​Children's Heart Center

Echocardiogram

Echocardiography is used to assess the heart’s structures and function. Echocardiography is also referred to as echo, cardiac ultrasound or ultrasonography, cardiac Doppler, and transthoracic echocardiography or TTE. A small probe called a transducer is placed on the patient’s chest and sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on the patient’s chest in certain locations and at certain angles, the ultrasonic sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce (or “echo”) off of the heart structures. The transducer picks up the reflected waves and sends them to a computer. The computer interprets the echoes into an image of the heart walls and valves.

Types of Echocardiography

An examination may include one or more of the special types of echocardiography listed below:

  • M-Mode echocardiography – This is the simplest type of echocardiography. It produces an image similar to a tracing, rather than an actual picture of heart structures. M-mode echo is useful for measuring heart structures, such as the heart’s pumping chambers, the size of the heart itself and the thickness of the heart’s walls.
  • Doppler echocardiography – This Doppler technique is used to measure and assess the flow of blood through the heart’s chambers and valves. The amount of blood pumped out with each beat is an indication of the heart’s functioning. Also, Doppler can detect abnormal blood flow within the heart, which can indicate such problems as an opening between chambers of the heart, a problem with one or more of the heart’s four valves or a problem with the heart’s walls.
  • Color Doppler – This is an enhanced form of Doppler echocardiography. With color Doppler, different colors are used to designate the direction of blood flow. This simplifies the interpretation of the Doppler images.
  • 2-D (2-dimensional) echocardiography – This technique is used to “see” the actual structures and motion of the heart structures. A 2-D echo view appears cone-shaped on the monitor, and the real-time motion of the heart’s structures can be observed. This enables the physician to see the various heart structures at work and evaluate them.
  • 3-D (3-dimensional) echocardiography – This is a specialized technique used to provide a three-dimensional image of structures in the heart. It can allow cardiologists to better understand details of the heart’s structures. It can also be used to measure how well the heart muscle is squeezing. It requires measurements and manipulation of the images after the study is finished.

Echocardiography is often useful in diagnosing patients with these conditions:

  • Aneurysm – A dilation of a part of the coronary arteries or the aorta (the large artery that carries oxygenated blood out of the heart to the rest of the body), which may cause a weakness of the tissue at the site of the aneurysm. In extreme cases, the aneurysm may rupture, which is an emergency situation, causing rapid blood loss out of the blood vessels.
  • Cardiomyopathy – An enlargement of the heart due to thickening or weakening of the heart muscle to the extent that blood cannot be pumped efficiently; thus, causing a buildup (congestion) of fluid in the blood vessels, lungs, feet, ankles and other parts of the body.
  • Congenital (present at birth) defects – Abnormalities or deficiencies in one or more heart structures that occur during formation of the fetus.
  • Pericarditis – An inflammation of the membrane that surrounds the heart.
  • Valve disease – One or more of the heart’s four valves becomes defective, or may be congenitally malformed.

Performing an Echocardiogram

The test may be done in a cardiologist’s office, a clinic, a hospital or a medical center as either an outpatient or inpatient procedure. In most cases, parents will be allowed to stay with the patient to provide reassurance during the procedure.

During an Echocardiogram:

  • The technologist will need to see the patient’s chest from the waist up. Privacy will be maintained by drapes across the patient’s chest and by limiting access into the procedure area.
  • Electrodes will be attached to the patient’s chest with adhesive patches.
  • The patient will lie on a table or bed during the procedure. A pillow or wedge may be placed behind their back for support.
  • The room will be darkened so that the images on the echo monitor can be better viewed by the technologist.
  • The technologist will place gel on the patient’s chest and then place the transducer probe on the gel. The patient will feel a slight pressure as the transducer is positioned to get the desired images of the patient’s heart.
  • During the test, the technologist will move the transducer probe around and apply varying amounts of pressure to obtain images of different locations and structures of the patient’s heart. The amount of pressure behind the probe should not be uncomfortable. If it is, the patient should let the technologist know.
  • After the procedure has been completed, the technologist will wipe the gel from the patient’s chest and remove the electrodes.

Use of Sedation and Anesthesia for Echocardiography

Many patients have feelings of anxiety about procedures. This anxiety often goes away. If necessary, sedatives can be used to help patients relax. This requires the expertise of doctors and nurses with advanced training in pediatric anesthesiology and sedation.

Patients who can’t lie still, including adults with special needs, may need general anesthesia so they can be completely asleep during the test. Anesthesia is administered through a breathing mask or an IV. The anesthesiologist will maintain the patient’s breathing during the scan with a breathing tube. When anesthesia is required, one of our board-certified pediatric anesthesiologists will perform and monitor the sedation. When the exam is completed, the breathing tube will be removed and the patient will recover in a special-care area.

With sedation or anesthesia, the patient may feel groggy, tired or sleepy for a period of several hours after the exam. However, these effects will usually disappear within a day or so.