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Book Details
Abstract
The new edition of Practice of Clinical Echocardiography provides expert guidance on interpreting echocardiographic images and Doppler flow data. Designed for those already equipped with a mastery of basic principles, this definitive reference shows you how to apply these findings to your daily clinical decision making. Each chapter focuses on a specific disease process with technical details of qualitative and quantitative interpretation of echocardiographic images and Doppler flow data.
- Disease-oriented chapters emphasize the role of echocardiography in clinical decision making and prediction of clinical outcomes.
- New chapters cover emerging technologies, including transcatheter procedures for structural heart disease.
- Numerous images illustrate findings, while diagrams explain pathophysiology and flow charts guide clinical practice.
- Each chapter includes a summary box with a practical approach to echo data acquisition, measurement, and interpretation.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| IFC | ES1 | ||
| THE PRACTICE OF CLINICAL ECHOCARDIOGRAPHY | i | ||
| THE PRACTICE OF CLINICAL ECHOCARDIOGRAPHY | iii | ||
| Copyright | iv | ||
| CONTRIBUTORS | v | ||
| PREFACE | xi | ||
| ACKNOWLEDGMENTS | xiii | ||
| CONTENTS | xv | ||
| GLOSSARY | xvii | ||
| I - Advanced Principles for the Echocardiographer | 1 | ||
| 1 - The Diagnostic Echocardiography Laboratory: Structure, Standards, and Quality Improvement | 3 | ||
| QUALITY IN CONTEXT | 3 | ||
| STRUCTURE AND STANDARDS | 3 | ||
| LABORATORY STRUCTURE | 3 | ||
| QUALITY IMPROVEMENT | 9 | ||
| PATIENT SELECTION AND APPROPRIATE USE CRITERIA | 9 | ||
| REPRODUCIBILITY AND VARIABILITY | 11 | ||
| ECHOCARDIOGRAPHY OUTSIDE THE ECHOCARDIOGRAPHY LABORATORY | 13 | ||
| QUALITY IN AN ERA OF HEALTH CARE REFORM | 14 | ||
| REFERENCES | 16 | ||
| 2 - 3D Echocardiography: Principles of Image Acquisition, Display, and Analysis | 18 | ||
| ULTRASOUND IMAGING SYSTEM FUNCTION | 18 | ||
| RESOLUTION IN 3D ECHO | 20 | ||
| SPATIAL RESOLUTION | 20 | ||
| TEMPORAL RESOLUTION | 21 | ||
| Single-Beat or Multibeat Acquisition | 21 | ||
| Parallel Beamforming | 21 | ||
| Interpolation of Images or Image Sectors | 22 | ||
| Frame Reordering | 22 | ||
| Virtual Array | 23 | ||
| Multiline Transmission | 23 | ||
| High-Pulse Repetition Frequency | 23 | ||
| RELATIONSHIP BETWEEN SPATIAL AND TEMPORAL RESOLUTION | 24 | ||
| 3D ECHO DATA ACQUISITION | 24 | ||
| 2D IMAGE OPTIMIZATION | 24 | ||
| 3D ACQUISITION MODES | 24 | ||
| Simultaneous Multiplane Mode | 24 | ||
| Pyramidal Size | 26 | ||
| “Zoom” | 26 | ||
| Narrow Sector | 26 | ||
| Wide Sector | 26 | ||
| COLOR FLOW DOPPLER | 26 | ||
| CHALLENGES WITH 3D ECHO ACQUISITION | 27 | ||
| Temporal Versus Spatial Resolution | 27 | ||
| ECG-Gating and Breath-Hold | 27 | ||
| 3D IMAGE OPTIMIZATION | 27 | ||
| GAIN | 27 | ||
| BRIGHTNESS | 27 | ||
| SMOOTHING | 27 | ||
| COLORIZATION | 27 | ||
| 3D IMAGE DISPLAY | 28 | ||
| DATA SET CROPPING | 28 | ||
| Autocrop | 29 | ||
| Box Crop | 29 | ||
| Plane Crop | 29 | ||
| Two-Plane Crop | 30 | ||
| POSTACQUISITION DISPLAY | 30 | ||
| Volume Rendering | 30 | ||
| Surface Rendering | 30 | ||
| 2D Tomographic Slices | 30 | ||
| 3D ECHO ANALYSIS | 31 | ||
| MULTIPLANAR RECONSTRUCTION | 31 | ||
| MODELING | 31 | ||
| COLOR DOPPLER | 31 | ||
| 3D ECHO ACQUISITION AND ANALYSIS PROTOCOLS | 32 | ||
| LEFT VENTRICLE | 32 | ||
| Acquisition | 32 | ||
| Presentation | 32 | ||
| Analysis | 32 | ||
| Limitations | 32 | ||
| RIGHT VENTRICLE | 33 | ||
| II - The Left Ventricle | 105 | ||
| 7 - Quantitative Evaluation of Left Ventricular Structure, Wall Stress, and Systolic Function | 107 | ||
| DEFINITIONS AND THEORETICAL CONSIDERATIONS | 108 | ||
| ASSESSMENT OF LEFT VENTRICULAR MASS, VOLUME, AND GEOMETRY | 111 | ||
| M-MODE ECHOCARDIOGRAPHY | 111 | ||
| Mass | 111 | ||
| Volume | 113 | ||
| Relative Wall Thickness | 113 | ||
| TWO-DIMENSIONAL ECHOCARDIOGRAPHY | 115 | ||
| Mass | 115 | ||
| Geometry | 116 | ||
| Doppler Echocardiography | 117 | ||
| ASSESSMENT OF LEFT VENTRICULAR SYSTOLIC FUNCTION | 117 | ||
| EJECTION FRACTION | 119 | ||
| Hemodynamic Determinants of the Ejection Fraction | 119 | ||
| FRACTIONAL SHORTENING AND RELATED INDICES | 120 | ||
| STRESS-SHORTENING RELATIONS | 120 | ||
| Midwall Stress-Shortening Analysis | 121 | ||
| PRESSURE-VOLUME ANALYSIS | 122 | ||
| POTENTIAL LIMITATIONS | 123 | ||
| REFERENCES | 126 | ||
| 8 - Myocardial Mechanics: Velocities, Strain, Strain Rate, Cardiac Synchrony, and Twist | 128 | ||
| VELOCITY AND DISPLACEMENT IMAGING | 128 | ||
| VELOCITIES BY COLOR DOPPLER | 128 | ||
| VELOCITIES BY PULSED DOPPLER | 128 | ||
| DISPLACEMENT IMAGING | 129 | ||
| DEFORMATION IMAGING | 131 | ||
| BASIC CONCEPTS | 131 | ||
| STRAIN AND STRAIN RATE BY TISSUE DOPPLER IMAGING | 132 | ||
| PHYSICAL PRINCIPLES OF SPECKLE TRACKING ECHOCARDIOGRAPHY | 132 | ||
| STRAIN AND STRAIN RATE BY SPECKLE TRACKING ECHOCARDIOGRAPHY | 133 | ||
| LEFT VENTRICULAR ROTATION AND TWIST | 133 | ||
| LIMITATIONS OF VELOCITY AND STRAIN IMAGING | 134 | ||
| ANGLE DEPENDENCY | 134 | ||
| INADEQUATE TRACKING | 134 | ||
| NOISE REDUCTION VERSUS SPATIAL AND TEMPORAL RESOLUTION | 134 | ||
| MOVEMENT OF SAMPLE VOLUME RELATIVE TO MYOCARDIUM | 135 | ||
| REVERBERATIONS | 135 | ||
| LOAD DEPENDENCY | 136 | ||
| LIMITATIONS OF LEFT VENTRICULAR ROTATION AND TWIST | 136 | ||
| TRANSMURAL STRAIN GRADIENT | 136 | ||
| INTERVENDOR VARIABILITY IN STRAIN | 136 | ||
| NORMAL LV PHYSIOLOGY | 136 | ||
| SYSTOLIC VELOCITIES | 137 | ||
| DIASTOLIC VELOCITIES | 137 | ||
| MYOCARDIAL ISCHEMIA | 138 | ||
| CARDIAC SYNCHRONY | 139 | ||
| MECHANISMS OF LEFT VENTRICULAR INTRAVENTRICULAR DYSSYNCHRONY | 139 | ||
| EFFECT OF LEFT BUNDLE BRANCH BLOCK ON LEFT VENTRICULAR FUNCTION | 141 | ||
| DYSSYNCHRONY AND RISK OF VENTRICULAR ARRHYTHMIAS | 141 | ||
| STRAIN IMAGING IN SUBCLINICAL LEFT VENTRICULAR DYSFUNCTION | 142 | ||
| RIGHT VENTRICULAR FUNCTION | 143 | ||
| REFERENCES | 144 | ||
| 9 - Left Ventricular Diastolic Function | 147 | ||
| BASIC PRINCIPLES | 147 | ||
| PHYSIOLOGY OF DIASTOLIC FUNCTION | 147 | ||
| EFFECT OF AGING ON DIASTOLIC FUNCTION | 148 | ||
| MITRAL INFLOW PATTERN | 150 | ||
| PULMONARY VENOUS FLOW | 152 | ||
| COLOR M-MODE DOPPLER | 152 | ||
| TISSUE DOPPLER IMAGING | 152 | ||
| ASSESSMENT OF LEFT VENTRICULAR FILLING PRESSURE: E/E′ RATIO | 153 | ||
| ASSESSMENT OF DIASTOLIC FUNCTION IN SPECIAL CIRCUMSTANCES | 154 | ||
| SINUS TACHYCARDIA | 154 | ||
| ATRIAL FIBRILLATION | 154 | ||
| MITRAL REGURGITATION | 154 | ||
| SUPPORTIVE ECHOCARDIOGRAPHIC FINDINGS OF DIASTOLIC DYSFUNCTION | 155 | ||
| LEFT ATRIAL ENLARGEMENT AND ABNORMAL LEFT ATRIAL FUNCTION | 155 | ||
| PULMONARY HYPERTENSION | 156 | ||
| EVALUATION OF DIASTOLIC FUNCTION IN THE CLINICAL SETTING | 156 | ||
| GRADING OF LEFT VENTRICULAR DIASTOLIC FUNCTION | 156 | ||
| ESTIMATION OF LEFT VENTRICULAR FILLING PRESSURES | 157 | ||
| NEW TECHNOLOGIES FOR THE ASSESSMENT OF DIASTOLIC FUNCTION | 158 | ||
| DIASTOLIC STRESS ECHOCARDIOGRAPHY | 158 | ||
| STRAIN | 159 | ||
| LEFT VENTRICULAR TWIST AND TORSION | 161 | ||
| ACKNOWLEDGEMENTS | 161 | ||
| REFERENCES | 163 | ||
| 10 - Digital Image Processing and Automated Image Analysis in Echocardiography | 166 | ||
| DIGITAL IMAGE PROCESSING AND AUTOMATED ANALYSIS:DEFINITION AND MOTIVATION | 166 | ||
| DIGITAL IMAGE STORAGE, COMMUNICATION, AND COMPRESSION | 167 | ||
| DIGITAL IMAGES | 167 | ||
| STORAGE FORMATS AND IMAGE COMMUNICATION | 167 | ||
| Digital Imaging and Communications in Medicine | 167 | ||
| General-Purpose Formats | 167 | ||
| IMAGE COMPRESSION | 167 | ||
| MEDICAL IMAGE PROCESSING | 167 | ||
| IMAGE ENHANCEMENT: LEVEL MANIPULATIONS, FILTERING | 167 | ||
| IMAGE INTERPRETATION: THE INTERPRETATION PYRAMID | 168 | ||
| Cardiac Image Interpretation | 168 | ||
| Rules for a Well-Behaved Automated Border Detection Method | 169 | ||
| AUTOMATED BORDER DETECTION IN ECHOCARDIOGRAPHY | 169 | ||
| PROBLEMS AND PITFALLS | 169 | ||
| PRACTICAL CONSIDERATIONS | 170 | ||
| Acquisition and Image Quality | 170 | ||
| Contour Definitions and Consistency | 170 | ||
| Choice of Detection Technique | 170 | ||
| OVERVIEW OF AUTOMATED BORDER DETECTION METHODS | 170 | ||
| FEATURE-DRIVEN METHODS | 170 | ||
| STRUCTURE-BASED METHOD: TISSUE TRACKING | 170 | ||
| OBJECT-BASED METHODS: GEOMETRIC MODELING | 173 | ||
| PATTERN MATCHING | 173 | ||
| 3D ACTIVE SURFACE DETECTION | 174 | ||
| POPULATION MODEL–BASED METHOD: ACTIVE APPEARANCE MODELS | 177 | ||
| CLASSIFICATION AND AUTOMATED LOCALIZATION | 178 | ||
| COMPARISON BETWEEN AUTOMATED BORDER DETECTION METHODS | 178 | ||
| FUTURE PROMISE: INTELLIGENT ULTRASOUND SYSTEMS | 178 | ||
| REFERENCES | 180 | ||
| III - Ischemic Heart Disease | 183 | ||
| 11 - The Role of Echocardiographic Evaluation in Patients Presenting with Acute Chest Pain to the Emergency Department | 185 | ||
| BACKGROUND AND PRINCIPLES | 185 | ||
| ECHOCARDIOGRAPHY AND THE PHYSIOLOGY OF ACUTE ISCHEMIA | 185 | ||
| TECHNICAL ASPECTS OF ECHO | 186 | ||
| IMAGE ACQUISITION | 186 | ||
| CLINICAL APPLICATIONS | 187 | ||
| TRIAGE OF PATIENTS WITH CHEST PAIN | 187 | ||
| STRAIN IMAGING | 188 | ||
| STRESS ECHOCARDIOGRAPHY | 189 | ||
| USE OF MYOCARDIAL CONTRAST | 191 | ||
| ASSESSMENT OF THE NEED FOR URGENT CORONARY ANGIOGRAPHY | 191 | ||
| RISK STRATIFICATION AND LONG-TERM OUTCOMES | 192 | ||
| POINT OF CARE CARDIAC ULTRASOUND IN THE EMERGENCY DEPARTMENT | 193 | ||
| USE OF ECHOCARDIOGRAPHY IN CHEST PAIN UNITS AND CLINICAL ALGORITHMS | 194 | ||
| COST EFFECTIVENESS | 194 | ||
| EVALUATION OF NONISCHEMIC CAUSES OF CHEST PAIN | 195 | ||
| AORTIC DISSECTION | 195 | ||
| PULMONARY EMBOLUS | 195 | ||
| PERICARDITIS | 195 | ||
| AORTIC STENOSIS | 195 | ||
| LIMITATIONS | 195 | ||
| ISCHEMIA EVALUATION | 195 | ||
| IMAGE QUALITY | 196 | ||
| PERSONNEL AVAILABILITY | 197 | ||
| SUMMARY | 197 | ||
| REFERENCES | 198 | ||
| 12 - Echocardiography in the Coronary Care Unit: Management of Acute Myocardial Infarction, Detection of Complications, and Prognosti... | 200 | ||
| APPLICABLE MODES OF ECHOCARDIOGRAPHY IN THECORONARY CARE UNIT | 200 | ||
| ECHOCARDIOGRAPHY IN THE DIAGNOSIS AND LOCALIZATION OF ACUTE MYOCARDIAL INFARCTION | 201 | ||
| DIAGNOSTIC ROLE OF ECHOCARDIOGRAPHY | 201 | ||
| LOCALIZATION OF INFARCTION | 201 | ||
| RIGHT VENTRICULAR INFARCTION | 203 | ||
| DETECTING COMPLICATIONS OF ACUTE MYOCARDIAL INFARCTION | 204 | ||
| HEMODYNAMIC ASSESSMENT OF MYOCARDIAL INFARCTION USING DOPPLER ECHOCARDIOGRAPHY | 204 | ||
| POSTINFARCTION PERICARDIAL EFFUSION | 204 | ||
| ACUTE MITRAL REGURGITATION | 204 | ||
| VENTRICULAR SEPTAL RUPTURE | 205 | ||
| RUPTURE OF THE VENTRICULAR FREE WALL | 208 | ||
| PSEUDOANEURYSM | 208 | ||
| INFARCT EXPANSION AND TRUE ANEURYSM FORMATION | 208 | ||
| LEFT VENTRICULAR THROMBUS | 209 | ||
| RISK STRATIFICATION AFTER MYOCARDIAL INFARCTION | 210 | ||
| LEFT VENTRICULAR SYSTOLIC FUNCTION | 210 | ||
| REGIONAL WALL MOTION SCORE | 211 | ||
| LEFT VENTRICULAR DIASTOLIC FUNCTION | 211 | ||
| LEFT ATRIAL VOLUME | 212 | ||
| LEFT VENTRICULAR REMODELING | 212 | ||
| STRESS ECHOCARDIOGRAPHY | 213 | ||
| CORONARY FLOW RESERVE | 213 | ||
| MITRAL REGURGITATION | 213 | ||
| REFERENCES | 215 | ||
| 13 - Stress Echocardiography for Coronary Ischemia | 218 | ||
| PHYSIOLOGIC AND PATHOPHYSIOLOGIC PRINCIPLES | 218 | ||
| THE ISCHEMIC CASCADE | 218 | ||
| DETERMINANTS OF MYOCARDIAL OXYGEN DEMAND AND SUPPLY | 219 | ||
| INDICATIONS AND CONTRAINDICATIONS FOR STRESS ECHOCARDIOGRAPHY | 219 | ||
| INDICATIONS | 219 | ||
| Use of Exercise Stress Echocardiography to Assess Preoperative Risk in Noncardiac Surgery | 223 | ||
| CONTRAINDICATIONS | 223 | ||
| COST-EFFECTIVENESS | 223 | ||
| STRESS PROTOCOLS | 223 | ||
| GENERAL CONSIDERATIONS | 223 | ||
| EQUIPMENT AND PERSONNEL | 224 | ||
| PATIENT PREPARATION | 224 | ||
| EXERCISE STRESS TESTING | 225 | ||
| EXERCISE STRESS PROTOCOLS | 225 | ||
| Treadmill Protocols | 225 | ||
| Bicycle Protocols | 225 | ||
| Handgrip | 225 | ||
| EXERCISE STRESS ECHOCARDIOGRAPHY WITH MEDICAL THERAPY | 225 | ||
| OUTCOME ASSESSMENT OF STRESS ECHOCARDIOGRAPHY | 225 | ||
| Symptoms, Angina, and Perceived Effort | 225 | ||
| Heart Rate | 226 | ||
| Heart Rate Recovery | 226 | ||
| Blood Pressure | 227 | ||
| Functional Capacity | 227 | ||
| Electrocardiographic Changes | 227 | ||
| Echocardiographic Imaging | 227 | ||
| Duke Treadmill Score | 228 | ||
| Other Important Stress Echocardiographic Outcomes | 228 | ||
| TERMINATION OF STRESS ECHOCARDIOGRAPHY | 231 | ||
| ACCURACY OF EXERCISE STRESS ECHOCARDIOGRAPHY | 231 | ||
| SENSITIVITY, SPECIFICITY, AND PROGNOSTIC VALUE | 232 | ||
| FUTURE DEVELOPMENTS | 235 | ||
| STRAIN ECHOCARDIOGRAPHY | 235 | ||
| 3D ECHOCARDIOGRAPHY | 237 | ||
| REFERENCES | 241 | ||
| 14 - NONEXERCISE STRESS ECHOCARDIOGRAPHY FOR DIAGNOSIS OF CORONARY ARTERY DISEASE | 243 | ||
| PHARMACOLOGIC STRESS ECHOCARDIOGRAPHY IN CURRENT CLINICAL PRACTICE | 254 | ||
| DOBUTAMINE STRESS ECHOCARDIOGRAPHY | 244 | ||
| DIPYRIDAMOLE STRESS ECHOCARDIOGRAPHY | 245 | ||
| ERGONOVINE | 245 | ||
| PACING STRESS ECHOCARDIOGRAPHY | 245 | ||
| DIAGNOSTIC ACCURACY OF NONEXERCISE STRESS ECHOCARDIOGRAPHY FOR DIAGNOSING SIGNIFICANT CORONARY ARTERY DISEASE | 245 | ||
| ASSESSMENT OF MYOCARDIAL VIABILITY | 247 | ||
| NEW TECHNIQUES IN STRESS ECHOCARDIOGRAPHY | 252 | ||
| THREE-DIMENSIONAL STRESS ECHOCARDIOGRAPHY | 252 | ||
| CORONARY FLOW VELOCITY RESERVE | 253 | ||
| TISSUE DOPPLER IMAGING AND TWO-DIMENSIONAL SPECKLE TRACKING STRAIN ECHOCARDIOGRAPHY | 253 | ||
| REFERENCES | 257 | ||
| IV - Valvular Heart Disease | 259 | ||
| 15 - Aortic Stenosis: Disease Severity, Progression, and Timing of Intervention | 261 | ||
| VALVE MORPHOLOGY | 262 | ||
| HEMODYNAMIC SEVERITY | 263 | ||
| AORTIC VELOCITY AND MEAN PRESSURE GRADIENT | 263 | ||
| CONTINUITY EQUATION AORTIC VALVE AREA | 264 | ||
| Left Ventricular Outflow Tract Velocity | 264 | ||
| Left Ventricular Outflow Tract Diameter | 265 | ||
| STROKE VOLUME INDEX | 265 | ||
| VELOCITY RATIO | 265 | ||
| TRANSESOPHAGEAL ECHOCARDIOGRAPHY PLANIMETRY VALVE AREA | 266 | ||
| CLINICAL CHALLENGES IN ASSESSMENT OF AORTIC STENOSIS SEVERITY | 268 | ||
| MEASUREMENT PRECISION AND VARIABILITY | 268 | ||
| EFFECT OF TRANSAORTIC FLOW | 268 | ||
| ANATOMIC VERSUS EFFECTIVE AORTIC VALVE AREA | 269 | ||
| PRESSURE RECOVERY | 269 | ||
| DISCORDANCE BETWEEN DIFFERENT MEASURES OF AORTIC STENOSIS SEVERITY | 270 | ||
| ADJUSTMENT FOR BODY SIZE | 270 | ||
| CONCURRENT HYPERTENSION | 270 | ||
| LEFT VENTRICULAR CHANGES IN AORTIC STENOSIS | 270 | ||
| LEFT VENTRICULAR HYPERTROPHY AND REMODELING | 270 | ||
| DIASTOLIC FUNCTION | 270 | ||
| SYSTOLIC FUNCTION | 270 | ||
| STROKE VOLUME INDEX | 271 | ||
| LONGITUDINAL FUNCTION | 271 | ||
| ASSOCIATED FINDINGS | 271 | ||
| AORTIC REGURGITATION | 271 | ||
| CONCOMITANT SUBVALVULAR OBSTRUCTION | 271 | ||
| MITRAL ANNULAR CALCIFICATION AND MITRAL REGURGITATION | 271 | ||
| CORONARY ARTERY DISEASE | 273 | ||
| PULMONARY HYPERTENSION | 273 | ||
| ALTERNATIVE DIAGNOSTIC MODALITIES | 273 | ||
| EXERCISE STRESS TESTING | 273 | ||
| CARDIAC CATHETERIZATION | 273 | ||
| Gradients | 273 | ||
| Aortic Valve Area | 273 | ||
| COMPUTED TOMOGRAPHY | 273 | ||
| CARDIAC MAGNETIC RESONANCE IMAGING | 274 | ||
| CLINICAL APPROACH | 274 | ||
| PROGNOSTIC VALUE | 274 | ||
| STRATEGIES TO MITIGATE OR HALT PROGRESSION | 274 | ||
| Timing of Aortic Valve Replacement | 276 | ||
| SYMPTOMATIC PATIENTS | 278 | ||
| ASYMPTOMATIC PATIENTS | 278 | ||
| LOW-GRADIENT AORTIC STENOSIS WITH REDUCED EJECTION FRACTION (STAGE D2) | 278 | ||
| LOW-GRADIENT AORTIC STENOSIS WITH PRESERVED EJECTION FRACTION (STAGE D3) | 279 | ||
| PATIENTS WITH INDICATIONS FOR OTHER CARDIAC SURGERY | 282 | ||
| ACKNOWLEDGMENT | 282 | ||
| REFERENCES | 284 | ||
| 16 - Transcatheter Aortic Valve Implantation: Role of Echocardiography in Patient Selection, Procedural Planning and Monitoring, and Monitoring, and Evaluation of Outcomes. | 287 | ||
| SEVERITY OF AORTIC STENOSIS | 287 | ||
| HIGH-RISK ASSESSMENT | 288 | ||
| SPECIFIC ASSOCIATED CONDITIONS | 288 | ||
| Bicuspid Aortic Valve | 288 | ||
| Mitral Regurgitation | 288 | ||
| Left Ventricular Hypertrophy and Obstruction | 289 | ||
| Ascending Aortic Aneurysm | 289 | ||
| Exuberant Aortic Atheroma | 289 | ||
| Intracardiac Masses | 289 | ||
| PLANNING OF THE PROCEDURE | 289 | ||
| MEASURING THE AORTIC ANNULUS AND PROSTHESIS SIZING | 289 | ||
| DISTANCE BETWEEN PLANE OF AORTIC ANNULUS AND CORONARY OSTIA | 291 | ||
| BASAL SEPTAL HYPERTROPHY | 291 | ||
| AORTIC VALVE CALCIFICATION | 291 | ||
| GUIDING THE PROCEDURE—INTRAPROCEDURAL COMPLICATIONS | 292 | ||
| TRANSESOPHAGEAL GUIDANCE | 292 | ||
| Before Implantation | 292 | ||
| Balloon Valvuloplasty | 292 | ||
| Prosthesis Positioning and Deployment | 292 | ||
| IS TRANSESOPHAGEAL ECHOCARDIOGRAPHY MANDATORY DURING TRANSCATHETER AORTIC VALVE IMPLANTATION? | 293 | ||
| IMMEDIATE COMPLICATIONS | 294 | ||
| Annulus Rupture | 294 | ||
| Pericardial Effusion and Tamponade | 294 | ||
| Coronary Obstruction and Myocardial Infarction | 294 | ||
| Prosthesis Malposition and Malfunction and Severe Aortic Regurgitation | 294 | ||
| Acute Mitral Regurgitation | 295 | ||
| Cardiogenic Shock | 295 | ||
| SHORT-TERM AND MIDTERM OUTCOME | 295 | ||
| HEMODYNAMIC PERFORMANCE OF IMPLANTED PROSTHESIS | 295 | ||
| PARAVALVULAR REGURGITATION | 296 | ||
| THROMBOSIS | 298 | ||
| ENDOCARDITIS | 299 | ||
| PROSTHESIS DEGENERATION | 300 | ||
| CONCLUSION | 300 | ||
| REFERENCES | 301 | ||
| 17 - Aortic Valve Regurgitation: Quantitation of Disease Severity and Timing of Surgical Intervention | 303 | ||
| ETIOLOGY | 303 | ||
| LEAFLET ABNORMALITIES | 303 | ||
| AORTIC ROOT ABNORMALITIES | 305 | ||
| AORTIC REGURGITATION SEVERITY | 305 | ||
| COLOR DOPPLER ECHOCARDIOGRAPHY | 305 | ||
| Semiquantitative Methods | 306 | ||
| Quantitative Methods | 306 | ||
| PULSED WAVE DOPPLER | 308 | ||
| CONTINUOUS WAVE DOPPLER | 308 | ||
| Deceleration Time of Regurgitant Flow | 308 | ||
| INTEGRATING DOPPLER INDEXES OF SEVERITY | 309 | ||
| ALTERNATIVE APPROACHES | 309 | ||
| LEFT VENTRICLE SIZE AND SYSTOLIC FUNCTION | 310 | ||
| DIMENSIONS AND CONTRACTILE FUNCTION OF THE LEFT VENTRICLE | 310 | ||
| CONTRACTILE RESERVE EVALUATION | 310 | ||
| AORTIC ROOT AND ASCENDING AORTA EVALUATION | 310 | ||
| AORTIC VALVE AND ROOT FUNCTION | 311 | ||
| NATURAL HISTORY AND SERIAL TESTING IN CHRONIC AORTIC REGURGITATION | 312 | ||
| MANAGEMENT AND TIMING OF SURGERY | 312 | ||
| MEDICAL TREATMENT | 312 | ||
| INDICATIONS FOR SURGERY | 313 | ||
| Symptomatic Patients with Left Ventricular Dysfunction | 314 | ||
| Symptomatic Patients with Normal Left Ventricular Systolic Function | 314 | ||
| Asymptomatic Patients with Reduced Ejection Fraction | 314 | ||
| Asymptomatic Patients with Normal Ejection Fraction | 314 | ||
| Concomitant Aortic Root Disease | 314 | ||
| SELECTING AND GUIDING SURGICAL TREATMENT | 314 | ||
| ROLE OF ECHOCARDIOGRAPHY | 314 | ||
| SURGICAL IMPLICATIONS | 315 | ||
| RESULTS OF SURGERY AND FOLLOW-UP | 316 | ||
| ACUTE AORTIC REGURGITATION | 316 | ||
| ACUTE TYPE A AORTIC DISSECTION | 317 | ||
| INFECTIVE ENDOCARDITIS | 317 | ||
| OTHER UNCOMMON CAUSES OF ACUTE AORTIC REGURGITATION | 318 | ||
| SUMMARY AND FUTURE PERSPECTIVES | 318 | ||
| REFERENCES | 320 | ||
| 18 - Mitral Regurgitation: Valve Anatomy, Regurgitant Severity, and Timing of Intervention | 322 | ||
| ANATOMY AND PATHOPHYSIOLOGY | 322 | ||
| MITRAL VALVE ANATOMY | 322 | ||
| Embryology and Components of the Mitral Valve | 322 | ||
| Mitral Annulus | 322 | ||
| Mitral Leaflets | 322 | ||
| Chordae Tendineae and Papillary Muscles | 323 | ||
| MECHANISM OF MITRAL REGURGITATION | 323 | ||
| Primary Mitral Regurgitation | 323 | ||
| Secondary Mitral Regurgitation | 325 | ||
| Carpentier Classification Nomenclature | 329 | ||
| Mitral Regurgitation Mechanisms Summary | 329 | ||
| QUANTITATION OF MITRAL REGURGITATION | 329 | ||
| COLOR DOPPLER METHODS | 329 | ||
| Distal Jet Area Method | 329 | ||
| Vena Contracta Width Method | 330 | ||
| Proximal Isovelocity Surface Area Method | 331 | ||
| Geometric Factors That Influence the Proximal Isovelocity Surface Area Method | 332 | ||
| Technical Factors | 332 | ||
| Different Reference Values for Effective Regurgitant Orifice Area based on the Cause of Mitral Regurgitation | 333 | ||
| VOLUMETRIC METHODS USING PULSED DOPPLER | 333 | ||
| SUPPORTIVE ECHO AND DOPPLER DATA | 333 | ||
| Pulmonary Venous Flow Pattern: Systolic Flow Reversal | 333 | ||
| Holosystolic versus Nonholosystolic Mitral Regurgitation | 334 | ||
| Peak E Wave Velocity | 334 | ||
| Continuous Wave Doppler Pattern | 334 | ||
| Valve Morphology and Left-Sided Chamber Size | 334 | ||
| ROLE OF THREE-DIMENSIONAL ECHOCARDIOGRAPHY | 334 | ||
| IMPORTANCE OF HEMODYNAMIC AND PHYSIOLOGIC FACTORS | 334 | ||
| Summary of Approach to Grading Mitral Regurgitation: Importance of Integrative Method | 334 | ||
| Integrative Approach to Quantitation of Mitral Regurgitation Severity | 335 | ||
| TIMING OF SURGICAL INTERVENTION | 335 | ||
| DISEASE COURSE | 335 | ||
| TIMING OF INTERVENTION | 336 | ||
| Therapy for Primary Mitral Regurgitation | 336 | ||
| Therapy for Secondary Mitral Regurgitation | 337 | ||
| CLINICAL CORRELATES | 337 | ||
| REFERENCES | 340 | ||
| 19 - Transesophageal Echocardiography for Surgical Repair of Mitral Regurgitation | 343 | ||
| THE TEAM APPROACH TO ECHOCARDIOGRAPHY-GUIDED MITRAL REPAIR | 343 | ||
| ESSENTIAL ANATOMY | 344 | ||
| MITRAL VALVE DISEASE | 344 | ||
| DEGENERATIVE (MYXOMATOUS) DISEASE | 345 | ||
| INFECTIVE ENDOCARDITIS | 345 | ||
| RHEUMATIC DISEASE | 347 | ||
| RADIATION NECROSIS | 347 | ||
| DYSTROPHIC CALCIFICATION | 347 | ||
| PAPILLARY MUSCLE RUPTURE | 347 | ||
| SECONDARY VALVE DISEASE | 347 | ||
| TRANSESOPHAGEAL IMAGING OF THE MITRAL VALVE | 348 | ||
| STANDARD MULTIPLANE IMAGING | 348 | ||
| PRINCIPLES OF AXIAL IMAGING | 349 | ||
| THREE-DIMENSIONAL IMAGING | 349 | ||
| PREREPAIR TRANSESOPHAGEAL ECHOCARDIOGRAPHY | 349 | ||
| DEGENERATIVE DISEASE | 356 | ||
| ENDOCARDITIS | 356 | ||
| RHEUMATIC DISEASE | 356 | ||
| PAPILLARY MUSCLE RUPTURE | 356 | ||
| SECONDARY DISEASE | 356 | ||
| DISEASE COMBINATIONS | 356 | ||
| SURGICAL TECHNIQUES OF IMAGE-GUIDED MITRAL REPAIR | 358 | ||
| DEGENERATIVE DISEASE | 358 | ||
| ENDOCARDITIS | 366 | ||
| RHEUMATIC DISEASE | 366 | ||
| PAPILLARY MUSCLE RUPTURE | 366 | ||
| SECONDARY DISEASE | 366 | ||
| POSTREPAIR TRANSESOPHAGEAL ECHOCARDIOGRAPHY | 366 | ||
| LEAFLET STRUCTURE AND FUNCTION | 366 | ||
| RESIDUAL MITRAL REGURGITATION | 367 | ||
| NEW MITRAL STENOSIS | 367 | ||
| VENTRICULAR DYSFUNCTION | 367 | ||
| SYSTOLIC ANTERIOR MOTION | 367 | ||
| REFERENCES | 371 | ||
| 20 - Transcatheter Mitral Valve Repair: Role of Echocardiography in Patient Selection, Procedural Guidance, and Evaluation of Outcome | 374 | ||
| PERCUTANEOUS THERAPIES FOR MITRAL REGURGITATION | 374 | ||
| OVERVIEW | 374 | ||
| EDGE-TO-EDGE MITRAL VALVE REPAIR | 376 | ||
| USE OF ECHOCARDIOGRAPHY IN PATIENT SELECTION | 376 | ||
| DETERMINING THE CAUSE OF MITRAL REGURGITATION | 376 | ||
| DEGENERATIVE MITRAL REGURGITATION | 377 | ||
| FUNCTIONAL MITRAL REGURGITATION | 378 | ||
| MIXED MITRAL REGURGITATION | 379 | ||
| DETERMINING MITRAL REGURGITATION SEVERITY | 379 | ||
| MODERATE TO SEVERE MITRAL REGURGITATION | 380 | ||
| SEVERE MITRAL REGURGITATION | 380 | ||
| ECHOCARDIOGRAPHIC MARKERS TO DETERMINE SUITABILITY FOR EDGE-TO-EDGE MITRAL VALVE REPAIR | 382 | ||
| PROCEDURAL GUIDANCE | 382 | ||
| TRANSSEPTAL PUNCTURE | 382 | ||
| NAVIGATION IN THE LEFT ATRIUM | 382 | ||
| GUIDING CATHETER AND DELIVERY SYSTEM STEERING | 382 | ||
| DEVICE ALIGNMENT TO THE MITRAL VALVE | 383 | ||
| DEVICE ADVANCEMENT INTO LEFT VENTRICLE | 383 | ||
| LEAFLET GRASPING | 384 | ||
| DEVICE RELEASE AND DETERMINATION OF RESIDUAL MITRAL REGURGITATION | 384 | ||
| CONSIDERATION FOR ADDITIONAL CLIPS | 384 | ||
| RETRIEVAL OF DELIVERY CATHETERS | 384 | ||
| ATRIAL SEPTAL DEFECT CHECK | 384 | ||
| EVALUATION OF POSSIBLE COMPLICATIONS | 384 | ||
| EVALUATION OF OUTCOMES | 385 | ||
| ALTERNATIVE IMAGING TECHNIQUES | 386 | ||
| RECENT ADVANCES AND FUTURE DIRECTIONS | 387 | ||
| REFERENCES | 393 | ||
| 21 - Mitral Stenosis: Patient Selection, Hemodynamic Results, Complications, and Long-Term Outcome with Balloon Mitral Commissurotomy | 395 | ||
| BASIC PRINCIPLES AND ECHOCARDIOGRAPHIC APPROACH | 395 | ||
| DIAGNOSIS | 396 | ||
| EVALUATION OF SEVERITY | 396 | ||
| ASSESSMENT OF HEMODYNAMIC CONSEQUENCES | 397 | ||
| ASSESSMENT OF CONSEQUENCES ON THE LEFT ATRIUM | 397 | ||
| ASSESSMENT OF VALVE ANATOMY | 397 | ||
| MITRAL REGURGITATION | 398 | ||
| ASSOCIATED LESIONS | 398 | ||
| THROMBOEMBOLIC COMPLICATIONS | 399 | ||
| USE OF THE DIFFERENT ECHOCARDIOGRAPHIC TECHNIQUES | 399 | ||
| TECHNIQUE, QUANTITATION, AND DATA ANALYSIS | 399 | ||
| BEFORE BALLOON MITRAL COMMISSUROTOMY | 399 | ||
| Valve Function | 399 | ||
| Valve Anatomy | 399 | ||
| Exercise Echocardiography | 400 | ||
| DURING BALLOON MITRAL COMMISSUROTOMY | 400 | ||
| EARLY AFTER BALLOON MITRAL COMMISSUROTOMY | 401 | ||
| DURING FOLLOW-UP | 402 | ||
| RESULTS OF BALLOON MITRAL COMMISSUROTOMY | 403 | ||
| Failure and Complications | 403 | ||
| Immediate Results | 403 | ||
| Late Results | 404 | ||
| The Elderly | 407 | ||
| Young Patients | 407 | ||
| Pregnant Women | 407 | ||
| IMPLICATIONS FOR PATIENT SELECTION | 407 | ||
| Contraindications | 407 | ||
| Choice of Procedure | 408 | ||
| Timing of the Procedure | 409 | ||
| RESEARCH APPLICATIONS | 410 | ||
| Stress Echocardiography | 410 | ||
| Evaluation of Atrioventricular Compliance | 411 | ||
| Evaluation of Valve Anatomy | 411 | ||
| POTENTIAL LIMITATIONS, FUTURE DIRECTIONS | 411 | ||
| ALTERNATE APPROACHES | 412 | ||
| REFERENCES | 413 | ||
| 22 - Endocarditis: The Role of Echocardiography in Diagnosis and Clinical Decision-Making | 416 | ||
| BASIC PRINCIPLES AND ECHOCARDIOGRAPHIC APPROACH | 416 | ||
| TECHNICAL DETAILS, QUANTITATION, AND DATA ANALYSIS | 417 | ||
| DIAGNOSIS OF ENDOCARDITIS | 421 | ||
| GENERAL CONSIDERATIONS | 421 | ||
| EVALUATION OF PATIENTS WITH BACTEREMIA | 424 | ||
| EVALUATION OF PATIENTS WITH PROSTHETIC VALVES | 424 | ||
| EVALUATION OF PATIENTS WITH CARDIAC IMPLANTABLE ELECTRONIC DEVICES | 425 | ||
| UTILITY IN MANAGEMENT | 425 | ||
| UTILITY IN FOLLOW-UP | 428 | ||
| RESEARCH APPLICATIONS | 429 | ||
| POTENTIAL LIMITATIONS AND FUTURE DIRECTIONS | 429 | ||
| ALTERNATE APPROACHES | 429 | ||
| REFERENCES | 431 | ||
| 23 - Fluid Dynamics of Prosthetic Valves | 433 | ||
| PRINCIPLES OF FLUID DYNAMICS | 433 | ||
| CONSERVATION OF MASS | 433 | ||
| MECHANICAL ENERGY | 434 | ||
| BERNOULLI’S EQUATION | 435 | ||
| THE CONTROL VOLUME ENERGY ANALYSIS | 435 | ||
| MECHANISMS OF MECHANICAL ENERGY LOSS | 436 | ||
| Viscous Losses | 436 | ||
| Turbulent Losses | 436 | ||
| Valvular Regurgitation | 436 | ||
| MECHANICAL ENERGY CONVERSION AND LOSS IN A STENOSIS | 436 | ||
| APPLICATIONS OF FLUID DYNAMICS TO PROSTHETIC HEART VALVES | 437 | ||
| PRESSURE DROP | 437 | ||
| DOPPLER GRADIENT | 438 | ||
| EFFECTIVE ORIFICE AREA | 438 | ||
| REGURGITANT VOLUME | 439 | ||
| MECHANICAL ENERGY LOSSES | 440 | ||
| NOVEL ENERGY LOSS PARAMETERS | 441 | ||
| IN VIVO EVALUATION OF PROSTHETIC VALVES | 441 | ||
| HEMODYNAMICS OF NATIVE VALVES | 441 | ||
| HEMODYNAMICS OF SPECIFIC PROSTHETIC VALVE DESIGNS | 443 | ||
| MECHANICAL VALVES | 445 | ||
| BIOPROSTHETIC VALVES | 445 | ||
| TRANSCATHETER VALVES | 445 | ||
| Antegrade Flow Fields | 448 | ||
| Normal Regurgitant Flow | 448 | ||
| FUTURE DIRECTIONS | 450 | ||
| ACKNOWLEDGMENTS | 451 | ||
| REFERENCES | 453 | ||
| 24 - Echocardiographic Recognition and Quantitation of Prosthetic Valve Dysfunction | 455 | ||
| PROSTHETIC VALVE COMPLICATIONS AND DYSFUNCTION | 455 | ||
| PROSTHESIS-PATIENT MISMATCH | 455 | ||
| PROSTHETIC VALVE THROMBOSIS AND PANNUS | 455 | ||
| STRUCTURAL VALVE DETERIORATION | 457 | ||
| INFECTIVE ENDOCARDITIS | 457 | ||
| BASIC PRINCIPLES FOR DOPPLER ECHOCARDIOGRAPHIC EVALUATION OF PROSTHETIC VALVE FUNCTION | 457 | ||
| TIMING OF ECHOCARDIOGRAPHIC FOLLOW-UP | 457 | ||
| CLINICAL DATA | 457 | ||
| RECOGNITION AND QUANTITATION OF PROSTHETIC VALVE STENOSIS | 457 | ||
| LEAFLET MORPHOLOGY AND MOBILITY | 457 | ||
| QUANTITATIVE PARAMETERS | 459 | ||
| Transprosthetic Velocity and Gradient | 459 | ||
| Transprosthetic Jet Contour and Acceleration Time | 460 | ||
| Effective Orifice Area | 461 | ||
| Doppler Velocity Index | 464 | ||
| RECOGNITION AND QUANTITATION OF PROSTHETIC VALVE REGURGITATION | 465 | ||
| PROSTHETIC AORTIC VALVE REGURGITATION | 465 | ||
| Parameters of the Severity of Prosthetic Aortic Valve Regurgitation | 466 | ||
| Color Doppler Parameters | 467 | ||
| Spectral Doppler Parameters | 468 | ||
| Quantitative Parameters | 468 | ||
| Integrative, Multiparametric Approach for the Evaluation of Prosthetic Aortic Valve Regurgitation | 469 | ||
| PROSTHETIC MITRAL VALVE REGURGITATION | 470 | ||
| Imaging Considerations | 470 | ||
| Parameters of the Severity of Prosthetic Mitral Valve Regurgitation | 470 | ||
| INDIRECT SIGNS AND CONSEQUENCES OF PROSTHETIC VALVE REGURGITATION | 471 | ||
| ROLE OF STRESS ECHOCARDIOGRAPHY | 471 | ||
| PROSTHETIC RIGHT HEART VALVES | 471 | ||
| PROSTHETIC TRICUSPID VALVE STENOSIS | 471 | ||
| PROSTHETIC TRICUSPID VALVE REGURGITATION | 471 | ||
| PROSTHETIC PULMONIC VALVES | 472 | ||
| INTERPRETATION OF DOPPLER ECHOCARDIOGRAPHIC DATA | 472 | ||
| HIGH TRANSPROSTHETIC GRADIENTS | 472 | ||
| Prosthetic Aortic Valves | 472 | ||
| Prosthetic Mitral Valves | 473 | ||
| LOW FLOW STATES | 473 | ||
| PERIOPERATIVE EVALUATION | 474 | ||
| DOPPLER ECHOCARDIOGRAPHY FOR THE MANAGEMENT OF SPECIFIC PROSTHETIC VALVE–RELATED COMPLICATIONS | 475 | ||
| PROSTHETIC VALVE THROMBOSIS | 475 | ||
| PROSTHETIC VALVE ENDOCARDITIS | 476 | ||
| SUMMARY | 477 | ||
| REFERENCES | 479 | ||
| V - Cardiomyopathies and Pericardial Disease | 481 | ||
| 25 - Dilated Cardiomyopathy: The Role of Echocardiography in Diagnosis and Patient Management | 483 | ||
| CLASSIFICATION OF DILATED CARDIOMYOPATHY | 483 | ||
| EPIDEMIOLOGY | 483 | ||
| CLINICAL PRESENTATION | 483 | ||
| ECHOCARDIOGRAPHIC FEATURES OF DILATED CARDIOMYOPATHY | 485 | ||
| LEFT VENTRICULAR SYSTOLIC FUNCTION | 485 | ||
| TISSUE DOPPLER IMAGING, STRAIN, AND STRAIN RATE | 486 | ||
| LEFT VENTRICULAR SYSTOLIC FUNCTION AND PROGNOSIS | 487 | ||
| LEFT VENTRICULAR SIZE AND SHAPE | 490 | ||
| LEFT VENTRICULAR DIASTOLIC FUNCTION | 490 | ||
| SECONDARY MITRAL REGURGITATION | 491 | ||
| LEFT VENTRICULAR CONTRACTILE RESERVE | 491 | ||
| RIGHT-SIDED INVOLVEMENT | 492 | ||
| FAMILIAL SCREENING | 492 | ||
| OTHER CARDIAC CONDITIONS THAT APPEAR SIMILAR TO DILATED CARDIOMYOPATHY | 494 | ||
| LEFT VENTRICULAR NONCOMPACTION | 494 | ||
| STRESS-INDUCED CARDIOMYOPATHY | 494 | ||
| MYOCARDITIS | 495 | ||
| CARDIAC RESYNCHRONIZATION THERAPY | 496 | ||
| INTRAVENTRICULAR DYSSYNCHRONY | 496 | ||
| M-mode | 497 | ||
| Tissue Doppler Imaging | 497 | ||
| Speckle Tracking Imaging | 497 | ||
| Three-Dimensional Echocardiography | 497 | ||
| INTERVENTRICULAR DELAY | 497 | ||
| RESPONSE TO CRT | 498 | ||
| CHANGES IN DIASTOLIC FUNCTION WITH CARDIAC RESYNCHRONIZATION THERAPY | 499 | ||
| MANAGEMENT OF NONRESPONDERS | 500 | ||
| TARGETED LEFT VENTRICULAR LEAD PLACEMENT | 500 | ||
| GUIDELINES AND CARDIAC RESYNCHRONIZATION THERAPY | 500 | ||
| HEART FAILURE RISK SCORES | 500 | ||
| REFERENCES | 502 | ||
| 26 - Hypertrophic Cardiomyopathy: Echocardiography in Diagnosis and Management of Patients | 505 | ||
| GENETICS | 505 | ||
| Diagnosis | 506 | ||
| DIAGNOSTIC CRITERIA | 506 | ||
| FAMILY SCREENING | 507 | ||
| DIFFERENTIAL DIAGNOSIS | 507 | ||
| MIMICS OF HYPERTROPHIC CARDIOMYOPATHY | 507 | ||
| STORAGE DISEASES | 508 | ||
| ATHLETE’S HEART | 508 | ||
| SEPTAL HYPERTROPHY IN THE ELDERLY | 508 | ||
| LEFT VENTRICULAR HYPERTROPHY | 509 | ||
| DISTRIBUTION AND PATTERNS OF HYPERTROPHY | 509 | ||
| TECHNICAL FACTORS | 511 | ||
| LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION | 511 | ||
| PATHOPHYSIOLOGY | 511 | ||
| MITRAL LEAFLET SYSTOLIC ANTERIOR MOTION | 511 | ||
| DOPPLER ASSESSMENT | 511 | ||
| TECHNICAL ASPECTS | 513 | ||
| MITRAL REGURGITATION | 513 | ||
| STRESS TESTING AND OTHER METHODS OF PROVOCATION | 514 | ||
| Types of Exercise in Patients with HCM | 516 | ||
| Other methods of provocation | 517 | ||
| HYPERTROPHIC CARDIOMYOPATHY SUBTYPES | 517 | ||
| ASYMMETRIC APICAL HYPERTROPHIC CARDIOMYOPATHY | 517 | ||
| MIDVENTRICULAR OBSTRUCTION AND APICAL ANEURYSMS | 518 | ||
| HYPERTROPHIC CARDIOMYOPATHY OF THE ELDERLY | 518 | ||
| DIASTOLIC DYSFUNCTION | 519 | ||
| FACTORS CONTRIBUTING TO IMPAIRED DIASTOLIC FUNCTION | 519 | ||
| ASSESSMENT OF DIASTOLIC FUNCTION | 519 | ||
| ASYNCHRONOUS RELAXATION | 520 | ||
| LEFT ATRIAL SIZE AND FUNCTION | 521 | ||
| NEWER ECHOCARDIOGRAPHIC TECHNIQUES | 522 | ||
| STRAIN IMAGING | 522 | ||
| THREE-DIMENSIONAL ECHOCARDIOGRAPHY | 522 | ||
| MANAGEMENT OF LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION | 523 | ||
| SURGICAL MYECTOMY | 523 | ||
| Role of Intraoperative Echocardiography | 523 | ||
| Outcomes after Myectomy | 524 | ||
| SEPTAL ETHANOL ABLATION | 524 | ||
| COMPARISON OF TREATMENT STRATEGIES | 526 | ||
| ECHOCARDIOGRAPHIC PREDICTORS OF CLINICAL OUTCOME | 527 | ||
| REFERENCES | 531 | ||
| 27 - Restrictive Cardiomyopathy: Diagnosis and Prognostic Implications | 534 | ||
| DEFINITION AND PATHOPHYSIOLOGY | 534 | ||
| 2D ECHOCARDIOGRAPHIC AND DOPPLER FEATURES | 535 | ||
| M-MODE IMAGING | 535 | ||
| 2D IMAGING | 535 | ||
| SPECTRAL DOPPLER IMAGING | 537 | ||
| FINDINGS | 537 | ||
| Mitral Inflow Pulsed Wave Doppler | 538 | ||
| Pulmonary Vein Pulsed Wave Doppler | 539 | ||
| Tissue Doppler of the Mitral Annulus | 539 | ||
| Color M-Mode | 539 | ||
| Tissue Doppler and Longitudinal Strain | 539 | ||
| Limitations and Pitfalls of Pulsed Wave Doppler and Color M-Mode | 539 | ||
| 2D SPECKLE TRACKING STRAIN IMAGING | 539 | ||
| SPECIFIC RESTRICTIVE CARDIOMYOPATHIES | 539 | ||
| AMYLOIDOSIS | 540 | ||
| Definition | 540 | ||
| Cardiac Features | 540 | ||
| Clinical Presentation | 540 | ||
| Echo Doppler | 541 | ||
| Magnetic Resonance Imaging | 541 | ||
| Nuclear Imaging | 541 | ||
| IDIOPATHIC RESTRICTIVE CARDIOMYOPATHY | 542 | ||
| HYPEREOSINOPHILIC SYNDROME AND ENDOMYOCARDIAL FIBROSIS | 542 | ||
| HEMOCHROMATOSIS | 544 | ||
| SARCOIDOSIS | 544 | ||
| STORAGE DISORDERS63 | 545 | ||
| Gaucher Disease | 545 | ||
| Glycogen Storage Disorder: Pompe Disease | 545 | ||
| Fabry Disease | 546 | ||
| DRUG-INDUCED RESTRICTIVE CARDIOMYOPATHY | 547 | ||
| POSTRADIATION CARDIOMYOPATHY | 547 | ||
| OTHER CAUSES OF RESTRICTIVE CARDIOMYOPATHY | 547 | ||
| DIFFERENTIATING BETWEEN RESTRICTIVE CARDIOMYOPATHY AND CONSTRICTIVE PERICARDITIS | 548 | ||
| REFERENCES | 553 | ||
| 28 - Pericardial Disease | 556 | ||
| PERICARDIAL ANATOMY AND FUNCTION | 556 | ||
| ANATOMY OF THE PERICARDIUM | 556 | ||
| PERICARDIAL FLUID | 556 | ||
| FUNCTIONS OF THE PERICARDIUM | 556 | ||
| PERICARDIAL PRESSURE AND NORMAL RESPIRATORY EFFECTS ON HEMODYNAMICS | 557 | ||
| PATHOPHYSIOLOGIC PRINCIPLES IN COMPRESSIVE PERICARDIAL DISEASE | 558 | ||
| ECHOCARDIOGRAPHIC EVALUATION FOR PERICARDIAL DISEASE | 558 | ||
| CONSTRICTIVE PERICARDITIS | 558 | ||
| DEFINITION AND ETIOLOGY | 558 | ||
| PATHOLOGY AND PATHOPHYSIOLOGY | 559 | ||
| CLINICAL PRESENTATION AND TREATMENT | 559 | ||
| ECHOCARDIOGRAPHIC DIAGNOSIS | 560 | ||
| Abnormal Ventricular Septal Motion: Ventricular Septal Shift and Shudder | 560 | ||
| Ventricular Septal Shift | 560 | ||
| Ventricular Septal Shudder | 560 | ||
| Respiratory Variation in the Hepatic Vein Doppler Profile: Prominent Diastolic Flow Reversals in Expiration | 560 | ||
| Annulus Reversus | 562 | ||
| Annulus Paradoxus | 563 | ||
| Respiratory Variation in Mitral Inflow Velocity | 563 | ||
| Other Doppler Findings | 564 | ||
| Strain Imaging | 564 | ||
| DIFFERENTIATION FROM RESTRICTIVE CARDIOMYOPATHY | 565 | ||
| EFFUSIVE-CONSTRICTIVE PERICARDITIS AND TRANSIENT CONSTRICTIVE PERICARDITIS | 566 | ||
| PERICARDIAL EFFUSION | 567 | ||
| ECHOCARDIOGRAPHIC DIAGNOSIS | 567 | ||
| PERICARDIAL TAMPONADE | 568 | ||
| DEFINITION AND ETIOLOGY | 568 | ||
| PATHOPHYSIOLOGY | 568 | ||
| ECHOCARDIOGRAPHIC DIAGNOSIS | 568 | ||
| Characterization of the Pericardial Effusion | 569 | ||
| Cardiac Chamber Collapse | 569 | ||
| Right Atrial Compression, Inversion, or Collapse | 569 | ||
| Right Ventricular Compression, Inversion, or Collapse | 569 | ||
| Left Heart Chamber Collapse | 570 | ||
| Plethora of the Inferior Vena Cava | 570 | ||
| Respiratory Variation in Right- and Left-Heart Filling | 570 | ||
| Combining Chamber Collapse with Abnormal Hepatic Venous Flow: Test Performance Characteristics | 570 | ||
| REGIONAL TAMPONADE | 571 | ||
| ECHOCARDIOGRAPHICALLY GUIDED PERICARDIOCENTESIS | 571 | ||
| Contraindications | 572 | ||
| Procedural Steps | 572 | ||
| ACUTE PERICARDITIS | 572 | ||
| CONGENITAL ABSENCE OF THE PERICARDIUM | 573 | ||
| PERICARDIAL CYSTS | 573 | ||
| ACKNOWLEDGMENTS | 573 | ||
| REFERENCES | 575 | ||
| 29 - Cardiac Transplantation: Pretransplant and Posttransplant Evaluation | 577 | ||
| EVALUATION BEFORE CARDIAC TRANSPLANTATION | 577 | ||
| RISK ASSESSMENT IN HEART FAILURE | 577 | ||
| STRUCTURE AND FUNCTION OF THE CARDIAC ALLOGRAFT | 579 | ||
| TRANSPLANT OPERATIVE TECHNIQUE | 579 | ||
| LEFT VENTRICULAR WALL THICKNESS AND SYSTOLIC AND DIASTOLIC FUNCTION | 580 | ||
| RIGHT HEART STRUCTURE AND FUNCTION | 581 | ||
| STRUCTURE AND FUNCTION OF THE CARDIAC ALLOGRAFT DURING ACUTE REJECTION | 581 | ||
| POSTTRANSPLANT MONITORING | 582 | ||
| ROUTINE FOLLOW-UP | 582 | ||
| PERICARDIAL EFFUSION | 582 | ||
| ECHOCARDIOGRAPHIC GUIDANCE FOR ENDOMYOCARDIAL BIOPSY | 582 | ||
| DIAGNOSIS OF CARDIAC ALLOGRAFT VASCULOPATHY | 583 | ||
| CORONARY ANGIOGRAPHY WITH INTRAVASCULAR ULTRASOUND | 586 | ||
| STRESS ECHOCARDIOGRAPHY | 587 | ||
| MYOCARDIAL PERFUSION IMAGING | 587 | ||
| REFERENCES | 593 | ||
| 30 - Echocardiography in Mechanical Circulatory Support: Normal Findings, Complications, and Speed Changes | 596 | ||
| BASIC PRINCIPLES OF MECHANICAL CIRCULATORY SUPPORT AND THE ECHOCARDIOGRAPHIC APPROACH | 596 | ||
| Implanted Ventricular Assist Devices | 596 | ||
| Percutaneous Mechanical Circulatory Support Devices | 597 | ||
| PREIMPLANT ASSESSMENT | 599 | ||
| PERIPROCEDURAL GUIDANCE | 600 | ||
| POSTIMPLANT SURVEILLANCE AND COMPLICATIONS | 601 | ||
| OVERFILLING | 601 | ||
| UNDERFILLING | 601 | ||
| VALVULAR DYSFUNCTION | 602 | ||
| SPEED CHANGE STUDIES | 603 | ||
| Optimization of Device Settings | 603 | ||
| Optimization of Percutaneous Mechanical Circulatory Support Position | 603 | ||
| Ramp Studies | 603 | ||
| Ventricular Recovery | 603 | ||
| LEFT VENTRICULAR END-DIASTOLIC DIAMETER AND SEPTAL ORIENTATION | 604 | ||
| VENTRICULAR FUNCTION | 605 | ||
| AORTIC VALVE OPENING | 605 | ||
| PERICARDIUM | 605 | ||
| CANNULAE | 605 | ||
| OPTIMIZATION STUDIES | 607 | ||
| RAMP STUDIES | 607 | ||
| WEANING AND TURNDOWN STUDIES | 608 | ||
| POTENTIAL LIMITATIONS AND FUTURE DIRECTIONS | 609 | ||
| ALTERNATE APPROACHES | 610 | ||
| REFERENCES | 614 | ||
| VI - The Right Heart | 617 | ||
| 31 - Right Ventricular Anatomy, Function, and Echocardiographic Evaluation | 619 | ||
| BASIC PRINCIPLES AND ECHOCARDIOGRAPHIC APPROACH | 619 | ||
| RIGHT VENTRICULAR ANATOMY | 619 | ||
| TECHNICAL DETAILS, QUANTITATION, AND DATA ANALYSIS | 621 | ||
| TRANSTHORACIC ECHOCARDIOGRAPHIC VIEWS | 621 | ||
| TRANSESOPHAGEAL ECHOCARDIOGRAPHIC VIEWS | 623 | ||
| INTRACARDIAC ECHOCARDIOGRAPHIC VIEWS | 623 | ||
| QUANTITATIVE EVALUATION | 623 | ||
| RIGHT VENTRICULAR WALL THICKNESS AND SIZE | 623 | ||
| RIGHT VENTRICULAR SYSTOLIC FUNCTION | 624 | ||
| RIGHT VENTRICULAR DIASTOLIC FUNCTION | 625 | ||
| CLINICAL UTILITY AND OUTCOME DATA | 626 | ||
| RESEARCH APPLICATIONS | 627 | ||
| POTENTIAL LIMITATIONS AND FUTURE DIRECTIONS | 628 | ||
| ALTERNATE APPROACHES | 629 | ||
| ACKNOWLEDGMENTS | 629 | ||
| REFERENCES | 631 | ||
| 32 - Pulmonary Hypertension: Role of Echocardiography in Diagnosis and Patient Management | 633 | ||
| GENERAL PRINCIPLES | 633 | ||
| ESTIMATING RIGHT ATRIAL PRESSURE | 634 | ||
| ESTIMATING THE RIGHT VENTRICULAR–TO–RIGHT ATRIAL PRESSURE DIFFERENCE FROM THE TRICUSPID REGURGITATION PROFILE | 634 | ||
| PULMONARY REGURGITATION PROFILE | 634 | ||
| PULMONARY ACCELERATION TIME | 634 | ||
| MIDSYSTOLIC NOTCHING OF THE RIGHT VENTRICULAR OUTFLOW DOPPLER | 636 | ||
| FACTORS THAT AFFECT PULMONARY ARTERY PRESSURE IN NORMAL INDIVIDUALS | 636 | ||
| IDENTIFYING THE CAUSE FOR PULMONARY HYPERTENSION | 636 | ||
| GENERAL CLASSIFICATION | 636 | ||
| PULMONARY ARTERIAL HYPERTENSION | 636 | ||
| PULMONARY HYPERTENSION DUE TO CONGENITAL HEART DISEASE | 637 | ||
| PULMONARY HYPERTENSION DUE TO LEFT HEART DISEASE | 639 | ||
| PULMONARY HYPERTENSION DUE TO LUNG DISEASE | 640 | ||
| PULMONARY HYPERTENSION DUE TO CHRONIC PULMONARY THROMBOEMBOLIC DISEASE | 640 | ||
| ACUTE PULMONARY HYPERTENSION | 640 | ||
| EFFECT OF PULMONARY HYPERTENSION ON THE RIGHT HEART | 641 | ||
| MEASUREMENT OF RIGHT VENTRICULAR FUNCTION IN THE SETTING OF PRESSURE LOADING | 641 | ||
| RIGHT VENTRICULAR DIMENSIONS | 642 | ||
| RIGHT VENTRICULAR WALL THICKNESS | 642 | ||
| RIGHT VENTRICULAR SYSTOLIC FUNCTION | 642 | ||
| THREE-DIMENSIONAL ANALYSIS OF RIGHT VENTRICULAR SYSTOLIC FUNCTION | 643 | ||
| RIGHT VENTRICULAR DIASTOLIC FUNCTION | 645 | ||
| VENTRICULAR SEPTAL MOTION | 645 | ||
| ESTIMATING PULMONARY VASCULAR RESISTANCE | 645 | ||
| EXERCISE STRESS ECHOCARDIOGRAPHY AND PULMONARY HYPERTENSION | 646 | ||
| DIAGNOSTIC APPROACH FOR A PATIENT WITH SUSPECTED PULMONARY HYPERTENSION | 646 | ||
| REFERENCES | 650 | ||
| 33 - RIGHT-SIDED VALVE DISEASE IN ADULTS | 651 | ||
| TRICUSPID VALVE DISEASE | 651 | ||
| TRICUSPID REGURGITATION | 651 | ||
| BACKGROUND | 651 | ||
| BASIC PRINCIPLES AND ECHOCARDIOGRAPHIC APPROACH TO DIAGNOSIS | 651 | ||
| TECHNICAL DETAILS, QUANTITATION, AND DATA ANALYSIS | 651 | ||
| Determining the Cause of Tricuspid Regurgitation | 651 | ||
| Determining the Severity of Tricuspid Regurgitation | 654 | ||
| CLINICAL UTILITY AND OUTCOMES DATA | 658 | ||
| POTENTIAL LIMITATIONS | 662 | ||
| TRICUSPID STENOSIS | 662 | ||
| BACKGROUND | 662 | ||
| BASIC PRINCIPLES AND ECHOCARDIOGRAPHIC APPROACH | 662 | ||
| TECHNICAL DETAILS, QUANTITATION, AND DATA ANALYSIS | 662 | ||
| CLINICAL UTILITY AND OUTCOMES DATA | 663 | ||
| ALTERNATE APPROACHES | 663 | ||
| PULMONIC VALVE STENOSIS | 663 | ||
| BACKGROUND | 663 | ||
| BASIC PRINCIPLES AND ECHOCARDIOGRAPHIC APPROACH | 663 | ||
| TECHNICAL DETAILS, QUANTITATION, AND DATA ANALYSIS | 663 | ||
| CLINICAL UTILITY AND OUTCOMES DATA | 664 | ||
| ALTERNATE APPROACHES | 666 | ||
| PULMONIC VALVE REGURGITATION | 666 | ||
| BACKGROUND | 666 | ||
| BASIC PRINCIPLES AND ECHOCARDIOGRAPHIC APPROACH | 666 | ||
| TECHNICAL DETAILS, QUANTITATION, AND DATA ANALYSIS | 667 | ||
| CLINICAL UTILITY AND OUTCOMES DATA | 668 | ||
| ALTERNATE APPROACHES | 669 | ||
| REFERENCES | 671 | ||
| VII - Vascular and Systemic Diseases | 675 | ||
| 34 - AORTIC DISSECTION AND TRAUMA: VALUE AND LIMITATIONS OF ECHOCARDIOGRAPHY | 677 | ||
| PATHOPHYSIOLOGY OF AORTIC DISSECTION | 677 | ||
| ANATOMY AND HISTOLOGY | 677 | ||
| MECHANICAL AND SHEAR STRESSES | 677 | ||
| SPECTRUM OF ACUTE AORTIC SYNDROMES | 679 | ||
| AORTIC DISSECTION | 679 | ||
| Classification | 679 | ||
| Time Course | 680 | ||
| Sequelae | 680 | ||
| INTRAMURAL HEMATOMA | 680 | ||
| PENETRATING AORTIC ULCER | 680 | ||
| AORTIC TRAUMA | 680 | ||
| IMAGING ACUTE AORTIC SYNDROMES | 680 | ||
| COMPUTED TOMOGRAPHY | 681 | ||
| MAGNETIC RESONANCE IMAGING | 682 | ||
| TRANSTHORACIC ECHOCARDIOGRAPHY | 682 | ||
| TRANSESOPHAGEAL ECHOCARDIOGRAPHY | 683 | ||
| Safety of Transesophageal Echocardiography | 684 | ||
| Complications of Dissection | 685 | ||
| Intramural Hematoma | 686 | ||
| Penetrating Aortic Ulcer | 686 | ||
| Aortic Trauma | 686 | ||
| INCONCLUSIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHIC RESULTS | 686 | ||
| SURGICAL CONSIDERATIONS | 687 | ||
| AORTIC REGURGITATION | 688 | ||
| MITRAL REGURGITATION | 689 | ||
| PERFUSION OF DISTAL VASCULAR BEDS | 689 | ||
| ENDOVASCULAR REPAIR CONSIDERATIONS | 689 | ||
| FOLLOW-UP OF PATIENTS AFTER AORTIC DISSECTION | 689 | ||
| CONCLUSIONS | 690 | ||
| REFERENCES | 690 | ||
| 35 - ECHOCARDIOGRAPHIC FINDINGS IN SYSTEMIC DISEASES CHARACTERIZED BY IMMUNE-MEDIATED INJURY | 692 | ||
| SYSTEMIC LUPUS ERYTHEMATOSUS | 692 | ||
| BACKGROUND | 692 | ||
| CARDIOVASCULAR INVOLVEMENT | 692 | ||
| Valve Disease, Intracardiac Thrombosis, and Thromboembolism | 692 | ||
| Atherosclerosis | 694 | ||
| Myocardial Disease | 695 | ||
| Pericardial Disease | 697 | ||
| Pulmonary Hypertension | 699 | ||
| PRIMARY ANTIPHOSPHOLIPID SYNDROME | 699 | ||
| BACKGROUND | 699 | ||
| CARDIOVASCULAR INVOLVEMENT | 700 | ||
| Valve Disease, Intracardiac Thrombosis, and Thromboembolism | 700 | ||
| Pulmonary Hypertension | 701 | ||
| VIII - Adult Congenital Heart Disease and the Pregnant Patient | 859 | ||
| 43 - Heart Disease in Pregnancy | 861 | ||
| PHYSIOLOGIC CHANGES DURING PREGNANCY | 861 | ||
| SYSTEMIC VASCULAR RESISTANCE | 861 | ||
| CARDIAC OUTPUT | 861 | ||
| ECHOCARDIOGRAPHIC FINDINGS IN NORMAL PREGNANCY | 862 | ||
| CARDIAC CHAMBER SIZE | 862 | ||
| DOPPLER FLOWS | 862 | ||
| SYSTOLIC AND DIASTOLIC FUNCTION | 862 | ||
| INTERPRETATION OF ECHOCARDIOGRAPHIC FINDINGS DURING PREGNANCY | 862 | ||
| PREGNANCY RISKS | 862 | ||
| CARDIAC SHUNTS | 864 | ||
| TETRALOGY OF FALLOT | 865 | ||
| COARCTATION OF THE AORTA | 866 | ||
| EBSTEIN ANOMALY | 866 | ||
| TRANSPOSITION OF THE GREAT ARTERIES | 867 | ||
| FONTAN CIRCULATION | 867 | ||
| CYANOTIC HEART DISEASE | 868 | ||
| AORTIC VALVE DISEASE | 868 | ||
| MITRAL VALVE DISEASE | 869 | ||
| PROSTHETIC HEART VALVES | 870 | ||
| AORTOPATHIES | 870 | ||
| CARDIOMYOPATHIES | 871 | ||
| FETAL AND NEONATAL RISK | 872 | ||
| MANAGEMENT PRINCIPLES | 873 | ||
| ANTEPARTUM | 873 | ||
| LABOR AND DELIVERY | 874 | ||
| POSTPARTUM | 874 | ||
| MANAGEMENT OF COMPLICATIONS | 874 | ||
| REFERENCES | 877 | ||
| 44 - Congenital Shunts | 879 | ||
| PATENT FORAMEN OVALE | 880 | ||
| ANATOMY AND PATHOPHYSIOLOGY | 880 | ||
| IMAGING | 880 | ||
| INDEX | 990 | ||
| A | 990 | ||
| B | 991 | ||
| C | 992 | ||
| D | 993 | ||
| E | 994 | ||
| F | 994 | ||
| G | 994 | ||
| H | 994 | ||
| I | 995 | ||
| K | 995 | ||
| L | 995 | ||
| M | 996 | ||
| N | 997 | ||
| O | 997 | ||
| P | 998 | ||
| Q | 999 | ||
| R | 999 | ||
| S | 999 | ||
| T | 1000 | ||
| U | 1002 | ||
| V | 1002 | ||
| W | 1002 | ||
| Z | 1002 | ||
| IBC | ES2 |