Basics of Paediatric Echocardiography
This most important non-invasive tool for evaluation of the child’s cardiovascular system provides exact morphological diagnosis and enables haemodynamic assessment in most cases helping to avoid invasive diagnostic heart catheterisation. Basic rules and
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Martin Köstenberger, Andreas Gamillscheg, and Michael Riccabona
Abbreviations Ao Aorta AS Aortic stenosis ASD Atrial septal defect AVSD Atrioventricular septum defect CMP Cardiomyopathy CoA Aortic coarctation CW-Doppler Continuous wave Doppler PW-Doppler Pulsed wave Doppler DORV Double outlet right ventricle IAS Interatrial septum IVS Interventricular septum LA Left atrium LV Left ventricle PA Pulmonary atresia PDA Patent ductus arteriosus PS Pulmonary stenosis PV Pulmonary vein RA Right atrium
M. Köstenberger · A. Gamillscheg (*) Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria e-mail: [email protected]; [email protected] M. Riccabona Department of Radiology, Division of Pediatric Radiology, Medical University Graz and University Hospital Graz, Graz, Austria e-mail: [email protected] © Springer Nature Switzerland AG 2020 M. Riccabona (ed.), Pediatric Ultrasound, https://doi.org/10.1007/978-3-030-47910-7_11
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RV TAPVR TGA TOF UVH VSD
M. Köstenberger et al.
Right ventricle Total anomalous pulmonary venous return Transposition of the great arteries Tetralogy of Fallot Univentricular heart Ventricular septum defect
11.1 Introduction US = most important non-invasive tool for evaluation of the child’s cardiovascular system, provides exact morphological diagnosis and enables haemodynamic assessment in most cases—often avoiding invasive diagnostic heart catheterisation.
11.2 Equipment Needs and Specific Considerations 11.2.1 Transducers Large variety of (mostly sector) transducers necessary to fulfil all imaging requirements—as age and size of patients from preterm infants to adolescents: • 8–10–12 MHz transducer for good near-field resolution in premature/newborn infants, in this age also linear transducers can be used. • 5–2 MHz transducer for far-field penetration and high-flow velocities in older children/young adults.
11.2.2 Standard US Techniques • • • • •
M-mode. Two-dimensional ultrasound (2DUS). Continuous wave Doppler (CW-Doppler). Pulsed wave Doppler (PW-Doppler). Colour Doppler sonography (CDS).
11.2.3 Patient Position Ideally transthoracic echocardiography performed in reclined position with patient lying left side down—to avoid interference from lung tissue (especially in older children). A supporting pillow helpful. For suprasternal views use hyperextended neck to gain access.
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11.2.4 Sedation Transthoracic echocardiography mostly feasible without sedation. However, sometimes sedation undispensable and essential to obtain accurate diagnostic information.
11.3 S tandard Planes and Standardised Course of Examination Four basic planes: Transducer positioned to four echocardiographic windows to obtain planes (Fig. 11.1): • • • •
Long-axis plane parallel to major axis of left ventricle (LV). Short-axis plane orthogonal to major axis of LV. Coronal plane through cardiac apex (four-chamber view). Suprasternal vie
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