Pediatric Echocardiography

Published on 27/02/2015 by admin

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Last modified 27/02/2015

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Pediatric Echocardiography

James René Herlong

Echocardiography is the primary imaging modality used to assess the heart and the vasculature proximal to the heart in pediatrics. Vascular ultrasound typically is used to assess the remainder of the vasculature. Echocardiography is sufficiently robust to be used as the sole imaging modality in assessing cardiac anatomy before surgical repair in most pediatric patients with congenital heart disease. Thus familiarity with echocardiography is important for anyone involved in diagnostic imaging in pediatric patients.

Technique

Transthoracic echocardiography is an ultrasound technique that is optimized for imaging the moving heart. Standard imaging windows that are free of interference from the lungs are illustrated in Figure 64-1. These windows allow imaging of the heart in multiple planes. These planes are based on the axes of the heart and not on the axes of the body (Fig. 64-2).

Figure 64-1 Probe positions for the four standard windows used in transthoracic echocardiography.
Position 1, parasternal; position 2, apical; position 3, subcostal; position 4, suprasternal. (From Snider AR, Serwer GA, Ritter SB: Echocardiography in pediatric heart disease. 2nd ed. St Louis: Mosby–Year Book; 1997.)

Figure 64-2 A, Three standard cardiac imaging planes. Plane A is a long-axis plane parallel to the major axis of the left ventricle. Plane B is a short-axis plane perpendicular to the major axis of the left ventricle. Plane C is a coronal plane of the heart through the cardiac apex that produces a standard four-chamber view. B, Two standard suprasternal notch imaging planes. Plane A is a long-axis plane parallel to the major axis of the aortic arch. Plane B is a short-axis plane perpendicular to the major axis of the aortic arch. (From Snider AR, Serwer GA, Ritter SB: Echocardiography in pediatric heart disease. 2nd ed. St Louis: Mosby–Year Book; 1997.)

In each acoustic window, the heart is imaged in orthogonal planes. Because the heart is a three-dimensional structure and because ultrasonography is a tomographic imaging technique, slow sweeps in each view are necessary to understand the complex relationships between various segments of the heart. Three- and four-dimensional echocardiography are becoming ever more robust, but they are not yet capable of high-resolution imaging of the entire heart. Currently, the utility of these techniques is largely in the assessment of the cardiac valves, particularly the atrioventricular valves.

Assessment of ventricular systolic function is performed in every echocardiographic examination. Among the various techniques of quantifying left ventricular systolic function, the left ventricular shortening fraction is the most easily accomplished and universally used. Figure 64-3

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