(Microsoft PowerPoint - echo1-1 [\310\243\310\257 \270\360\265\345])

Size: px

Start display at page:

Download "(Microsoft PowerPoint - echo1-1 [\310\243\310\257 \270\360\265\345])"

하니 만
6 years ago
Views:

1 echocardiography RDMS, RT Kang Hye Kyoung

3 Basal surface

5 LAYERS 심막 (pericardieum) visceral layer( 장쪽막 ) + parietal layer( 벽쪽막 ) - pericardial effusion - epicardium( 심외막 ) 심근 (myocardium) 심내막 (endocardium)

6 Rt atrium

7 Rt ventricle

8 Tricuspid valve

9 Lt atrium

10 Lt ventricle

11 Mitral valve

12 Aortic valve

14 THE ATRIA AND VENTRICLES 심장은오른쪽 2개, 왼쪽2개 4개의 chamber 우심방, 우심실, 좌심방좌심실 심실을실제내보내는 chamber 수축 ( 심실의수축 ) 할때혈액은심실로부터혈관계를지나다른쪽으로들어올충분한압력으로 eject 심실은수축하고혈액을다시내보내기전에채울 ( 이완할 ) 충분한시간을가져야한다. 심방은채워지는방이다. 심실이수축할때혈액을채운다. 이혈액은이완기에심실을채울수있다.

15 VALVES AND VALVE APPARATUS 판막은심장내에서혈류의방향을조절 심장의효율을극대화하기위해서혈류는한쪽방향으로만흘러야한다. 거꾸로흐르는혈류는펌프로서심장의효율을떨어뜨린다. 사실, 심장은작은양의역류가있어도대부분의혈액은제대로보낸다. 역류하는양이너무많아서감당할수없을때역류하는혈액을받는 chamber은커지기시작한다. 심장에는 4개의판막이있다. 삼첨판, 폐동맥판, 승모판, 대동맥판 방실판막과반월판

16 The Atrioventricular Valves 삼첨판막은오른쪽의방실판막 승모판막은왼쪽의방실판막 AV valve는수축기에심실에서심방으로혈류가역류하는것을막는다. AV valve는 cusps또는 leaflets을갖는다. 혈류정방향으로흐르도록열리고, 거꾸로흐르는것을막기위해닫힌다. 삼첨판막 - Anterior, posterior, septal leaflets 승모판막 - Anterior, posterior AV valve는그기능을돕기위해 apparatus 를갖는다 - chordae tendinae, papillary muscles AV valve apparatus가판막을열거나닫는것은아니다. Valve apparatus의기능은수축기때 AV valve leaflets이탈출 (prolapsing) 하는것을막는다

17 The Semilunar Valves 반월판은심실과이연결되는대혈관사이에위치 폐동맥판막은오른쪽에위치하는반월판 - 우심실과폐동맥사이에위치 대동맥판막은왼쪽에위치 - 좌심실과대동맥사이에위치한다. 반월판은이완기때대혈관에서심실로혈류가역류하는것을막는다. 반월판은정방향의혈류에열리고역방향의혈류에닫히는각각세개의 cusps 또는 leaflets 을갖는다. 폐동맥판막 - Anterior, right posterior, left posterior 대동맥판막 - Right, left, non-coronary : 각각의 cusps 위치에서 Sinus of Valsalva 로알려진 pouch 가있다.

18 Valvular Function Valve 는수동적인구조 심장내에판막을열거나닫는구조물은없다. 판막은심장내압력의변화에의해열리고닫히는것이다.

19 CARDIAC BLOOD SUPPLY 심장근육 (myocardium) 은산소의큰 user 혈액은관상동맥 (coronary arteries) 에 myocardium에공급 우, 좌관상동맥 (right and left coronary arteries) 은우, 좌대동맥동 (right and left Sinus of Valslava) 으로부터기시 우관상동맥은우심실은공급하는 acute marginal branch 로갈라진다.- atrioventricular goove를따라심장의후면으로이어지는 posterior descending artery Posterior descending artery는 interventricular groove를따라간다.

20 CARDIAC BLOOD SUPPLY Left coronary artery 는심장의후면에왼쪽 atrioventricular groove 를따라가는 circumflex artery 로이어진다.- left anterior descending coronary artery 가전면 interventricular groove 로간다. 관상동맥은이완기 (diastole) 때혈류를공급받는다. 좌심실이수축할때 (systole) aortic cusp 은 Sinus of Valsalva 를막고열려서관상동맥으로혈류를막는다. 대동맥판막이열릴때 (diastole) 관상동맥에혈류는발생한다.

25 CONDUNCTION SYSTEM 심장의기능은폐순환과체순환을통해혈류를내보낸다. 심장의전달체계는심근을전기적으로자극하고, 압력이증가할때수축하게된다. The Sinoatrial Node The Atrioventricular Node The Bundle of His and the Bundle Branches The Purkinje Fibers

26 The Sinoatrial Node( 동방결절 ) SVC 가우심방에들어오는자리에위치 심장의 pacemaker SA node에의해생긴자극이심방에전달되고수축을일으킨다. 자극은 AV node 에전달된다.

27 The Atrioventricular Node 심방에서심실로자극을전달 심방과심실사이에자극을전달하는전기적다리역할

28 The Bundle of His and the Bundle Branches AV node 를떠난자극은 IVS 의오른쪽으로약 1cm 떨어진 common branch 에이르고, 왼쪽과오른쪽으로나뉜다. 이 branch 가심첨부까지자극을운반

29 The Purkinje Fibers 심근에자극을보내는섬유조직 자극은심내막 (endocardium) 에서심근 (myocardium) 을거쳐심외막 (epicardium) 으로전달

30 Systolic 대동맥과폐동맥으로혈액을방출하는심실수축 대개 0.3~0.4 초동안지속되는심실수축에뒤이어방출기 ( 放出期 ) 가시작되는데, 그동안 80~100 cm3의혈액이심실에서방출 수축기동안동맥혈압은최고에도달 ( 수축기혈압 ) 정상적으로는 120 mm Hg 혈관벽의팽창성때문에심실의압력보다약간낮다. 심방수축기는심실이다시혈액으로채워지는심실확장기끝무렵에시작된다.

31 Diastolic 두수축기사이에일어난다. 이완기는 0.5~0.6초동안지속되는데그동안급속히혈액이채워지고 ( 차단되었던혈액이동맥으로부터밀려들어오면서 ), 뒤이어잠깐동안심방수축이일어난다. 동맥의혈압 - 80mmHg

33 Diastolic valve

34 Systolic valve

38 Electrophysiology 탈분극 (Depolarization) 전기적자극을받아파동이일어남, 심장은수축한다. 재분극 (repolarization) 제자리로돌아옴

39 Electrophysiology P-wave 심방수축 (SA node) QRS complex 심실수축 (AV node~bundle branchs) T-wave 심실재분극

40 심장초음파검사법 경흉부심초음파검사 경식도심초음파검사 조영심초음파 bubble이혈류에들어가면부옇게떠다니는특징을이용한검사법으로좌우단락을확진하거나심근허혈의연구에이용 부하심초음파 약물및운동부하를주면서심초음파검사를하여관상동맥질환의진단과심기능의평가에이용 혈관또는심장내초음파검사 심도자 (cather) 에탐촉자를부착하여여러혈관및심장내강에넣어검사하는방법으로동맥경화증및중재적시술의합병증판단에사용

41 TTE(Trans Thoracic Echo.) Echo exam

42 TTE(Trans Thoracic Echo.) 1. Two-dimensional echocardiography (2D) 2. M-mode echocardiography 3. Doppler echocardiography - Color Doppler - Pulsed wave (PW) Doppler - Continuous wave (CW) Doppler

43 M-mode echocardiography 하나의선만으로초음파를전송및수신을하기때문에움직이는구조물을기록하는데 2D 보다민감도가높다. 시간별로반사되는깊이와강도가그래프로그려진다. 판막의열림, 닫힘, 심실의움직임과같은운동의변화를표시할수있다.

44 M-mode echocardiography

45 Pulsed wave (PW) Doppler 국소적인흐름장애나어느작은부분에서혈액의속도를측정 Sample volum의위치에서특정부분의혈류속도측정 시간지연으로샘플링할수있는비율이한정되기때문에측정할수있는최대속도는약 2m/s 이다. Aliasing 현상주의

46 Continuous wave (CW) Doppler 지속적인송신과수신이가능하다. 빠른속도를측정하는데유용 각신호가어느지점에서발행하는지알수없다.

47 용도 2D : 해부, 심실과판막의움직임, M-mode 와도플러초음파를위한위치선정 M-mode : 치수의측정, 특정부위의시간측정 Pulsed wave Doppler : 정상적인판막흐름의패턴, 좌심실이완기능, 일회박출량과심장박출량 CW Doppler : 판막협착증의중증도, 판막역류의중증도

48 초음파를이용한심질환의진단 심실기능의평가 호흡곤란과심부전의평가 심잡음 비특이적인심전도 흉통 심장에서기인한색전 저혈압, 심장성쇼크 심장좌상및공여자심장평가 고혈압

49 제한점 과도비만환자 가슴이기형인환자 만성폐질환자 ( 만성환기장애, 폐과팽창, 폐섬유화증 )

50 심실기능의평가 좌심실의기능을이해하는것은모든심장검사에서기본적인단계 심초음파를이용한정량적인평가는환자의증상을설명, 적절한치료선택, 적절한수술시기결정 환자의수축기와이완기능평가

51 호흡곤란과심부전의평가 호흡곤란은비정상적인질환의임상양상 수축, 이완기능평가 판막의구조와기능평가 심장단락평가 중심정맥과판막의호흡변형평가 심근증여부 폐동맥고혈압 기타

52 비특이적인심전도 심전도는몇몇심장의병적상태를진단에매우유용 그러나많은심전도이상소견은특이적이거나진단적이지못하다. 심전도이상은수술전평가에있어서관심이증대 비특이적심전도이상은수술적처치나중재적시술후에도발생할수있다. 이와관련된심근허혈이나심근경색등에대한평가에심초음파가이용

53 비특이적인심전도 심근경색과허혈에의한벽운동평가 Pericardial effusion Intracardiac mass Pulmonary embolism LV hypertrophy Valvular heart disease

54 흉통 심전도이상이없으며증상이있을때유용 Ischemia or infaction Aortic dissection Pericarditis Valvular heart disease Cardiomyopathy Pulmonary embolism mass

55 심장에서기인한색전 심장원인 - 심내혈전 - 종양 - Vegetation - 심방중격류 - Foramen ovale를통한 embolism - 대동맥의 ulcerated plaques

56 저혈압, 심장성쇼크 환자곁에서시행하는가장의의있는진단도구 LV and RV function Valvular abnormalities Cardiac tamponade LV outflow tract obstruction Hypovolemia(small LV cavity size with hypercontractile walls) Pulmonary embolism Cardiac shunt Aortic dissection Cardiac rupture

57 고혈압 LV cavity and wall dimensions LV mass index LV systolic and diastolic function Dynamic LV outflow tract obstruction

58 Cardiac condition and their associated symptoms Congestive heart failure LV failure tachycardia fatigue with exertion dyspnea with mild exercise (due to pulmonary edema) paroxymal nocturnal dyspnea with cough cough (in advance CHF) with occasional hemoptysis cyanosis (central)

59 RV failure increasing fatigue edema beginning at ankles ascites in later stages weight gain secondary to retained fluid cyanosis (peripheral)

60 Acute Pulmonary Edema (secondary to LV failure) Extreme dyspnea Cyanosis Restlessness and anxiety hemoptysis

61 Superior Vena Cava Syndrome Obstruction of the SVC, often a lung tumor Edema of the upper extremities, face and neck

62 Mitral Valve Prolapse Usually asymptomatic Chest pain Palpitations Fatigue dyspnea

63 Mitral Insufficiency Fatigue Dyspnea Congestive heart failure

64 Mitral stenosis Exertional dyspnea Late paroximal nocturnal dyspnea ( 발작성야간호흡곤란 ) Exertional tachycardia Pulmonary edema (late) Right heart failure (late)

65 Aortic Insufficiency Asymptomatic if mild Dyspnea Fatigue on exertion Syncope Chest pain Congestive heart failure (late)

66 Aortic Stenosis Fatigue Exertional dyspnea Angina (inadequate coronary perfusion) Syncope on exertion

67 Tricuspid Insufficiency Neck vein distension Peripheral edema Abdominal distension (ascites)

68 Tricuspid stenosis Neck vein distension Peripheral edema Abdominal distension (ascites)

69 Pulmonary Insufficiency Few specific symptoms May be secondary to pulmonary hypertension

70 Pulmonary Stenosis Pulmonic stenosis almost always a congenital lesion possibly with associated abnormalities symptoms will vary

71 IHSS (idiopathic hypertrophic subaortic stenosis) Patient may be asymptomatic Fatigue Dyspnea Palpitations Precordial( 전흉부의 ) discomfort or angina-type chest pain Syncope Sudden death

72 Myxoma Fever Weigth loss Congestive heart failure Syncope Symtoms may clinically mimic mitral stenosis due to tumor prolapse through the mitral valve

73 Pulmonary Embolism( 폐색전증 ) 폐동맥이나그가지가혈류에의해운반된혈병또는이물에의해폐쇄 경색증을일으키는질환 대개는정맥혈전, 특히다리의심재정맥혈전이폐동맥에유입됨으로인해폐동맥이폐색되어폐혈관계의순환이저해되는질환 외상특히고령자의골반이나대퇴골의골절 화상 수술 산욕 심장질환 악성종양 혈액질환등의경우에발생하기쉽다

74 Dyspnea of sudden onset Retrosternal pain Anxiety and restlessness Pallor( 창백 ) with peripheral cyanosis Hemoptysis( 객혈 )

75 Pulmonary Hypertension Decreased exercise tolerance with syncope on exertion Fatigue and weakness Progressive dyspnea RV failure

76 Acute MI May be silent (asymptomatic) Chest pain (similar to angina but more severe)with squeezing or pressure radiating to jaw( 턱 ) and left arm Restlessness and apprehension( 불안감 ) dyspnea

77 Aortic Dissection Back or chest pain (excruciating) of sudden onset Some patients may be asymptomatic

78 Hypertension May be asymptomatic Dizziness Fatigue May have symtoms of LV failure in May have symtoms of LV failure in chronic hypertension

79 syncope Hypotension

80 Pericarditis Sharp left-sided pain aggravated by deep breathing, swallowing, coughing and movement. Pain is relieved by sitting up and leaning forward. Fever and chills( 오한 ) Weakness Cough

81 Endocarditis Fever and chills Malaise ( 불안, 권태감 ) Arthralgia ( 관절통, painful joints)

82 Standard Image Plane of 2-D

83 Standard Image Plane of 2-D Parasternal long axis view Parasternal short axis view Apical view 4 chamber view 2 chamber view 3 or 5 chamber view Subxiphoid view / Suprasternal view

85 Anatomy of the PLAX View

86 2D Echo. : PLAX view Parasternal Long Axis View

88 LV and LA Measurements LV posterior wall (D) Normal Values Male Left atrium 3.0 ~ 4.5 LV diastolic dimension 4.3 ~ 5.9 LV systolic dimension 2.6 ~ 4.0 LV Interventricular septum (D) 0.6 ~ 1.3 Aortic Measurements Aortic annulus Sinus of Valsalva Sinotubular junction Aortic arch Abdominal aorta 0.6 ~ 1.2 Absolute value 1.7 ~ ~ ~ ~ ~ 2.2 Female 2.7 ~ ~ ~ ~ ~ 1.1 Indexed to BSA 1.1 ~ ~ ~ ~ ~ 1.3

93 2D Echo. : PSAX view

97 2D Echo. : PSAX view

100

101 2D Echo. : PSAX view

102

103

104 2D Echo. : Apical view

105

106 Apical 4 chamber view 1. MV, TV color Doppler 2. Mitral inflow 측정 ( E, A wave, DT ) 3. Mitral Annulus Velocity ( E ) 4. Wall motion analysis 5. MR, TR velocity 측정 6. RV

107

108 2D Echo. : Apical view

109

110 Apical 3 chamber view 1. AV & LVOT 관찰 2. Wall motion analysis - Anteroseptum - Post. wall

111

112 Apical 2 chamber view 1. MV 정밀관찰 ( MVP ) 2. Wall motion analysis - Inf. wall - Ant. wall

113 2D Echo. : Suprastenal view

114 2D Echo. : Subcostal view

115 Subcostal view 1. IVC plethora 관찰 2. Atrial septum - ASD

116 심장초음파검사 심초음파도를이용한심장내경의측정 좌심실의수축기능평가 좌심실의이완기능평가및이완기심부전 혈역학적평가 심초음파를이용한관동맥혈류관찰과예비력평가 판막질환

117 심장초음파검사 감염성심내막염 허혈성심질환 심근병증 심낭질환

118 심초음파도를이용한심장내경의측정 M mode 심초음파도측정 2D 심초음파도측정 심실기능평가

119 2D

120 M mode : LV mid level Parasternal Short Axis View papillary Muscle Level 에서그림과같이 M-mode 실행

121 M mode LV EF(M-mode) 측정방법

122 혈역학적평가 1 회박출량과심박출량 압력차 판막면적 심장내압력 도플러심장초음파

123 Stroke volume(sv) 1 회심박출량 수축기에좌심실에서보내지는혈류량 Stroke volume = (end-diastolic volume) (end-systolic volume) 정상범위 75~100ml 구멍을가로지르는흐름은단면적과유속을곱한값이다 흐름 = 단면적 x 속도

124 Ejection fraction(ef) 박출량 수축기에박출한이완기말좌심실용적의백분율 Ejection fraction = stroke volume/(enddiastolic volume) 정상범위 > 55%

125 Ventricular systolic function 2D, M-mode 측정 EF(%) =EDV-ESV/EDV*100% 55-80% FS(%)=LVIDd-LVIDs/LVIDd*100% 25-45% SV=EDV-ESV LVES-LVED-LV end-diastolic dimension LV end-systolic dimension EDV=LV end diastolic volume ESV=LV end systolic volume

126 LV 용적과 EF 측정 1. Cube method V=D³ 2. Teichholz method V=[7/(2.4+D)]XD³ 3. Simpson s method, Area-length method

127 Modified Simpson Method

128 Cardiac output 단위시간당 (1 분 ) 좌심실에서내보낸혈류량 Cardiac output = stroke volume x heart rate 정상범위 5.0~7.5 liters/min

129 Abnormal pattern M-Mode Mode Ld Ls

130 Parasternal Long Axis 1. MV, AV 의 Function ( Color Doppler ) 2. LV, Aorta, LA Size 측정 (Chamber size) 3. LVH, pericardium 관찰 4. Septum, Post wall 의 wall motion 측정

131 Parasternal Short Axis 1. Aortic valve level - PV PW and AV, TV color doppler - LA, AV size 측정 ( M- mode ) 2. Mitral Valve level - MV morphology 관찰 ( M-mode) 3. Mid LV level ( Papillary muscle level ) - LV EF 측정 ( M-mode ) - Wall motion 관찰 4. Apex level - Wall motion 관찰 - Wall motion 관찰

132 M mode : AV level Adult Normal value Ao root diameter : 21~37mm LA diameter : 22~40mm Parasternal Short Axis View Aortic valve Level에서그림과같이 M-mode 실행

133 Interpretation of Report LV dimension LV wall thickness LV systolic function RV dimension IVC plethora LA and Aortic size Pericardial effusion E-point septal separation

134 좌심실의이완기능평가및이완기심부전 정상이완기능 : 심방의압력증가없이심실이적절히채워짐 평가방법 - E/A ratio : 유입혈류최고속도 (E velocity), 심방수축에의한후기혈류속도 (A velocity) 의비 E/A = 1~2 - DT time : 감속시간으로이완기능장애시증가 160~240ms

135 Assessment of Diastolic Function : MV PW & MV anntdi Normal Pattern PW Doppler Tissue Doppler

136 Assessment of Diastolic Function Sohn DW et al, J Am Coll Cardiol 1997;30:474) Sohn DW et al, J Am Coll Cardiol 1997;30:474)

137 Pulsed Wave Doppler : MV, Pvein and PV Normal Pattern MV - PW Doppler Normal : PVs2>PVd PV PW Doppler Impaired : PVs2>>PVd Pseudopattern : PVs2<PVd Restrictive : PVs2<<PVd

138 Interpretation of Report Valve morphology Represent LV diastolic function Represent severity of mitral stenosis Presence and severity of mitral regurgitation Echo score in mitral stenosis

139 Normal Values Normal ranges for measures of systolic and diastolic function 2D Measurement Fractional shortening (%) End-diastolic volume (ml) End-systolic volume (ml) Ejection fraction (%) Doppler 28 ~ ~ 166 (male) 3 ~ 67 (male) 50 ~ ~ 129 (female) 9 ~ 57 (female) Systolic velocity integral 15 ~ ~ 25 (elderly) Mitral E velocity (cm/sec) 44 ~ ~ 90 (elderly) Mitral A velocity (cm/sec) 20 ~ ~ 87 (elderly) E/A ratio 0.7 ~ ~ 1.7 (elderly) Time interval Mitral deceleration time (msec) 139 ~ ~ 282 (elderly) Isovolumic relaxation time(msec) 54 ~ ~ 124 (elderly)

140 Valvular Heart Disease MR(mitral regurgitation) MS(mitral stenosis) AR(aortic regurgitation) AS(aortic stenosis)

141 Diagnostic Evaluation of MR 1. Mitral valve anatomy 1) Cause of regurgitation 2) Normal, excessive, or restrictive leaflet motion 3) Reparability of valve 2. LV size and systolic function 1) Dimensions and volumes 2) Ejection fraction(ef) 3) Regional wall motion 3. LA size 4. Pulmonary artery pressure & RV function 5. Regurgitant severity 1) Color Flow Doppler 2) CW Doppler signal strength and shape 3) Regurgitant volume(rv) 4) Regurgitant orifice area (ERO)

142 MR(Mitral Valve regurgitation) PLAX view or Apical 4ch(2ch) view 모두관찰하는것이바람직하다. 보통 MR flow 가 LA 에미치는정도에 따라서약한정도부터 trivial(minimal) mild Apical 4chamber View moderate -severe 로구별한다.

143 Color Doppler 로측정한 MR 의중증도 Color Flow Mapping +1 = trivial +2 = mild +3 = moderate +4 = severe

144 PISA method 로측정한 MR 의중증도 Proximal Isovelocity Surface Area method Proximal Convergence Method Proximal Side regurgitant orifice (r) r 42cm/2 (V o ) (v)

145

146

147 PISA method Process Acquisition Review & Analysis ZOOM Change Baseline

148 PISA method Process Acquisition Review & Analysis Measure Pisa

149 PISA method 로측정한 MR 의중증도 Estimation of Mitral Regurgitation severity by ERO: Grade I: < 0.10 mm 2 Grade II: mm 2 Grade III: mm 2 Grade IV: >35mm 2 Estimation of Mitral Regurgitation severity by RV(Regurgitant Volume) Grade I = 1-25cc Grade II = 25-40cc Grade III =40-55cc Grade IV = >55cc

150 MS(Mitral Valve Stenosis)

151 MS(Mitral Valve Stenosis) 2D and Color Doppler

152 MS(Mitral Valve Stenosis) CW Doppler

153 MVA(Mitral Valve Area) 2D and CW Doppler 1. 2D Planimetry : MV area trace 2. Doppler : MVA=220/PHT MVA Normal : 4-6cm2 Mild : cm2 Severe : < 1.0 cm2

154 Mitral Stenosis Severity MVA Mean PG CO (cm 2 ) (mmhg) (L/min) Mild 1.5~ ~9.0 Moderate 1.0~1.5 5~10 5.5~6.5 Severe ~5.0

155 Mitral Valve Area

156 EchoCG in MS Mitral Stenosis Measurement of MVA Planimetry and PHT Morphologic evaluation of MV; Echo score PMV vs. MVR LA thrombi? TEE > TTE Combined MR? Pulmonary hypertension?

157 Mitral Stenosis Echo score Mobility Thickening Calcium Subvalve Mobile valve Thin No bright echo Spars echo Immobile valve Severely thickened Multiple bright echo Multiple thick chordae

158 PMV ; Contraindications High echo score Mitral Stenosis Good Intermediate Poor LA thrombi Mural thrombi; absolute CIx Appendageal thrombi; relative CIx Moderate to severe MR Combined aortic valve disease

159 AS(Aortic Valve Stenosis)

160 AS 의특징 Increased thickeness of AoV leaflet LVH and increased LV mass Decreased LV systolic function(late) LAE

161 Aortic Stenosis

162 Aortic Stenosis

163 Aortic Stenosis

164 Aortic Stenosis Continuity equation for AVA

165 Aortic Stenosis Severity Mild Moderate Severe Very severe AVA (cm 2 ) > ~ ~1.0 <0.75 AVA index (cm 2 / M 2 ) > ~ ~0.6 <0.4

166 Aortic Regurgitation mmhg Mild AR BP 140/70 Severe AR BP 140/40 50 LVEDP 14mmHg LVEDP 28mmHg

167 Aortic Regurgitation 150 Mild AR Severe AR

168 Aortic Regurgitation Aortic valve regurgitant(ar)

169 Aortic Valve Area AVA Normal : cm2 Mild : cm2 Moderate : Severe : < 0.75 cm2

170 Aortic valve regurgitant(ar) Aortic valve regurgitant(ar)- Ao Arch view

171 Interpretation of Report Valve morphology Presence and severity of aortic regurgitation Presence and severity of aortic stenosis

172 TR(Tricuspid Valve Regurgitation)

173 TR method 로측정한 pulm. HT PASP=RVSP PASP =RAP+TRp

174 TR method 로측정한 pulm. HT Normal PASP=18-25 mmhg Mild pulm. HT =30-40 mmhg Moderate pulm. HT=40-70 mmhg Seevere pulm. HT=>70mmHg

175 Interpretation of Report Valve morphology Presence and severity of tricuspid regurgitation Presence and severity of pulmonary hypertension Tricuspid inflow

176 Interpretation of Report M-mode and 2D Measurements Valve functions

177 감염성심내막염

178 감염성심내막염

179 감염성심내막염

180 ASD

181 ASD

182 ASD

183 AS

184 Bicuspid valve

185 aorta

186 Aortic arch

187 Pulmonary artery

188 myxoma

189 심초음파를이용한관동맥혈류 관찰과예비력평가

190

191

192 Ischemic heart disease

193

194 Dilated cardiomyopathy

195 Dilated cardiomyopathy

196

197 Hypertrophic cardiomyopathy

198 Hypertrophic cardiomyopathy

199 심낭질환

200 허혈성심질환

201 Prosthetic valve

202 Prosthetic valve

203 Prosthetic valve

204 Prosthetic valve

205 ASD

206 ASD

207 ASD

208

<4D F736F F F696E74202D20BFA1C4DA5FC0D3BBF3C3CAC0BDC6C42E BC8A3C8AF20B8F0B5E55D>

<4D F736F F F696E74202D20BFA1C4DA5FC0D3BBF3C3CAC0BDC6C42E BC8A3C8AF20B8F0B5E55D> 심장 (Heart) 심초음파 서울대병원내과 김용진 심장은평생몇번이나뛸까요? 1) 3 백만번 2) 3 천만번 3) 3 억번 4) 30 억번 30 억박동, 2 억리터의혈액 Cause 심장질환 6.2 12.4 11.1 16.2 뇌졸중 4.3 8.5 7.7 11.3 기타심혈관질환 2.6 5.1 6.0 8.8 심혈관질환 13.1 26.0 24.8 36.3 총사망 50.4