M-mode echo: principles and classic findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

One-dimensional or M-mode echocardiography is one beam of ultrasound directed toward the heart.

Historical Perspectives

• One of the first modes available
• Excellent resolution

Keys to interpretation

• What structure is being imaged?
• Where is the cursor?
• Size
• Septum in HOCM
• Timing
• Tamponade - diastolic collapse
• Density
• Myxomatous leaflets, masses

Technology

A single crystal rapidly alternates between transmission and receiver modes with rapid updating result, rapidly moving structures (eg, valve leaflets) can be monitored for their characteristic motion very high temporal resolution

Specific Structures

Aortic Valve M-mode Analysis

• During systole do the aortic valve leaflets oppose the aorta?
• Are the leaflets thick and calcified (bright)?
• Possible to have normal appearance on m-mode if non-calcific
• Are leaflets open throughout systole - HOCM, low-output state

Aortic M-Mode

Mitral Valve M-mode Analysis

• Anterior leaflet with E/A appearance of diastology
• Decreased EF slope in MS
• Scalloping of leaflet tip in end systole in prolapse

Mitral M-Mode

Ventricular M-mode

• Ventricular Wall Thickness
• Ventricular Chamber Size
• Intraventricular Masses

Ventricular M-Mode

M Mode Pathologic States

M Mode in Aortic Stenosis

• Thickened, calcified leaflets
• Dense, persistent echoes replacing the normal motion patterns
• Post-stenotic aortic root dilation (> 35mm)
• LVH
• Eccentrically placed diastolic closure line (BAV)

Aortic Stenosis M Mode

M Mode in Mitral Valve Prolapse

• Systolic bowing of the posterior mitral valve leaflet

MVP M Mode

M Mode in Hypertrophic Cardiomyopathy

• Septal hypertrophy
• Systolic anterior motion (SAM) of the anterior mitral valve leaflet
• Mid-systolic (premature) closure of the aortic valve due to outflow track obstruction

HOCM M Mode

HOCM Mid Systolic AV Closure

HOCM M Mode

M Mode in Mitral Stenosis

• Leaflet tips bright (calcified) and thickened
• E/F slope decreased

Mitral Stenosis M Mode

M Mode in Tamponade

• Diastolic collapse of the right ventricle

Tamponade M Mode

Tamponade M Mode

M Mode Aortic Regurgitation

• Increased duration between E and A peaks
• Fluttering of the anterior mitral valve leaflet due to AI jet turbulence
• Clinical setting to decide mechanism

Aortic Regurgitation M Mode

Other M Mode Findings

B Bump

• Elevated left ventricular end diastolic pressure

B Bump

M Mode in Endocarditis

• Thickened leaflets
• Good motion
• Mass
• Clinical scenario likely to give clue - dialysis patient, etc.

Aortic Valve Endocarditis M Mode

Left Atrial Myxoma

• Bright hyperdensity in mitral orifice throughout cardiac cycle
• Functional MS

Left Atrial Myxoma M Mode

Pulmonary Hypertension

• M-mode of pulmonary valve - W appearance indicates elevated pulmonary pressures

Hypertensive Heart Disease

Hypertensive Heart Disease M Mode |-

Mitral Stenosis

Mitral Stenosis M Mode

Mitral Valve Prolapse

MItral Valve Prolapse.jpg M Mode

Mitral Regurgitation

Flail Posterior Mitral Leaflet M Mode