Echocardiography (Echo) Laboratory

Echocardiography means the ultrasonography of heart. The echo image is obtained by the reflection of stroking high-frequency sound waves (ultrasound) from heart walls, which are sent to heart through probe.

Echocardiography shows the structure (anatomy) of heart, its contractions (functions) and structural anomalies, if any, by means of, 1 (M-mode), 2 and 3 dimensional images. The defects (holes) between heart cavities and large blood vessels, the obstructions and deficiencies of cardiac valves can be detected by conventional Doppler and color Doppler echocardiography.

In which conditions is echo performed?

It is performed when a cardiovascular disease and/or murmur and alteration in heart sounds are detected during examination, as it is a noninvasive (harmless), easy applicable and secure method.

By whom is it performed?

It is performed by pediatric and adult cardiologists.

Does echo cause pain or harm?

It is a secure, harmless and painless test, however, sometimes children may cry. Patients should remain in lying position approximately for half an hour, in order to perform an optimum test. Toys, various colorful objects and cartoon videos are used to calm the anxious and crying children. The children who cannot be calmed, are given sedative medications (midazolam, for instance) orally. Patients who may be required to be given sedatives must not eat or drink (even water) for 4 hours.

ECHOCARDIOGRAPHY METHODS

Transthoracic echocardiography
Transthoracic echo is performed by panning the gel covered probe on the front-left side of the chest wall, directing it to heart from above and below the chest wall bone.

The image quality can be corrupted in patients with excessive overweight and with increased aerations in lungs (bronchiolitis, emphysema).

Transesophageal echocardiography

Transesophageal echocardiography is an echocardiographic method, which is performed by placing the probe in esophagus through mouth, in order to obtain a clearer image of the heart in certain circumstances. This procedure is performed in an environment (such as operating room, catheterization room), where the heart rate, blood pressure and respiration of the patient can be evaluated. General anesthesia is required in order to let the the probe through the throat and perform the test accurately. The procedure takes approximately 30- 60 minutes. It can be performed on both inpatients and outpatients. Outpatients are allowed to leave after they are followed up for 2-3 hours and completely wake up after the procedure.

The test is used for determination of aortic (carotid) dissections, formation of thrombus (clot) on spaces of heart and heart valves, and vegetation (infected clot), and to help surgeons during cardiac surgeries in which the vessels have been recovered. Furthermore, it is used in closure of transcatheter atrial septal defect or ventricular septal defect and to determine the size of the defect or whether the position of the device placed placed into the defect is appropriate.

Patients may feel throat ache for a few hours after the procedure. Although it is a safe method, there is a very low risk of esophageal trauma and perforation.

Intraoperative echocardiography

Intraoperative echo is performed by placing the probe directly on heart or moving it forward through the mouth to esophagus, in sterilized conditions, during surgery. The surgery practice and heart functions are evaluated with this method. Itimmediately allows to overcome the problem occurred during surgery.

Stress echocardiography

It is used to determine whether partial obstruction (that does not show indication during rest, but interrupts feeding the cardiac muscle during exercise or stress) exists in the coronary arteries, which provide blood supply to cardiac muscle. The systoles of the heart are evaluated during rest and under stress with this method. Stress can be created with exercises or with various medications (such as dobutamin or dipyridamole) that increase the heart rate or cause reduction in coronary blood flow. When it is performed with medications, It is called pharmacologic stress echocardiography when performed with medications. Pharmacologic stress is preferred since performing echocardiography is difficult during the exercise.

Fetal echocardiography

The heart of an unborn baby (fetus) can be evaluated withfatal echo. This is the most practical and safe method. It is performed by panning the gel covered probe on the abdomen of the mother. It is suggested to perform the first fetal echo between the 18th and 20th weeks of pregnancy, but it can also be performed on the following weeks. It does not cause any harm in mother and in fetus.

Fetal echocardiography is performed if suspicious conditions related with the hearts of the babies occur during the routine ultrasonography, in case of problems of mothers and/or families that may effect the babies' heart health or it is performed upon request of the families.

USAGE AREAS OF FETAL ECHOCARDIOGRAPHY

Definition of cardiovascular system morphology
Evaluation of heart rhythm, rate and function disorder
Monitoring of arrhythmias and fetal cardiac functions
Follow-up of treatments of arrhythmia and heart failure
Observation of adverse effects of treatment in fetus which will be applied to mother
In case of patient being in severe cardiac diseases group during intrauterine period it can give an idea to gynecologists to determine the birth time and method when there is an apparent cardiac disease (that can be completely recovered with surgical treatment after delivery) or when the pregnancy cannot be terminated due to advanced maternal age, or the family do not prefer to terminate the pregnancy. In such a case it is suggested the birthing is performed in a center, where the required medical and surgical treatments can be performed for the newborn.
If it will not be possible to recover completely with surgical methods after birthing, or if the fetus is in severe cardiac diseases group during intrauterine period, the family is informed that the pregnancy can be terminated before the 24th week (or before the legally specified time of period).
It is provided that the family receives genetic consultancy. The family can be informed whether the pregnancy can be maintained or not, in accordance with the severity of the cardiac disease, if the termination is not an alternative genetically.
It helps new treatment methods such as prenatal surgery and interventional catheter procedure, to be developed and performed.
The pregnant that have fetus with severe or apparent cardiac diseases should be directed to tertiary centers which have newborn care unit, pediatric cardiology and cardiovascular surgery services.

Considerations before echo test

General anesthesia is required for only transesophageal echo among the echo tests, for this reason, patients should fast at least for 6-8 hours before this test. Fasting is not necessary for other echo tests. Since hunger causes unease and cry in little children, it is suggested for them to be with a slightly full stomach.

If additional preparations are required related with the features of the test, please comply with the instructions of your physician.

How is daily appointment queue of echo test determined?

Echo appointments are scheduled in two groups; morning and afternoon. Any patient in these groups may be tested in accordance with the busyness of test room and type of the test. As the patients should be quite and calm during test, PRIORITY IS GIVEN TO SLEEPING CHILDREN, EMERGENCY PATIENTS AND INPATIENTS IN DIFFICULT SITUATION. Thus, patients should allocate approximately 2-3 hours of their time for the test, and they should not hurry about queue.

When will you receive your echo result?

Echo results are submitted immediately after the test. By means of clearness of echo images, several patients can be referred to surgeries without the need of advanced tests (e.g. cardiac catheterization). On the COUNCIL MEETING to be held on the first Wednesday after the echocardiographic test, such patients are discussed based on their histories, physical examinations and test results physical examinations and test results and after the meeting the defined treatment plans are immediately submitted to the families of patients.