The practice of clinical echocardiography

CLINICAL ECHOCARDIOGRAPHY
Preface
Acknowledgments
Glossary
1 - 3D Echocardiographic Image Acquisition, Display, and Analysis
Resolution in 3D Echocardiography
Spatial Resolution
Temporal Resolution
Single-­Beat or Multibeat Acquisition
Parallel Beamforming
Interpolation of Images or Image Sectors
Frame Reordering
Virtual Array
Multiline Transmission
High Pulse Repetition Frequency
Relationship Between Spatial and Temporal Resolution
Multiview 3D Echocardiography Image Fusion
3D Echocardiography Data Acquisition
2D Image Optimization
Simultaneous Multiplane Mode
Pyramidal Size
Zoom
Narrow Sector
Wide Sector
Color-­Flow Doppler
Temporal Versus Spatial Resolution
ECG-­Gating and Breath-­Hold
3D Image Optimization
Gain
Brightness
Smoothing
Colorization
Data Set Cropping
Box Crop
Plane Crop
Quick Cropping Methods
Post-­Acquisition Display
Volume Rendering
Surface Rendering
2D Tomographic Slices
3D Echocardiographic Analysis
Multiplanar Reconstruction
Modeling
Color Doppler
True 3D Visualization
3D Echocardiographic Acquisition and Analysis Protocols
Acquisition
Presentation
Analysis
Limitations
Acquisition
Presentation
Analysis
Limitations
Acquisition
Presentation
Analysis
Limitations
Acquisition
Presentation
Analysis
Limitations
Acquisition
Presentation
Analysis
Limitations
Acquisition
Presentation
Analysis
Limitations
Acquisition
Presentation
Analysis
Limitations
References
3 - Contrast Echocardiography
Investigational Agents
Microbubble Ultrasound Signal Generation
Contrast-­Specific Imaging Methods
Resting Quantitation of LV Volumes and Ejection Fraction
Resting LV Regional Wall Motion
LV Opacification During Stress
LV Opacification for Intracardiac Abnormalities
Myocardial Perfusion Imaging
Detection of Ischemia
Myocardial Viability
Other Perfusion Imaging Applications
References
4 - Quantitative Analysis of Left Ventricular Anatomy and Systolic Function
LV Wall Thickness and Mass
LV Shape and Its Implications for Measurements
LV Response to Pressure and Volume Overload
Pressure Overload
Volume Overload
LV Mechanics
Ejection Fraction
Strain
dP/dt
Myocardial Work and Pressure-­Volume Loops
Myocardial Segments
Fractional Shortening
Mitral Annulus Plane Systolic Excursion
Tissue Doppler Imaging
References
5 - Left Ventricular Diastolic Function
Invasive Evaluation of LV Diastolic Function
Basic Principles
Mitral Inflow Parameters
Mitral Inflow Patterns
Pulmonary Venous Flow Parameters
Color M-­Mode Echocardiography
Tissue Doppler Echocardiography
Echocardiographic Findings Supporting the Presence of Diastolic Dysfunction
Left Atrial Dilation
Pulmonary Hypertension
Considerations about the Assessment of Diastolic Function in the Elderly
Diastolic Stress Echocardiography
Left Ventricular Strain
Left Atrial Strain
Echocardiographic Assessment of LV ­Filling Pressure
Algorithms to Diagnose LV Diastolic Dysfunction and Estimate LV Filling Pressure by Echocardiography
Atrial Fibrillation
Hypertrophic Cardiomyopathy
Constrictive Pericarditis
Hemodynamic Validation
Prognostic Validation
Clinical Implications
Limitations
Future Perspectives
References
6 - Right Ventricular Anatomy and Function
RV External Anatomy
RV Internal Anatomy
Tricuspid Valve
Right Atrium and Inferior Vena Cava
Pulmonic Valve and Pulmonary Artery
RV Blood Supply
RV Physiology
Basic Principles of Image ACQUISITION
Qualitative Evaluation
2D Measurements of RV Size
3D Volumetric Measurements of RV Size
Qualitative Evaluation
Fractional Area Change
Tricuspid Annular Plane Systolic Excursion
The dP/dt Function for Assessing ­Myocardial Work
Tissue Doppler Tricuspid Annular Systolic Velocity
RV Index of Myocardial Performance
3D Volumetric Assessment of RV Function
RV Strain and Strain Rate
RV Diastolic Function
TRANSESOPHAGEAL ECHOCARDIOGRAPHY
Intracardiac Echocardiography
Cardiac Magnetic Resonance Imaging
Cardiac Computed Tomography Angiography
Radionucleotide Angiography
Disease States and Outcome Data
Transcatheter Procedures
Mechanical Support Devices
Future Directions
References
7 - Diagnostic Echocardiography ­Laboratory: Structure, Standards, and Quality Improvement
Quality in Context
Structure and Standards
Laboratory Structure
Laboratory Accreditation
Laboratory Staff
Physician Training
Medical Director
Medical Staff
Technical Director
Technical Staff
Ancillary Personnel
Facility
Infection Control
Time-­Out
Moderate Sedation
Radiation Safety
Instrument Maintenance
Instrument Inventory
Quality Improvement Program
Appropriate Use Criteria: A Brief History and Guideline Updates
Appropriate Indications
Rarely Appropriate Indications
Appropriate Use In Practice
Protocol Consistency
Transthoracic Echocardiography Protocol
Analysis and Interpretation Quality
Echocardiography Core Laboratory
Reporting
Report Completeness and Consistency
Report Timeliness
Examination Status and Turnaround Times
Summary
References
8 - Comprehensive Diagnostic Transthoracic and Transesophageal Echocardiography
Patient and Transducer Position
Parasternal Long-­Axis View.For the left parasternal window, the patient is placed in a left lateral decubitus position with the...�
RV Inflow View.The RV inflow view is obtained by tilting the transducer inferomedially from the PLAX and rotating it slightly cl...
Parasternal Short-­Axis Views.The parasternal short-­axis (PSAX) views are obtained by rotating the transducer 90 degrees clockw...�
Apical 4-­Chamber View.The apical window is obtained by placing the transducer at the point of maximal impulse, with the patient...�
Apical 2-­Chamber and Long-­Axis Views.Rotating the transducer counterclockwise approximately 60 degrees from the apical 4-­cham...�
Subcostal Window
Suprasternal Notch Window
M-­Mode Echocardiography
Doppler Echocardiography
Principles of Doppler Echocardiography
Continuous-­Wave Doppler Echocardiography
Pulsed-­Wave Doppler Echocardiography
Application of Doppler Echocardiography: LV Outflow Tract
Application of Doppler Echocardiography: Pulmonary Pressure Estimation
Application of Doppler Echocardiography: Diastolic Function
Color Doppler Flow Imaging
Proposed Sequence of a Comprehensive TTE Study
Indications For TEE
Training and Personnel
Patient Preparation and Sedation
Esophageal Intubation
Probe Manipulation and Standard Imaging Views
Image Formatting and Display
Left and Right Ventricles
Atria and Left Atrial Appendage
Aortic Valve and Aorta
Mitral Valve
Tricuspid and Pulmonic Valves
3-­Dimensional Echocardiography
Atrial Fibrillation and Cardiac Source of Embolus
Native and Prosthetic Valve Evaluation
Infective Endocarditis
Acute Aortic Syndromes
Proposed Sequence of a Comprehensive TEE Study
References
10 - Interventional Echocardiography
Echocardiographic Imaging Modes
2D TEE
3D TEE
Intraprocedural TEE for Transcatheter Aortic Valve Replacement
Intraprocedural TEE for PERCUTANEOUS Mitral Valve ­Edge-­To-­Edge Repair
Mitral Valve and Regurgitant Jet Evaluation
Transseptal Puncture
Positioning of Steerable Guide Catheter and Clip Delivery System
Advancement of Clip Device into LV and Mitral Leaflet Grasping
Assessment of Postprocedural Results and Complications
Intraprocedural TEE for Transcatheter Mitral Valve Replacement
Evaluation of Mitral Valve Pathology
Transseptal Puncture and Advancement of the Transcatheter Heart Valve
Positioning and Deployment of the ­Transcatheter Heart Valve
Assessment of Postprocedural Results and Complications
Intentional Laceration of the Anterior Mitral Valve Leaflet to Prevent LV Outflow Tract Obstruction (Lampoon Procedure)
Intraprocedural TEE for Percutaneous Paravalvular Leak Occlusion
Para-­Aortic Defect Repair
Para-­Mitral Defect Repair
Intraprocedural TEE for Left Atrial Appendage Occlusion
Periprocedural Multimodality Imaging
Intraprocedural TEE Assessment
Transseptal Puncture and Advancement of the Left Atrial Appendage Access Sheath
Device Deployment and Release
Challenges and Hazards
Future Directions
References
11 - Focused Cardiac Ultrasound at the Bedside
Focused Cardiac Ultrasound at the Bedside
Echocardiography as an Adjunct to the Physical Examination
Diagnostic Targets of FoCUS
LV Size and Function
RV Size and Function
Pericardial Effusion
Intravascular Volume Status
Limitations of FoCUS
Basic Approach to the FoCUS Examination
Positioning
Standard Views
Parasternal Long-­Axis View
Parasternal Short-­Axis View at the Mid-­Ventricle
Apical 4-­Chamber View
Subcostal 4-­Chamber View
Subcostal Inferior Vena Cava View
Documentation
Emergency Diagnoses
Undifferentiated Hypotension and Shock
Penetrating Chest Trauma
Massive Pulmonary Embolus
Cardiac Tamponade
Cardiac Arrest
Patient Outcomes
Training and Certification
Current Training Practices
Training Recommendations
1. Structured Training Should Include Didactic and Hands-­On Learning
2. Training Should Address Image Acquisition, Quality Assessment, and Image Interpretation
3. Ongoing Practice Is Required for Skills Retention
Certification, Credentialing, and Competency
Quality Assurance
References
12 - Dilated Cardiomyopathy
Familial Screening
Appropriateness Criteria for Echocardiography
LV Systolic Function
LV Systolic Function and Prognosis
LV Size and Shape
Tissue Doppler Imaging
Strain Imaging
LV Torsion
LV Diastolic Function
Secondary Mitral Regurgitation
LV Contractile Reserve
Right-­Sided Involvement
Myocarditis
Chagas Heart Disease
LV Noncompaction
Stress-­Induced Cardiomyopathy
Cardiac Resynchronization Therapy
Echocardiography and Cardiac Resynchronization Therapy
Intraventricular Dyssynchrony
Septal Flash and Apical Rocking
Speckle-Tracking Imaging
Interventricular Delay
Changes in Diastolic Function with Cardiac Resynchronization Therapy
Response to Cardiac Resynchronization Therapy
Management of Nonresponders
Targeted LV Lead Placement
Heart Failure Risk Scores
References
13 - Hypertrophic Cardiomyopathy
Diagnosis
Differential Diagnosis
Pressure Overload Conditions
Genetic Phenocopies and Infiltrative Conditions
Athlete’s Heart
Severity, Distribution, and Patterns of Hypertrophy
Echocardiographic Assessment of Hypertrophy
Hypercontractility, Cavity Size, and Adverse Remodeling
Mitral Valve Abnormalities
Dynamic LV Outflow Tract Obstruction
Systolic Anterior Motion of the Mitral Leaflets
Loading Conditions and Provocative Maneuvers
Doppler Assessment of Obstruction
Pitfalls of Doppler Evaluation
Myocardial Deformation and Strain
Factors Contributing to Impaired Diastolic Function
Echocardiographic Assessment of Diastolic Function
Assessment of Hypertrophic Cardiomyopathy Subtypes
Apical Variant Hypertrophic Cardiomyopathy
Mid-­Ventricular Obstruction
Thin-­Filament Hypertrophic Cardiomyopathy
Nonfamilial Hypertrophic Cardiomyopathy
Management of LV Outflow Tract Obstruction
Septal Reduction Therapies
Surgical Myectomy
Alcohol Septal Ablation
Clinical Results After Septal Reduction
Echocardiography in the Risk Stratification for Sudden Death
Family Screening and Preclinical Hypertrophic Cardiomyopathy
References
14 - Restrictive Cardiomyopathy
Introduction to Imaging in Restrictive Cardiomyopathy
2D Echocardiographic and Doppler Features
M-­Mode Imaging
2D Imaging
Spectral Doppler Imaging
Findings
Mitral Inflow Pulsed-­Wave Doppler Imaging
Pulmonary Vein Pulsed-­Wave Doppler Imaging
Tissue Doppler Imaging of the Mitral Annulus
Color M-­Mode
Tissue Doppler Imaging and Longitudinal Strain
Limitations and Pitfalls of Pulsed-­Wave Doppler and Color M-­Mode
2D Speckle Tracking Strain Imaging
Other Imaging Modalities
Specific Restrictive Cardiomyopathies
Amyloidosis
Definition
Clinical Features
Echocardiography
Echo-­Doppler Imaging
Magnetic Resonance Imaging
Nuclear Imaging
Treatment
Idiopathic Restrictive Cardiomyopathy
Hypereosinophilic Syndrome and Endomyocardial Fibrosis
Hemochromatosis
Sarcoidosis
Glycogen Storage Disorder: Pompe Disease
Fabry Disease
Drug-­Induced Restrictive Cardiomyopathy
Postradiation Cardiomyopathy
Other Causes of Restrictive Cardiomyopathy
Differentiating Between Restrictive Cardiomyopathy and Constrictive Pericarditis
References
15 - Cardiac Transplantation
Post-­Transplantation Evaluation
Surgical Considerations in Echocardiographic Imaging and Interpretation
Perioperative Post-­Transplantation Period
Acute Post-­Transplantation Period
Primary Graft Dysfunction
Acute Rejection
RV Failure
Pericardial Effusions and Tamponade
Infections
Complications After Endomyocardial Biopsy
Subacute Post-­Transplantation Period
Chronic Post-­Transplantation Period
Chronic Graft Failure
Chronic Rejection
Cardiac Masses
Challenges to Diagnosing Complications by Echocardiography
Prognostic Significance of Echocardiography After Transplantation
Future Directions
Conclusions
References
16 - Cardiac Assist Devices
Percutaneous Mechanical Circulatory Support Devices
Total Artificial Heart
Preimplantation Assessment
Periprocedural Guidance
Postimplantation Surveillance and Complications
Overfilling
Underfilling
Valvular Dysfunction
Effects of Speed Changes
Pump Thrombosis
Ventricular Recovery
Percutaneous Mechanical Circulatory Support Device Position
Technical Details, Quantitation, and Data Analysis
LV End-­Diastolic Diameter and Septal Orientation
Ventricular Function
Aortic Valve Opening
Pericardial Pathology
Cannulas
Optimization Studies
Ramp Studies
Turndown Studies for Ventricular Recovery
Clinical Utility and Outcome Data
Potential Limitations and Future Directions
Alternative Approaches
References
17 - Pericardial Disease
Pericardial Pressure and Normal Respiratory Effects on Hemodynamics
Pathophysiologic Principles in Compressive Pericardial Disease
Echocardiographic Evaluation of Pericardial Disease
Definition and Etiology
Pathology and Pathophysiology
Clinical Presentation and Treatment
Echocardiographic Diagnosis
Abnormal Ventricular Septal Motion: Ventricular Septal Shift and Shudder
Ventricular Septal Shift
Ventricular Septal Shudder
Respiratory Variation in the Hepatic Vein Doppler Profile: Prominent Diastolic Flow Reversals in Expiration
Preserved or Elevated e′ Values
Annulus Reversus
Annulus Paradoxus
Respiratory Variation in Mitral Inflow Velocity
Other 2D and M-­Mode Findings
Other Doppler Findings
Strain Imaging
Differentiation From Restrictive Cardiomyopathy
Effusive-­Constrictive Pericarditis and Transient Constrictive Pericarditis
Multimodality Imaging of Constrictive Pericarditis
Pericardial Effusion
Echocardiographic Diagnosis
Definition and Etiology
Pathophysiology
Echocardiographic Diagnosis
Characterization of the Pericardial Effusion
Cardiac Chamber Collapse
RA Compression, Inversion, or Collapse
RV Compression, Inversion, or Collapse
Left Heart Chamber Collapse
Plethora of the Inferior Vena Cava
Respiratory Variation in Right and Left Heart Filling
Combining Chamber Collapse With Abnormal Hepatic Venous Flow: Test Performance Characteristics
Regional Tamponade
Echocardiographically Guided Pericardiocentesis
Contraindications
Procedural Steps
Acute Pericarditis
Congenital Absence of the Pericardium
Pericardial Cysts
References
18 - Cardiac Tumors and Cardio-­oncology
Doppler Methods for Detection of Cardiotoxicity
Speckle Tracking Characteristics of Cardiac Mechanics in Cardio-­Oncology
Chemotherapeutic Impact on the RV
Considerations in Radiation-­Induced Heart Disease
Cardiac Masses and Tumors
Benign Tumors
Other Benign Cardiac Tumors: Lipomas and Lipomatous Hypertrophy
Echocardiography and Cardiac Tumors
Alternative Imaging Modalities
Tumor Types, Physiology, and Treatment Considerations
Primary Cardiac Malignant Tumors
Secondary (Metastatic) Cardiac Malignant Tumors
Differential Diagnosis
Prognosis
Treatment
References
19 - Stress Echocardiography for Detecting Coronary Ischemia
The Ischemic Cascade
Indications and Contraindications for Stress Echocardiography
Indications
Exercise Stress Echocardiography for Preoperative Risk Assessment in Noncardiac Surgery
Contraindications
Cost-­Effectiveness of Exercise Stress Echocardiography
General Considerations
Equipment and Personnel
Patient Preparation
Exercise Stress Testing
Exercise Stress Protocols
Treadmill Protocols
Bicycle Protocols
Handgrip
Effects of Medical Therapy
Symptoms, Angina, and Perceived Effort
Heart Rate
Heart Rate Recovery
Blood Pressure
Functional Capacity
Electrocardiographic Changes
Echocardiographic Imaging
Duke Treadmill Score
Other Important Stress Echocardiographic Outcomes
Termination of Stress Echocardiography
Reporting of Stress Echocardiography Findings
Accuracy of Exercise Stress Echocardiography
Sensitivity, Specificity, And Prognostic Value of Stress Echocardiography
Strain Echocardiography
3D Echocardiography
Myocardial Contrast Perfusion Stress Echocardiography
References
20 -Nonexercise Stress Echocardiography for Diagnosis of Coronary Disease
Dobutamine and Atropine Stress Echocardiography
Dipyridamole, Adenosine, And Regadenoson Stress Echocardiography
Ergonovine Stress Echocardiography
Pacing Stress Echocardiography
Assessment of Myocardial Viability
Nonexercise Stress Echocardiography in Specific Clinical Scenarios
Use of Contrast During Nonexercise Stress Echocardiography
Emerging Techniques in Stress Echocardiography
Three-­Dimensional Stress Echocardiography
Two-Dimensional Tissue Doppler and Speckle Tracking Strain Echocardiography
Coronary Flow Velocity Reserve
Myocardial Contrast Perfusion and Myocardial Contrast Blood Flow Reserve
Nonexercise Stress Echocardiography: Role in Current Clinical Practice
Future Directions
References
21 - Role of Echocardiography in Patients With Acute Coronary Syndrome
Localization of Infarction
Detecting Complications of Acute Myocardial Infarction
Papillary Muscle Rupture
Ventricular Septal Rupture
Rupture of the Ventricular Free Wall
Postinfarction Pericardial Effusion
Pseudoaneurysm
Infarct Expansion and True Aneurysm Formation
LV Thrombus
LV Systolic Function
Regional Wall Motion Score
LV Diastolic Function
LA Volume and Function
LV Remodeling
Stress Echocardiography
Mitral Regurgitation
References
22 - Aortic Stenosis (Including Evaluation for Transcatheter Aortic Valve Replacement)
Hemodynamic Severity
Aortic Velocity And Mean Pressure Gradient
Continuity Equation Aortic Valve Area
LV Outflow Tract Velocity
LV Outflow Tract Diameter
Stroke Volume Index
Velocity Ratio
Tee Planimetry Valve Area
Measurement Variability And Errors
Effect of Transaortic Flow
Adjustment For Body Size
Concurrent Hypertension
Anatomic Versus Effective Aortic Valve Area And Pressure Recovery
Discordance Between Measures Of Aortic Stenosis Severity
Lv Remodeling
Diastolic Function
Ejection Fraction
Stroke Volume Index
Longitudinal Function
Associated Findings
Aortic Regurgitation
Concomitant Subvalvular Obstruction
Mitral Annular Calcification And Mitral Regurgitation
Amyloidosis
Coronary Artery Disease
Pulmonary Hypertension
Exercise Stress Testing
Aortic Valve Area Planimetry
Fusion Approach
Calcium Scoring
Preparation for Transcatheter Aortic Valve Implantation
Cardiac Magnetic Resonance Imaging
Cardiac Catheterization
Gradients
Aortic Valve Area
Clinical Approach
Timing of Aortic Valve Replacement
Progression of Aortic Stenosis (Stage B)
Asymptomatic Patients (Stage C)
Symptomatic Patients (Stage D1)
Low-­Flow, Low-­Gradient Severe Aortic Stenosis With Reduced Ejection Fraction (Stage D2)
Low-­Flow, Low-­Gradient Severe Aortic Stenosis With Preserved Ejection Fraction (Stage D3)
Patients Undergoing Cardiac Surgery For Other Indications
Type of Valve Replacement
Risk Assessment
Associated Findings
Valve Anatomy
References
23 - Aortic Regurgitation
Aortic Root Abnormalities
Color Doppler Echocardiography
Semiquantitative Methods
Quantitative Methods
Pulsed-­Wave Doppler
Continuous-­Wave Doppler
Integrating Doppler Indexes of Severity
TEE
3D Echocardiography
Magnetic Resonance Imaging
LV Dimensions and Contractile Function
Contractile Reserve Evaluation
Aortic Root and Ascending Aorta Evaluation
Aortic Valve and Root Function
Natural History and Serial Testing in Chronic Aortic Regurgitation
Medical Treatment
Indications for Surgery
Symptomatic Patients With LV Dysfunction
Symptomatic Patients With Normal LV Systolic Function
Asymptomatic Patients With Reduced Ejection Fraction
Asymptomatic Patients With Normal Ejection Fraction
Concomitant Aortic Root Disease
Selecting and Guiding Surgical Treatment
Role of Echocardiography
Surgical Implications
Results of Surgery and Follow-­Up
Acute Aortic Regurgitation
Acute Type a Aortic Dissection
Infective Endocarditis
References
24 - Mitral Regurgitation: Valve Anatomy, Regurgitant Severity, and Timing of Intervention
Compensatory Leaflet Growth
Chordae Tendineae and Papillary Muscles
Mechanisms of Mitral Regurgitation
Primary Mitral Regurgitation
Secondary Mitral Regurgitation
Atrial Functional Mitral Regurgitation
Carpentier Classification
Quantification of Mitral Regurgitation
Distal Jet Area Method
Vena Contracta Width Method
Proximal Isovelocity Surface Area Method
Geometric Factors Influencing the PISA Method
Technical Factors
EROA in Primary and Secondary Mitral Regurgitation
3D-­Guided Vena Contracta Area
Pulmonary Venous Inflow Pattern: Systolic Flow Reversal
Peak E-­Wave Velocity
CW Doppler Pattern
Volumetric Methods Using Pulsed-­Wave Doppler
Valve Morphology and Left-­Sided Chamber Size
Holosystolic Versus Non-­Holosystolic Jets
Hemodynamic and Physiologic Factors
Grading Mitral Regurgitation With an Integrative Method
Pathophysiology
Timing of Intervention
Therapy for Primary Mitral Regurgitation
Therapy for Secondary Mitral Regurgitation
References
25 - Transesophageal Echocardiography for Surgical Repair of Mitral Regurgitation
Essential Anatomy
Mitral Valve Disease
Degenerative (Myxomatous) Disease
Infective Endocarditis
Rheumatic Disease
Radiation Necrosis
Dystrophic Calcification
Papillary Muscle Rupture
Secondary REGURGITATION
Standard Multiplane Imaging
Principles of Axial Imaging
3d Imaging
Pre-­Repair Tee
Degenerative Disease
Endocarditis
Rheumatic Disease
Papillary Muscle Rupture
Secondary REGURGITATION
Disease Combinations
Surgical Techniques of Image-­Guided Mitral Repair
Degenerative Disease
Endocarditis
Rheumatic Disease
Papillary Muscle Rupture
Secondary REGURGITATION
Post-­Repair Tee
Leaflet Structure And Function
Residual Mitral Regurgitation
New Mitral Stenosis
Ventricular Dysfunction
Systolic Anterior Motion
References
26 - Transcatheter Mitral Valve Repair
Edge-­To-­Edge Mitral Valve Repair
Use of Echocardiography In Patient Selection
Determining the Cause of Mitral Regurgitation
Primary Mitral Regurgitation
SECONDARY Mitral Regurgitation
Mixed Mitral Regurgitation
Determining Mitral Regurgitation Severity
Moderate To Severe Mitral Regurgitation
Severe Mitral Regurgitation
Echocardiographic Parameters to Determine Suitability for MITRAL TRANSCATHETER EDGE-TO-EDGE (TEER) Repair
Procedural Guidance
Transseptal Puncture
Device Navigation in The La
Guiding Catheter and Clip Delivery System Steering
Device Alignment to Mitral Valve
Device Advancement into Lv
Leaflets Grasping
Device Release and Determination of Residual Mitral Regurgitation
Consideration for Additional Clips
Retrieval of Delivery Catheters
Atrial Septal Defect Check
Evaluation of Possible Complications
Evaluation of Outcomes
Alternative Imaging Techniques
Recent Advances and Future Directions
References
27 - Mitral Stenosis
Evaluation of the Severity
Assessment of Hemodynamic Consequences
Assessment of Consequences on the La
Assessment of Valve Anatomy
Mitral Regurgitation
Associated Lesions
Thromboembolic Complications
Use of the Different Echocardiographic Techniques
Technique, Quantitation, and Data Analysis
Valve Function
Valve Anatomy
Exercise Echocardiography
During Balloon Mitral Commissurotomy
Early After Balloon Mitral Commissurotomy
During Follow-­Up after Balloon Mitral Commissurotomy
Assessment of Degenerative Mitral Stenosis
Clinical Utility
Results of Balloon Mitral Commissurotomy
Failure and Complications
Immediate Results
Late Results
Restenosis After Previous Commissurotomy
The Elderly
Young Patients
Pregnant Women
Contraindications
Choice of Procedure
Timing of the Procedure
Transcatheter Mitral Valve Replacement for Degenerative Calcific Mitral Stenosis
Stress Echocardiography
Evaluation of Atrioventricular Compliance
Evaluation of Valve Anatomy
Potential Limitations and Future Directions
Alternative Approaches
References
28 - Right-­Sided Valve Disease in Adults
Basic Echocardiographic Imaging Principles
Assessing the Mechanism and Severity of Tricuspid Regurgitation
Quantification of Regurgitant Severity
TEE
Role of Echocardiography in Clinical Care
Tricuspid Stenosis
Pulmonary Valve Anatomy
Pulmonary Valve Stenosis
Quantification of Pulmonary Stenosis Severity
Role of Echocardiography in Clinical Care
Pulmonary Regurgitation
Echocardiographic Evaluation of Pulmonary Regurgitation
Role of Echocardiography in Clinical Care
References
29 - Endocarditis
Technical Details, Quantitation, and Data Analysis
Utility in Diagnosis
General Considerations
Evaluation of the Patient With Bacteremia
Evaluation of the Patient With Prosthetic Valves
Evaluation of Patients With Cardiac Implantable Electronic Devices
Utility in Management
Utility in Follow-­Up
Research Applications
Potential Limitations and Future Directions
Alternative Approaches
References
30 -Fluid Dynamics of Prosthetic Valves
Mechanical Energy
Bernoulli’s Equation
Control Volume Energy Analysis
Mechanisms of Mechanical Energy Loss
Viscous Losses
Turbulent Losses
Valvular Regurgitation
Mechanical Energy Conversion and Loss in a Stenosis
Pressure Drop
Doppler Gradient
Effective Orifice Area
Regurgitant Volume
Mechanical Energy Losses
Novel Energy Loss Parameters
In Vivo Evaluation of Prosthetic Valves
Hemodynamics of Native Valves
Hemodynamics of Specific Prosthetic Valve Designs
Mechanical Valves
Bioprosthetic Valves
Transcatheter Valves
Antegrade Flow
Normal Regurgitant Flow
Thrombosis
Future Directions
References
31 - Echocardiographic Recognition and Quantitation of Prosthetic Valve Dysfunction
Structural Valve Deterioration
Doppler Echocardiographic Evaluation of Prosthetic Valve Function
Timing of Echocardiographic Follow-­Up
Clinical Data
Recognition and Quantitation of Prosthetic Valve Stenosis
Leaflet Morphology and Mobility
Quantitative Parameters
Transprosthetic Velocity and Gradient
Transprosthetic Jet Contour and Flow Ejection Dynamics
Effective Orifice Area
Doppler Velocity Index
Recognition and Quantitation of Prosthetic Valve Regurgitation
Prosthetic Aortic Valve Regurgitation
Imaging Considerations
Parameters of the Severity of Prosthetic Aortic Valve Regurgitation
Color Doppler Parameters
Spectral Doppler Parameters
Quantitative Parameters
Integrative, Multiparametric Approach to the Evaluation of Prosthetic Aortic Valve Regurgitation
Prosthetic Mitral Valve Regurgitation
Imaging Considerations
Parameters of the Severity of Prosthetic Mitral Valve Regurgitation
Indirect Signs and Consequences of Prosthetic Valve Regurgitation
Prosthetic Tricuspid Valves
Prosthetic Pulmonary Valves
Interpretation of High Transprosthetic Gradients
Prosthetic Aortic Valves
Prosthetic Mitral Valves
Low-­Flow States
Prosthetic Valve Thrombosis
Prosthetic Valve Endocarditis
Conclusions
References
32 - Acute Aortic Syndromes
Complications
Clinical Presentation and Diagnostic Approach
Echocardiographic Views of the Aorta
Acute Aortic Dissection
Aortic Intramural Hematoma
Penetrating Aortic Ulcer
Traumatic Aortic Injury
Diagnosis of Complications by Echocardiography
Aortic Regurgitation
Coronary Artery Dissection
Pericardial Effusion
Distal Vessel Involvement
Echocardiographic Procedural Guidance
Imaging Follow-­Up After an Acute Aortic Syndrome
References
33 - Inherited Connective Tissue Disorders
Other Fibrillinopathies
Loeys-­Dietz Syndrome
Ehlers-­Danlos Syndrome
Familial Thoracic Aortic Aneurysm And Dissection
Bicuspid Aortic Valve
Turner Syndrome
Histopathology
Normal Aortic Measurements
Aortic Dilation
Aortic Dissection
Aortic Arch and Descending Thoracic Aortic Complications
Mitral Valve Prolapse
Lv Function
Diastolic Function
Systolic Function
Pulmonary Artery
Natural History
Pharmacologic Approaches
Surgical Approaches
Methods Of Assessment
Limitations of Assessment
Alternative Diagnostic Approaches
References
34 - Hypertensive Heart Disease and ­Nutritional and Metabolic Disorders
Clinical Interventions
Background
Technical Considerations
Structural Changes
Diastolic Function
Systolic Function
Epicardial Fat
Clinical Interventions
Background
Echocardiographic Findings
Clinical Interventions
Background
Echocardiographic Findings
Clinical Interventions
Endocrinopathies
Hyperthyroidism
Hypothyroidism
Acromegaly
Growth Hormone Deficiency
Cushing Syndrome
Hyperparathyroidism
Pheochromocytoma
Liver Diseases
Cirrhotic Cardiomyopathy
Liver Transplantation
Alcohol
Nonalcoholic Fatty Liver Disease
References
35 - The Athletic Heart on Echocardiography
Structure
Systolic Function
Diastolic Function
Structure
Function
Atria
Aorta
Electrical Remodeling
Detraining Effects
Screening Echocardiography in Athletes
Technical Considerations and Physiologic Differences
Acute Effects of Exercise
Alternative Imaging Modalities
Common Clinical Dilemmas
Valve Disease in Athletes
Endurance Athlete or Dilated Cardiomyopathy
Strength-­Trained Athlete or Hypertrophic Cardiomyopathy
Endurance Athlete or Rv Cardiomyopathy
Can This Athlete Continue To Compete Safely
References
36 - Pulmonary Hypertension
Clinical Classification of Pulmonary Hypertension
ESTIMATING Pulmonary Artery Pressures
Estimating the RV-­RA Pressure Difference From the Tricuspid Regurgitation Profile
Estimating RA Pressure
Pulmonary Regurgitation Profile
Pulmonary Acceleration Time
Mid-­Systolic Notching of the RV Outflow Doppler Signal
Factors Affecting Pulmonary Artery Pressure in Normal Individuals
Pulmonary Arterial Hypertension
Pulmonary Hypertension Due to Congenital Heart Disease
Pulmonary Hypertension Due to Left Heart Disease
Pulmonary Hypertension Due to Lung Disease
Pulmonary Hypertension Due to Pulmonary Artery Obstruction
Acute Pulmonary Hypertension
Effects Of Pulmonary Hypertension On The Right Heart
RV Shape Changes in the Setting of Pressure Loading
Ventricular Septal Motion
RV Dimensions
RV Wall Thickness
RV Systolic Function
RV Strain
3D Analysis of RV Systolic Function
RV Diastolic Function
Estimating Pulmonary Vascular Resistance at Rest
Exercise Stress Echocardiography and Pulmonary Hypertension
Diagnostic Approach for a Patient with Suspected Pulmonary Hypertension
Monitoring Pulmonary Hypertension and Rv Responses
References
37 - Systemic Diseases Characterized by Immune-­Mediated Injury
Atherosclerosis
Myocardial Disease
Pericardial Disease
Pulmonary Hypertension
Background
Valve Disease and Thromboembolism
Pulmonary Hypertension
Atherosclerosis
Myocardial Disease
Background
Atherosclerosis
Pericardial Disease
Valve Disease
Myocardial Disease
Pulmonary Hypertension
Background
Aortitis and Valve Disease
Conduction Abnormalities
Myocardial and Pericardial Disease
Atherosclerosis
Background
Atherosclerosis
Myocardial Disease
Pulmonary Hypertension
Pericardial Disease
Valve Disease
Background
Myocardial Disease
Pericardial Disease, Atherosclerosis, Valve Disease, and Pulmonary Hypertension
Takayasu Arteritis
Background
Vascular Disease
Heart Disease
Diagnostic Imaging
Therapy
Background
Vascular Disease
Heart Disease
Diagnostic Imaging and Therapy
Background
Vascular Disease
Heart Disease
Diagnostic Imaging and Therapy
References
38 - Echocardiographic Evaluation of Patients With a Systemic Embolic Event
Myocardial Infarction, Lv Dysfunction, And Thrombus
Valvular Vegetations And Strands
Intracardiac Tumors
La Thrombus And Spontaneous Echocardiographic Contrast
Atrial Septum Abnormalities: Patent Foramen Ovale And Atrial Septal Aneurysm
Detection of Patent Foramen Ovale
Patent Foramen Ovale, Atrial Septal Aneurysm, and Stroke Risk
Possible Associated Factors
Prevention of Recurrent Embolism
Atherosclerotic Plaques In The Proximal Aorta
Therapy for and Prevention of Recurrent Events
Potential Limitations And Alternative Approaches
References
39 - Echocardiography in Patients With Atrial Fibrillation and Flutter
Atrial Size
Stroke and Atrial Fibrillation
Role of the Left Atrial Appendage
Appendage Morphology
Appendage Function
Appendage Tissue Changes
Hemostatic Changes
Tee in the Management of Atrial Fibrillation
Valvular Versus Nonvalvular Atrial Fibrillation
Atrial Fibrillation Catheter Ablation
Intracardiac Echocardiography
Transesophageal Echocardiography
Atrial Flutter Ablation
Left Atrial Appendage Closure
References
40 - Heart Disease in Pregnancy
Cardiac Chamber Size
Doppler Flows
Systolic And Diastolic Function
Interpretation Of Echocardiographic Findings During Pregnancy
Pregnancy Risks
Cardiac Shunts
Tetralogy Of Fallot
Coarctation Of The Aorta
Ebstein Anomaly
Transposition Of The Great Arteries
Fontan Circulation
Cyanotic Heart Disease
Aortic Valve Disease
Mitral Valve Disease
Prosthetic Heart Valves
Aortopathies
Cardiomyopathies
Fetal And Neonatal Risk
Management Principles
Antepartum Period
Labor And Delivery
Postpartum Period
Management of Complications
Limitations of Echocardiography and Alternative Appoaches
References
41 - Congenital Shunts
Overview
Management
Overview
Management
Overview
Management
Overview
Management
Overview
Management
Overview
Management
Overview
Management
Ruptured Sinus of Valsalva Aneurysm
Patent Ductus Arteriosus
Coronary Artery Fistula
References
42 - Left Heart Anomalies
Cleft Mitral Valve
Supramitral Ring
Double-­Orifice Mitral Valve
Parachute Mitral Valve
Mitral Arcade
Congenital Lv Outflow Tract Obstruction
Subaortic Obstruction
Valvular Congenital Aortic Disease
Supravalvular Aortic Stenosis
Coarctation Of The Aorta
Aortic Arch Anomalies
Interrupted Aortic Arch
Double Aortic Arch
Right Aortic Arch
Cervical Aortic Arch
Anomalies of Coronary Artery Origins
Anomalous Coronary Artery Origin From the Opposite Sinus
Anomalous Coronary Artery Origin From the Pulmonary Artery
Coronary-­Cameral Fistulas
References
43 - Right Heart Anomalies
Indications for Intervention and Assessment After Intervention
Background
Pathophysiology and Clinical Presentation
Echocardiography of Subpulmonic Stenosis
Indication for Surgical Repair
Background
Clinical Presentation and Physical Examination
Imaging and Management
Background and Morphology
Echocardiography of Ebstein Anomaly
Surgical Repair and Outcomes
Review
References
44 - Complex Conotruncal Anomalies
Genetics Considerations
Aortopathy in Conotruncal Anomalies
Tetralogy of Fallot
Truncus Arteriosus
Double-­Outlet Ventricle
Double-­Outlet Right Ventricle
Double-­Outlet LV
Anatomically Corrected Malposition of the Great Arteries
Aortopulmonary Window
Conclusions
References
45 -Transposition of the Great Arteries
Evaluation of the Patient After a Mustard or Senning Atrial Switch Procedure
Evaluation of the Systemic RV and Tricuspid Valve
Evaluation of Tricuspid Regurgitation
Evaluation of the Patient After an Arterial Switch Operation
Neoaortic Root After an Arterial Switch Operation
Neoaortic Regurgitation
Supravalvular and Branch Pulmonary Artery Stenosis
Coronary Artery Disease After the Arterial Switch Operation
Evaluation of the Patient After a Rastelli Operation
Anatomy and Definitions
Epidemiology
Surgical Repair
References
46 - Single Ventricles
Surgical Evolution After The Fontan Operation
Preparation For The Scan
Terminology
Technical Aspects
Fontan Connections
Connection Between the Inferior Vena Cava and Fontan Circulation
Connection Between the Superior Vena Cava and Fontan Circulation
Connection Between the Fontan Circulation and Branch Pulmonary Arteries
Pulmonary Venous Return
Atrioventricular Valve Function
Ventricular Systolic Function
Qualitative Assessment
Quantitative Assessment
Nongeometric Indices
Ventricular Diastolic Function
Outflow Tracts
Conclusions
References