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LCH S SIEU AM TIMPGS.TS PHAM NGUYEN VINHT lau, ngi ta a nhan thay di bay tm moi c du trong em toiLazzaro Spallanzani (1 973) thc nghiem : du bt mat, di van bay tm moi c.Hartridge (1920) a ra gia thuyet : di phong ra song sieu am.Ludwig & Struthers (l949) : dung song sieu am do soi mat va vat la trong c cua cho.Wild va Reid (l 952) chan oan 18 ca u vu bang sieu amEdler & Hertz au tien ng dung echo tim :o vach tim (1953), tran dch mang tim (1954)l 955 : anh gia va theo doi sau mo hep hai la1 955 : tm ra u nhay nh trai bang sieu am.T l 956 : tinh the thach anh c thay bang barium titanate

LCH S SIEU AM TIM

Hertz & Olofsson (1960) : may sieu am tim 2 chieu (bi-dimensional echocardiograph) Bom (l972) : Hoan thien sieu am 2 chieu Hsu Chih Chang (1961) lam sach au tien ve sieu am chan oan My : nghien cu sieu am t l961 (Reid & Joyner)Feigenbaum (1963) : o cung lng that bang sieu am Satomura (1956) : ng dung Doppler vao tim Liv Hattle (Na Uy) (l 970) co cong ln trong ng dung lam sang Doppler Omoto (l 982) Doppler mau.

KY THUAT KHAM NGHIEM BANG SIEU AM TIM PGS.TS PHAM NGUYEN VINH Cac ky thuat sieu am tim- SAT qua thanh ngc- SAT qua thc quan- SAT trong buong tim- SAT trong long mach mau- SAT trong long ong mach vanh- SAT thai nhi- SAT 3 chieu

Cac v tr ngc e khao sat sieu am 4 mat cat c ban.KY THUAT KHAM NGHIEM BANG SIEU AM TIM

V tr cua au do ng cat canh c ben trai.KY THUAT KHAM NGHIEM BANG SIEU AM TIM

V tr cua au do ng cat t mom tim.KY THUAT KHAM NGHIEM BANG SIEU AM TIM

V tr cua au do ng cat di sn.KY THUAT KHAM NGHIEM BANG SIEU AM TIM

V tr cua au do ng cat tren hom c.KY THUAT KHAM NGHIEM BANG SIEU AM TIM

KY THUAT KHAM NGHIEM BANG SIEU AM TIM

- Sieu Am mot chieu (TM - Time motion echocardiography)

- Sieu am 2 chieu (2D - Bi dimensional echocardiography)

- Sieu am Doppler :* Doppler xung* Doppler lien tuc* Doppler mau


Khao sat TM ngang van MC


Khao sat TM ngang that trai. Cac tr so buong tim o c giup lng gia chc nang tim. TTTTr - TTTTh PXCR = --------------------- ( bt = 28 - 42 % ) TTTTrTTTTr : ng knh that trai cuoi TT TTTTh : ng knh that trai cuoi TTh ThTTTr - ThTTThPXTM = --------------------------- (bt > 55%)ThTTTrThTTTr : The tch cuoi tam trng ThTTTh : The tch cuoi tam thu

* Ty le be day cuoi tam trng cua vach that trai : VLT ----------------- ( bt : 0,9 - 1,3 ) VSTTVLT : Vach lien thatVSTT : Vach sau that trai


Sieu am hai chieu (2D)- Khao sat van ong cua cac cau truc cua tim.- 4 mat cat c ban: + canh c+ mom tim+ di b sn hay di mom c+ tren hom c


Sieu am hai chieu : mat cat canh c truc doc


Sieu am hai chieu : mat cat canh c truc ngang, ngang van MC


Sieu am hai chieu : mat cat canh c truc ngang, ngang van 2 la


Sieu am hai chieu : mat cat canh c truc ngang, ngang cot c


Sieu am hai chieu : mat cat 4 buong t mom


Sieu am hai chieu : mat cat 3 buong t mom


Sieu am hai chieu : mat cat 4 buong di sn


Sieu am hai chieu : mat cat di sn theo truc ngang


Sieu am hai chieu : mat cat c ban tren hom c.


Sieu am hai chieu : mat cat theo truc ngang MC

SO SANH GIA SIEU AM 2D VA DOPPLERTL : Feigenbaum H, Armstrong WF, Ryan T. Feigenbaums echocardiography, 6th ed 2005. Lippincott Williams & Wilkins, p. 32


SIEU AM DOPPLERVan toc mau trong buong tim va mach mau .

Fd = 2Fo x V x Cosin q / C hay Fd x C V= 2 Fo cosin q Fo : Chum phat ra Fd : Chuyen dch Doppler q : Goc tao bi chum tia Doppler phat ra va hng dong mau C : Hang so V : Van toc dong mau

NGUYEN LY C BAN CUA HIEN TNG DOPPLERTL : Feigenbaum H, Armstrong WF, Ryan T. Feigenbaums echocardiography, 6th ed 2005. Lippincott Williams & Wilkins, p. 33

KY THUAT KHAM NGHIEM BANG SIEU AM TIMSIEU AM DOPPLER1. Phan tch cac bieu hien Doppler- Bang nghe- Bang hnh anh2. Cac he thong ghi Doppler- Doppler xung (Pulsed Doppler)LPRF, HPRF - Hien tng phu trum (Aliasing)(LPRF : Low Pulsed Repetition Frequency)- Doppler lien tuc (Continuous Doppler)- Doppler mau (Color Doppler)

S KHAC BIET GIA DOPPLER XUNG VA DOPPLER LIEN TUCTL : Feigenbaum H, Armstrong WF, Ryan T. Feigenbaums echocardiography, 6th ed 2005. Lippincott Williams & Wilkins, p. 35

MOT V DU VE HIEN TNG PHU TRUM (ALIASING)TL : Feigenbaum H, Armstrong WF, Ryan T. Feigenbaums echocardiography, 6th ed 2005. Lippincott Williams & Wilkins, p. 36

VAN TOC DONG CHAY TANG, PHO DOPPLER RONG HNTL : Feigenbaum H, Armstrong WF, Ryan T. Feigenbaums echocardiography, 6th ed 2005. Lippincott Williams & Wilkins, p. 38

TNG QUAN GIA DIEN TCH LO H VI VAN TOC DONG CHAY VA TN HIEU DOPPLER MAUTL : Feigenbaum H, Armstrong WF, Ryan T. Feigenbaums echocardiography, 6th ed 2005. Lippincott Williams & Wilkins, p. 40

KY THUAT KHAM NGHIEM BANG SIEU AM TIMSIEU AM DOPPLER: KHAO SAT CAC DONG BNH THNG- Dong van 2 la : * Song E; song A* E/A > 1* V song E: 0,9m / giay (0,6 - 1,3 m/giay)- Dong MC :V = 1,35 m/giay (1 - 1,7 m/giay)- Dong 3 la : V = 0,5 m/giay (0,3 - 0,7 m/giay)- Dong MP :V = 0,75 m/giay (0,6 - 0,9 m/giay)


DOPPLER XUNG: CON TRO (CURSOR) VA MAU NH V (SAMPLE VOLUME LOCATOR)


DOPPLER DONG VAN 2 LA(NH TRAI --> THAT TRAI)


DOPPLER DONG MAU QUA VAN MC


DOPPLER DONG MAU QUA VAN MP


DOPPLER DONG H VAN 3 LA


AP DUNG LAM SANG CUA DOPPLER TIM- o dien tch m van 2 la:Cong thc Liv Hattle S = 220 / PHTPHT = Pressure Half Time

- o chenh ap lc ngang van: Cong thc Bernouilli gian lc : P = 4V2

- o dien tch m van bang phng trnh lien tuc: V1 x S1 = V2 x S2


AP DUNG LAM SANG CUA DOPPLER TIM- o cung lng tim:CLT = TPVTM x DT x TS TPVTM : Tch phan van toc mau theo thi gian VTI (Velocity time integral)DT : Dien tch van (cm 2)TS : Tan so tim

- Phat hien dong chay thong trong tim (Shunts): TD: TLN, TLT,... - o ap lc MP- Phat hien va nh lng h van

CAC KY THUAT MISieu am tim trong long MVSieu am trong buong timSieu am tim 3 chieuDoppler mo c tim (Tissu Doppler Imaging-TDI)

DOPPLER MO C TIMCung nguyen tac Doppler dong mauMuc tieu : mo c tim thay v hong cau

NGUYEN TAC DOPPLER MO C TIMTL : Feigenbaum H, Armstrong WF, Ryan T. Feigenbaums echocardiography, 6th ed 2005. Lippincott Williams & Wilkins, p. 53

DOPPLER MO C TIM : MO C TIM XA AU DO MAU XANH, VE PHA AU DO (TAM THU) CHO MAU OTL : Feigenbaum H, Armstrong WF, Ryan T. Feigenbaums echocardiography, 6th ed 2005. Lippincott Williams & Wilkins, p. 53

DOPPLER MO C TIM : TMTL : Feigenbaum H, Armstrong WF, Ryan T. Feigenbaums echocardiography, 6th ed 2005. Lippincott Williams & Wilkins, p. 54

DOPPLER MO C TIM : CAT DOPPLER XUNG PHAN BEN VONG VAN 2 LATL : Feigenbaum H, Armstrong WF, Ryan T. Feigenbaums echocardiography, 6th ed 2005. Lippincott Williams & Wilkins, p. 54

S O BIEU TH PHNG PHAP KHAO SAT DOPPLER MO VONG 2 LA 2 IEM : TNH C STRAIN VA STRAIN RATEStrain : keo cangStrain rate : van toc keo cang

TL : Feigenbaum H, Armstrong WF, Ryan T. Feigenbaums echocardiography, 6th ed 2005. Lippincott Williams & Wilkins, p. 55

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