Essential Echocardiography: A Review of Basic Perioperative TEE and Critical Care Echocardiography

Preface
Contents
Contributors
Part I: Basic Perioperative and Critical Care Echocardiography
1: Introduction to Basic Perioperative and Critical Care Echocardiography: Examination, Certification, Indications, and Contraindications
Introduction
Transesophageal Echocardiography in Noncardiac Surgery and Intensive Care
Certification in Basic Perioperative Transesophageal Echocardiography
Basic TEE Examination
Contraindications
Complications
Using the TEE Probe
Insertion
Manipulation
Orientation
Point-of-Care Transthoracic Echocardiography and Ultrasound
Certification in Critical Care Echocardiography
Basic TTE Examination
Patient Positioning and Optimization
Contraindications and Complications
Using the TTE Probe
Manipulation
Orientation
Point-of-Care Echocardiography Reporting and Image Storage
Conclusion
Questions
References
2: Transesophageal Echocardiography: Probe Manipulation and Essential Views
Introduction
Basic PTE Examination
Transgastric (TG) Midpapillary Short-Axis (SAX) View
Midesophageal (ME) Four-Chamber View
ME Two-Chamber View
ME Long-Axis (LAX) View
ME AV SAX View
ME RV Inflow-Outflow View
ME Bicaval View
ME Ascending Aortic SAX and LAX Views
Descending Aortic SAX and LAX Views
Additional Views
Deep TG Five-Chamber View
TG Basal SAX View
TG Apical SAX View
TG Two-Chamber View
TG LAX View
TG RV Basal View
TG RV Inflow-Outflow View
TG RV Inflow View
ME Five-Chamber View
ME Mitral Commissural View
ME Left Atrial Appendage View
ME AV LAX View
ME Modified Bicaval TV View
UE Right and Left Pulmonary Veins View
ME Right Pulmonary Vein View
Upper Esophageal (UE) Aortic Arch LAX and SAX Views
Conclusion
Questions
References
3: Point-of-Care Transthoracic Echocardiography: Probe Manipulation, Positioning, and Essential Views
Introduction
Probe Manipulation
Positioning
Essential TTE Views (Table 3.1)
Parasternal Long-Axis (LAX) View
Parasternal Short-Axis (SAX) View
Apical Four-Chamber View
Subcostal Views
Suprasternal View
Conclusion
Questions
References
4: Basic Ultrasound Physics, Doppler Ultrasound, and Hemodynamic Assessment
Introduction
Physics of Ultrasound
Ultrasound Probes
Doppler Ultrasound
Hemodynamic Assessment
Flow
Valvular Area
Pressure Gradient Estimation
3D Echocardiography
Bioeffects
Conclusion
Questions
References
5: Knobology and Image Optimization
Introduction
Resolution
2D Controls
Preprocessing Versus Postprocessing
Transmit Power
Gain
Time Gain Compensation and Lateral Gain Compensation
Autoscan/iScan
Depth
Focus
Sector Width/Sector Steer
Freeze
M-Mode
Doppler Controls
Doppler Effect
Pulsed-Wave Doppler
Continuous-Wave Doppler
Color Flow Doppler
Conclusion
Questions
Part II: Echocardiographic Assessment
6: Left Ventricular Systolic Function
Introduction
Visual Estimation of Ejection Fraction
Fractional Shortening
Fractional Area Change
Left Ventricular Volumes
Modified Simpson’s Method
Rate of Rise of Ventricular Pressure (dP/dt)
Tissue Doppler Imaging
Advanced Methods
Three-Dimensional (3D) EF Calculation
Global Longitudinal Strain (GLS)
Measurements of Left Ventricular Geometry
Left Ventricular Wall Thickness
LV Mass Calculation
Conclusion
Questions
References
7: Regional Ventricular Function
Introduction
Coronary Anatomy
Application of Coronary Topography to Echocardiography
Transesophageal Echocardiography Correlation
Transthoracic Echocardiography Correlation
Grading of Regional Wall Motion Abnormalities (Highlight Box 7.1)
Complications from Myocardial Ischemia
Conclusion
Questions
References
8: Mitral Valve
Introduction
Anatomy and Function
2D Imaging of the Mitral Valve
TEE: Midesophageal Four-Chamber View (ME Four-Chamber View)
TEE: ME Mitral Commissural View
TEE: ME Two-Chamber View
TEE: ME Long-Axis View (ME LAX View)
TEE: Transgastric Basal Short-Axis View (TG Basal SAX)
TEE: Transgastric Two-Chamber View (TG Two-Chamber View)
TTE: Parasternal Long-Axis View (PLAX)
TTE: Parasternal Short-Axis (PSAX)
TTE: Apical Four-Chamber View (A4C)
TTE: Apical Two-Chamber (A2C)
Mitral Regurgitation (Highlight Box 8.1)
Grading Severity
2D Echocardiography
Color Flow Doppler
Vena Contracta
Pulmonary Venous Flow Profile
Proximal Isovelocity Surface Area (PISA)
Hemodynamics
Mitral Stenosis (Highlight Box 8.2)
2D Echocardiography
Quantitative Assessment of Mitral Stenosis
Pressure Gradients
Mitral Valve Area Calculations
Pressure Half-Time (PHT)
Proximal Isovelocity Surface Area (PISA)
Planimetry
Conclusion
Questions
References
9: Aortic Valve
Introduction
Aortic Stenosis
Echocardiographic Evaluation (Highlight Box 9.1)
Two-Dimensional Assessment
Color Flow Doppler
Spectral Doppler
Aortic Regurgitation (Insufficiency)
Echocardiographic Evaluation (Highlight Box 9.2)
Two-Dimensional Assessment
Color Flow Doppler
Quantification of Aortic Regurgitation
Vena Contracta
Jet Width to LVOT Diameter
Spectral Doppler
Aortic Valve Pressure Half Time
Descending Aorta Reversal of Flow
Conclusion
Questions
References
10: The Right Heart
Introduction
Right Ventricle Structure and Function
Echocardiographic Views for Evaluation of the Right Ventricle
TEE Views
Midesophageal (ME) Four-Chamber View
ME RV Inflow-Outflow View
ME Bicaval View
ME Ascending Aortic Short-Axis View
Transgastric (TG) Midpapillary Short-Axis View
TG RV Inflow View
TTE Views
Parasternal Long-Axis View
Parasternal RV Inflow View
Parasternal Short-Axis View (RVOT Level)
Parasternal Short-Axis View (Midpapillary Level)
Apical Four-Chamber View
Three-Dimensional Echocardiography
Physiology of the Right Heart: Adaptations to Pulmonary Hypertension
Right Ventricular Enlargement
Right Ventricular Hypertrophy
Quantitative Assessment of Right Ventricular Function (Highlight Box 10.1)
Tricuspid Annular Plane Systolic Excursion
Right Ventricular Fractional Area Change
Tissue Doppler Imaging
Right Ventricular Myocardial Performance Index
Evaluation of the IVS to Assess RV Function
Adaptation to Chronic Right Ventricular Overload
Tricuspid Regurgitation
Pulmonary Artery
Interatrial Septum
Acute Pulmonary Embolism
Assessment of the Right Ventricle with Left Ventricular Assist Devices
Conclusion
Questions
References
11: Atria
Introduction
The Right Atrium
Anatomy
Size
Linear Dimension
Area
Volume
The Left Atrium
Anatomy
Size
Linear Dimension
Area
Volume
Left Atrial Appendage
The Interatrial Septum
Anatomy
Position
Conclusion
Questions
References
12: Diastology
Introduction
Phases of Diastole
Assessment of Chamber Filling: Pulsed-Wave Doppler Echocardiography
Transmitral Inflow: Measuring Flow into the Left Ventricle
Pulmonary Venous Flow: Measuring Flow into the Left Atrium
Tissue Doppler Imaging: Measuring the Velocity of Myocardial Tissue
Stages of Diastolic Dysfunction: From Mild to Severe Dysfunction (Table 12.1) (Highlight Box 12.1)
Impaired Relaxation
Pseudonormalization: Impaired Relaxation with Elevated LA Pressure
Restrictive: Impaired Relaxation, Poor LV Compliance, and Elevated LA and LV Pressures
Clinical Implications of Diastolic Dysfunction: Real-Time Measurements
Conclusion
Questions
References
13: Thoracic Aorta
Introduction
Echocardiographic Views of the Thoracic Aorta
TEE Views
TTE Views
Aortic Dissection (Highlight Box 13.1)
Dissection Flap Identification
Differentiating True from False Lumens
Identifying Complicating Pathologies
Aortic Aneurysm (Highlight Box 13.2)
Aortic Atheroma
Thoracic Aortic Trauma
Conclusion
Questions
References
14: Pericardium
Introduction
Anatomy and Physiology of the Pericardium
Anatomy
Transverse Sinus
Oblique Sinus
Epicardial Fat Pad
Function
Respirophasic Variation
Echocardiographic Views of the Pericardium
TEE and TTE Views
Indications for Echocardiography
Pericardial Effusions (Highlight Box 14.1)
Pericardial Hematoma
Cardiac Tamponade
Constrictive Pericarditis (Highlight Box 14.2)
Differentiating Constrictive Pericarditis and Restrictive Cardiomyopathy
Conclusion
Questions
References
15: Perioperative Rescue Echocardiography
Introduction
Acute Valvular and Aortic Pathology
Cardiac Tamponade (Highlight Box 15.1)
Right Ventricular Dysfunction (Highlight Box 15.2)
Pulmonary Embolism (Highlight Box 15.3)
Left Ventricular Dysfunction (Highlight Box 15.4)
Hypovolemia (Highlight Box 15.5)
Low Afterload (Highlight Box 15.6)
Conclusion
Questions
References
16: Imaging Artifacts, Normal Anatomic Variants, and Common Misdiagnoses
Introduction
Normal Anatomic Variants/Misdiagnoses
Epicardial and Extracardiac Fat
Eustachian Valve
Moderator Band
Crista Terminalis
Lipomatous Hypertrophy of the Interatrial Septum
Lambl’s Excrescences
Fibroelastoma
Nodules of Arantius
Coumadin Ridge
Chiari Network
Artifacts
Dropout
“Railroad” Artifact
Acoustic Shadowing
Acoustic Enhancement
Side Lobe
Reverberation
Ring-Down and Comet-Tail Artifacts
Mirroring
Spectral Doppler Mirroring
Beam Width
Aliasing Artifact
Conclusion
Questions
References
17: Intracardiac Masses, Devices, and Foreign Bodies
Introduction
Thrombi (Highlight Box 17.1)
Endocarditis (Highlight Box 17.2)
Tumors: Benign (Highlight Box 17.3)
Tumors: Malignant
Tumors with Systemic Cardiac Manifestations
Carcinoid
Renal Cell Carcinoma
Foreign Bodies (Highlight Box 17.4)
Intravascular Catheters
Prosthetic Valves
Cardiovascular Implantable Electronic Devices
MitraClip™
Atrial Appendage Occlusion Devices
PFO Closure Devices
Mechanical Circulatory Support
Conclusion
Questions
References
18: Adult Congenital Heart Disease
Introduction
Atrial Septal Defect (ASD) (Highlight Box 18.1)
Ostium Secundum ASD
Ostium Primum ASD
Sinus Venosus ASD
Coronary Sinus ASD (Unroofed Coronary Sinus)
Transesophageal Echocardiographic Examination for ASDs
Transthoracic Echocardiographic Examination for ASDs
Ventricular Septal Defect (VSD) (Highlight Box 18.2)
Transesophageal Echocardiographic Examination of VSDs
Transthoracic Echocardiographic Examination for VSDs
Persistent Left Superior Vena Cava (SVC)
Patent Ductus Arteriosus/Aorticopulmonary Window
Transesophageal Echocardiographic Evaluation of Tetralogy of Fallot (Highlight Box 18.3)
Transthoracic Echocardiographic Examination of Tetralogy of Fallot
Conclusion
Questions
References
Part III: Critical Care Ultrasonography
19: Abdominal and Vascular Ultrasound
Introduction
Focused Assessment with Sonography for Trauma (Highlight Box 19.1)
Background
Anatomy
Epidemiology and Pathophysiology
Ultrasound Technique
Right Upper Quadrant
Left Upper Quadrant
Pelvis
Subcostal (Subxiphoid) View
Image Interpretation
Deep Venous Thrombosis (Highlight Box 19.2)
Background
Anatomy
Lower Extremity Veins
Upper Extremity Veins
Pathophysiology and Epidemiology
Ultrasound Technique
Differentiation Between Acute and Chronic Deep Vein Thromboses
Abdominal Aorta (Highlight Box 19.3)
Background
Anatomy
Epidemiology and Pathophysiology
Ultrasound Technique
Conclusion
Questions
References
20: Volume Assessment and Fluid Responsiveness
Introduction
Physiology
Predicting Preload Responsiveness (Highlight Box 20.1)
Assessment of Ventricular Volumes
Assessment of Left Ventricular Outflow Tract
Assessment of Mitral Inflow Velocity
Assessment of the Inferior Vena Cava
Assessment of Arterial Velocity
Assessing Response to Volume Challenge
Conclusion
Questions
References
21: Lung Ultrasonography
Introduction
Equipment
Performing the Examination
Artifacts and Findings (Highlight Box 21.1)
Shadowing
Lung Sliding
T-Lines and Lung Pulse
Lung Point
A-Lines (Reverberation Artifact)
B-Lines (Comet Tails)
Consolidation
Profiles
Diagnoses
Pneumothorax
Pulmonary Edema
Pleural Effusion
Pneumonia
Lung Contusion
Pulmonary Embolism
Diaphragmatic Weakness
Asthma/COPD
Thromboembolic Disease
Protocols
BLUE Protocol
Extended BLUE Protocol
PINK Protocol
CLOT Protocol
FALLS Protocol
Conclusion
Questions
References
22: Shock and Cardiac Arrest
Introduction
Using Point-of-Care Echocardiography
Cardiogenic Shock (Table 22.2)
Rate and Rhythm Abnormalities
Global Systolic Function
Regional Wall Motion Abnormalities
Valvular Abnormalities
Right Ventricular Dysfunction
Obstructive Shock (Table 22.3)
Pulmonary Embolism
Cardiac Tamponade
Tension Pneumothorax
Great Vessel Compression
Hypovolemic Shock (Table 22.4)
Left Ventricular Chamber Size
IVC Evaluation
Stroke Volume Variation
Distributive Shock
Point-of-Care Ultrasound During Cardiac Arrest
Systematic Evaluation
Conclusion
Questions
References
23: Ultrasound for Vascular Access
Introduction
Probe Orientation
Vessel Selection
Vessel Identification
Static Versus Dynamic Imaging
Performing the Procedure
Internal Jugular Vein Cannulation
Subclavian/Axillary Vein Cannulation
Femoral Vein Cannulation
Ultrasound for Arterial Access
Ultrasound for Peripheral Venous Access
Ultrasound for Guidewire Confirmation and Pulmonary Arterial Catheter Placement
Guidewire Placement and Catheter Patency
Pulmonary Arterial Catheter Placement with Ultrasound
Conclusion
Questions
References
Appendix – Answers
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Index