Module 10 : PSAX Color and Spectral Doppler

Question 1

order of images

Answer 1

1) optimize 2D
2) optimise color doppler
3) optimize spectral doppler (PW, CW)

Question 2

PSAX routine

Answer 2

AV                          TV
 \+ 2d                         + 2D
 \+ 2D zoom              + Color
 \+ color                     + CW
MV                          IAS
 \+ 2D                         + Color
 \+ color                   RVOT / PV / PA / Bifur
LV                              + 2D
 \+base                       + color
 \+ mid                        + PW
 \+ apex                      + CW (for regurge)

Question 3

AV zoom reasons

Answer 3

• see if there is congenital bicuspid AV raphe between cusps

Question 4

AV color

Answer 4

• should see no regorge when valve shut during diastole

Question 5

MV level with color

Answer 5

• again shouldn’t see lots of regurge when valves shut

- also no holes in valves

Question 6

wall motion analysis

Answer 6

• use the images at the 3 levels I the LV
• watch ENDOCARDIAL MOTION
  + assess wall thickening not just movement
  + note any abnormalities

Question 7

PSAX RV inflow

Answer 7

• similar to SAX at the AV level but tilts to MOVE THE TV MORE INTO THE CENTER
• RV / TV/ RA / IAS should be well seen

Question 8

PSAX TV color

Answer 8

• assess for severe regurge caused by no coaptation of valves

Question 9

CW of TR jet

Answer 9

• place cursor where regurge takes place

* MEASURE PEAK JET VELOCITY

Question 10

RVSP (right ventricle systolic pressure) equation

Answer 10

• use the peak velocity and the right atria pressure (RAP)
  RVSP = 4 (V^2) + RAP

RAP is determined by the IVC sniff test

Question 11

color IVS

Answer 11

• sweep from base to apex with color box placed over IVS

- look for abnormal flow across IVS indicating ventricular septal defect

Question 12

sweep to apex

Answer 12

• sweeping all the way to apex in SAX will allow you ti detect muscular ventricular septal defect

Question 13

SAX - RVOT color spectral doppler

Answer 13

• image. RVOT, PA , PV, bifur in 2D
• use color to asses PV for leaks or stenosis
• USE PW IN RVOT
  + 5mm on the RVOT side to calculate RV stroke volume
• USE CW THROUGH PV AND PA
  + to assess PV stenosis or stenosis of pulmonary artery

Question 14

RVOT/ PA spectral doppler

Answer 14

• use pulsed wave to asses the rv outflow velocity
• many congenital abnormalities increase velocity
• if PV has regurge in diastole it is ignored can also be used for the RV STROKE VOLUME CALCULATION VTI

Question 15

CW pulmonary valve

Answer 15

• use CW to interrogate the PV for
  + pulmonary valve stenosis
  + pulmonary valve regurge

Question 16

Measurements RVOT - acceleration time (AT)

Answer 16

• PAT/RVOT - AT = the time it takes for RVOT flow to reach peak velocity
• measure with PW sample volume placed over RVOT
• measures mean pulmonary artery pressure (MPAP)

Question 17

Mean pulmonary artery pressure (MPAP) equation

Answer 17

MPAP = 79 - (0.49 x PAT)