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Pocket Guide to Perioperative and Critical Care Echocardiography

CD Videos and Graphics

Table of Contents

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Chapter 1: Ultrasound in perioperative and critical care clinical practice Videos

  1. Mitral Valve. Colour Doppler interrogation of a myxomatous mitral valve with a prolapse posterior leaflet and eccentric regurgitation. Following repair with a quadrangular resection, sliding leaflet repair and annuloplasty ring showing minimal residual regurgitation.
  2. Cardiac tamponade with a collapsed right atrium and right ventricle following coronary surgery.
  3. Hypovolaemia and underfilled left ventricle demonstrating complete emptying of the left ventricle at the end of systole.
  4. Vasodilation Hyperdynamic left ventricular function in a septic patient.
  5. Inferior systolic wall motion abnormality. Views in the 2 chamber and mid papillary view.

Graphics

  1. Abdominal aortic aneurysm within your thrombus.
  3. Normal FAST examination of the right upper quadrant.
  4. Positive FAST in Morrisons pouch.

Chapter 2: Understanding the echocardiography machine

No videos.

Chapter 3: Obtaining the best ultrasound image Videos

  1. Thickness artefact Highly reflective object outside the plane of the scan can still cause reflection of the ultrasound beam and be registered as though it were in the scan plane.
  2. Side lobe artefact A central ultrasound beam is associated with a secondary beam on either side. The side lobe beams have less intensity, but if they encounter a strong reflector surface, they may produce an image. The ultrasound machine will assume that this image has come from the central beam.
  4. Dropout artefact This results from signal attenuation caused by inadequate time gain compensation or too high a frequency for the probe being used resulting in poor visualisation of distant structures.
  5. Shadowing artefact. High levels of acoustic reflection or absorption between the transducer and the region of interest, may result in shadowing artefacts, particularly at an area of change in tissue density.
  6. Reverberation artefact. Multiple reflections between surfaces (typically the object of interest and the transducer), may result in a second image of this object at exactly twice the distance from the transducer. This is caused by the ultrasound signal being reflected from the object back to the transducer and then from the transducer back to the object and then back to the transducer once more. This takes twice the time, therefore the signal is interpreted as being twice the distance from the transducer.
  7. Mirror artefact. A false image may be generated as a result of the transmitted sound passed deflecting from multiple surfacesbefore returning to the transducer.
  8. Refraction artefact. The ultrasound ways may bend as it enters or leaves and interface at an angle.
  9. Noise artefact. An artefact generated by acoustic or electrical interference.
  10. Aliasing. This occurs when the velocity of the flow or the tissue exceeds the limit that had been set by the user on the scale. The velocity that is greater than the upper limit, for example, is then displayed at the lower limit of the scale. Or in the case of colour flow, velocities toward the transducer that exceed the upper limit, may be then displayed as velocities at the lowest limit and so flow in one direction can have a mixture of colours (Red becomes Blue or vice versa).

    Graphics
  1. Thickness artefact. Highly reflective object outside the plane of the scan can still cause reflection of the ultrasound beam and be registered as though it were in the scan plane.
  2. Side lobe artefact. A central ultrasound beam is associated with a secondary beam on either side. The side lobe beams have less intensity, but if they encounter a strong reflector surface, they may produce an image. The ultrasound machine will assume that this image has come from the central beam.
  4. Dropout artefact. This results from signal attenuation caused by inadequate time gain compensation or too high a frequency for the probe being used resulting in poor visualisation of distant structures.
  5. Shadowing artefact. High levels of acoustic reflection or absorption between the transducer and the region of interest, may result in shadowing artefacts, particularly at an area of change in tissue density.
  6. Reverberation artefact. Multiple reflections between surfaces (typically the object of interest and the transducer), may result in a second image of this object at exactly twice the distance from the transducer. This is caused by the ultrasound signal being reflected from the object back to the transducer and then from the transducer back to the object and then back to the transducer once more. This takes twice the time, therefore the signal is interpreted as being twice the distance from the transducer.
  7. Mirror artefact. A false image may be generated as a result of the transmitted sound passed deflecting from multiple surfacesbefore returning to the transducer.
  8. Refraction artefact. The ultrasound ways may bend as it enters or leaves and interface at an angle.
  9. Noise artefact. An artefact generated by acoustic or electrical interference.
  10. Aliasing. This occurs when the velocity of the flow or the tissue exceeds the limit that had been set by the user on the scale. The velocity that is greater than the upper limit, for example, is then displayed at the lower limit of the scale. Or in the case of colour flow, velocities toward the transducer that exceed the upper limit, may be then displayed as velocities at the lowest limit and so flow in one direction can have a mixture of colours (Red becomes Blue or vice versa). PW Doppler. Colour Doppler.

Chapter 4: Core anatomy for echocardiography

No videos or graphics.

Chapter 5: Standard transoesophageal echocardiography examination

Videos and Graphics
20 standard views of transoesophageal echocardiography (TOE or TEE)

  1. Mid-oesophageal aortic valve short axis Video Image
  2. Mid-oesophageal right ventricular inflow and outflow Video Image
  3. Mid-oesophageal aortic valve long axis Video Image
  4. Mid-oesophageal bicaval Video Image
  5. Mid-oesophageal 4 chamber Video Image
  6. Mid-oesophageal mitral commissural Video Image
  7. Mid-oesophageal 2 chamber Video Image
  8. Mid-oesophageal long axis Video Image
  9. Mid-oesophageal ascending aortic short axis Video Image
  10. Mid-oesophageal ascending aortic long axis Video Image
  11. Mid-oesophageal descending aortic short axis Video Image
  12. Upper oesophageal aortic arch long axis Video Image
  13. Upper oesophageal aortic arch short axis Video Image
  14. Mid-oesophageal descending aortic long axis Video Image
  15. Trans-gastric basal short axis Video Image
  16. Transgastric long axis Video Image
  17. Transgastric mid shot axis Video Image
  18. Transgastric to chamber Video Image
  19. Transgastric right ventricular inflow Video Image
  20. Deep transgastric long axis Video Image

Non standard views

Mid ascending aorta Image
Non standard 5 chamber Image
Mid-oesophageal 5 chamber Image
Coronary sinus Image
Screen representations
Correlations between the true anatomical orientation and the image displayed on the screen

Chapter 6: Standard transthoracic echocardiography examination

Videos
1. Parasternal views

Parasternal long axis left ventricle
Parasternal long axis right ventricular inflow
Parasternal short axis apical left ventricle
Parasternal short axis mid papillary left ventricle
Parasternal basal left ventricle
Parasternal short axis aortic valve

2. Apical views

Apical 4 chamber
Apical 5 chamber
Apical 2 chamber
Apical long axis

3. Subcostal views

Subcostal 4 chamber
Subcostal short axis left ventricle mid papillary
Subcostal short axis aortic valve
Subcostal right atrial inflow IVC
Subcostal descending aorta

4. Suprasternal view

Suprasternal aortic arch

Chapter 7: Introduction to Doppler imaging and equations

No videos or graphics

Chapter 8: Assessing the basic haemodynamic state

Videos and Graphics

1. Filling and function

TOE - TG mid Image
TTE - PLAX Image

2. Estimation of the left atrial pressure via the Internet atrial septal motion (TOE)

Low LAP
Normal LAP Image
High LAP Image

3. Haemodynamic states
Normal haemodynamic state

TG LV Image
Interatrial septum

Empty (hypovolaemia) state

TG LV Image
Interatrial septum

Primary diastolic failure

TG LV Image
Interatrial septum

Primary systolic failure

TG LV Image
Interatrial septum

Systolic and diastolic failure

TTE 4C Image

Vasodilation

TG LV Image
Interatrial septum

Right ventricular failure

RV volume overload
Biatrial enlargement
TTE 4C
Image

Chapter 9: Problems with ventricles

Ischaemic heart disease

Dilated cardiomyopathy

DCM A4C
DCM PLAX
Restrictive cardiomyopathy

Hypertrophic cardiomyopathy

HOCM PSAX
HOCM PLAX
HOCM SAM
Regional wall motion abnormalities

Thrombus

left ventricular aneurysm
left ventricular aneurysm thrombus
left ventricular apical thrombus
left atrial appendage thrombus

Vegetations

aortic valve LAX
aortic valve SAX
aortic valve LAX with regurgitation

Tumours

LA Myxoma 2C
LA Myxoma AV SAX
LA Myxoma CFD
AV Fibroelastoma

Chapter 10: Problems with valves

Degenerative calcific aortic valve stenosis

Bicuspid valve

Bicuspid AV SAX
Bicuspid AV LAX

Mitral stenosis

Rheumatic MV
Rheumatic MV CFD

Mitral regurgitation

Myxomatous MV prolapse
MV prolapse CFD
HOCM MV SAM
MV papillary muscle rupture
Tricuspid regurgitation

Bioprosthetic valves

Bioprosthetic AV
Prosthetic MV paravalvular leak

Endocarditis

Native AV endocarditis with prolapse
Native AV endocarditis CFD
Native AV endocarditis

Chapter 11: Problems with great vessels

Thoracic aorta
Aortic dilation

Aortic dissection

Ascending aortic dissection
Ascending aortic dissection CFD
Ascending aortic dissection AI
Descending aortic dissection

Acute aortic syndrome

Aortic intramural haematoma LAX
Aortic intramural haematoma SAX
Epiaortic ultrasound assessment of atheroma

Chapter 12: Problems with pericardium and pleura

Videos
Pericardial anatomy

Oblique sinus
Transverse sinus
Acute tamponade

Case example

Normal LV TG mid SAX
Normal LV MO 4C
Pericardial effusion TG mid SAX
Tamponade MO 4C

Graphics
Doppler transmitral diastolic flow showing exaggerated respiratory variation

Chapter 13: Ultrasound guided regional anaesthesia

Intercalene region
Supraclavicular region

Infraclavicular region
Axillary region

Upper arm
Doppler
Injection with local anaesthetic

Chapter 14: Ultrasound guided vascular access

Find and mark technique for femoral artery cannulation.The femoral vein is being compressed to differentiated from the artery.
Needle insertion. This video demonstrates movement of the needle as it is passing through the tissues and compression of the vein before it punctures it.

Needle movement
Vein puncture

Internal jugular vein cannulation at various levels.

Angle of the jaw
Cricothyroid membrane
Supraclavicular
Right femoral vessels

Radial artery cannulation

Needle penetrating forearm fascia
Needle glancing off radial artery
Needle tip compressing radial artery

Brachial vein cannulation

Veins near the elbow
Superficial veins being compressed
Superficial vein CFD

Chapter 15: Education and training

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