Cardiac Assessment
Cardiac Assessment Video Module using the Butterfly IQ+ on a newborn
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Images acquired in the apical views on a newborn using the ButterflyIQ+
Apical 4 chamber view. Eventual clockwise rotation to obtain the Apical 5 chamber view
Apical 4 chamber view. Left ventricle is on the right side of the screen.
Apical 2 chamber view. Once in Apical 4 chamber view, counterclockwise rotation to visualize the LV anterior and posterior wall. Left atrium and mitral valve can also be appreciated on this view.
Apical 5 chamber view - LV outflow tract is visualized
Line of interrogation is through the Apex and the attachement of the tricuspid valve of the free wall of the right ventricle. The M-Mode is used in order to measure the tricuspid annular plane systolic excursion (TAPSE), a measure of systolic function of the RV.
Line of interrogation is through the Apex and the attachement of the mitral valve of the lateral wall of the left ventricle. The M-Mode is used in order to measure the mitral annular plane systolic excursion (MAPSE), a measure of systolic function of the LV (longitudinal, which is not the main contractile power of the LV, the main is the circumferential plane).
Pulse-Wave Doppler in the inflow of the left ventricle using the Vascular present (vascular access or carotide)
Pulse-Wave Doppler at the LV outflow tract using the Vascular present (vascular access or carotide)
Images acquired in the parasternal short axis view on a newborn using the ButterflyIQ+
Sweep in the parasternal short axis
Parasternal short axis indicating good LV function (systolic). No clear pericardial effusion.
M-Mode can be done at the tip of the mitral valve leaflet in the parasternal short axis to measure the end diastolic diameter and the end systolic diameter of the LV in order to calculate the shortening fraction
M-mode through the Aortic Valve and the posterior left atrium, to calculate the Left Atrial to Aorta Ratio in parasternal short axis.
Using the cardiac preset of the probe (with the colour flow at high velocity filter), we can evaluate in the PDA view for the presence of a ductus arteriosus, and (if present) its directionality. In this case, there is no obvious PDA present.
Images acquired in the parasternal Long axis view on a newborn using the ButterflyIQ+
Parasternal long axis view
M-Mode can be done at the tip of the mitral valve leaflet in the parasternal long axis to measure the end diastolic diameter and the end systolic diameter of the LV in order to calculate the shortening fraction
M-mode through the Aortic Valve and the posterior left atrium, to calculate the Left Atrial to Aorta Ratio in parasternal short axis.
After processing of the DICOM image in TomTEC. We are able to compute the shortening fraction (39%) and the LV mass.
Images acquired in the subcostal view on a newborn using the ButterflyIQ+
Subcostal view. The Liver is on top of the screen. The right atrium sits on the liver and the left atrium is posterior.
By using colour flow from the cardiac present (pediatric) we can appreciate the presence of a left to right inter-atrial shunt (likely patent foramen ovale)
PowerPoint on the use of Basic Measurements for Cardiac Evaluation in Hypoxic Ischemic Encephalopathy by Dr Anie Lapointe
Some of the images within this document were taken from the online-accessible Rotunda Hospital (Dublin, Ireland) - NPE/TNE teaching manual - available here. PDF available here. This manual was developed by Dr. Afif El-Khuffash . This module was developed by Dr Anie Lapointe from CHU Sainte-Justine / Université de Montréal.
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