Omerovic Silvan, Jain Ashika
McLaren Greater Lansing
New York University Langone Health
Echocardiography is the use of ultrasound to evaluate the structural components of the heart in a minimally invasive strategy. Although, prior to the invention of today's routinely used 2-dimensional echocardiography, there was motion-based (M-mode) echocardiography. In 1953, Inge Edler, regarded as the father of echocardiography, first described M-mode technology, which began the era of diagnostic noninvasive echocardiography. M-Mode echocardiography was the combination of amplitude-based (A-mode) ultrasonography with Brightness-based (B-mode) techniques, which allowed the addition of a "time" dimension when the B-mode was swept across the oscilloscope; however this was not a picture, per se, but how structures evolved through the cardiac cycle. This was the primary technology until two-dimensional (2D) ultrasonography was developed over the next decades. In 1973, S.L. Johnson developed 2D ultrasonography and doppler technology, which ultimately allowed physicians to detect blood flow in vessels, and, in 1979, Holen and Hatle found that by using the Bernoulli equation they could detect pressure gradients. The combination of all these technologies is the echocardiography that is commonly used every day in today's medical profession. The most commonly used technique among these is transthoracic echocardiography (TTE). This allows the clinician to obtain real-time sizes, structure, and function of the heart during the cardiac cycle. Another useful and important use of these methods is stress echocardiography. Stress echocardiography is the combination of standard transthoracic echocardiography and either pharmacological or physical stress to the cardiac structures to assess wall motion abnormalities. Physical stresses may include running on a treadmill, and pharmacological stress, including medications. When higher resolution imaging of cardiac structures, including valves, is required, transesophageal echocardiography (TEE) is considered. TEE is more invasive than standard TTE, as it requires the insertion of a probe into the patient's esophagus to obtain images not hindered by the patient's chest wall, including; muscle, tissue, and bone. When more accurate and even higher-resolution imaging is needed, during intracardiac procedures, intracardiac echocardiography (ICE) is an option that can be considered. Echocardiography is a low cost, at times minimally invasive, and readily available test that can provide information that can change the treatment course, and in some cases, provide real-time life-saving information. Many of the clinical uses of echocardiography are multidisciplinary in practice, and the overlap between the different utilities of echocardiogram is large. The addition of contrast to echocardiography, or the addition of strain to TTE are all examples of combinations of these utilities. The utilization of echocardiography is vast and can be applied in a variety of ways and a wide range of situations, and these forms will be discussed in detail.
超声心动图是一种利用超声波以微创方式评估心脏结构组成部分的技术。不过，在当今常规使用的二维超声心动图发明之前，存在基于运动的（M 型）超声心动图。1953 年，被誉为超声心动图之父的英格·埃德勒首次描述了 M 型技术，开启了诊断性无创超声心动图时代。M 型超声心动图是基于幅度的（A 型）超声检查与基于亮度的（B 型）技术的结合，当 B 型扫描示波器时，它增加了一个“时间”维度；然而，这本身并不是一幅图像，而是结构在心动周期中的演变情况。在接下来的几十年里二维（2D）超声检查技术发展出来之前，这一直是主要技术。1973 年，S.L. 约翰逊开发了 2D 超声检查和多普勒技术，这最终使医生能够检测血管中的血流，并且在 1979 年，霍伦和哈特发现通过使用伯努利方程他们可以检测压力梯度。所有这些技术的结合就是当今医学领域日常常用的超声心动图。其中最常用的技术是经胸超声心动图（TTE）。这使临床医生能够在心动周期中获取心脏的实时大小、结构和功能。这些方法的另一个有用且重要的应用是负荷超声心动图。负荷超声心动图是标准经胸超声心动图与对心脏结构施加药物或物理负荷相结合，以评估室壁运动异常。物理负荷可能包括在跑步机上跑步，药物负荷包括使用药物。当需要对包括瓣膜在内的心脏结构进行更高分辨率成像时，会考虑经食管超声心动图（TEE）。TEE 比标准 TTE 的侵入性更强，因为它需要将探头插入患者食管以获取不受患者胸壁（包括肌肉、组织和骨骼）阻碍的图像。当在心脏内操作过程中需要更精确甚至更高分辨率的成像时，可以考虑心腔内超声心动图（ICE）。超声心动图是一种低成本、有时微创且易于获得的检查，它可以提供能够改变治疗方案的信息，在某些情况下，还能提供实时救命信息。超声心动图的许多临床应用在实践中是多学科的，并且超声心动图不同用途之间的重叠很大。在超声心动图中添加造影剂，或者在 TTE 中添加应变都是这些用途组合的例子。超声心动图的应用非常广泛，可以以多种方式应用于各种情况，这些形式将详细讨论。
