Doppler echocardiography

Dr.S.R.SRUTHI MEENAXSHI MBBS,MD,PDF

BASICS
• A moving target will backscatter an ultrasound beam to the
transducer so that the frequency observed when the target
is moving toward the transducer is higher and the
frequency observed when the target is moving away from
the transducer is lower than the original transmitter
frequency 
Doppler effect
• Christian Andreas Doppler was
an
Austrian mathematician and phy
sicist.
• He is celebrated for his principle
– known as the Doppler effect –
that the observed frequency of a
wave depends on the relative
speed of the source and the
observe
Doppler effect
•V
DOPPLER SHIFT
• Doppler shift (F[d])  =  F[r]  -  F[t]
• Blood flow velocity (V) is related to the Doppler shift by the
speed of sound in blood (C) and ø, the intercept angle
between the ultrasound beam and the direction of blood
flow. A factor of 2 is used to correct for the "round-trip"
transit time to and from the transducer.
• F[d]  =  2  x  F[t]  x  [(V  x  cos ø)]  ÷  C
• This equation can be solved for V, by substituting (F[r]  -  F[t])
for F[d]:
• V  =  [(F[r] -F[t])  x  C]  ÷  (2  x  F[t]  x  cos ø)
• Note that the angle of the ultrasound
beam and the direction of blood flow
are critically important in the
calculation
• ●For ø of 0º and 180º (parallel with
blood flow), cosine ø = 1
• ●For ø of 90º (perpendicular to blood
flow), cosine ø = 0 and the Doppler
shift is 0
• ●For ø up to 20º, cos ø results in a
minimal (less than 10 percent)
change in the Doppler shift
• ●For ø of 60º, cosine ø = 0.50
SPECTRAL ANALYSIS
• Spectral analysis — When the backscattered signal is
received by the transducer, the difference between the
transmitted and backscattered signal is determined by
comparing the two waveforms with the frequency content
analyzed by fast Fourier transform (FFT).
• The display generated by this frequency analysis is termed
spectral analysis. By convention, time is displayed on the x
(horizontal) axis and frequency shift on the y (vertical) axis.
• On spectral Doppler, shifts toward the transducer are
represented as "positive" deflections from the "zero"
baseline, and shifts away from the transducer are displayed
as "negative" deflections
DOPPLER MODALITIES
• Doppler methods used for cardiac evaluation:
• continuous wave
• pulsed wave
• color flow 
CONTINUOUS WAVE DOPPLER (CW)
• Continuous wave Doppler employs two dedicated
ultrasound crystals: one for continuous transmission and a
second for continuous reception of ultrasound signals.
• This permits measurement of very high frequency Doppler
shifts or velocities.
• receives a continuous signal along the entire length of the
ultrasound beam.
CW DOPPLER PROFILE
• ideal Doppler profile is one with a smooth "outer" contour,
well-defined edge and maximum velocity, and abrupt onset
and termination
• The continuous wave Doppler profile is usually "filled in"
because lower-velocity signals proximal and distal to the
point of maximum velocity are also recorded.
• Continuous wave Doppler is typically used to measure
higher velocities as in pulmonary hypertension and aortic
stenosis
CONTINUOUS WAVE DOPPLER
PULSE WAVE DOPPLER (PW)
• pulsed wave Doppler permits sampling of local blood flow
velocities at a specific region (or sample volume).

• This modality is particularly useful for assessing the

relatively low velocity flows associated with
• mitral or tricuspid inflow, pulmonary venous flow, left atrial
appendage flow, left ventricular outflow, or right ventricular
outflow blood flows
• To permit this, an ultrasound pulse is transmitted and then the
receiver "listens" during a subsequent interval defined by the
distance from the transmitter and the sample site.

• This transducer mode of transmit-wait-receive is repeated at

an interval termed the pulse-repetition frequency (PRF). The
PRF is therefore depth-dependent, being greater for near
regions and lower for distant or deeper regions.

• The width and length of the sample volume is varied by

adjusting the length of the transducer "receive" interval. Pulsed
Doppler is always performed with 2D guidance to determine
the optimal sample volume position.
• pulsed Doppler, the PRF is determined by the maximum
depth of the Doppler signals
NYQUIST LIMIT and ALIASING
PHENOMENON
• The Nyquist limit defines the frequency at which aliasing
and range ambiguity will occur, and is equal to the PRF/2.

• The Nyquist limit defines when aliasing will occur using PW

Doppler. The Nyquist limit specifies that measurements of
frequency shifts (and, thus, velocity) will be appropriately
displayed only if the pulse repetition frequency (PRF) is at
least twice the maximum velocity (or Doppler shift
frequency) encountered in the sample volume.
COLOR FLOW DOPPLER
• Doppler color flow imaging is based upon the principles of
pulsed wave Doppler echocardiography.
• Along each scan line, a pulse of ultrasound is transmitted,
and the backscattered signals are then received from each
"gate" or sample volume along each line. In order to
calculate accurate velocity data, several bursts along each
scan line are used, known as the burst length.
• With color flow imaging, velocities are displayed using a
color scale,

• flow toward the transducer typically displayed

in orange/red
• flow away from the transducer displayed as blue.
• Lighter shades are assigned higher velocities within the
Nyquist limit
• aliasing is depicted as color reversal.  
• Turbulent flow is characterized by varied blood velocities
and directions.

• The variance of velocities within jets is usually color coded

as a multicolored mosaic display.
Tissue doppler imaging
• Tissue Doppler imaging is a form of pulsed wave Doppler
that is used for recording myocardial tissue velocity.
• Tissue Doppler early diastolic signal from the mitral
annulus in the apical view is used in evaluation of left heart
diastolic function, while tissue Doppler systolic recording
from the tricuspid annulus or basal right ventricular free
wall in the apical four chamber view may be used to aid in
the assessment of right ventricular systolic function,
Bernoulli equation
• he Bernoulli Equation can be considered to be a statement of the 
conservation of energy principle appropriate for flowing fluids.

• The qualitative behavior that is usually labeled with the term "Bernoulli effect"
is the lowering of fluid pressure in regions where the flow velocity is increased.

• In the high velocity flow through the constriction, kinetic energy must increase
at the expense of pressure energy.
Bernoulli principle
• This states that, in a steady flow, the sum of all forms of energy
in a fluid along a streamline is the same at all points on that
streamline. This requires that the sum of kinetic energy, 
potential energy and internal energy remains constant.[Thus an
increase in the speed of the fluid – implying an increase in its
kinetic energy (dynamic pressure) – occurs with a simultaneous
decrease in (the sum of) its potential energy (including the 
static pressure) and internal energy
RELATIONSHIP BETWEEN DOPPLER
VELOCITY AND PRESSURE GRADIENT
• One of the most powerful attributes of Doppler
echocardiography is the ability to estimate the pressure
difference across a stenotic valve (eg, aortic stenosis) or

• between two chambers (eg, estimation of the pulmonary

artery systolic pressure from the tricuspid regurgitation
velocity). 
•  This relationship is defined by the Bernoulli equation and is
dependent on the velocity proximal to a stenosis (V1),
velocity in the stenotic jet (V2), density of blood (p),
acceleration of blood through the orifice (dv/dt), and viscous
losses (R[v]). The pressure gradient (ΔP) can be calculated
from:
• ΔP  =  [0.5  x  p  x  (V2 x V2 - V1 x V1)]  +  [p  x  (dv/dt)]  +  R[v]
• If one assumes that the last two terms (acceleration and
viscous losses) are small and then enters the constants, the
formula is simplified to:
• ΔP (mmHg)  =  4  x  (V2 x V2 - V1 x V1)
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