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M mode echo
1. Dr. Amit Kumar
Senior Resident, Department of Cardiology
R.N.T Medical College
Udaipur , India
2. For many years, this type of examination was only
available echocardiographic technique. They used to
form backbone of clinical echocardiography.
Today also M-mode importance couldn’t be
underestimated even in presence of 2D ,3D, real time
3D, or doppler echocardiography.
3. M-Mode Physics
The transducer emits an ultrasound beam, which
reflects at each anatomic interface.
The reflected wavefronts can be represented as dots
(B- mode) or spikes (A-mode). Brightness of dot or
magnitude of spike vary with the amplitude of the
reflected wave.
If the B-mode scan is swept from left to right with
time, an M-mode image is produced
4.
5. M-Mode Physics….
M-mode has got better temporal resolution and
thus subtle abnormalities in motion and timing is
better appreciated. For eg. systolic anterior motion of
mitral valve in HCM & RV diastolic collapse in
tamponade.
Because of its high sampling frequency( upto 1000
pulses per second), M-mode has excellent axial
resolution and is useful in identifying the relative
location of structures and measuring range of motion.
6. M-mode echocardiography is use to evaluate the
morphology of structures ; movement and velocity
of cardiac valves and walls; and timing of cardiac
events.
13. M-mode at the Mitral Valve
The mitral valve has 2 leaflets – anterior
and posterior.
14.
15. Mitral stenosis: M-mode
features
Decrease EF slope.
Paradoxical anterior diastolic motion of PML.
Seperation between leaflets is decreased.
Thickening of leaflets.
Early diastolic dip of IVS.
Reduced mitral valve leaflet excursion( D-E excursion)
Earlier pliability for BMV used to be decided on basis of D-
E amplitude. A MV with D-E amplitude of 20mm or more
is usually considered pliable.
17. Mitral regurgitation: m-mode
features
Indirect evidences- LA enlargement, LV enlargement
Exaggerated septal motion (1cm)
LAE with systolic expansion of the posterior left atrial
wall.
18.
19.
20. Mitral valve prolapse : m-
mode features
Thick redundant mitral valve leaflets.
Mid to late systolic sagging back of the anterior,
posterior or both MV leaflet >2mm from C-D point of
MV.
Holosystolic sagging back of the anterior, posterior, or
both MV leaflet >3mm from the C-D point of MV.
21.
22. Flail mitral leaflet : m-mode
features
Coarse diastolic fluttering of mitral leaflets.
Flail mitral leaflet may appear within LA
23.
24.
25. Infective endocarditis: m-
mode features
Valve leaflet appear thickened, “smudged”, “shaggy”.
Vegetation on a valve leaflet usually doesn’t restrict
valve motion.
28. LA myxoma: m-mode
features
Blunted E point of the mitral valve.
Decrease E-F slope.
Heavy band of echoes behind the anterior mitral
leaflet in diastole.
Echo free space at anterior mitral leaflet at onset of
diastole prior to dense echoes from tumor
29.
30. Premature closure of Mitral
valve: m-mode features
When C-point of the mitral valve occurs before the
onset of the QRS complex.
37. M-mode at the Aortic Valve
The aortic valve has 3 cusps – right coronary,
left coronary and non-coronary cusps.
The cusps imaged in the PLAX view are the
right coronary and the non-coronary cusps.
Leaflet may show fine systolic fluttering in
healthy individuals.
38. M-mode at the Aortic Valve
Coronary
cusp
Non-coronary cusp
Anterior aortic root
Posterior aortic root
Left Atrium
39.
40. M-mode at the Aortic Valve
LA dimension
Cusp Separation (1.5-2.5cms in adult)
Aortic root
41. M-mode at the Aortic Valve
LA dimension
Measurements are made
from leading edge to
leading edge.
42. Aortic stenosis: m-mode
features
Thickening valve leaflets.
Decreased excursion of valve leaflet.
Absence of systolic flutter of aortic valve leaflet.
50. Early closure of AV due to Severe LV dysfun
M-mode in a pt with LV dysfunction-
showing rounded closure of
AV,indicating decrease forward flow
at end of systole
53. a- downward motion, concides with A-wave of MV; b- represents
onset of ventricular systole; c- max downward position ; d- closure
begins; e- closure is completed
54. In adults it is unusual to record more than posterior
leaflet of the pulmonary valve.
In children or in pt with unusually large pulmonary
arteries, one may also record anterior leaflet.
In reality one can rarely record the entire excursion of
the pulmonar valve throughout cardiac cycle in adults.
85. Normal E point to septal separation is < 6 mm
With reduced lvef, EPSS may be increased.
86.
87.
88.
89. help in differentiating pleural
effusion from pericardial
effusion
If the ultrasonic beam is directed towards the left
atrium :
1)Gradual decrease in the echo free space–
pericardial effusion
2)Sudden cessation of echo free space- pleural
effusion
90.
91.
92. Quantitation of pericardial fluid can be done by m-mode echo,
but 2D-echocardiography gives a better idea esp. in c/o large or
loculated effusion
93. Cardiac tamponade- m
mode features
Compressed RV (RVID<7mm)
Increase in RV dimension with inspiration and
simultaneously decrease in LV dimension during
inspiration.
Decrease mitral valve EF-slope with inspiration.
Decrease mitral valve DE-amplitude with inspiration.
RV diastolic collapse.(specific)
RA diastolic collapse.(sensitive)
Dilated IVC with blunted respiratory changes.
100. Constrictive pericarditis: m-
mode features
Pericardial thickening
Paradoxical septal motion
Septal bounce( abrupt displacement of the IVS during early
diastole)
Flattening of mid & late diastolic motion of the posterior
LV wall.
Rapid early diastolic, or E-F, slope of the mitral valve.
Rapid downward motion of the posterior aortic wall in
early diastole.
Premature opening of pulmonary valve
Dilated IVC with blunted respiratory changes.
106. Motion of the posterior aortic wall
reflects the filling and emptying patterns
of the left atrium.
107. With impaired LA emptying, the aortic wall motion is
reduced during the rapid emptying phase, or the first third
of diastole.
LA emptying index-
If the first third of diastole does not represent at least 40%
of the total amplitude of the aortic wall motion during
diastole, then restriction to ventricular filling is suspected.
116. TAPSE – a measure for
assessing RV function
TAPSE reference range 15 to 20mm
Mildly abnormal- 13 to 15mm
Moderately abnormal- 10 to 12mm
Severely abnormal- <10mm
