Begin by saving two cardiac cycles from each patient to the external media in its raw DICOM format and transfer to a laboratory station with image processing software for detailed offline analyses. Once offline, identify the most prominent or main vortex. Record the number of independent, complete oval-shaped vortices forming throughout the cardiac cycle for each clip.
Measure the position of the main vortex relative to known landmarks within the left ventricle. For measuring the vortex depth, use the distance measurement tool to measure the vertical distance from the vortex eye to the middle of the mitral valve annulus. For the vortex transverse position, measure the horizontal distance between the vortex eye and the endocardial border of the interventricular septum.
Obtain the vortex shape by measuring the vertical and horizontal edge-to-edge distances of the main vortex relative to the left ventricular length and width. Next, use the tracing measurement tool to click on and trace the outermost vortex ring from the most prominent point of the main vortex to obtain the vortex area. Assess the peak vortex formation time by recording the cardiac frame when the vortex is most prominent and calculate the number of frames relative to the total number of frames in one cardiac cycle of the patient.
Assess the vortex duration by measuring the frames from which the vortex first appears to when the vortex loses its circular ring formation. Preterm neonate comprehensive echocardiograms with BSI assessment showed a strong positive correlation between the vortex area and LV and diastolic dimension. The vortex duration and eon ePrime ratio were inversely correlated.
BSI application in characterizing cardiac landmarks with unique flow patterns was explored to describe venous return flow in neonates. In the right ventricle, the main vortex is seen as a clockwise rotating structure that rolls along the septum with its maximum area just before the pulmonary valve and artery. A main vortex is formed due to the mixing of inflow via the inferior vena cava and superior vena cava in the right atrium.
The left atrium has limited areas where the flow of the four pulmonary veins is not directly mixing and vortices can be difficult to capture.
