evaluation of diastolic dysfunction by echocardiogram超声心动图评价舒张功能不全

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1、EvaluationofDiastolicDysfunctionbyEchocardiographyBrandonKuebler,MDPediatricCardiologyFellowWednesday,February09,2011AssessmentofDiastolicVentricularFunctionDefiningdiastoleMethodstoassessdiastolePatternsofdiastolicdiseaseAge-relatedchangesWhendoesdiastoleoccur?Isit

2、aroundteatime?NoRequiredforeveryheartbeatSystoleDiastolePhasesofDiastoleIsovolumetricrelaxationRapidfillingE-wave2/3LVfillingDiastasisAtrialcontractionA-wave1/3LVfillingFactorsAffectingDiastoleVentricularfunctionAVvalvefunctionRateofrelaxationVentricularcomplianceAt

3、rialsystolicfunctionPreloadHeartrateandrhythmPlaceApical4wPWinDistalPVPulmonaryVenousInflowApical4-chamberviewIdentifyRUPVorLUPVinflowparalleltobeamPulsed-wavesampling1-2cmdistaltoorificeAlternativesviews:ParasternalSuprasternalSubcostalsPulsed-wavePulmonaryVeinInfl

4、owIdentifypeakSandDvelocitiesMeasureatrialreversal(AR)durationARpresenceisvariable.ItisindicativeofabnormalelevatedLApressureinaneonate,butmaybenormalinachildwithmorecompliantpulmonaryveins.ThedurationofflowreversalismorehelpfulinrelationtoatrialsystoleNote:S-wavema

5、ybebiphasicowingtodifferencesofatrialrelaxationandmitralvalveannulardisplacementShouldtakethehighestofthepeaksMitralInflowApical4-chamberviewAlignDopplerbeamtobeparalleltomitralinflowPulsed-wavesamplingattipsofMVleafletsDecreasedvelocityifsampledwithinLAPulsed-waveM

6、itralValveInflowPeakEandAvelocities,ratioE/AMitralA-waveduration(tocomparewithPVARduration)Mitraldecelerationtime(frompeakofE-wavetobase)MitralDopplerVTI(andvalvearea)MitralValveDopplerEvaluationIna5chamberviewContinuous-waveacrosstipsofMVthroughLVOTObtainmitralinfl

7、ow&LVoutflowMeasureIsovolumetricRelaxationTime(IVRT)TissueDopplerMeasuresdisplacementofmyocardiumwhileavoidingbloodflowdetectionthroughoutthecardiaccycleForourpurposes:MitralvalveannularjunctionSeptalannularjunctionTricuspidannularjunctionMitralandtricuspiddataisrel

8、ativelyvolumeloadindependent,includingrespiratorycycleTDIMethodologyUsingDopplerpulsedcursor,3-5mmSetNyquistlimitsto15-30cm/sUsinglowestwa