitation are given in (f) and (i). Additional comments in the text. for grey scale and colour-coded imaging of the upper right pulmonary vein for documentation of the pulsed wave Doppler spectrum of the pulmonary vein flow for analysis of diastolic function. The sample volume has to be positioned into the left atrium 10–15 mm ahead of the entry of the pulmonary vein. The pulsed wave Doppler spectrum has to be acquired in low pulse repetition frequency mode to prevent overlapping of the signals of the flow through the mitral valve and the signals of the pulmonary vein ( Fig. 1.19a–e). For the documentation of the anterolateral and posteromedial commissure of the mitral valve, two further oblique views of the apical 4-chamber view have to be adjusted ( Fig. 1.20). The documentation of the P3/A3 scallops of the mitral valve (= posteromedial commissure) is performed by tilting the transducer to the dorsal region of the left ventricle, which will show the dorsal mitral annulus with the target structure of a longitudinal section of the coronary sinus ( Fig. 1.20a–d). The documentation of the P1/A1 scallops of the mitral valve (= anterolateral commissure) is possible by tilting the transducer to the ventral region of the left ventricle, which will show the 5-chamber view ( Fig. 1.20e–h). In the 5-chamber view the left ventricular outflow tract and parts of the aortic valve are visualized. The 5-chamber view is an oblique view through the left ventricle, which shows the anteroseptal and anterolateral basal segments of the left ventricular wall and the inferoseptal and lateral apical segments of the left ventricle. The target structure of the 5-chamber view is the left ventricular outflow tract. Both views should also be documented using colour-coded Doppler to analyse the localization of mitral valve regurgitation. Subcostal and suprasternal scanning should be performed with the patient in strict supine position. Subcostal scanning should start with the subcostal 4-chamber view, which is easily adjusted by holding the transducer with the
18 chapter 1 conventional echocardiography—basic principles Fig. 1.18 Illustration of a colour-coded tissue Doppler 4-chamber view during systole (a) and diastole (b) and the corresponding tissue pulsed wave Doppler spectra at the basal septal (c) and lateral (d) myocardium near the mitral annulus. Additional comments in the text. Fig. 1.19 Illustration of a deep grey scale 4-chamber view during systole (a) and diastole (b) and the corresponding colour-coded 4-chamber view during systole (c) and diastole (d). The pulsed wave Doppler spectrum of the flow in the right upper pulmonary vein is displayed in (e). Additional comments in the text.