ACHD
US Physics
Quantitative Echo
Anatomy
Prosthetic Valves
100

These VSDs are associated with the prolapse of the right coronary cusp of the aortic valve.

Supracristal and perimembranous (only 10% of perimembranous)

100

Narrowing this increases lateral resolution.

Beam width

100

When determining mitral valve area, this method is not influenced by AI or MR.

PISA method

100

The arteria radicularis magna or great anterior radiculomedullary artery or artery of Adamkiewcz responsible for the majority of the anterior spinal cord blood supply is typically found between these spinal levels. 

T9-T12 (although can be as high as T3 and as low as L4)

100

This type of defect involving a fistulous connection between the left ventricle and right atrium can occur with infective endocarditis. 

Gerbode defect

200

This VSD is the most common.

Perimembranous/membranous (70%); muscular VSD is 2nd most common (20%)

200

This type of intensity is most important for the thermal bioeffects of ultrasound

Spatial peak temporal average intensity

200

The modified bernoulli equation MUST be used when the velocity proximal to the valve is > ____. 

1.5 m/s
200

With aortic trauma, injury most commonly occurs at this site.

Bonus: this is the most common traumatic aortic pathology at this site.

Aortic isthmus


Transection

200

Normal "washing jets" are visualized with bileaflet mechanical valves in the aortic position during this part of the cardiac cycle.

Holodiastolic

300

This ASD is the most common and is associated with ______. 

Ostium secundum ASD, mitral valve prolapse

300

These 2 properties of the medium determine velocity of ultrasound in the medium

density (lower density = greater velocity), and stiffness (greater stiffness = greater velocity)

300

The percentage of time the system is emitting the pulse is known as _____. 

Duty factor

300

An RVEF by cardiac MRI of greater than or equal to ____ is considered normal. 

45%

300

For TAVR, severe paravalvular regurgitation is when greater than ___ % of the valve circumference is occupied by regurgitation.

Bonus: moderate and mild?

>30% for severe, 10-30% for moderate, <10% for mild

400

This is the most common cardiac tumor seen in children, and it is associated with _____. 

Rhabdomyosarcoma, tuberous sclerosis

400

Continuous wave doppler has a ____ bandwidth and a _____ Q factor. 

Narrow bandwidth, high Q factor

400

Although controversial, this has been invoked to explain the higher peak instantaneous gradient measured on echo compared to cath lab peak to peak gradients for aortic stenosis. 

Pressure recovery

400

This is the location most susceptible to a Mallory-Weiss tear from flexion of a TEE probe.

GEJ

400
After mitral valve replacement, VTI MV/VTI LVOT greater than ____ is concerning for prosthetic mitral stenosis. 

> 2.5 (<2.2 suggest a high output state w/NO prosthetic valve stenosis). 

500

This directs fetal blood from the IVC across the foramen ovale. 

Eustachian valve

500

If a 4 MHz sound beam travels 4 cm, this is the attenuation coefficient and amount of attenuation expected at 4 cm in dB. 

2 dB/cm and 8 dB

500

This is the equation for doppler shift

delta f = received frequency - transmitted frequency = v(cosine)theta(2)(transmitted frequency)/c where c = the speed of US in blood/tissue, v = the velocity (of RBCs), theta = the angle between the doppler beam, and the direction of blood flow. 

500

This view best correlates with surgical measurement of the tricuspid valve annulus. 

Transgastric RV inflow view

500

This EOA/BSA is most consistent with severe aortic valve prosthesis stenosis. 

0.65 or less (0.65-0.85 moderate)