Ch 10 Apical CD Flashcards
From a physics perspective, any area of flow disruption results in what?
Turbulence
Are small amounts of aliasing normal in certain scenarios?
Yes, due to the inherent nature of hemodynamics
(valves cause small areas of turbulence + aliasing which is normal)
Is off axis imaging allowed when evaluating pathology as the primary goal?
Yes b/c we are trying to visualize the entirety of the anomaly
Where should we put our CD box when imaging the AP4 MV?
-Place over entire LA + at least half of the LV
-MV in center of box
What color is flow in AP4?
Red - b/c it is going towards the probe during diastole
Is RV + LV inflow biphasic?
Yes:
-early diastolic wave (80%)
-late diastolic wave (20%)
What would regurgitation + stenosis look like with CD in AP4?
Regurg: blue/mosaic flow into atria during systole
Stenosis: red/mosaic flow into ventricles during diastole
What 3 things other than regurg + stenosis should we watch for within the CD box while in AP4?
-IAS (ASD/PFO)
-IVS (VSD)
-Abnormal pulmonary vein flow (from LA)
What pathology could cause pulmonary vein reversal?
MV regurgitation
If we had seen a VSD in PLAX or PSAX, what additional image should we take in AP4? How would it be affected by angulation?
-Expand our CD box over the IVS in AP4
-Must make IVS parallel to flow by angling out heart over more in order to best assess the VSD
How can we achieve the AP4 pulmonary vein view with CD?
-Increase depth + set box over LA + beyond
-Slight angulation of probe to help bring in PV
-Manipulate CD gains + lower scale to visualize PV blood flow
-RUPV m/c assessed
How would the CD flow look with AP4 pulmonary vein?
Red antegrade flow
(abnormal if large amount of blue flow or mosaic colors)
Which pulmonary vein is m/c assessed in AP4?
Right upper pulmonary vein (RUPV)
Where should we put our CD box when imaging the AP4 TV?
-Place over entire RA + at least half of RV
-TV in middle of box
Why would we change our CD scale + shift the baseline to have a different value on the top + bottom of scale?
To show aliasing + regurgitation better when evaluating pathology
Where do we put our CD box in AP5?
-Over the SoV to encompass the AoV, LVOT + as much LV as possible
-SoV is m/c in bottom left corner of box
What color is flow in AP5?
Retrograde blue flow + some aliasing near the AoV
List 3 reasons why some aliasing occurs in AP5?
-Caused by higher velocities
-Mostly parallel angle
-Presence of the AoV
(remember small amounts are normal)
List pathology that can be seen within the LVOT in AP5?
-AoV regurg is visible in LVOT
-Aliasing above the AoV, into the LVOT + LV itself can indicate obstructive pathophysiology
-2D can show a thick IVS near LVOT, a membrane, or the AMVL obstructing the area of aliasing in CD
What would it look like in color if a thrombus was seen in the LV apex?
-May see aliasing + reversal of flow
-Will see filling defect (no color filling around thrombus)
How would regurg + stenosis of the AoV appear on CD in AP5?
Regurg: red/mosaic flow into LV during diastole
Stenosis: blue/mosaic flow through AoV during systole
What 4 things other than AoV regurg + stenosis should we watch for within the CD box while in AP5?
-Ao dissection
-IAS (ASD/PFO)
-IVS (VSD, m/c perimembranous)
-MV regurg
Where should be put our box when in AP2?
-Place over entire LA + at least half of LV
-MV in middle of box
What color is flow in AP2?
Red
If we already evaluated the MV with color in AP4, why are we checking it again in AP2?
B/c we are very parallel to flow in AP2, stuff can jump out here + ensures we do not miss anything
How would regurg + stenosis look in AP2?
Regurg: blue/mosaic flow into LA during systole
Stenosis: red/mosaic flow into LV during diastole
Where should we place CD box in AP3 focusing on MV?
-Place box over entire LA + at least half of LV
-MV in middle of box
What color is flow in AP3 when box is over MV?
Red
How would regurg + stenosis look in AP3 when box is over MV?
Regurg: blue/mosaic flow into LA during systole
Stenosis: red/mosaic flow into LV during diastole
Where should we place CD box in AP3 focusing on AoV?
-Place over SoV to encompass the AoV, LVOT + as much LV as possible
-SoV m/c in bottom right corner of box
What color is flow in AP3 when box is over AoV?
Blue, some aliasing may occur close to AoV
(small amount of aliasing due to higher velocities, mostly parallel angle + presence of AoV)
Why is AP3 potentially an excellent view for assessing AS/AR/MS/MR/LVOTO?
B/c we are parallel to flow in this view
What color would AoV regurg + stenosis be in AP3?
Regurg: red/mosaic flow into LV during diastole
Stenosis: blue/mosaic flow through AoV during systole
What 4 things other than AoV regurg + stenosis should we watch for within the CD box while in AP3?
-LVOTO (LVOT obstructions)
-Ao dissection
-IVS (VSD)
-MV regurg
What is the most important factor when using CD to ensure accuracy of measurements?
Our alignment of the u/s beam to blood flow
How can we help align our u/s beam for CD?
-By tilting + rotating
-Trying multiple views, including off axis imaging
If we see something, should we alter our protocol to investigate further?
Yes! Bigger CD boxes often allow us to “catch” pathology we weren’t targeting
