Children's Heart Institute | Cardiac Testing: Echocardiography

The Children's Heart Institute - Hasan Abdallah, M.D.

What is it? | Color Doppler | Black & White vs. Color | Sound

Pediatric Echocardiography:
Black & White vs. Color Doppler

The color doppler is very important in diagnosing congenetal heart disease. Compare the black & white echo pictures below with those that have color added.

The Aortic Arch - Black & White
This black and white echocardiogram picture shows the Aortic Arch from its origination from the left side of the heart (Left Ventricle). The Aortic Arch begins as the Ascending Aorta. The first branch off of the Aortic Arch is the Right Innominate Artery, followed by the Left Common Carotid Artery, the Left Subclavian Artery, and then it continues to flow downward as the Descending Aorta where it will supply the lower parts of the body with blood.

The Aortic Arch - Color
One very nice aspect of echo in color is its usefullness when we image the Aortic Arch. You can see in the picture that the blood is going up the Ascending Aorta (AA) towards the probe. The probe has coded this blood flow red. As this blood flow moves along the Aorta and moves down away from the probe to go to the legs it is coded blue. Doctors recognize this pattern as normal. Color helps show doctors if blood is flowing the right direction in the heart and if there are any holes.

Let us for arguments sake say that the color coming up instead of being red some of it is blue. The doctors would know by looking at this color echocardiogram picture that the valve beneath it is leaking backward and the blood is flowing in the wrong direction.

You may wonder when looking at this picture why you cannot see the blood flowing into the branch arteries coming off of the Aortic Arch (subclavian and carotid arteries). Blood is indeed flowing through those arteries, but at this point in time the technology is not sensitive enough to image those areas in color.

You may notice as you look at the color picture that there is a mixture of color between red, yellow, and blue in the center of the picture. This is because there's a turbulance in that area. This same patient happened to have a small Ductus Arteriosus, and that is how it shows up on a color echocardiogram.

Atrial Septal Defect from Straight On - Black & White
This black and white picture shows that there is a hole between the Right Atrium and Left Atrium or Atrial Septal Defect (ASD).

Atrial Septal Defect from Straight On - Color
When we add color you will notice 2 things:

There is blood flowing through that hole, which is the red color flowing from the Left Atrium to the Right Atrium. The color gives the doctor a better idea of how large the hole is.
You will notice that the color between the lower parts of the heart (Left Ventricle and Right Ventricle) did not cross from the left to the right or the right to the left because there are no holes between them.

Atrial Septal Defect from Underneath - Black & White
This picture was taken from a vantage point underneath the heart to examine the defect from another angle.

Atrial Septal Defect from Underneath - Color
Here is what the same underneath vantage point looks like in color.

4 Chambers of the Heart - Black & White
This picture shows the 4 chambers of the heart. You can see the that the Right Atrium and Left Atrium are separated by a wall (Atrial Septum - AS) and that the Right Ventricle and Left Ventricle are separated by a wall (Ventricular Septum - VS).

4 Chambers of the Heart - Color
When color is added to this picture we can see that there are no holes between these two walls because no color is crossing.

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Next we will show how doctors use sound to diagnose heart problems with echocardiography.

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