Bài giảng Cập nhật một số kỹ thuật mới trong siêu âm tim - TS.BS. Nguyễn Thị thu Hoài

CẬP NHẬT MỘT SỐ KỸ THUẬT
MỚI TRONG SIÊU ÂM TIM
TS.BS.NGUYỄN THỊ THU HOÀI
PHÓ VIỆN TRƯỞNG - VIỆN TIM MẠCH QUỐC GIA VIỆT NAM


CÁC KỸ THUẬT SIÊU ÂM TIM MỚI
✓ Siêu âm tim 3D real - time
✓ Siêu âm đánh dấu mô cơ tim speckle- tracking
✓ Siêu âm cản âm


TỪ SIÊU ÂM 2D ĐẾN SIÊU ÂM 3D


3D Echocardiography: From research to routine
application: Today an obligatory application for a
comprehensive investigation of the heart


4D echocardiography, history and actual performance. How to
implement it to your routine echo lab


3D Echocardiography 2015: State of the Art

TEE: AS diagnosis quantitative
TTE: Pacemaker leads
•
•
•

•
•
•

LV
AS
MR
LAA
ASD
TR

Volume, Mass, radial, longitudinal, twist, torsion
TAVI, preinterventional, intra-, postprocedural, complications
differential diagnosis MitraClip®, Cardioband ®, parav. leak
preinterventional, intraprocedural
preinterventional, intraprocedural
preinterventional, intraprocedural


2D Image Quality
• Before 3DE acquisition, the 2D image should be
optimized
– Poor 2D images, poor 3D images


Modes of Acquisition
Zoom
Narrow
volume/Live 3D

Single-beat

Wide angle/
Full volume
Color Doppler

Multi-beat


How do
we
assess
How
do
we
assess
HOW WE ASSESS LV FUNCTION
Eye ball
ball (Eye LV
ball)Function?
LV
Function?
Eye

Limitations

Limitations

Subjective
Experience

Subjective dependent

Lack
of standardization
Experience
dependent
Large inter- and intraLack ofvariability
standardizatio
observer


Evaluation of 2D
EVALUATION
OF
2D
ECHOCARDIOGRAPHY
Echocardiography: 2013
Hand tracing

Correct view? Foreshortening?
Correct shape? Geometry dependent?
Tracing errors? Correct trace?


11

Why is 3D More
Accurate?

long axis (cm)

A4C
10

*
9
8
7
2D

Mor-Avi V, Lang RM et al., Circulation 2004. 110: 1814-1818.

3D


Am Heart J;130: 812-22


Long Axis (sagittal)

Nanda et al. Echocardiography 2004;21:763.


4-Chamber (coronal)

Nanda et al. Echocardiography 2004;21:763.


Short Axis
(transverse)

apical

basal


Chamber
Quantification


RT3DE volume measurements:

Validation by MRI
EDV, ESV

Excellent correlation
(r²>0.85)
•

Ahmad M, et al. J Am Coll Cardiol 2001; 37:1303-9

•

Qin JX, et al. J Am Coll Cardiol 2000; 36:900-7

•

Arai K, et al. Am J Cardiol 2004; 94:552-8

•

Jenkins C, et al. J Am Coll Cardiol 2004; 44:878-86

•

Kuhl HP, et al. J Am Coll Cardiol 2004; 43:2083-90.

•

Gutierrez-Chico JL, et al. Am J Cardiol 2005; 95:809-13


Real-Time Automated Transthoracic Three-Dimensional Echocardiographic
Left Heart Chamber Quantification using an Adaptive Analytics Algorithm

Dilated

Banana

Sigmoid Septum

Normal


Lang RM, Badano L, J Am Soc Echocardiogr 2015;28:1-39



SIÊU ÂM TIM 3D
ĐÁNH GIÁ CÁC CẤU TRÚC TIM

ĐÁNH GIÁ VAN HAI LÁ


Standardardized visualization of the MV
◼

Morphology
◼

◼

Papillary
muscles
Chordae
tendineae
◼

„rough zone“ C.

◼

commissural C.

◼

basal C. (AML)

◼

coaptation

◼

tissue quality

◼

mitral ring

from: Manuel J. Antunes, Mitral
valve repair, Kempten 1989



Mitral valve
3D analysis

Easy way
Long axis
view

Commissural
view
P3

P1
P2

to get the

optimal 2D images