BOOK
ASE’s Comprehensive Echocardiography E-Book
Steven A Goldstein | Itzhak Kronzon | Bijoy K Khandheria | Victor Mor-Avi
(2015)
Additional Information
Book Details
Abstract
Written and endorsed by world experts from the American Society of Echocardiography (ASE), this unique multimedia resource uses text, case studies, and online components to cover the latest uses of echocardiography, including the most recent 2D and 3D advances. Unlike other existing textbooks in echocardiography, including the predecessor of this volume, entitled Dynamic Echocardiography, this 2nd edition, with its new title, covers a full range of topics, reflected in its 200 chapters that include essential material in a succinct format. Dr. Roberto M. Lang and his expert colleagues provide everything you need to assess cardiac anatomy and function and obtain clinically useful, noninvasive information for more accurate diagnosis and evaluation of heart disease.
- Tap into the knowledge and skills of a team of experts from the ASE, led by world-renowned authorities in echocardiography.
- Consult this title on your favorite e-reader.
- Get fully up to date with the latest echo practice guidelines and advanced technologies, including 3D echocardiography and myocardial strain.
- Gain a better understanding of the latest methods to assess cardiac chamber size and function, valvular stenosis/regurgitation, cardiomyopathies, coronary artery disease, complications of myocardial infarction, and much more – all in a practical, well-illustrated brief yet comprehensive format extensively supported by multimedia material.
- Stay up to date with hot topics in this rapidly evolving field: interventional/intraoperative echocardiography, transesophageal echocardiography, cardiac resynchronization therapy, and more.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front Cover | ES2 | ||
| ASE’s Comprehensive Echocardiography | iii | ||
| Copyright | iv | ||
| Contributors | v | ||
| Foreword | xiv | ||
| Preface | xv | ||
| Contents | xvi | ||
| Section I: Physics and Instrumentation | 1 | ||
| Chapter 1: General Principles of Echocardiography | 1 | ||
| Transducer | 1 | ||
| Instrument | 1 | ||
| Artifacts | 1 | ||
| Safety | 3 | ||
| Reference | 3 | ||
| Chapter 2: Three-Dimensional Echocardiography | 3 | ||
| Comparison between 2DE and 3DE ultrasound transducers | 4 | ||
| 3D Echocardiography physics | 6 | ||
| Image acquisition and display | 8 | ||
| Color doppler displays | 11 | ||
| Chapter 3: Doppler Principles | 11 | ||
| Spectral doppler displays | 12 | ||
| Aliasing | 12 | ||
| References | 13 | ||
| Chapter 4: Tissue Doppler Imaging and Speckle Tracking Echocardiography | 13 | ||
| Principles of tissue doppler imaging | 13 | ||
| Strain rate, strain, and displacement | 14 | ||
| Speckle tracking echocardiography | 15 | ||
| Evaluations of LV mechanics by TDI and STE | 16 | ||
| References | 16 | ||
| Chapter 5: Tissue Harmonic Imaging | 17 | ||
| Advantages of tissue harmonic imaging | 17 | ||
| Disadvantages of tissue harmonic imaging | 17 | ||
| Key application principles for tissue harmonic imaging | 17 | ||
| Conclusions | 18 | ||
| References | 18 | ||
| Section II: Transthoracic Echocardiography | 19 | ||
| Chapter 6: Transthoracic Echocardiography: Nomenclature and Standard Views | 19 | ||
| Parasternal window | 19 | ||
| Long Axis: Left Ventricle | 19 | ||
| Long Axis: Right Ventricular Inflow and Outflow | 19 | ||
| Short Axis | 19 | ||
| Right Parasternal Window | 21 | ||
| Apical window | 21 | ||
| Four-Chamber View | 22 | ||
| Two-Chamber View | 22 | ||
| Three-Chamber (Long-Axis) View | 22 | ||
| Subcostal window | 23 | ||
| Suprasternal notch window | 23 | ||
| References | 24 | ||
| Chapter 7: Technical Quality | 24 | ||
| Optimizing 2D images | 24 | ||
| Optimizing spectral doppler traces | 25 | ||
| Optimizing color doppler images | 25 | ||
| Summary | 26 | ||
| References | 26 | ||
| Chapter 8: Transthoracic Echocardiography Tomographic Views | 26 | ||
| Parasternal window: long-axis, right ventricular inflow and outflow, and short-axis views | 26 | ||
| Transthoracic apical window | 27 | ||
| Subcostal window | 29 | ||
| Transthoracic suprasternal window | 29 | ||
| Off-axis views | 29 | ||
| References | 29 | ||
| Chapter 9: M-Mode Echocardiography | 30 | ||
| Left ventricle | 30 | ||
| Mitral valve | 30 | ||
| Normal Motion | 30 | ||
| Mitral Stenosis | 32 | ||
| Mitral Valve Prolapse | 32 | ||
| Systolic Anterior Motion of the Anterior Mitral Leaflet | 35 | ||
| The Mitral Valve in Aortic Insufficiency | 35 | ||
| The Mitral Valve in Left Ventricular Dysfunction | 35 | ||
| Color M-Mode | 35 | ||
| Aortic valve | 35 | ||
| Normal Motion | 35 | ||
| The Aortic Valve in Hypertrophic Obstructive Cardiomyopathy | 36 | ||
| Premature Aortic Valve Opening | 36 | ||
| Pulmonic valve | 36 | ||
| Normal Motion | 36 | ||
| Severe Pulmonary Hypertension | 36 | ||
| Pericardial disease | 37 | ||
| Cardiac tamponade | 37 | ||
| Constrictive pericarditis | 37 | ||
| References | 39 | ||
| Chapter 10: Doppler Echocardiography: Normal Antegrade Flow Patterns | 39 | ||
| Basic concepts | 39 | ||
| Technical considerations for optimal doppler recordings | 40 | ||
| Individual flow profiles | 41 | ||
| LV Outflow | 41 | ||
| RV Outflow | 42 | ||
| LV Inflow | 42 | ||
| RV Inflow | 43 | ||
| Pulmonary Venous Flow | 43 | ||
| Hepatic Vein Flow | 44 | ||
| Descending Thoracic Aortic Flow | 44 | ||
| References | 45 | ||
| Section III: Transesophageal Echocardiography | 47 | ||
| Chapter 11: Protocol, Probe Insertion and Manipulation, Risks and Complications | 47 | ||
| Protocol | 47 | ||
| Topical anesthesia | 47 | ||
| Sedation | 47 | ||
| Probe insertion | 48 | ||
| Probe manipulation | 48 | ||
| General Points in Probe Manipulation | 49 | ||
| Risks and complications | 49 | ||
| References | 49 | ||
| Chapter 12: Transesophageal Echocardiography: Tomographic View | 50 | ||
| Midesophageal five-chamber view | 50 | ||
| Midesophageal four-chamber view | 50 | ||
| Midesophageal mitral commissural view | 51 | ||
| Midesophageal two-chamber view | 51 | ||
| Midesophageal long-axis view | 51 | ||
| Midesophageal AV LAX view | 51 | ||
| Midesophageal ascending aorta LAX view | 51 | ||
| Midesophageal ascending aorta short-axis view | 52 | ||
| Midesophageal right pulmonary vein view | 52 | ||
| Midesophageal AV SAX view | 52 | ||
| Midesophageal right ventricle inflow-outflow view | 52 | ||
| Midesophageal modified bicaval TV view | 52 | ||
| Midesophageal bicaval view | 52 | ||
| Midesophageal right and left pulmonary veins view | 53 | ||
| Midesophageal left atrial appendage view | 53 | ||
| Transgastric basal SAX view | 53 | ||
| Transgastric midpapillary SAX view | 53 | ||
| Transgastric apical SAX view | 53 | ||
| Transgastric RV basal view | 53 | ||
| Transgastric RV inflow-outflow view | 53 | ||
| Deep transgastric five-chamber view | 53 | ||
| Transgastric two-chamber view | 53 | ||
| Transgastric right ventricle inflow view | 54 | ||
| Transgastric long-axis view | 54 | ||
| Descending aorta SAX and LAX views | 54 | ||
| Upper esophageal aortic arch long-axis view | 54 | ||
| Upper esophageal aortic arch short-axis view | 54 | ||
| References | 54 | ||
| Chapter 13: Applications of Transesophageal Echocardiography | 55 | ||
| Valvular heart disease | 55 | ||
| Aortic Valve Disease | 55 | ||
| Mitral Valve Disease | 55 | ||
| Tricuspid and Pulmonic Valve Disease | 56 | ||
| Prosthetic Valve Disease | 56 | ||
| Interventional imaging | 57 | ||
| Atrial Fibrillation Ablation and Left Atrial Appendage Closure | 57 | ||
| Patent Foramen Ovale or Atrial/Ventricular Septal Defect Closure | 57 | ||
| Transcatheter Aortic and Mitral Valve Interventions | 57 | ||
| Intraoperative imaging | 57 | ||
| Valvular and Aortic Surgery and Congenital Heart Disease Repair | 57 | ||
| Cardiac thrombus and embolus evaluation | 57 | ||
| Precardioversion in Atrial Fibrillation and Cardiac Source of Emboli | 57 | ||
| Endocarditis and cardiac mass investigation | 58 | ||
| Aortic evaluation | 58 | ||
| Critically ill patients | 58 | ||
| Summary | 58 | ||
| References | 59 | ||
| Chapter 14: Pitfalls and Artifacts in Transesophageal Echocardiography | 59 | ||
| Tee pitfalls | 59 | ||
| Crista Terminalis | 59 | ||
| Eustachian Valve and Chiari Network | 60 | ||
| Lipomatous Hypertrophy of the Atrial Septum | 60 | ||
| Coumadin Ridge | 60 | ||
| Moderator Band | 61 | ||
| Lambl Excrescences | 61 | ||
| Prosthetic Valve Structures | 61 | ||
| Pericardial Fat | 61 | ||
| Pleural Effusion | 61 | ||
| Hiatal Hernia | 61 | ||
| Tee artifacts | 62 | ||
| Low Imaging Quality | 62 | ||
| Section IV: Intracardiac Echocardiography | 65 | ||
| Chapter 15: Applications of Intracardiac Echocardiography | 65 | ||
| Device closure of interatrial communications | 65 | ||
| Electrophysiologic ablation procedures | 65 | ||
| Transcatheter aortic valve replacement | 67 | ||
| Rare and investigational applications | 68 | ||
| Summary | 71 | ||
| References | 71 | ||
| Chapter 16: Limitations of Intracardiac Echocardiography | 71 | ||
| Technical limitations | 72 | ||
| Operator-dependent limitations | 72 | ||
| Cost-benefit ratio | 72 | ||
| Current limitations of three-dimensional intracardiac echocardiography | 73 | ||
| References | 73 | ||
| Section V: Intravascular Ultrasound | 75 | ||
| Chapter 17: Intravascular Ultrasound: Instrumentation and Technique | 75 | ||
| Intravascular ultrasound imaging technology | 75 | ||
| Performance of the IVUS procedure | 75 | ||
| Modalities of IVUS imaging | 76 | ||
| Conclusions | 78 | ||
| References | 78 | ||
| Chapter 18: Intravascular Ultrasound: Applications and Limitations | 78 | ||
| Current applications | 78 | ||
| Types of IVUS Imaging and Basics of Image Interpretation | 78 | ||
| IVUS for Assessment of Lesion Severity | 79 | ||
| IVUS for Assessment of Plaque Characteristics | 81 | ||
| Pre- and Post-PCI Assessment Using IVUS | 81 | ||
| Limitations | 82 | ||
| Conclusions | 83 | ||
| References | 83 | ||
| Section VI: Hand-Held Echocardiography | 85 | ||
| Chapter 19: Hand-Carried Cardiac Ultrasound: Background, Instrumentation, and Technique | 85 | ||
| Background | 85 | ||
| Instrumentation | 85 | ||
| Technique | 85 | ||
| References | 87 | ||
| Chapter 20: Focused Cardiac Ultrasound | 88 | ||
| Applications | 88 | ||
| Limitations | 88 | ||
| References | 89 | ||
| Section VII: Contrast Echocardiography | 91 | ||
| Chapter 21: Contrast Echocardiography: Introduction | 91 | ||
| References | 91 | ||
| Chapter 22: Ultrasound Contrast Agents | 91 | ||
| Ultrasound contrast agent composition | 92 | ||
| Technical considerations and responsibilities | 92 | ||
| Role of the physician | 92 | ||
| Role of the sonographer or nurse | 92 | ||
| Safety of ultrasound contrast agents | 92 | ||
| References | 94 | ||
| Chapter 23: Physical Properties of Microbubble Ultrasound Contrast Agents | 94 | ||
| Microbubble contrast agents | 94 | ||
| Contrast-specific imaging techniques | 95 | ||
| Clinical perspective | 96 | ||
| References | 97 | ||
| Chapter 24: Applications of Ultrasound Contrast Agents | 98 | ||
| Clinical applications | 98 | ||
| Assessment of Cardiac Function | 98 | ||
| Delineation of Intracardiac Pathology | 99 | ||
| Summary | 99 | ||
| References | 101 | ||
| Chapter 25: Stress Echocardiography and Contrast | 102 | ||
| Contrast stress echocardiography: methodology and interpretation | 102 | ||
| Methodology | 102 | ||
| Interpretation | 102 | ||
| Contrast left ventricular opacification stress echocardiography | 103 | ||
| Diagnostic Efficacy | 103 | ||
| Prognostic Role | 103 | ||
| Cost-Effectiveness | 103 | ||
| Contrast off-label use for myocardial perfusion stress echocardiography | 105 | ||
| Diagnostic Efficacy | 105 | ||
| Prognostic Role | 105 | ||
| Conclusion | 105 | ||
| References | 106 | ||
| Chapter 26: Contrast-Enhanced Carotid Imaging | 107 | ||
| Clinical applications of carotid ultrasound | 107 | ||
| Methodology of contrast-enhanced carotid ultrasound | 107 | ||
| Detection of plaques | 107 | ||
| Improvement of the Doppler signal | 108 | ||
| Assessment of plaque vulnerability | 108 | ||
| Limitations of contrast-enhanced carotid ultrasound | 108 | ||
| Future perspectives | 110 | ||
| Conclusions | 110 | ||
| References | 110 | ||
| Section VIII: Left Ventricular Systolic Function | 113 | ||
| Chapter 27: Introduction | 113 | ||
| Indications for systolic function evaluation | 113 | ||
| Limitations of ejection fraction | 113 | ||
| Choice for assessment tool of lv systolic function in multimodality ERA | 113 | ||
| Conclusions | 115 | ||
| References | 115 | ||
| Chapter 28: Left Ventricular Systolic Function: Basic Principles | 115 | ||
| Functional anatomy of the left ventricle | 115 | ||
| Left ventricular volume and its dynamic geometry | 116 | ||
| Cardiac cycle | 117 | ||
| Determinants of LV performance | 118 | ||
| Response to exercise | 120 | ||
| References | 120 | ||
| Chapter 29: Global Left Ventricular Systolic Function | 120 | ||
| Echocardiographic methods used to assess lv global systolic function | 120 | ||
| M-Mode Echocardiography | 120 | ||
| Two-Dimensional Echocardiography | 120 | ||
| Three-Dimensional Echocardiography | 120 | ||
| Doppler Echocardiography | 122 | ||
| Tissue Doppler Imaging | 122 | ||
| Speckle Tracking Echocardiography | 122 | ||
| Global LV systolic functional parameters | 122 | ||
| Fractional Shortening and Ejection Fraction | 122 | ||
| Ejection Acceleration Time | 122 | ||
| Myocardial Performance Index | 122 | ||
| Strain and Strain Rate | 122 | ||
| Limitations and technical considerations | 122 | ||
| Conclusion and recommendations | 122 | ||
| References | 124 | ||
| Chapter 30: Regional Left Ventricular Systolic Function | 124 | ||
| LV myocardial segmentation | 124 | ||
| Methods for assessment of regional lv systolic function | 124 | ||
| Visual Assessment of Regional LV Systolic Function | 125 | ||
| Assessment of the Myocardial Contractile Function by Speckle Tracking Echocardiography | 125 | ||
| Other Techniques | 126 | ||
| Correlation with coronary blood supply | 127 | ||
| Correlation with extent of infarction | 127 | ||
| Nonischemic causes of regional LV systolic dysfunction | 127 | ||
| References | 128 | ||
| Chapter 31: Assessment of Left Ventricular Dyssynchrony | 128 | ||
| Electrical dispersion and mechanical dyssynchrony | 128 | ||
| Echocardiographic approaches to assess mechanical dyssynchrony | 129 | ||
| Interventricular mechanical delay | 129 | ||
| Tissue doppler imaging | 129 | ||
| Speckle tracking strain | 130 | ||
| Dyssynchrony in patients with widened QRS complex for prognosis | 131 | ||
| Dyssynchrony as a marker for arrhythmias | 131 | ||
| Mechanical dyssynchrony in myocardial disease with narrow QRS complex | 133 | ||
| Mapping latest mechanical activation for left ventricular lead placement | 133 | ||
| Three-dimensional speckle tracking imaging | 136 | ||
| References | 138 | ||
| Section IX: Right Heart | 139 | ||
| Chapter 32: Right Ventricular Anatomy | 139 | ||
| Coronary flow to the right ventricle | 139 | ||
| Echocardiographic assessment of right ventricular anatomy | 139 | ||
| Reference values for right ventricular structure | 139 | ||
| References | 142 | ||
| Chapter 33: The Physiologic Basis of Right Ventricular Echocardiography | 142 | ||
| Structure and anatomy of the right ventricle | 142 | ||
| Ejection and function of the right ventricle | 145 | ||
| Right ventricular hemodynamics | 146 | ||
| RV Preload | 146 | ||
| RV Contractility | 146 | ||
| RV Afterload | 147 | ||
| Coronary blood flow of the right ventricle | 148 | ||
| Interventricular dependence | 149 | ||
| RV diastolic function | 149 | ||
| Rhythm disturbances originating from the RV | 150 | ||
| Newer imaging modalities to image RV | 150 | ||
| Conclusion | 150 | ||
| References | 150 | ||
| Chapter 34: Assessment of Right Ventricular Systolicand Diastolic Function | 151 | ||
| Introduction | 151 | ||
| Anatomy and physiology | 151 | ||
| Quantitative evaluation by echocardiography | 152 | ||
| Right Ventricular Size | 152 | ||
| Two-Dimensional Measurements | 152 | ||
| Volume of the Right Ventricle | 153 | ||
| Right ventricular systolic function | 153 | ||
| Fractional Area Change | 153 | ||
| Tricuspid Annular Plane Systolic Excursion and Velocity | 153 | ||
| Right Ventricular Index of Myocardial Performance | 153 | ||
| Three-dimensional right ventricular ejection fraction | 155 | ||
| Right ventricular strain | 155 | ||
| Right ventricular diastolic function | 156 | ||
| Transtricuspid Flow | 156 | ||
| Hepatic Vein Flow | 156 | ||
| Tissue Doppler Echocardiography and Strain | 156 | ||
| Lateral Tricuspid Annulus Velocities | 156 | ||
| Tricuspid E/e Ratio | 156 | ||
| Grading Diastolic Function | 157 | ||
| Clinical impact of right ventricular size and function: prognosis | 157 | ||
| Summary and recommendations | 157 | ||
| References | 158 | ||
| Chapter 35: Right Ventricular Hemodynamics | 158 | ||
| Flow | 159 | ||
| Pressure | 159 | ||
| Resistance | 159 | ||
| Pulmonary artery catheter in a box | 159 | ||
| Right Atrial Pressure | 159 | ||
| Secondary Indices of Right Atrial Pressure | 160 | ||
| Right Ventricular Systolic Pressure | 161 | ||
| Pulmonary Artery Pressure (Fig.35.2, A, B) | 161 | ||
| Pulmonary Vascular Resistance | 161 | ||
| Summary | 161 | ||
| References | 161 | ||
| Chapter 36: The Right Atrium | 161 | ||
| Introduction | 161 | ||
| Anatomy | 161 | ||
| Anatomic Landmarks | 162 | ||
| Physiology | 162 | ||
| Echocardiographic views | 162 | ||
| Anatomic variants | 162 | ||
| Right atrial size measurement | 163 | ||
| Right Atrial Dimensions and Volume Measurement by Two-Dimensional Echocardiography | 163 | ||
| Right Atrial Volume Assessment Based on Three-Dimensional Echocardiography | 163 | ||
| Clinical Implications of Right Atrial Enlargement | 165 | ||
| Right atrium pressure and performance | 166 | ||
| Assessment of Right Atrial Pressure by Two-Dimensional Echocardiography | 166 | ||
| Conclusion | 166 | ||
| References | 166 | ||
| Chapter 37: Pulmonary Embolism | 166 | ||
| Introduction | 166 | ||
| Diagnosis | 167 | ||
| Transthoracic echocardiography | 167 | ||
| Transesophageal echocardiography | 169 | ||
| Prognosis | 170 | ||
| Summary | 170 | ||
| References | 171 | ||
| Section X: Diastolic Function | 174 | ||
| Chapter 38: Physiology of Diastole | 174 | ||
| LV relaxation | 174 | ||
| LV stiffness | 174 | ||
| Ventricular arterial coupling | 175 | ||
| Diagnosis of diastolic heart failure | 176 | ||
| References | 176 | ||
| Chapter 39: Methods of Assessment | 176 | ||
| Invasive assessment of diastolic function | 176 | ||
| Noninvasive assessment of diastolic function: echocardiography | 176 | ||
| References | 180 | ||
| Chapter 40: Echo Doppler Parameters of Diastolic Function | 180 | ||
| Doppler mitral flow velocity patterns | 180 | ||
| Valsalva maneuver | 181 | ||
| Pulmonary venous flow | 182 | ||
| Systolic/Diastolic ratio | 183 | ||
| Reverse Flow at Atrial Contraction Velocity | 183 | ||
| Color M-mode flow propagation velocity | 183 | ||
| Tissue doppler annular velocity | 183 | ||
| Myocardial performance index | 184 | ||
| Integration of doppler echocardiography parameters | 184 | ||
| Conclusion | 184 | ||
| References | 185 | ||
| Chapter 41: Estimation of Left Ventricular Filling Pressures | 186 | ||
| Difficult cases | 188 | ||
| References | 188 | ||
| Chapter 42: Clinical Recommendations for Echocardiography Laboratories for Assessment of Left Ventricular Diastolic Function | 188 | ||
| Estimation of left ventricular filling pressures in patients with depressed ejection fraction | 189 | ||
| Estimation of left ventricular filling pressures in patients with normal ejection fraction | 189 | ||
| Grading of left ventricular diastolic function | 189 | ||
| Estimation of left ventricular filling pressures in patients with atrial fibrillation | 190 | ||
| Estimation of left ventricular filling pressures in patients with mitral regurgitation | 190 | ||
| Prognostic power of the american society of echocardiography/european association of echocardiography diastolic function grade | 190 | ||
| References | 191 | ||
| Chapter 43: Newer Methods to Assess Diastolic Function | 191 | ||
| Myocardial muscle mechanics | 191 | ||
| Three-dimensional strain | 191 | ||
| Fluid mechanics | 192 | ||
| Conclusion | 194 | ||
| References | 194 | ||
| Chapter 44: Causes of Diastolic Dysfunction | 194 | ||
| Definition | 194 | ||
| Prevalence of diastolic dysfunction in common comorbid conditions | 194 | ||
| Hypertension | 195 | ||
| Coronary Artery Disease | 195 | ||
| Diabetes Mellitus | 195 | ||
| Obesity | 196 | ||
| Hypertrophic cardiomyopathy | 196 | ||
| Diastolic dysfunction in restrictive cardiomyopathy | 197 | ||
| Amyloidosis | 197 | ||
| Hemosiderosis | 197 | ||
| Cardiac Sarcoidosis | 197 | ||
| Hypereosinophilic Syndrome | 197 | ||
| Systemic Sclerosis | 197 | ||
| Impact on survival | 197 | ||
| Mechanistic considerations | 197 | ||
| Transition from diastolic dysfunction to overt heart failure | 198 | ||
| References | 198 | ||
| Section XI: Left Atrium | 200 | ||
| Chapter 45: Assessment of Left Atrial Size | 200 | ||
| Left atrial remodeling: an echocardiographic diagnosis | 200 | ||
| Definition of left atrial remodeling | 200 | ||
| Diastolic dysfunction and left atrial size | 200 | ||
| Left atrial enlargement for outcome prediction and prognostication | 200 | ||
| Echocardiographic methods of left atrial size assessment | 200 | ||
| Pitfalls of left atrial volume measurement | 201 | ||
| Newer modalities of echocardiographic left atrial volume assessment | 201 | ||
| Reverse remodeling of LA | 201 | ||
| Future directions | 202 | ||
| References | 203 | ||
| Chapter 46: Assessment of Left Atrial Function | 204 | ||
| Left atrial function | 205 | ||
| Volumetric methods | 206 | ||
| Spectral doppler | 206 | ||
| Tissue doppler imaging | 206 | ||
| Deformation analysis (strain and strain rate imaging) | 206 | ||
| Challenges to measurement of left atrial function | 208 | ||
| References | 208 | ||
| Section XII: Ischemic Heart Disease | 210 | ||
| Chapter 47: Introduction to Ischemic Heart Disease | 210 | ||
| References | 210 | ||
| Chapter 48: Ischemic Heart Disease: Basic Principles | 210 | ||
| Acute effects of myocardial ischemia | 210 | ||
| Echocardiographic detection of myocardial ischemia and infarction | 210 | ||
| Patterns of ischemia based on coronary artery involvement | 211 | ||
| False indications of ischemia on echocardiography | 211 | ||
| References | 212 | ||
| Chapter 49: Acute Chest Pain Syndromes: Differential Diagnosis | 212 | ||
| Left ventricle | 213 | ||
| Left Ventricular Function and Acute Coronary Syndrome | 213 | ||
| Left Ventricular Function and Cardiomyopathies | 213 | ||
| Right ventricle | 214 | ||
| Aorta | 215 | ||
| Pericardium | 215 | ||
| References | 216 | ||
| Chapter 50: Echocardiography in Acute Myocardial Infarction | 216 | ||
| Left ventricular thrombosis | 217 | ||
| Postinfarction ventricular septal rupture | 217 | ||
| Left ventricular free wall rupture | 218 | ||
| Acute mitral regurgitation and papillary muscle rupture | 218 | ||
| Left ventricular outflow tract obstruction | 219 | ||
| Right ventricular infarction | 219 | ||
| References | 220 | ||
| Chapter 51: Echocardiography in Stable Coronary Artery Disease | 221 | ||
| Diagnosis | 221 | ||
| Stress echocardiography | 221 | ||
| Image interpretation | 222 | ||
| Prognostic value of stress echocardiography | 222 | ||
| Mechanisms of reversibility | 222 | ||
| Role of dobutamine stress echocardiography in viability assessment | 222 | ||
| Importance of viability | 223 | ||
| Conclusion | 223 | ||
| References | 223 | ||
| Chapter 52: Old Myocardial Infarction | 223 | ||
| Chronic remodeling | 224 | ||
| LV Size and Function | 224 | ||
| Other Manifestations of Remodeling | 224 | ||
| Risk Factors for Chronic Remodeling | 225 | ||
| Treatment and Prevention of Adverse Remodeling | 225 | ||
| Early Detection of Adverse Remodeling | 226 | ||
| Viability | 226 | ||
| Ischemic MR | 227 | ||
| References | 227 | ||
| Chapter 53: End-Stage Cardiomyopathy due to Coronary Artery Disease | 228 | ||
| Etiology of ventricular dysfunction | 229 | ||
| Characterization of left ventricular size and function | 229 | ||
| Right ventricle | 229 | ||
| Diastolic function | 229 | ||
| Mitral regurgitation | 229 | ||
| Left ventricular aneurysm | 230 | ||
| Serial evaluation | 230 | ||
| References | 230 | ||
| Chapter 54: Coronary Artery Anomalies | 231 | ||
| Classification of coronary artery anomalies | 231 | ||
| Multimodality imaging for the identification of coronary artery anomalies | 233 | ||
| Imaging protocol for transthoracic echocardiography | 233 | ||
| Incidence of coronary anomalies diagnosed by echocardiography | 235 | ||
| Perioperative transesophageal echocardiography | 235 | ||
| Conclusion | 235 | ||
| References | 236 | ||
| Section XIII: Stress Echocardiography | 238 | ||
| Chapter 55: Stress Echocardiography: Introduction | 238 | ||
| References | 239 | ||
| Chapter 56: Effects of Exercise, Pharmacological Stress, and Pacing on the Cardiovascular System | 239 | ||
| Hemodynamic effects | 240 | ||
| Mechanisms of ischemia | 240 | ||
| Left ventricular response to stress | 240 | ||
| Comparisons of stressors | 241 | ||
| Hypertensive response to stress | 241 | ||
| Parameters to assess for noncoronary indications | 241 | ||
| Mitral Regurgitation | 241 | ||
| Aortic Stenosis | 241 | ||
| Diastolic Dysfunction | 241 | ||
| Conclusions | 242 | ||
| References | 242 | ||
| Chapter 57: Diagnostic Criteria and Accuracy | 242 | ||
| Diagnostic criteria | 242 | ||
| Semiquantification of Left Ventricular Wall Motion Using Wall Motion Score Index | 244 | ||
| Wall Motion Abnormalities at Low Heart Rates | 244 | ||
| Left Atrial Size | 244 | ||
| Right Ventricular Function | 244 | ||
| Transient Ischemic Dilatation | 244 | ||
| Diagnostic accuracy | 244 | ||
| References | 245 | ||
| Chapter 58: Stress Echocardiography Methodology | 245 | ||
| Exercise echocardiography | 246 | ||
| Exercise protocols | 246 | ||
| Treadmill | 246 | ||
| Bicycle Ergometry | 247 | ||
| Pharmacologic stress protocols | 247 | ||
| Dobutamine | 247 | ||
| Vasodilator Stress Echocardiography | 248 | ||
| Other modalities | 248 | ||
| Handgrip | 248 | ||
| Diastolic Stress Test | 248 | ||
| References | 248 | ||
| Chapter 59: Stress Echocardiography: Image Acquisition | 249 | ||
| References | 252 | ||
| Chapter 60: Prognosis | 252 | ||
| Risk stratification and prognosis with extent and severity of wall motion abnormalities | 252 | ||
| Single vessel and multivessel coronary artery disease | 253 | ||
| Prediction of myocardial infarction versus cardiac death | 253 | ||
| Functional parameters, including heart rate reserve, important in prognosis | 253 | ||
| Heart rate when wall motion abnormality occurs | 253 | ||
| Prognostic value of stress echocardiography versus stress electrocardiography | 253 | ||
| Duration of regional wall motion abnormalities | 253 | ||
| Role of right ventricular wall motion | 254 | ||
| Transient ischemic left ventricular cavity dilatation | 254 | ||
| Left atrial size | 254 | ||
| Warranty time of a normal stress echocardiogram | 254 | ||
| References | 254 | ||
| Chapter 61: Viability | 255 | ||
| Dobutamine stress echocardiography | 256 | ||
| Rationale | 256 | ||
| Protocol | 257 | ||
| Prognostic value | 257 | ||
| Comparison with other modalities | 259 | ||
| Thallium scintigraphy | 259 | ||
| Fluorodeoxyglucose F 18 Positron Emission Tomography | 259 | ||
| Magnetic Resonance Imaging | 259 | ||
| Reasons for discordant findings between various modalities to assess viability | 259 | ||
| Future advances | 259 | ||
| Nitroglycerin-Enhanced Dobutamine Stress Echocardiography | 259 | ||
| Enoximone Stress Echocardiography | 260 | ||
| Strain Rate Measurement | 260 | ||
| Myocardial Contrast Echocardiography | 260 | ||
| Conclusions | 260 | ||
| References | 260 | ||
| Chapter 62: Contrast-Enhanced Stress Echocardiography | 261 | ||
| Ultrasound contrast applications for stress echocardiography | 261 | ||
| Approaches to optimize contrast use during stress echocardiography | 262 | ||
| Physiologic basis for examining myocardial perfusion with ultrasound contrast agents | 262 | ||
| Technical considerations and components | 263 | ||
| Role of physician | 263 | ||
| Role of sonographer and nurse | 264 | ||
| Advantages and disadvantages of using RTPE instead of other imaging techniques | 264 | ||
| Acquisition of RTPE images | 264 | ||
| Specific stress protocols | 264 | ||
| Exercise Stress RTPE Acquisition | 264 | ||
| Analysis of Images | 266 | ||
| Dobutamine stress real-time perfusion echocardiography and left ventricular opacification protocols | 266 | ||
| Acquisition | 266 | ||
| Analysis of Images | 267 | ||
| Vasodilator stress myocardial perfusion imaging | 267 | ||
| Acquisition | 267 | ||
| Analysis | 267 | ||
| Pitfalls and clinical tips for all RTPE stress acquisitions | 269 | ||
| References | 269 | ||
| Chapter 63: Three-Dimensional Stress Echocardiography | 269 | ||
| Introduction | 269 | ||
| Modes of 3D stress echocardiography | 269 | ||
| Real-Time Imaging | 269 | ||
| Real-Time 3D Full Volume Data Acquisition | 269 | ||
| Temporal resolution | 270 | ||
| 3D volume data acquisition | 270 | ||
| LV segment visualization | 270 | ||
| Left ventricular contrast opacification | 270 | ||
| Workflow and display | 271 | ||
| Analysis | 273 | ||
| Other methods of 3D stress analysis and display | 273 | ||
| Conclusion | 273 | ||
| References | 274 | ||
| Chapter 64: Stress Echocardiography for Valve Disease: Aortic Regurgitation and Mitral Stenosis | 275 | ||
| Introduction | 275 | ||
| Stress echocardiography protocol | 275 | ||
| Aortic regurgitation | 275 | ||
| Indications | 275 | ||
| Prognostic value of left ventricular contractile reserve | 275 | ||
| Mitral stenosis | 276 | ||
| Indications | 276 | ||
| Prognostic value of changes in transmitral pressure gradient and systolic pulmonary artery pressure | 276 | ||
| Impact on clinical decision making | 276 | ||
| References | 278 | ||
| Chapter 65: Appropriate Use Criteria for Stress Echocardiography | 278 | ||
| What are appropriate use criteria for stress echocardiography? | 278 | ||
| Is the current clinical practice of stress echocardiography appropriate? | 278 | ||
| Do the appropriate use criteria for stress echocardiography stratify diagnosis and prognosis? | 279 | ||
| References | 279 | ||
| Chapter 66: Comparison with Other Techniques | 280 | ||
| Exercise electrocardiography stress testing and stress echocardiography | 280 | ||
| Nuclear stress testing | 280 | ||
| Cardiac magnetic resonance perfusion imaging | 282 | ||
| Coronary computed tomography angiography | 282 | ||
| Advantage of stress echocardiography over other imaging techniques | 283 | ||
| References | 283 | ||
| Section XIV: Cardiomyopathies | 286 | ||
| Chapter 67: Introduction to Cardiomyopathies | 286 | ||
| Definition of cardiomyopathy | 286 | ||
| Role for echocardiography | 286 | ||
| References | 286 | ||
| Chapter 68: Pathophysiology and Variants of Hypertrophic Cardiomyopathy | 287 | ||
| Anatomic variants | 287 | ||
| Pathophysiology | 288 | ||
| Diastolic Dysfunction | 288 | ||
| Myocardial Ischemia | 289 | ||
| Autonomic Dysfunction | 289 | ||
| Physiologic variants | 289 | ||
| Nonobstructive Hypertrophic Cardiomyopathy | 289 | ||
| Hypertrophic Cardiomyopathy with Left Ventricular Outflow Tract Obstruction | 290 | ||
| Mid-Ventricular Obstruction in Hypertrophic Cardiomyopathy | 290 | ||
| Apical Hypertrophic Cardiomyopathy | 290 | ||
| References | 290 | ||
| Chapter 69: Hypertrophic Cardiomyopathy: Pathophysiology, Functional Features, and Treatment of Outflow Tract Obstruction | 291 | ||
| Pathophysiology of left ventricular outflow tract obstruction | 291 | ||
| Mechanisms of mitral regurgitation | 291 | ||
| Functional features of obstructive hypertrophic cardiomyopathy | 291 | ||
| Echocardiographic and doppler assessment of obstructive hypertrophic cardiomyopathy | 293 | ||
| Treatment strategies for obstructive hypertrophic cardiomyopathy | 294 | ||
| References | 294 | ||
| Chapter 70: Differential of Hypertrophic Cardiomyopathy versus Secondary Conditions That Mimic Hypertrophic Cardiomyopathy | 295 | ||
| Hypertensive heart disease | 295 | ||
| Athletes´ hearts | 296 | ||
| Infiltrative disorders of the myocardium | 296 | ||
| Cardiac Amyloidosis | 296 | ||
| Cardiac Sarcoidosis | 298 | ||
| Isolated left ventricular noncompaction cardiomyopathy | 298 | ||
| Storage diseases | 298 | ||
| Lysosomal Storage Disorders | 300 | ||
| Anderson-Fabry disease | 300 | ||
| Danon Disease | 301 | ||
| Glycogen Storage Diseases | 301 | ||
| Syndromic hypertrophic cardiomyopathy | 301 | ||
| RASopathies: Noonan Syndrome and LEOPARD Syndrome | 301 | ||
| Friedreich Ataxia | 302 | ||
| References | 302 | ||
| Chapter 71: Echocardiographic Features of Hypertrophic Cardiomyopathy: Mechanism of Systolic Anterior Motion | 303 | ||
| The left ventricle | 303 | ||
| Pathophysiologic classification | 303 | ||
| Obstructive Hypertrophic Cardiomyopathy | 303 | ||
| Nonobstructive Hypertrophic Cardiomyopathy | 303 | ||
| Echocardiographic Features of Obstructive Hypertrophic Cardiomyopathy with Left Ventricular Outflow Obstruction | 303 | ||
| The Mitral Leaflets | 303 | ||
| The Mitral Annulus | 303 | ||
| Mechanisms of Systolic Anterior Motion | 305 | ||
| Doppler Assessment of Left Ventricular Outflow Obstruction | 305 | ||
| Role of Intraoperative Echocardiography to Guide Surgical Myectomy | 305 | ||
| Echocardiographic Features of Obstructive Hypertrophic with Mid-Ventricular Obstruction | 306 | ||
| Nonobstructive Hypertrophic Cardiomyopathy | 307 | ||
| Prognostic Implications of Echocardiographic Findings | 308 | ||
| Doppler Assessment of Diastolic Function | 308 | ||
| The right ventricle | 308 | ||
| Conclusion | 308 | ||
| References | 308 | ||
| Chapter 72: Hypertrophic Cardiomyopathy: Assessment of Therapy | 308 | ||
| Treatment and assessment of obstructive hypertrophic cardiomyopathy | 308 | ||
| Pharmacologic therapy | 308 | ||
| Surgical myectomy | 309 | ||
| Alcohol septal ablation | 310 | ||
| Dual-chamber pacing | 312 | ||
| References | 312 | ||
| Chapter 73: Hypertrophic Cardiomyopathy: Screening of Relatives | 313 | ||
| Genetics of hypertrophic cardiomyopathy | 313 | ||
| Genetic testing in hypertrophic cardiomyopathy | 313 | ||
| Recommendations for clinical screening | 313 | ||
| Clinical and Electrocardiographic Assessment | 314 | ||
| Echocardiographic Assessment | 314 | ||
| Assessment by Cardiac Magnetic Resonance Imaging | 314 | ||
| Findings in hypertrophic cardiomyopathy gene carriers | 314 | ||
| Echocardiographic Studies | 314 | ||
| Other Morphologic Abnormalities in Hypertrophic Cardiomyopathy Gene Carriers | 314 | ||
| References | 314 | ||
| Chapter 74: Apical Hypertrophic Cardiomyopathy | 315 | ||
| Morphology and Echocardiographic Features | 315 | ||
| Subtypes | 318 | ||
| Apical Aneurysms | 318 | ||
| References | 319 | ||
| Chapter 75: Echocardiography in Athletic Preparticipation Screening | 320 | ||
| Sports medicine physicians | 320 | ||
| The athletic heart | 320 | ||
| Transthoracic echocardiography | 320 | ||
| Benefits of echocardiographic preparticipation screening | 321 | ||
| Chapter application | 322 | ||
| Conclusions | 322 | ||
| References | 323 | ||
| Chapter 76: Dilated Cardiomyopathy: Etiology, Diagnostic Criteria, and Echocardiographic Features | 323 | ||
| Etiology | 323 | ||
| Echocardiographic assessment of dilated cardiomyopathy | 324 | ||
| Morphological Assessment | 324 | ||
| Assessment of Chamber Dimensions and Function | 325 | ||
| Secondary Findings | 326 | ||
| References | 326 | ||
| Chapter 77: Imaging in Familial Dilated Cardiomyopathy | 327 | ||
| Etiology | 327 | ||
| Epidemiology | 328 | ||
| Case reports | 328 | ||
| Value of imaging in familial dilated cardiomyopathy | 333 | ||
| References | 333 | ||
| Chapter 78: Echocardiographic Predictors of Outcome in Patients with Dilated Cardiomyopathy | 334 | ||
| Left ventricular dimensions and ejection fraction | 334 | ||
| Left ventricular diastolic dysfunction | 334 | ||
| Left atrial size | 336 | ||
| Other variables: myocardial viability, ischemia, and dyssynchrony | 336 | ||
| References | 337 | ||
| Chapter 79: Right Ventricle in Dilated Cardiomyopathy | 338 | ||
| Pathophysiology of right ventricular dysfunction | 338 | ||
| Echocardiographic methods for evaluating right ventricular size and function | 339 | ||
| Studies evaluating right ventricular function | 339 | ||
| Fractional Area Change | 339 | ||
| Right Ventricular Index of Myocardial Performance | 339 | ||
| Tricuspid Annular Plane Systolic Excursion | 340 | ||
| Doppler S | 340 | ||
| Two-Dimensional Strain Imaging | 340 | ||
| Multiple Parameters | 341 | ||
| Pulmonary hemodynamics | 341 | ||
| Conclusion and Recommendations | 341 | ||
| References | 341 | ||
| Chapter 80: Restrictive Cardiomyopathy: Classification | 342 | ||
| References | 344 | ||
| Chapter 81: Cardiac Amyloidosis: Echocardiographic Features | 344 | ||
| Pathology | 344 | ||
| Classification | 344 | ||
| Diagnostic imaging modalities for the evaluation of cardiac amyloidosis | 345 | ||
| Echocardiography | 345 | ||
| Doppler Echocardiography | 346 | ||
| Prognosis | 347 | ||
| Treatment | 348 | ||
| References | 349 | ||
| Chapter 82: Hereditary and Acquired Infiltrative Cardiomyopathy | 349 | ||
| Clinical spectrum | 350 | ||
| Diagnosis | 350 | ||
| Echocardiography | 350 | ||
| Speckle Tracking | 351 | ||
| Cardiac Magnetic Resonance | 351 | ||
| Endomyocardial Biopsy | 351 | ||
| Infiltrative cardiomyopathy with thick walls | 351 | ||
| Fabry Disease | 352 | ||
| Danon Disease | 352 | ||
| Oxalosis | 352 | ||
| Mucopolysaccharidoses | 352 | ||
| Glycogen Storage Disease | 352 | ||
| Infiltrative cardiomyopathy with the dilated phenotype | 352 | ||
| Hemochromatosis | 353 | ||
| Conclusions | 353 | ||
| References | 353 | ||
| Chapter 83: Endomyocardial Fibrosis | 353 | ||
| Etiology | 353 | ||
| Epidemiology | 354 | ||
| Pathophysiology | 354 | ||
| Physical examination | 354 | ||
| Diagnostic testing | 354 | ||
| References | 359 | ||
| Chapter 84: Restriction versus Constriction | 359 | ||
| Etiology and physiopathology | 359 | ||
| Constrictive Pericarditis | 359 | ||
| Restrictive Cardiomyopathy | 360 | ||
| Echocardiography | 360 | ||
| Other investigations | 360 | ||
| References | 363 | ||
| Chapter 85: Echocardiography in Arrhythmogenic Right Ventricular Cardiomyopathy | 363 | ||
| Echocardiographic findings in arrhythmogenic right ventricular cardiomyopathy | 363 | ||
| Right Ventricular Structure | 363 | ||
| Right Ventricular Function | 365 | ||
| Newer Echocardiographic Techniques in Arrhythmogenic Right Ventricular Cardiomyopathy | 365 | ||
| Echocardiography versus other modalities for arrhythmogenic right ventricular cardiomyopathy | 365 | ||
| Summary | 366 | ||
| References | 366 | ||
| Chapter 86: Echocardiographic Analysis of Left Ventricular Noncompaction | 367 | ||
| Echocardiographic features | 367 | ||
| Available diagnostic criteria | 367 | ||
| Echocardiography tricks and tips | 368 | ||
| References | 369 | ||
| Chapter 87: Takotsubo-like Transient Left Ventricular Dysfunction: Takotsubo Cardiomyopathy | 369 | ||
| References | 371 | ||
| Chapter 88: A Systematic Echocardiographic Approach to Left Ventricular Assist Device Therapy | 371 | ||
| Echocardiographic analysis | 371 | ||
| The left ventricular assist device | 371 | ||
| Post-Left Ventricular Assist Device Implantation Evaluation | 372 | ||
| Left ventricular assist device malfunction considerations | 372 | ||
| Postoperative Troubleshooting | 373 | ||
| Summary | 373 | ||
| References | 373 | ||
| Chapter 89: Posttransplantation Echocardiographic Evaluation | 374 | ||
| Screening | 374 | ||
| Recipient Evaluation | 374 | ||
| Donor Evaluation | 374 | ||
| Perioperative monitoring | 374 | ||
| Ventricular Structure and Function | 375 | ||
| Valve Function | 375 | ||
| Pericardial Effusion | 375 | ||
| Posttransplantation surveillance | 375 | ||
| Early Surveillance | 375 | ||
| Late Surveillance | 376 | ||
| References | 376 | ||
| Chapter 90: Familial Cardiomyopathies | 377 | ||
| Friedreich ataxia | 377 | ||
| Cardiac Manifestations | 377 | ||
| Imaging | 377 | ||
| Section XV: Aortic Stenosis | 390 | ||
| Chapter 94: Aortic Stenosis Morphology | 390 | ||
| Congenital aortic stenosis | 390 | ||
| Bicuspid Aortic Valve | 390 | ||
| Natural History of Bicuspid Aortic Valves | 390 | ||
| Echocardiographic Features of Bicuspid Aortic Valves | 390 | ||
| Coarctation | 393 | ||
| Infective Endocarditis | 393 | ||
| Aortic Complications | 394 | ||
| Surveillance (Serial Assessment of Patients with Bicuspid Aortic Valve) | 395 | ||
| Family Screening of Patients with BAV | 395 | ||
| Unicuspid Aortic Valve | 395 | ||
| Quadricuspid Aortic Valve | 396 | ||
| Calcific (degenerative) aortic stenosis | 397 | ||
| Rheumatic aortic stenosis | 397 | ||
| References | 398 | ||
| Chapter 95: Quantification of Aortic Stenosis Severity | 400 | ||
| Normal aortic valve | 400 | ||
| Two-Dimensional Echocardiography | 400 | ||
| M-Mode Echocardiography | 400 | ||
| Quantitative diagnosis of aortic stenosis | 401 | ||
| Quantitative doppler assessment of severity of aortic stenosis | 401 | ||
| Transaortic Velocities | 401 | ||
| Pressure Gradients | 402 | ||
| Aortic Valve Area by Continuity Equation | 403 | ||
| Limitations and pitfalls in the echo-doppler quantitation of aortic stenosis | 406 | ||
| Planimetry of aortic valve orifice | 408 | ||
| Three-dimensional assessment of the aortic valve area | 408 | ||
| Other methods of measuring aortic stenosis severity | 408 | ||
| Serial evaluation of aortic stenosis | 410 | ||
| Physiologic consequences of aortic stenosis | 410 | ||
| Left Ventricular Systolic Dysfunction | 410 | ||
| Left Ventricular Diastolic Dysfunction | 410 | ||
| Pulmonary Hypertension | 410 | ||
| Aortic valve sclerosis | 411 | ||
| References | 411 | ||
| Chapter 96: Asymptomatic Aortic Stenosis | 412 | ||
| Arguments for surgery in asymptomatic aortic stenosis | 412 | ||
| Risk of Sudden Cardiac Death | 412 | ||
| Risk of Irreversible Myocardial Damage | 413 | ||
| Surgical Considerations | 413 | ||
| Duration of the Asymptomatic Phase | 413 | ||
| Studies Reporting Better Outcome with Early Surgery in Asymptomatic Severe Aortic Stenosis | 413 | ||
| Predictors of outcome and risk stratification in asymptomatic severe aortic stenosis | 414 | ||
| Echocardiography at rest | 414 | ||
| Exercise testing | 415 | ||
| Incremental value of exercise hemodynamics assessed by doppler echocardiography | 416 | ||
| Biomarkers | 416 | ||
| Summary | 416 | ||
| References | 416 | ||
| Chapter 97: Risk Stratification—Timing of Surgery | 417 | ||
| Risk stratification in asymptomatic aortic stenosis | 417 | ||
| Importance of the predicted postinterventional survival on decision-making | 417 | ||
| Assessing the risk of an intervention | 418 | ||
| References | 418 | ||
| Chapter 98: Low-Flow, Low-Gradient Aortic Stenosis with Reduced Left Ventricular Ejection Fraction | 418 | ||
| Usefulness of dobutamine stress echocardiography for assessing left ventricular flow reserve and stenosis severity | 419 | ||
| Assessing left ventricular flow reserve | 419 | ||
| Assessing stenosis severity | 420 | ||
| Therapeutic management | 422 | ||
| Conclusions | 422 | ||
| References | 422 | ||
| Chapter 99: Low-Flow, Low-Gradient Aortic Stenosis with Preserved Left Ventricular Ejection Fraction | 423 | ||
| Clinical presentation and pathophysiology of paradoxical low-flow, low-gradient aortic stenosis | 423 | ||
| Assessment of flow and stenosis severity | 425 | ||
| Therapeutic management | 426 | ||
| Conclusion | 427 | ||
| References | 427 | ||
| Chapter 100: Stress (Exercise) Echocardiography in Asymptomatic Aortic Stenosis | 427 | ||
| Exercise testing protocol | 428 | ||
| Exercise echocardiography protocol | 428 | ||
| Clinical and prognostic value | 428 | ||
| Exercise Electrocardiographic Parameters | 428 | ||
| Echocardiographic Parameters | 428 | ||
| Valve Compliance and Pressure Gradients | 428 | ||
| Left Ventricular Function and Contractile Reserve | 428 | ||
| Pulmonary Arterial Pressure | 431 | ||
| Left Ventricular Diastolic Parameters and Mitral Regurgitation | 431 | ||
| Impact on clinical decision-making | 431 | ||
| Conclusion | 432 | ||
| References | 432 | ||
| Chapter 101: Subaortic Stenosis | 432 | ||
| Epidemiology | 432 | ||
| Morphology | 432 | ||
| Etiology and/or pathophysiology | 432 | ||
| Diagnosis | 433 | ||
| Treatment | 434 | ||
| Acknowledgments | 436 | ||
| References | 436 | ||
| Section XVI: Aortic Regurgitation | 438 | ||
| Chapter 102: Introduction to Aortic Regurgitation | 438 | ||
| References | 439 | ||
| Chapter 103: Aortic Regurgitation: Etiologies and Left Ventricular Responses | 439 | ||
| Etiology | 439 | ||
| Left ventricular responses to aortic regurgitation | 441 | ||
| Prognosis and guideline-based management of aortic regurgitation | 442 | ||
| References | 443 | ||
| Chapter 104: Aortic Regurgitation: Pathophysiology | 443 | ||
| Aortic regurgitation pathophysiology | 443 | ||
| Acute aortic regurgitation | 444 | ||
| Chronic aortic regurgitation | 445 | ||
| References | 447 | ||
| Chapter 105: Quantitation of Aortic Regurgitation | 447 | ||
| Quantitation of aortic regurgitation | 447 | ||
| Semiquantitative Methods | 447 | ||
| Quantitative Methods | 448 | ||
| Left ventricular measurements | 448 | ||
| Role of transesophageal echocardiography | 449 | ||
| Role of three-dimensional echocardiography | 449 | ||
| Conclusions | 449 | ||
| References | 450 | ||
| Chapter 106: Risk Stratification: Timing of Surgery for Aortic Regurgitation | 451 | ||
| Introduction | 451 | ||
| Medical therapy | 451 | ||
| Acute Aortic Regurgitation | 451 | ||
| Chronic Aortic Regurgitation | 451 | ||
| Percutaneous interventional therapy | 451 | ||
| Percutaneous Aortic Valves | 451 | ||
| Intra-aortic Balloon Pump | 451 | ||
| Surgical therapy | 451 | ||
| Severity of Aortic Regurgitation | 451 | ||
| Acute Versus Chronic Aortic Regurgitation | 451 | ||
| Symptoms | 452 | ||
| LV Systolic Function | 452 | ||
| Need for Other Cardiac Surgery | 452 | ||
| Decision algorithms for surgical treatment of aortic regurgitation | 452 | ||
| Level of Evidence | 452 | ||
| Strength of Recommendations | 452 | ||
| Severe acute aortic regurgitation | 452 | ||
| Severe chronic aortic regurgitation | 452 | ||
| Class I Indications: AV Surgery Should Be Performed | 452 | ||
| Class IIa Indications: AV Surgery Is a Reasonable Option | 452 | ||
| Class IIb Indication: AV Surgery May Be Considered | 452 | ||
| References | 453 | ||
| Section XVII: Mitral Stenosis | 454 | ||
| Chapter 107: Mitral Stenosis: Introduction | 454 | ||
| References | 454 | ||
| Chapter 108: Rheumatic Mitral Stenosis | 455 | ||
| Etiology of mitral stenosis | 455 | ||
| Epidemiology | 455 | ||
| Pathophysiology | 456 | ||
| Physical examination | 456 | ||
| Electrocardiography | 457 | ||
| Chest radiography | 457 | ||
| Transthoracic echocardiography | 457 | ||
| Transesophageal echocardiography | 458 | ||
| Therapy | 459 | ||
| Medical Therapy | 459 | ||
| Percutaneous Mitral Balloon Valvuloplasty | 459 | ||
| Mitral Valve Surgery | 459 | ||
| References | 460 | ||
| Chapter 109: Quantification of Mitral Stenosis | 461 | ||
| Mean pressure gradient measurements | 461 | ||
| Mitral valve area measurements | 463 | ||
| Pressure Half-Time Method | 463 | ||
| Mitral Deceleration Time Method | 464 | ||
| Mitral Valve Area by Planimetry | 464 | ||
| Mitral Valve Area by Doppler Techniques | 464 | ||
| Mitral Valve Area by Continuity-Equation Method | 464 | ||
| Mitral Valve Area by Proximal Isovelocity Surface Area Method | 464 | ||
| Semiquantitative Mitral Valve Area Assessment by M-Mode Echocardiography | 465 | ||
| Secondary changes due to mitral stenosis | 465 | ||
| Summary | 465 | ||
| References | 465 | ||
| Chapter 110: Other (Nonrheumatic) Etiologies of Mitral Stenosis; Situations That Mimic Mitral Stenosis | 466 | ||
| Mitral annular calcification | 466 | ||
| Other nonrheumatic forms of acquired mitral stenosis | 467 | ||
| Cor Triatriatum | 467 | ||
| Other Congenital Etiologies of Mitral Stenosis | 468 | ||
| References | 468 | ||
| Chapter 111: Role of Hemodynamic Stress Testingin Mitral Stenosis | 469 | ||
| Role of exercise hemodynamics: when and how according to current guidelines? | 469 | ||
| Evaluation of right heart pressure | 469 | ||
| Change in mitral valve area with exercise | 469 | ||
| Stress echocardiography and timing of intervention | 471 | ||
| Conclusions | 471 | ||
| References | 472 | ||
| Chapter 112: Consequences of Mitral Stenosis | 472 | ||
| Pulmonary edema | 472 | ||
| Pulmonary hypertension | 472 | ||
| Right heart failure | 473 | ||
| Atrial arrythmias | 473 | ||
| Atrial thrombus | 473 | ||
| Low cardiac output | 474 | ||
| Other valve involvement | 474 | ||
| Pregnancy | 474 | ||
| Complications from percutaneous mitral valvotomy | 475 | ||
| Summary | 475 | ||
| References | 475 | ||
| Section XVIII: Mitral Regurgitation | 478 | ||
| Chapter 113: Introduction to Mitral Regurgitation | 478 | ||
| References | 478 | ||
| Chapter 114: Etiologies and Mechanisms of Mitral Valve Dysfunction | 478 | ||
| Mitral valve etiologies | 479 | ||
| Mitral valve lesions | 479 | ||
| Mitral valve dysfunction | 480 | ||
| References | 482 | ||
| Chapter 115: Mitral Valve Prolapse | 482 | ||
| Etiology | 483 | ||
| Diagnosis | 483 | ||
| Mitral Valve Repair | 485 | ||
| Summary | 485 | ||
| References | 485 | ||
| Chapter 116: Quantification of Mitral Regurgitation | 485 | ||
| Definition of severe mitral regurgitation | 486 | ||
| Hemodynamics underlying the assessment of mitral regurgitation | 486 | ||
| Anatomy | 486 | ||
| Two-dimensional color doppler | 486 | ||
| Two-Dimensional Color Doppler Jet Area | 486 | ||
| Two Dimensional Vena Contracta Width | 487 | ||
| Two-Dimensional Proximal Isovelocity Surface Area Method | 487 | ||
| Two-Dimensional Volumetric Methods | 488 | ||
| Three-dimensional echocardiography | 489 | ||
| Three-Dimensional Vena Contracta Area | 489 | ||
| Three-Dimensional Proximal Isovelocity Surface Area | 489 | ||
| Three-Dimensional Anatomic Regurgitant Orifice Area | 490 | ||
| Three-Dimensional Mitral Inflow and Left Ventricular Outflow Tract Stroke Volume | 490 | ||
| Limitations of Three-Dimensionally-Derived Quantitative Measurements for Mitral Rergurgitation | 491 | ||
| Supportive finding of severe mitral regurgitation | 491 | ||
| Summary | 492 | ||
| References | 493 | ||
| Chapter 117: Asymptomatic Severe Mitral Regurgitation | 493 | ||
| Indications for surgery in mitral regurgitation | 493 | ||
| Symptomatic Patients | 493 | ||
| Asymptomatic Patients | 494 | ||
| The question of surgery for truly asymptomatic patients | 494 | ||
| Likelihood of mitral valve repair | 494 | ||
| References | 495 | ||
| Chapter 118: Role of Exercise Stress Testing | 496 | ||
| Exercise Echocardiography and Protocols | 496 | ||
| Primary Mitral Regurgitation | 497 | ||
| Indications | 497 | ||
| Clinical and Prognostic Value | 497 | ||
| Dynamic MR and Pulmonary Hypertension | 497 | ||
| LV Function and Contractile Reserve | 497 | ||
| Impact on Clinical Decision Making | 497 | ||
| Secondary (Ischemic) Mitral Regurgitation | 498 | ||
| Pathophysiology | 498 | ||
| Indications | 499 | ||
| Clinical and Prognostic Value | 499 | ||
| Impact on Clinical Decision-Making | 499 | ||
| References | 500 | ||
| Chapter 119: Ischemic Mitral Regurgitation | 501 | ||
| Introduction and definition | 501 | ||
| Mechanisms | 501 | ||
| Chronic Mitral Regurgitation Due to Geometric Changes (Remodeling) of the Left Ventricle | 501 | ||
| Papillary Muscle Rupture | 505 | ||
| Echocardiographic Assessment of Ischemic Mitral Regurgitation | 506 | ||
| Prognosis | 506 | ||
| Management of ischemic mitral regurgitation | 507 | ||
| Conclusion | 507 | ||
| Acknowledgments | 508 | ||
| References | 508 | ||
| Section XIX: Tricuspid Regurgitation | 512 | ||
| Chapter 120: Epidemiology, Etiology, and Natural History of Tricuspid Regurgitation | 512 | ||
| Epidemiology | 512 | ||
| Etiology and mechanisms of tricuspid regurgitation | 512 | ||
| Natural history | 517 | ||
| References | 517 | ||
| Chapter 121: Quantification of Tricuspid Regurgitation | 518 | ||
| References | 523 | ||
| Chapter 122: Indications for Tricuspid Valve Surgery | 524 | ||
| Severity of tricuspid regurgitation | 524 | ||
| Right ventricular function | 525 | ||
| Tricuspid annular dilatation | 525 | ||
| Late development of tricuspid regurgitation following mitral valve surgery | 526 | ||
| References | 527 | ||
| Chapter 123: Tricuspid Valve Procedures | 527 | ||
| Annuloplasty band | 527 | ||
| Annuloplasty Suture | 527 | ||
| Bicuspidization | 528 | ||
| Edge-to-Edge Suture | 528 | ||
| Tricuspid valve replacement | 529 | ||
| Echocardiographic evaluation of prosthetic function | 529 | ||
| Conclusion | 529 | ||
| References | 529 | ||
| Section XX: Pulmonic Regurgitation | 530 | ||
| Chapter 124: Introduction and Etiology of Pulmonic Regurgitation | 530 | ||
| Epidemiology and etiology | 530 | ||
| Two-dimensional echocardiographic evaluation | 530 | ||
| Transthoracic Echocardiography | 530 | ||
| Transesophageal Echocardiography | 530 | ||
| Three-dimensional echocardiographic evaluation | 530 | ||
| Doppler echocardiographic evaluation | 530 | ||
| Color Flow Doppler | 530 | ||
| Continuous Wave Doppler | 531 | ||
| Pulsed Wave Doppler | 531 | ||
| Grading pulmonic regurgitation severity | 532 | ||
| Direct Evaluation | 532 | ||
| Indirect Evaluation | 533 | ||
| Surgical treatment of severe pulmonic regurgitation | 533 | ||
| References | 533 | ||
| Chapter 125: Pulmonic Regurgitation: Semiquantification | 533 | ||
| Introduction | 533 | ||
| Pulmonic regurgitation evaluation overview | 533 | ||
| Mechanism of pulmonic regurgitation | 533 | ||
| Semiquantitative assessment of pulmonic regurgitation severity | 534 | ||
| Color Doppler | 535 | ||
| Jet Length | 535 | ||
| Jet Area | 535 | ||
| Turbulent versus Laminar Regurgitant Jet | 535 | ||
| Vena Contracta | 535 | ||
| Continuous Wave Spectral Doppler | 535 | ||
| Jet Density | 535 | ||
| Deceleration Slope | 535 | ||
| Premature Cessation of Retrograde Flow | 535 | ||
| To-and-Fro Flow | 535 | ||
| Low Peak Pulmonic Regurgitation Velocity | 536 | ||
| Premature Tricuspid and Pulmonic Valve Events | 536 | ||
| Pulsed Wave (PW) Spectral Doppler | 536 | ||
| Regurgitant Fraction by Pulmonic Valve Pulsed Wave | 536 | ||
| Regurgitant Volume and Fraction by Comparing Pulmonic to Systemic Flow | 536 | ||
| Holodiastolic Flow Reversal in Pulmonary Artery | 536 | ||
| M-Mode Echocardiography | 536 | ||
| Impact of pulmonic regurgitation on cardiac chambers | 536 | ||
| References | 536 | ||
| Section XXI: Prosthetic Valves | 538 | ||
| Chapter 126: Prosthetic Valves: Introduction | 538 | ||
| General overview and approach | 538 | ||
| General considerations for evaluation of prosthetic valve function | 538 | ||
| Complications of prosthetic valves | 540 | ||
| Imaging in the catheterization laboratory: prosthetic valve implantation and repair | 540 | ||
| Summary | 541 | ||
| References | 543 | ||
| Chapter 127: Classification of Prosthetic Valve Types and Fluid Dynamics | 543 | ||
| Different types of prosthetic valves | 543 | ||
| Surgical prosthetic valves | 543 | ||
| Mechanical Valves | 543 | ||
| Ball-Cage Valves | 543 | ||
| Monoleaflet Valves | 545 | ||
| Bileaflet Valves | 545 | ||
| Tissue Valves | 545 | ||
| Stented Bioprostheses | 545 | ||
| Stentless Bioprostheses | 546 | ||
| Sutureless Bioprostheses | 547 | ||
| Aortic Homografts | 547 | ||
| Pulmonary Autografts (Ross Procedure) | 547 | ||
| Transcatheter bioprosthetic valves | 548 | ||
| Balloon-Expandable Valves | 548 | ||
| Self-expanding Valves | 548 | ||
| Pressure recovery | 549 | ||
| Localized high gradient in bileaflet mechanical valves | 549 | ||
| Prosthesis-patient mismatch | 549 | ||
| Conclusion | 550 | ||
| References | 550 | ||
| Chapter 128: Aortic Prosthetic Valves | 551 | ||
| Standard transthoracic echocardiographic assessment of aortic prosthetic valve function | 551 | ||
| Two-Dimensional Imaging | 551 | ||
| Doppler Parameters Used to Assess Aortic Prosthetic Valve Function | 551 | ||
| Doppler Velocity Index | 551 | ||
| Effective Orifice Area and Indexed Effective Orifice Area | 551 | ||
| Measurement of Left Ventricular Outflow Tract Parameters after Transcatheter Aortic Valve Implantation | 551 | ||
| Normal Doppler Values | 552 | ||
| Diagnosis of aortic prosthetic valve dysfunction | 552 | ||
| Interpretation of Elevated Valve Gradients | 552 | ||
| Prosthetic Valve Obstruction | 552 | ||
| Prosthesis-Patient Mismatch | 553 | ||
| Rapid Pressure Recovery | 553 | ||
| Aortic prosthetic valve regurgitation | 553 | ||
| Physiologic or \"Normal\" Regurgitation | 553 | ||
| Pathologic Regurgitation | 553 | ||
| Limitations of Transesophageal Echocardiography in Aortic Prostheses | 554 | ||
| Summary | 555 | ||
| References | 555 | ||
| Chapter 129: Mitral Prosthetic Valves | 556 | ||
| Standard transthoracic echocardiographic assessment of mitral prosthetic valve function | 556 | ||
| Two-Dimensional Imaging | 556 | ||
| Doppler Parameters Used to Assess Mitral Prosthetic Valve Function | 556 | ||
| Effective Orifice Area and Pressure Half-Time | 556 | ||
| Doppler Velocity Index | 556 | ||
| Normal Doppler Values | 556 | ||
| Diagnosis of mitral prosthetic valve dysfunction | 556 | ||
| Interpretation of Elevated Valve Gradients | 556 | ||
| Prosthetic Valve Obstruction | 556 | ||
| Prosthesis-Patient Mismatch | 557 | ||
| Doppler detection and quantitation of mitral prosthetic valve regurgitation | 557 | ||
| Normal\" Regurgitation | 557 | ||
| Pathologic Regurgitation | 557 | ||
| Optimal use of transesophageal echocardiography | 557 | ||
| Etiology of Obstruction | 557 | ||
| Confirmation of Regurgitation | 558 | ||
| Infective Endocarditis | 558 | ||
| Summary | 558 | ||
| References | 559 | ||
| Chapter 130: Periprosthetic Leaks | 560 | ||
| Prevalence | 560 | ||
| Clinical presentation | 560 | ||
| Diagnosis | 560 | ||
| Other imaging modalities | 562 | ||
| Treatment | 563 | ||
| References | 564 | ||
| Chapter 131: Tricuspid Prosthetic Valves | 565 | ||
| Tricuspid valve prosthesis dysfunction | 565 | ||
| Echocardiographic assessment of prosthetic tricuspid valve function | 565 | ||
| Two-Dimensional Echocardiography | 565 | ||
| Color Flow Imaging | 565 | ||
| Doppler Echocardiography | 565 | ||
| Mean Gradient | 567 | ||
| Pressure Half-Time | 568 | ||
| Velocity Time Interval Ratio for Tricuspid Valve Prostheses | 568 | ||
| Effective Orifice Area | 568 | ||
| Prosthetic valve regurgitation | 568 | ||
| Two-Dimensional Echocardiography | 569 | ||
| Color Flow Imaging | 569 | ||
| Spectral Doppler | 569 | ||
| Transesophageal echocardiography in patients with prosthetic tricuspid valves | 569 | ||
| Three-dimensional echocardiography | 570 | ||
| Transcatheter valve-in-valve implantation | 570 | ||
| References | 570 | ||
| Chapter 132: Mitral Valve Repair | 571 | ||
| Pre-cardiopulmonary bypass transesophageal echocardiographic examination | 571 | ||
| Post-cardiopulmonary bypass transesophageal echocardiographic examination | 572 | ||
| Three-dimensional echocardiography for mitral valve surgery | 572 | ||
| References | 573 | ||
| Section XXII: Infective Endocarditis | 576 | ||
| Chapter 133: Introduction and Echocardiographic Features of Infective Endocarditis | 576 | ||
| Vegetations | 576 | ||
| Other features | 577 | ||
| References | 577 | ||
| Chapter 134: Infective Endocarditis: Role of Transthoracic versus Transesophageal Echocardiography | 578 | ||
| Epidemiology of infective endocarditis | 578 | ||
| Types of infective endocarditis | 578 | ||
| Pathophysiology | 578 | ||
| Diagnosis | 578 | ||
| Types of echocardiography: indications and diagnosis | 579 | ||
| Echocardiography: detection of complications | 580 | ||
| Therapy | 580 | ||
| Acknowledgment | 580 | ||
| References | 580 | ||
| Chapter 135: Echocardiography for Prediction of Cardioembolic Risk | 581 | ||
| Introduction | 581 | ||
| Spectrum of cardioembolism | 581 | ||
| Stroke | 581 | ||
| Cardioembolic Stroke: Clinical Caveats | 581 | ||
| Cryptogenic Stroke | 581 | ||
| Echocardiographic evaluation | 582 | ||
| Specific cardioembolic clinical situations | 582 | ||
| Atrial Fibrillation | 582 | ||
| Thrombus | 582 | ||
| Left Atrial Thrombus | 582 | ||
| Masses | 583 | ||
| Endocarditis | 583 | ||
| Aortic Pathology | 583 | ||
| Conduits | 583 | ||
| Prosthetic Valves | 583 | ||
| Conditions that are low/uncertain risk for cardioembolism | 584 | ||
| Conclusion | 584 | ||
| Acknowledgments | 584 | ||
| References | 584 | ||
| Chapter 136: Echocardiography and Decision Making for Surgery | 585 | ||
| Transthoracic versus transesophageal echocardiography in infective endocarditis | 585 | ||
| Echocardiography and surgical decision making in infective endocarditis | 585 | ||
| Conclusion | 587 | ||
| References | 587 | ||
| Chapter 137: Intraoperative Echocardiography in Infective Endocarditis | 587 | ||
| Conclusion | 589 | ||
| References | 589 | ||
| Chapter 138: Limitations and Technical Considerations | 589 | ||
| References | 592 | ||
| Section XXIII: Pericardial Diseases | 594 | ||
| Chapter 139: Introduction to Pericardial Diseases | 594 | ||
| References | 596 | ||
| Chapter 140: Normal Pericardial Anatomy | 596 | ||
| Phylogeny and embryology | 597 | ||
| Basic anatomy | 597 | ||
| Pericardial thickness | 597 | ||
| Pericardial fluid | 597 | ||
| Intrapericardial pressure | 598 | ||
| Intrapericardial versus extrapericardial heart structures | 598 | ||
| Pericardial fat | 599 | ||
| Pericardial extensions | 600 | ||
| References | 600 | ||
| Chapter 141: Pericarditis | 600 | ||
| Definition | 600 | ||
| Epidemiology | 600 | ||
| Etiology | 600 | ||
| Diagnostic evaluation | 601 | ||
| Clinical features | 601 | ||
| Symptoms | 601 | ||
| Signs | 601 | ||
| Electrocardiography | 601 | ||
| Chest X-ray | 601 | ||
| Labs | 601 | ||
| Echocardiography | 601 | ||
| Magnetic resonance imaging | 602 | ||
| Computed tomographic imaging | 602 | ||
| Treatment | 603 | ||
| References | 603 | ||
| Chapter 142: Pericardial Effusion and Cardiac Tamponade | 603 | ||
| Normal anatomy of pericardium | 603 | ||
| Pericardial effusion | 603 | ||
| Echocardiography in pericardial effusion | 604 | ||
| Cardiac tamponade | 605 | ||
| Acute Tamponade | 605 | ||
| Subacute Tamponade | 605 | ||
| Echocardiography in Cardiac Tamponade | 605 | ||
| Chamber Collapse | 605 | ||
| Inferior Vena Cava Plethora | 606 | ||
| Echocardiographic or Doppler Signs of Increased Ventricular Interdependence | 606 | ||
| Caveats | 607 | ||
| Echo-guided pericardiocentesis | 608 | ||
| Acknowledgments | 608 | ||
| References | 608 | ||
| Chapter 143: Constrictive Pericarditis | 608 | ||
| Demographics and presenting symptoms | 609 | ||
| Pathophysiology | 609 | ||
| Diagnostics | 609 | ||
| Echocardiography | 610 | ||
| Pulsed Doppler Studies | 610 | ||
| Tissue Doppler | 610 | ||
| Treatment | 611 | ||
| References | 611 | ||
| Chapter 144: Effusive Constrictive Pericarditis | 612 | ||
| Epidemiology | 612 | ||
| Etiology | 612 | ||
| Pathophysiology | 612 | ||
| Diagnostic tests | 613 | ||
| Echocardiography | 613 | ||
| Other Techniques | 614 | ||
| Treatment | 614 | ||
| References | 614 | ||
| Chapter 145: Pericardial Cysts and Congenital Absence of the Pericardium | 615 | ||
| Pericardial cysts | 615 | ||
| Clinical Presentation | 615 | ||
| Imaging Modalities | 615 | ||
| Differential Diagnosis | 615 | ||
| Treatment | 615 | ||
| Absence of the pericardium | 615 | ||
| Epidemiology | 615 | ||
| Pathogenesis | 616 | ||
| Associated Anomalies | 616 | ||
| Clinical Presentation | 616 | ||
| Diagnostic Modalities | 616 | ||
| Echocardiography | 616 | ||
| Treatment | 616 | ||
| Cardiac Magnetic Resonance and Cardiac Computed Tomography | 616 | ||
| References | 617 | ||
| Section XXIV: Tumors and Masses | 618 | ||
| Chapter 146: Introduction to Echocardiographic Assessment of Cardiac Tumors and Masses | 618 | ||
| References | 619 | ||
| Chapter 147: Primary Benign, Malignant, and Metastatic Tumors in the Heart | 619 | ||
| Tumor classification and frequency | 620 | ||
| Primary benign tumors | 620 | ||
| Primary malignant tumors | 623 | ||
| Metastatic tumors | 624 | ||
| Summary | 624 | ||
| Acknowledgment | 624 | ||
| References | 624 | ||
| Chapter 148: Left Ventricular Thrombus | 625 | ||
| Left ventricular thrombus with impaired left ventricular function | 625 | ||
| Left ventricular thrombus with preserved left ventricular function | 626 | ||
| Diagnostic tests and the role of echocardiography | 626 | ||
| Prognosis and treatment | 627 | ||
| Summary | 627 | ||
| References | 627 | ||
| Chapter 149: Left Atrial Thrombus | 628 | ||
| Pathogenesis of left atrial thrombus formation | 628 | ||
| Transesophageal echocardiographic diagnosis of left atrial thrombus | 628 | ||
| Additional diagnostic techniques | 631 | ||
| Transthoracic Echocardiography and Contrast Echocardiography | 631 | ||
| Cardiac Computed Tomography and Magnetic Resonance Imaging | 631 | ||
| Clinical implications of the diagnosis of left atrial thrombus by transesophageal echocardiography | 631 | ||
| Cardiac Source of Embolism | 632 | ||
| Cardioversion of Atrial Fibrillation | 633 | ||
| References | 634 | ||
| Chapter 150: Right Heart Thrombi | 634 | ||
| Incidence | 634 | ||
| Risk factors associated with right heart thrombi | 634 | ||
| Special at-risk clinical populations | 634 | ||
| Atrial Fibrillation | 634 | ||
| Inflammatory Bowel Diseases | 635 | ||
| Children | 635 | ||
| Right heart thrombus imaging by echocardiography | 635 | ||
| Right heart thrombi morphology and outcomes | 636 | ||
| Specific echocardiographic imaging for right heart thrombi | 637 | ||
| Tissue characterization and contrast perfusion of right heart thrombi | 638 | ||
| Conventional management strategies | 639 | ||
| Contemporary Management Strategies | 640 | ||
| Conclusions | 640 | ||
| References | 640 | ||
| Chapter 151: Normal Anatomic Variants and Artifacts | 641 | ||
| Crista terminalis | 641 | ||
| Eustachian valve | 642 | ||
| Chiari network | 642 | ||
| Lipomatous hypertrophy of the atrial septum | 643 | ||
| Fat infiltration of the tricuspid annulus | 644 | ||
| Pectinate muscles in the left atrial appendage | 644 | ||
| Prominent ridge of tissue between the left atrial appendage and the left upper pulmonary vein | 644 | ||
| Fluid in the transverse sinus | 644 | ||
| Caseous calcification of the mitral annulus | 645 | ||
| Artifacts of the thoracic aorta | 646 | ||
| References | 647 | ||
| Chapter 152: Role of Contrast Echocardiography in the Assessment of Intracardiac Masses | 648 | ||
| Traditional echocardiographic diagnosis | 648 | ||
| Use of contrast to detect and define intracardiac masses | 649 | ||
| Differential diagnosis of cardiac masses with contrast perfusion imaging | 649 | ||
| Limitations | 649 | ||
| Conclusion | 650 | ||
| References | 653 | ||
| Chapter 153: Echocardiography-Guided Biopsy of Intracardiac Masses | 653 | ||
| Differential diagnosis of intracardiac mass lesions | 653 | ||
| Diagnostic evaluation | 653 | ||
| Indications for endomyocardial biopsy | 654 | ||
| Technique of endomyocardial biopsy | 655 | ||
| Potential complications of endomyocardial biopsy | 655 | ||
| Acknowledgments | 656 | ||
| References | 656 | ||
| Chapter 154: Cardiac Sources of Emboli | 657 | ||
| References | 659 | ||
| Section XXV: Diseases of the Aorta | 660 | ||
| Chapter 155: Introduction | 660 | ||
| Imaging techniques in aorta assessment | 660 | ||
| Transthoracic Echocardiography | 660 | ||
| Transesophageal Echocardiography | 660 | ||
| Computed Tomography | 660 | ||
| Magnetic Resonance Imaging | 661 | ||
| Multimodality imaging in aortic diseases | 661 | ||
| References | 661 | ||
| Chapter 156: Aortic Atherosclerosis and Embolic Events | 661 | ||
| Transesophageal echocardiography and aortic plaque | 662 | ||
| Other imaging modalities | 662 | ||
| Clot embolization versus cholesterol embolization | 662 | ||
| High-risk plaque | 662 | ||
| Aortic plaque and embolic events in heart surgery and invasive intravascular procedures | 662 | ||
| Management options | 663 | ||
| References | 663 | ||
| Chapter 157: Aortic Aneurysm | 664 | ||
| Etiology | 664 | ||
| Morphology | 664 | ||
| Diagnosis | 664 | ||
| Natural history and complications | 665 | ||
| Serial imaging | 665 | ||
| Surgical indication | 666 | ||
| References | 667 | ||
| Chapter 158: Sinus of Valsalva Aneurysm | 667 | ||
| Clinical significance | 667 | ||
| Diagnosis | 670 | ||
| Treatment | 672 | ||
| References | 672 | ||
| Chapter 159: Acute Aortic Syndrome | 672 | ||
| History | 673 | ||
| Classifications of aortic dissection | 673 | ||
| Temporal | 673 | ||
| Spatial | 673 | ||
| Epidemiology | 674 | ||
| Pathophysiology | 675 | ||
| Basic Features | 675 | ||
| Complications | 675 | ||
| Long-Term Changes | 675 | ||
| Diagnosis of aortic dissection | 675 | ||
| Echocardiography in aortic dissection | 676 | ||
| Therapy and prognosis | 677 | ||
| Conclusions | 680 | ||
| References | 680 | ||
| Chapter 160: Penetrating Atherosclerotic Ulcer and Intramural Hematoma | 681 | ||
| Penetrating atherosclerotic ulcer | 681 | ||
| Etiology | 681 | ||
| Imaging Features | 681 | ||
| Imaging modalities | 682 | ||
| Computed Tomography | 682 | ||
| Transesophageal Echocardiography | 682 | ||
| Intravascular Ultrasound | 683 | ||
| Magnetic Resonance Imaging | 683 | ||
| Angiography | 684 | ||
| Imaging Algorithm | 684 | ||
| Serial follow-up of a penetrating atherosclerotic ulcer | 684 | ||
| Treatment | 684 | ||
| Outcomes and prognosis | 685 | ||
| Intramural hematoma | 685 | ||
| Acknowledgments | 687 | ||
| References | 687 | ||
| Chapter 161: Aortic Trauma | 688 | ||
| Pathophysiology | 688 | ||
| Demographics and presenting symptoms | 688 | ||
| Echocardiographic findings | 688 | ||
| Diagnosis | 691 | ||
| Initial management | 691 | ||
| Conclusion | 691 | ||
| References | 691 | ||
| Chapter 162: Intraoperative Echocardiography | 692 | ||
| Intraoperative transesophageal echocardiography: the thoracic aorta | 692 | ||
| Epiaortic scanning: a solution to the \"blind spot | 693 | ||
| References | 694 | ||
| Chapter 163: Postoperative Echocardiography of the Aorta | 695 | ||
| Postsurgical imaging of the aortic root and aorta | 695 | ||
| What the Imager Needs to Know | 695 | ||
| Common aortic surgical techniques | 695 | ||
| Interposition Technique | 695 | ||
| Inclusion Technique | 695 | ||
| Composite Grafts | 696 | ||
| Reduction Aortic Aortoplasty | 696 | ||
| External Reinforcement (Wrapping) | 697 | ||
| Aortic Arch Grafts | 697 | ||
| Elephant Trunk Procedure | 697 | ||
| Cabrol Shunt Procedure | 697 | ||
| Technical Adjuncts | 697 | ||
| Normal postoperative features | 697 | ||
| Complications after aortic repair | 698 | ||
| Pseudoaneurysm | 698 | ||
| False Lumen Dilatation | 698 | ||
| Involvement of Aortic Branches | 699 | ||
| Infection | 699 | ||
| Recommendations for serial imaging techniques and schedules | 699 | ||
| References | 700 | ||
| Section XXVI: Adult Congenital Heart Disease | 702 | ||
| Chapter 164: Introduction | 702 | ||
| References | 704 | ||
| Chapter 165: Systematic Approach to Adult Congenital Heart Disease | 704 | ||
| History and natural history | 704 | ||
| Location of the scar: \"the scar is the clue | 705 | ||
| Segmental analysis | 705 | ||
| Cardiac Position and Visceral Situs | 706 | ||
| Visceral Situs | 706 | ||
| Atrial Situs | 706 | ||
| Ventricular Position and Morphologic Identification | 706 | ||
| Blood Flow into the Heart | 707 | ||
| Blood Flow through the Heart | 707 | ||
| Blood Flow out of the Heart | 707 | ||
| Coronary Artery Anatomy | 707 | ||
| Special pediatric views and their significance | 707 | ||
| Role of transesophageal echocardiography in an adult patient with congenital heart disease | 709 | ||
| Summary | 710 | ||
| References | 710 | ||
| Chapter 166: Common Congenital Heart Defects Associated with Left-to-Right Shunts | 710 | ||
| References | 718 | ||
| Chapter 167: Obstructive Lesions | 719 | ||
| Anatomy of the outflow tracts and thoracic aorta | 719 | ||
| Clinical presentation | 720 | ||
| Valvar aortic stenosis | 720 | ||
| Aortic coarctation | 720 | ||
| Subvalvar aortic stenosis | 722 | ||
| Supravalvar aortic stenosis | 722 | ||
| Valvar pulmonary stenosis | 722 | ||
| Double-chambered right ventricle | 722 | ||
| Supravalvar and peripheral pulmonic stenosis | 723 | ||
| References | 723 | ||
| Chapter 168: Adult with Unrepaired Complex Congenital Heart Defects | 724 | ||
| Sequential, segmental approach to complex congenital heart disease | 724 | ||
| Abdominal/Cardiac Situs | 724 | ||
| Cardiac Position | 725 | ||
| Definition of the Connection | 725 | ||
| Ventricular Looping | 727 | ||
| Associated Malformations | 727 | ||
| Cyanotic complex congenital heart disease | 727 | ||
| Tetralogy of Fallot | 727 | ||
| Complete Transposition of the Great Arteries (TGA or D-TGA) | 728 | ||
| Univentricular Heart | 728 | ||
| Palliative Shunts | 728 | ||
| Acyanotic complex congenital heart disease | 729 | ||
| Ebstein Anomaly | 729 | ||
| Physiologically \"Corrected\" Transposition of the Great Arteries (c-TGA) | 729 | ||
| Limitations in echocardiographic assessment of complex congenital heart disease | 730 | ||
| References | 731 | ||
| Chapter 169: Adult Congenital Heart Disease with Prior Surgical Repair | 731 | ||
| Historical perspective and timeline | 732 | ||
| Basic concepts of surgical repair | 732 | ||
| Palliative Operations | 732 | ||
| Anatomic Operations | 733 | ||
| Nonanatomic Operations | 733 | ||
| Important echocardiographic considerations in the postoperative patient | 733 | ||
| Representative case examples | 734 | ||
| Case1 | 734 | ||
| Repair of Conotruncal Defects | 734 | ||
| Section XXVII: Systemic Diseases | 740 | ||
| Chapter 170: Hypertension | 740 | ||
| Left ventricular size, chamber function, and mass | 740 | ||
| Cardiac mechanics | 740 | ||
| Arterial dynamics | 742 | ||
| References | 742 | ||
| Chapter 171: Diabetes | 743 | ||
| Pathophysiology | 743 | ||
| Time course of diabetes mellitus: anatomic and echocardiographic overview | 743 | ||
| Left ventricular systolic function | 744 | ||
| Left ventricular diastolic function | 744 | ||
| Right ventricular function | 744 | ||
| Aortic valve and aortic elasticity | 745 | ||
| Can echocardiography be used to determine efficacy of therapy? | 745 | ||
| Novel measures of cardiac function in diabetes: twist and torsion | 745 | ||
| References | 746 | ||
| Chapter 172: End-Stage Renal Disease | 747 | ||
| Epidemiology | 747 | ||
| Hypertension and/or Left Ventricular Hypertension | 747 | ||
| Congestive Heart Failure | 747 | ||
| Valvular Heart Disease | 747 | ||
| Pericarditis | 748 | ||
| Pulmonary Hypertension | 749 | ||
| Mobile Calcific Calcinosis of the Heart | 749 | ||
| Guidelines | 749 | ||
| Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients | 749 | ||
| 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Evaluation and Management of Chr... | 751 | ||
| Cardiac Disease and Evaluation and Management among Kidney and Liver Transplantation Candidates | 752 | ||
| References | 752 | ||
| Chapter 173: Obesity | 752 | ||
| Pathophysiology | 752 | ||
| Cardiac assessment by echocardiography | 753 | ||
| Doppler echocardiography | 754 | ||
| References | 755 | ||
| Chapter 174: Rheumatic Fever and Rheumatic Heart Disease | 755 | ||
| Epidemiology | 755 | ||
| Pathogenesis | 755 | ||
| Acute rheumatic fever | 755 | ||
| Diagnosis | 755 | ||
| Recurrent Acute Rheumatic Fever | 757 | ||
| Subclinical Carditis in Acute Rheumatic Fever | 757 | ||
| Rheumatic heart disease | 757 | ||
| Therapy | 758 | ||
| Treatment of Acute Rheumatic Fever | 758 | ||
| Conclusions | 758 | ||
| References | 758 | ||
| Chapter 175: Systemic Lupus Erythematosus | 758 | ||
| Etiology and pathophysiology | 758 | ||
| Prevalence and outcome | 759 | ||
| Diagnostic approach | 759 | ||
| Cardiac manifestations | 759 | ||
| References | 761 | ||
| Chapter 176: Antiphospholipid Antibody Syndrome | 761 | ||
| Demographics and presenting symptoms | 762 | ||
| Pathophysiology | 762 | ||
| Diagnostic approach | 763 | ||
| Cardiac manifestations | 763 | ||
| Management | 764 | ||
| References | 764 | ||
| Chapter 177: Carcinoid Heart Disease | 764 | ||
| Carcinoid heart disease | 765 | ||
| Echocardiographic findings of tricuspid valve involvement | 765 | ||
| Tricuspid valve replacement | 765 | ||
| Echocardiographic Findings of Pulmonic Valve Involvement | 765 | ||
| Pulmonic balloon valvuloplasty | 765 | ||
| References | 766 | ||
| Chapter 178: Amyloid | 766 | ||
| Introduction | 766 | ||
| Other amyloidogenic proteins | 767 | ||
| Clinical presentation | 767 | ||
| Echocardiographic features | 768 | ||
| Structural Changes | 768 | ||
| Functional Changes | 768 | ||
| Mitral tissue doppler | 768 | ||
| Mitral inflow pattern | 768 | ||
| Pulmonary vein pattern | 769 | ||
| Mitral flow propagation | 769 | ||
| Left ventricular strain imaging | 769 | ||
| References | 769 | ||
| Chapter 179: Sarcoidosis | 770 | ||
| Echocardiographic findings of cardiac sarcoidosis | 770 | ||
| Role of echocardiography in treatment, risk stratification, and surveillance of cardiac sarcoidosis | 772 | ||
| Other echocardiographic techniques for the detection of cardiac sarcoidosis | 773 | ||
| References | 773 | ||
| Chapter 180: Cardiac Involvement in Hypereosinophilic Syndrome | 774 | ||
| Demographics and presenting symptoms | 774 | ||
| Pathophysiology | 775 | ||
| Diagnostics and therapeutics | 775 | ||
| References | 776 | ||
| Chapter 181: Endocrine Disease | 777 | ||
| Hypothyroidism | 777 | ||
| Hyperthyroidism | 777 | ||
| Acromegaly | 779 | ||
| Hypercortisolism | 779 | ||
| Hyperaldosteronism | 779 | ||
| Conclusion | 779 | ||
| References | 781 | ||
| Chapter 182: Chagas Cardiomyopathy | 781 | ||
| Demographic and presenting symptoms | 781 | ||
| Pathophysiology | 781 | ||
| Diagnosis, doppler echocardiography, prognosis, and therapeutics | 782 | ||
| References | 783 | ||
| Chapter 183: Sickle Cell Disease | 784 | ||
| Left ventricular structure and systolic function | 784 | ||
| Diastolic dysfunction | 785 | ||
| Pulmonary hypertension | 785 | ||
| Other cardiac findings | 786 | ||
| Screening considerations | 786 | ||
| Limitations | 786 | ||
| References | 786 | ||
| Chapter 184: Human Immunodeficiency Virus | 787 | ||
| Pericardial disease | 787 | ||
| Myocardial disease and cardiomyopathy | 787 | ||
| Pulmonary hypertension | 787 | ||
| Cardiac tumors and valvular disease | 788 | ||
| Atherosclerotic disease | 788 | ||
| References | 788 | ||
| Chapter 185: Cardiotoxic Effects of Cancer Therapy | 789 | ||
| Cancer therapeutics-related cardiac dysfunction | 789 | ||
| Definition | 789 | ||
| Classification by Mechanism of Toxicity | 790 | ||
| Type 1 Cancer Therapeutics-Related Cardiac Dysfunction | 790 | ||
| Type 2 Cancer Therapeutics-Related Cardiac Dysfunction | 790 | ||
| Combined Chemotherapy | 790 | ||
| Echocardiographic evaluation of the patient receiving cancer therapy | 790 | ||
| Two-Dimensional Echocardiography | 790 | ||
| Contrast-Enhanced Echocardiography | 791 | ||
| Three-Dimensional Echocardiography | 791 | ||
| Contrast-Enhanced Three-Dimensional Echocardiography | 791 | ||
| Stress Echocardiography and Cardiotoxicity | 792 | ||
| Strain Imaging | 792 | ||
| Diastolic Function and Cardiotoxicity | 792 | ||
| Conclusions | 792 | ||
| References | 796 | ||
| Chapter 186: Pregnancy and the Heart | 798 | ||
| Physiologic changes with pregnancy | 798 | ||
| Echocardiographic findings during normal pregnancy | 798 | ||
| Cardiac Chamber Dimensions | 798 | ||
| Left Ventricular Contractility and Ejection Fraction | 798 | ||
| Right Ventricular Systolic Function | 799 | ||
| Cardiac Output | 799 | ||
| Diastolic Function | 799 | ||
| Valve Function | 802 | ||
| Pericardium | 802 | ||
| References | 802 | ||
| Chapter 187: Cocaine | 802 | ||
| Pathophysiology | 802 | ||
| Clinical assessment | 803 | ||
| Echocardiography | 803 | ||
| Cocaine use in pregnancy | 804 | ||
| Treatment | 804 | ||
| References | 804 | ||
| Section XXVIII: Echocardiography in the Emergency Department | 806 | ||
| Chapter 188: Echocardiography in Emergency Clinical Presentation | 806 | ||
| Diagnosis and prognosis in acute coronary syndrome | 806 | ||
| Diagnostic Algorithms for Acute Coronary Syndrome | 806 | ||
| Evaluation for Wall Motion Abnormalities | 806 | ||
| Myocardial Contrast Echocardiography for Left Ventricular Opacification | 807 | ||
| Myocardial Contrast Echocardiography Perfusion Imaging | 807 | ||
| Hypotension and dyspnea | 808 | ||
| Acute Complications of Myocardial Infarction | 808 | ||
| The Hypotensive Patient | 809 | ||
| References | 809 | ||
| Section XXIX: Interventional Echocardiography | 810 | ||
| Chapter 189: Introduction | 810 | ||
| References | 814 | ||
| Chapter 190: Transcatheter Aortic Valve Replacement | 815 | ||
| Transcatheter heart valve characteristics | 815 | ||
| Patient selection | 815 | ||
| Preprocedural imaging | 815 | ||
| Procedural imaging | 817 | ||
| Postimplantation follow-up | 818 | ||
| References | 819 | ||
| Chapter 191: MitraClip Procedure | 819 | ||
| Studies on effectiveness of mitraclip procedure | 819 | ||
| Indications and patient selection | 819 | ||
| Two-dimensional echocardiography | 820 | ||
| Transesophageal echocardiography | 820 | ||
| Three-dimensional transesophageal echocardiography | 820 | ||
| Mitraclip procedure guidance | 822 | ||
| Transseptal Puncture | 822 | ||
| Steerable Guide Catheter Introduction into the Left Atrium | 822 | ||
| Advancement of the Clip Delivery System into the Left Atrium | 822 | ||
| Steering and Positioning of the MitraClip above the Mitral Valve | 822 | ||
| Advancement of the MitraClip into the Left Ventricle | 822 | ||
| Grasping of the Leaflets and Assessment of Proper Leaflet Insertion | 823 | ||
| Assessment of Result and MitraClip Release | 823 | ||
| Additional MitraClip Implantation | 823 | ||
| Acknowledgments | 823 | ||
| References | 823 | ||
| Chapter 192: Mitral Balloon Valvuloplasty | 824 | ||
| Etiology of mitral stenosis | 824 | ||
| Patient selection for balloon mitral commissurotomy | 824 | ||
| Role of three-dimensional transesophageal echocardiography in balloon mitral commissurotomy | 825 | ||
| Technique for balloon mitral commissurotomy | 825 | ||
| Complications of balloon mitral commissurotomy | 827 | ||
| Long-term results of balloon mitral commissurotomy | 829 | ||
| Summary | 829 | ||
| References | 829 | ||
| Chapter 193: Transcatheter Valve-in-Valve Implantation | 829 | ||
| Valve in valve | 830 | ||
| Imaging | 830 | ||
| The procedure | 830 | ||
| Complications | 830 | ||
| Conclusion | 830 | ||
| References | 831 | ||
| Chapter 194: Atrial and Ventricular Septal Defect Closure | 832 | ||
| Atrial septal defect closure | 832 | ||
| Surgical Atrial Septal Defect Closure | 832 | ||
| Percutaneous Atrial Septal Defect Closure | 832 | ||
| Role of Echocardiography in Percutaneous Atrial Septal Defect Closure | 832 | ||
| Before Atrial Septal Defect Closure | 832 | ||
| During Atrial Septal Defect Closure | 833 | ||
| After Atrial Septal Defect Closure | 834 | ||
| Ventricular septal defect closure | 835 | ||
| Surgical Ventricular Septal Defect Closure | 835 | ||
| Percutaneous Ventricular Septal Defect Closure | 836 | ||
| Role of Echocardiography in Percutaneous Ventricular Septal Defect Closure | 836 | ||
| References | 837 | ||
| Chapter 195: Transcatheter Cardiac Pseudoaneurysm Closure | 838 | ||
| Left ventricular pseudoaneurysm | 838 | ||
| Echocardiographic imaging | 839 | ||
| Other imaging modalities | 839 | ||
| Clinical course and treatment options | 839 | ||
| Conclusions | 839 | ||
| References | 841 | ||
| Chapter 196: Patent Foramen Ovale | 841 | ||
| Prevalence | 841 | ||
| Anatomy and embryology | 842 | ||
| Pathophysiology | 842 | ||
| Clinical presentations | 842 | ||
| Cryptogenic stroke | 843 | ||
| Migraine | 844 | ||
| Decompression sickness in divers | 844 | ||
| Platypnea-orthodeoxia syndrome | 844 | ||
| Diagnosis | 844 | ||
| Medical management | 845 | ||
| Interventional closure | 845 | ||
| Conclusion | 845 | ||
| Acknowledgments | 845 | ||
| References | 845 | ||
| Chapter 197: Fusion of Three-Dimensional Echocardiography with Fluoroscopy for Interventional Guidance | 846 | ||
| Conclusion and future directions | 849 | ||
| References | 849 | ||
| Section XXX: Miscellaneous Topics in Echocardiography | 850 | ||
| Chapter 198: Appropriate Use Criteria | 850 | ||
| What are appropriate use criteria? | 850 | ||
| What led to the development of appropriate use criteria? | 850 | ||
| What do the appropriate use criteria for echocardiography tell us about current clinical practice? | 850 | ||
| What can we learn from ``inappropriate´´ (now termed ``rarely appropriate´´) studies? | 850 | ||
| How will the appropriate use criteria be implemented into clinical practice? | 850 | ||
| References | 851 | ||
| Chapter 199: Carotid Ultrasound to Evaluate Cardiovascular Disease Risk: Carotid Intima-Media Thickness and Plaque Detection | 852 | ||
| References | 855 | ||
| Chapter 200: Coronary Artery Imaging | 856 | ||
| System settings for coronary flow imaging | 856 | ||
| How to record coronary flow | 857 | ||
| Detection of total occlusion of the coronary arteries | 857 | ||
| Detection of proximal lad stenosis | 857 | ||
| Summary | 858 | ||
| References | 858 | ||
| Index | 860 | ||
| Inside Back Cover | ES3 |