Nihoyannopoulos / Kisslo Echocardiography

1. Auflage 2010
ISBN: 978-1-84882-293-1
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 480 Seiten

As increasing emphasis is placed on evidence-based medicine and the need to a rapid and clinically effective diagnosis of cardiac disease, so echocardiography is ever-more present at the forefront of cardiology. This book represents the current knowledge in the technique of cardiology and is designed to guide the resident and fellow through the most common applications of echocardiography while touching on some of the less often seen echocardiographic diagnoses.

Dr Petros Nihoyannopoulos is Reader in Cardiology, at the National Heart and Lung Institute, Imperial College School of Medicine and Technology (University of London) and Honorary Consultant Cardiologist Hammersmith Hospital, UK. He is a fully trained clinical cardiologist having completed medical studies in Strasbourg-France in 1979. He is now Head of Echocardiography laboratories at Hammersmith Hospital. Dr Nihoyannopoulos has developed the Hammersmith Echocardiology laboratory to the highest international standards to accommodate the ever increasing clinical demand but also to the highest national teaching center for echocardiology. He organizes both a clinical echocardiography service department with comprehensive technical support and a research unit which annually trains 5-6 post-graduate students from all over the world. At present, he has trained over 50 doctors and technicians from all over Europe in the art of echocardiology. His main research interest is in the use of echocardiography and Doppler techniques in clinical practice. To this end he leads the echocardiography laboratory at the Hammersmith Hospital in the following specific areas: stress echocardiography to assess wall motion in patients with syndrome X; the development of a three-dimensional ultrasound model of the thoracic aorta in health and disease; the use of contrast echocardiography for enhanced doppler signal and improved endocardial border detection and myocardial perfusion at rest and during stress; intravascular ultrasound system to compare imaging with histological plaque appearances. Dr Joseph Kisslo is Professor of Medicine at Duke University, Durham, NC USA. Dr. Kisslo's research has centered around the development and initial application of new ultrasound imaging devices. Focussed principally on morphologic diagnosis in the early years, the work has become progressively more physiologic in its orientation.

After more than two decades there are now 300 original research papers, several textbooks and other materials. Dr. Kisslo has distinguished himself as the first to use phased array ultrasound imaging in the human body and, accordingly, was the first to describe most of the disease for which the technique is now commonplace. He was very early into the applications of Doppler color flow imaging and transesophageal imaging with ultrasound. He has served as an officer or on the Board of a variety of national and international bodies. He was one of the first Presidents of the American Society of Echocardiography. He reviews in all aspects of cardiac imaging, but principally echocardiography.

Over the past 15 years he has also had a keen interest in medical economics and has served on various professional and governmental boards in describing medical costs and dealing with medical economics. More recently, he has taken interest in adult re-education through remote learning means (telemedicine) and has become the Clinical Director of Telemedicine at Duke. He is Executive Producer of the world's largest telemedicine program (Echo in Context) which has run for the past 14 years. This was the first educational event to circumnavigate the globe live.

He is a frequent scientific and motivational lecturer to scientific organizations and industry. He serves as advisor to several governmental and industrial organizations.

Autoren/Hrsg.

Kisslo, Joseph

Nihoyannopoulos, Petros

Inhaltsverzeichnis

1;Nihoyannopoulos_FM.pdf;1
2;Nihoyannopoulos_Ch01_O.pdf;12
2.1;Chapter 1;13
2.1.1;Physical Principles and the Basic Exam;13
2.1.1.1;Introduction;13
2.1.1.2;Basic Concepts;13
2.1.1.3;Imaging of Cardiac Structures;14
2.1.1.3.1;The Ultrasound Beam;14
2.1.1.3.2;The 2-D Sector Image;15
2.1.1.3.3;M-Mode;16
2.1.1.3.4;Attenuation, Reflection and Depth Compensation;18
2.1.1.3.5;Reverberation and Multiple Reflection Artifacts;18
2.1.1.3.6;Gray Scale;21
2.1.1.3.7;Resolution of Ultrasound Images;21
2.1.1.3.8;Parallel Processing;23
2.1.1.3.9;Harmonic Imaging;25
2.1.1.4;Transesophageal Imaging;26
2.1.1.5;Real-Time 3-D Imaging;27
2.1.1.6;Doppler Echocardiography;28
2.1.1.6.1;Doppler Principles;28
2.1.1.6.2;Continuous-Wave Spectral Doppler;29
2.1.1.6.2.1;Volumetric Flow;30
2.1.1.6.2.2;The Continuity Equation and Flow Through a Restricting Orifice;30
2.1.1.6.3;Pulsed Wave Doppler;32
2.1.1.6.4;High PRF PW Doppler;34
2.1.1.6.5;Color Flow Imaging;35
2.1.1.6.5.1;Advantages of Color Flow Imaging;36
2.1.1.6.5.2;Limitations of Color Flow Imaging;36
2.1.1.6.6;Tissue Doppler Imaging;37
2.1.1.6.7;Strain Rate Imaging;37
2.1.1.6.8;Second Harmonic Mode Doppler and Contrast Imaging;39
2.1.1.6.9;Power Mode (Amplitude) Imaging;39
2.1.1.7;Is Ultrasound Safe?;40
2.1.1.8;Conclusions;40
3;Nihoyannopoulos_Ch02_O.pdf;41
3.1;Chapter 2;41
3.1.1;Conducting a Cardiac Ultrasound Examination;41
3.1.1.1;2D Normal Views;41
3.1.1.1.1;Historical Perspective;41
3.1.1.1.2;Normal Cardiac Anatomy;42
3.1.1.1.3;Transthoracic Standard Imaging Planes;42
3.1.1.1.4;Left Parasternal Window;42
3.1.1.1.4.1;Long Axis;42
3.1.1.1.4.2;Short Axis;42
3.1.1.1.5;Apical Window;44
3.1.1.1.6;Subcostal window;45
3.1.1.1.7;Suprasternal Window;46
3.1.1.1.8;Transesophageal Standard Imaging Planes;46
3.1.1.2;Controls Settings;48
3.1.1.2.1;Introduction;48
3.1.1.2.2;Preparing the Machine;48
3.1.1.2.3;Two-Dimensional Imaging and Basic Image Manipulation;49
3.1.1.2.4;Measurements;52
3.1.1.2.5;Harmonics;52
3.1.1.2.6;Annotation;52
3.1.1.2.7;Color Doppler;53
3.1.1.2.8;Pulsed-Wave and Continuous-Wave Doppler;54
3.1.1.3;Conclusions;56
4;Nihoyannopoulos_Ch03_O.pdf;57
4.1;Chapter 3;57
4.1.1;Principles of Flow Assessment;57
4.1.1.1;Introduction;57
4.1.1.2;The Doppler Principle;57
4.1.1.3;Principle of Flow Assessment;59
4.1.1.3.1;Stroke Volume and Cardiac Output;60
4.1.1.4;Continuity Equation;61
4.1.1.5;Clinical Applications of Continuity Equation;62
4.1.1.5.1;Mitral Regurgitation;62
4.1.1.5.2;Aortic Regurgitation;62
4.1.1.5.3;Mitral Stenosis;63
4.1.1.5.4;Aortic Stenosis;63
4.1.1.6;Proximal Isovelocity Surface Area method;66
4.1.1.7;Clinical Applications of PISA Method;66
4.1.1.7.1;Mitral Regurgitation;66
4.1.1.7.2;Tricuspid Regurgitation;67
4.1.1.7.2.1;Aortic Regurgitation;68
4.1.1.7.3;Mitral Stenosis;70
4.1.2;References;70
5;Nihoyannopoulos_Ch04_O.pdf;73
5.1;Chapter 4;73
5.1.1;Principles of Hemodynamic Assessment;73
5.1.1.1;Transvalvular Pressure Gradient;73
5.1.1.2;Aortic Stenosis;73
5.1.1.3;Pulmonary Stenosis;75
5.1.1.4;Mitral Stenosis;76
5.1.1.5;Tricuspid Stenosis;78
5.1.1.5.1;Special Considerations with the Use of Simplified Bernoulli Equation;78
5.1.1.6;Increased Flow Acceleration;78
5.1.1.7;Increased Viscous Friction;78
5.1.1.8;Effect of the Angle;78
5.1.1.9;Increased Proximal Velocity;79
5.1.1.10;Alteration of the Blood Viscosity;79
5.1.1.11;Assessment of Intracardiac Pressures;79
5.1.1.11.1;Left Atrial Pressure;79
5.1.1.11.2;Left Ventricular End-Diastolic Pressures;79
5.1.1.11.3;Right Ventricular Pressure;84
5.1.1.12;Pulmonary Artery Pressures;85
5.1.2;References;86
6;Nihoyannopoulos_Ch05_O.pdf;89
6.1;Chapter 5;89
6.1.1;Tissue Doppler, Doppler Strain, and Non-Doppler Strain: Tips, Limitations, and Applications;89
6.1.1.1;Doppler Tissue Imaging;89
6.1.1.1.1;Principles and Modalities Have Been Published Previously1;89
6.1.1.1.2;Requirements for Image Acquisition when Acquiring Color Tissue Doppler Images;89
6.1.1.1.3;Postprocessing Analysis;90
6.1.1.1.4;Advantages of Tissue Doppler Echocardiography Over Conventional Echocardiography;91
6.1.1.1.5;Applications;91
6.1.1.1.6;Limitations of Tissue Doppler Echocardiography;95
6.1.1.2;Doppler Strain and Strain Rate;97
6.1.1.2.1;Principle and Modalities;97
6.1.1.2.2;Requirements for Image Acquisition;97
6.1.1.2.3;Postprocessing Analysis;97
6.1.1.2.4;Advantages of Doppler Strain and Strain Rate Over Doppler Tissue Velocity;97
6.1.1.2.5;Applications;99
6.1.1.2.6;Limitations of Doppler Strain and Strain Rate;101
6.1.1.3;Non-Doppler Tissue Velocity and Non-Doppler Strain;101
6.1.1.3.1;Principle;101
6.1.1.3.2;Validation;102
6.1.1.3.3;Requirements for Image Acquisition;102
6.1.1.3.4;Postprocessing Analysis;102
6.1.1.3.5;Normal Values;103
6.1.1.3.6;Advantages of STE Over Doppler-Derived Deformation Imaging;105
6.1.1.3.7;Applications;106
6.1.1.3.8;Limitations;106
6.1.1.4;Conclusion;108
6.1.2;References;110
7;Nihoyannopoulos_Ch06_O.pdf;111
7.1;Chapter 6;111
7.1.1;Transesophageal Echocardiography: Principles and Application;111
7.1.1.1;Patient Preparation and Instrumentation;111
7.1.1.1.1;Left Ventricle;112
7.1.1.1.2;Mitral Valve;114
7.1.1.1.3;Aortic Valve;115
7.1.1.1.4;Left Atrium;115
7.1.1.1.5;Right Ventricle;115
7.1.1.1.6;Tricuspid Valve;116
7.1.1.1.7;Right Atrium;116
7.1.1.1.8;Pulmonary Artery;116
7.1.1.1.9;Thoracic Aorta;117
7.1.1.2;Clinical Applications;117
7.1.1.2.1;Infective Endocarditis;117
7.1.1.2.2;Evaluation of Prosthetic Valves;117
7.1.1.2.3;Cardioembolic Strokes;117
7.1.1.2.4;Atrial Fibrillation;118
7.1.1.2.5;Aortic Diseases;118
7.1.1.2.6;Cardiac Masses;119
7.1.1.2.7;Congenital Heart Diseases and Intracardiac Shunts;119
7.1.1.2.8;Critically Ill Patients;119
7.1.1.2.9;Perioperative and TEE During Procedures;120
7.1.1.3;Pitfalls;120
7.1.1.4;Complications;122
7.1.1.5;Conclusions;123
7.1.2;References;123
8;Nihoyannopoulos_Ch07_O.pdf;125
8.1;Chapter 7;126
8.1.1;Aortic Valve Disease;126
8.1.1.1;Introduction;126
8.1.1.2;Etiology;126
8.1.1.2.1;Valvular;126
8.1.1.2.1.1;Calcific Degenerative Aortic Stenosis;126
8.1.1.2.1.2;Bicuspid Aortic Valve;126
8.1.1.2.1.3;Rheumatic;128
8.1.1.2.1.4;Vegetations;128
8.1.1.2.2;Subvalvular Aortic Stenosis;129
8.1.1.2.2.1;Discrete Subaortic Membrane;129
8.1.1.2.2.2;Hypertrophic Cardiomyopathy;129
8.1.1.2.3;Supravalvular Aortic Stenosis;130
8.1.1.2.3.1;Familial Hypercholesterolemia;130
8.1.1.2.3.2;William’s Syndrome;130
8.1.1.3;The Role of Echocardiography;131
8.1.1.3.1;Evaluate the Level of Stenosis and Describe the Anatomy;131
8.1.1.3.2;Evaluate Severity of Stenosis;131
8.1.1.3.2.1;Pressure Gradients;131
8.1.1.3.2.2;Aortic Valve Area;132
8.1.1.3.2.2.1;Advantages of Continuity Equation;133
8.1.1.3.2.2.2;Problems Using the Continuity Equation;133
8.1.1.3.2.3;Outflow-to-Aortic Velocity Index;134
8.1.1.3.2.4;Valve Resistance;134
8.1.1.3.2.4.1;Potential Advantages;134
8.1.1.3.2.4.2;Summary;134
8.1.1.3.3;Aortic Stenosis and Left Ventricular Dysfunction;135
8.1.1.4;Clinical Decision Making;135
8.1.1.5;Conclusions;135
8.1.1.6;B. Aortic Regurgitation;136
8.1.1.7;Introduction;136
8.1.1.8;Etiology of Aortic Regurgitation (Table 7.2);136
8.1.1.8.1;Degenerative Disease;136
8.1.1.8.2;Rheumatic;136
8.1.1.8.3;Congenital;137
8.1.1.8.4;Endocarditis;137
8.1.1.8.5;Connective Tissue Disease;138
8.1.1.8.6;Inflammatory Aortitis;139
8.1.1.8.7;Aortic Dissection;139
8.1.1.8.8;Others;139
8.1.1.9;Methods of Assessing Aortic Regurgitation;139
8.1.1.9.1;Doppler Methods;139
8.1.1.9.1.1;Color-Flow Doppler;139
8.1.1.9.1.1.1;Regurgitant Jet Size;139
8.1.1.9.1.1.2;Flow Convergence or PISA;140
8.1.1.9.1.1.3;Vena Contracta;140
8.1.1.9.1.2;Pulsed and Continuous-Wave Doppler;140
8.1.1.9.1.2.1;Quantitative Flow Methods (See Also Chap. 3);140
8.1.1.9.1.2.2;Aortic Diastolic Flow Reversal;141
8.1.1.9.1.2.3;Signal Density;141
8.1.1.9.1.2.4;Diastolic Jet Deceleration;141
8.1.1.10;Assessment of Ventricular Function;141
8.1.1.11;Acute vs. Chronic Aortic Regurgitation;142
8.1.1.12;Conclusion;143
8.1.2;References;143
9;Nihoyannopoulos_Ch08_O.pdf;144
9.1;Chapter 8;144
9.1.1;Mitral Valve Disease;144
9.1.1.1;Cardiac Anatomic Relationships;144
9.1.1.1.1;Parasternal Long Axis;144
9.1.1.1.2;Parasternal Short Axis;149
9.1.1.1.3;Apical views;151
9.1.1.1.4;The Surgical View;154
9.1.1.2;Functional Mitral Valve Anatomy;157
9.1.1.2.1;Functional Anatomic Segments;157
9.1.1.2.2;Functional Nomenclature in Other Views;157
9.1.1.3;Mitral Valve Spatial Movement and Flow Profiles;161
9.1.1.3.1;Cyclical Mitral Valve Movement;161
9.1.1.3.2;Normal Doppler Mitral Profiles;163
9.1.1.4;Comprehensive Evaluation of Mitral Regurgitation;165
9.1.1.4.1;Calculations of Jet Severity;167
9.1.1.4.2;Mitral Timing Relationships;167
9.1.1.4.3;Relationships of Spectral Doppler;168
9.1.1.5;Use of Color-Flow Doppler Controls;169
9.1.1.5.1;Use of Color Gain;170
9.1.1.5.2;Altered Nyquist (or Scale Factor);174
9.1.1.5.3;Effect of Frame Rate and Persistence;174
9.1.1.5.4;Excess Image Gain;174
9.1.1.5.5;System Setting Variability in Jet Size;176
9.1.1.5.6;Jet Duration;176
9.1.1.5.7;Hints from Spectral Doppler;179
9.1.1.6;Mitral Stenosis;181
9.1.1.6.1;Planimetry of the Mitral Orifice;185
9.1.1.6.2;Mean Mitral Gradient by Doppler;187
9.1.1.6.3;Pressure Half-Time Mitral Valve Area;187
9.1.1.7;Mitral Prolapse;191
9.1.1.7.1;Functional Classification of Mitral Regurgitation;192
9.1.1.7.2;Typical Type II, P2 Leaflet Prolapse;193
9.1.1.7.3;Typical Type II, A2 Leaflet Prolapse;196
9.1.1.7.4;Visualization of Other Mitral Procedures;198
9.1.1.8;Mitral Regurgitation and Congestive Heart Failure;202
9.1.1.9;Mitral Annular Calcification;204
9.1.1.10;Infective Vegetative Endocarditis;207
9.1.1.11;Left Atrial Myxoma;210
9.1.1.12;Congenital Anomalies of the Mitral Valve;216
9.1.2;References;222
10;Nihoyannopoulos_Ch09_O.pdf;223
10.1;Chapter 9;223
10.1.1;Tricuspid and Pulmonic Valve Disease;223
10.1.1.1;Tricuspid Valve;223
10.1.1.1.1;Tricuspid Regurgitation;223
10.1.1.1.1.1;Etiology;223
10.1.1.1.1.1.1;Functional;223
10.1.1.1.1.1.2;Infective Endocarditis;224
10.1.1.1.1.1.3;Ebstein’s Anomaly;225
10.1.1.1.1.1.4;Rheumatic Heart Disease and Carcinoid;225
10.1.1.1.1.1.5;Miscellaneous Etiologies;226
10.1.1.1.1.2;Assessment of TR Severity;226
10.1.1.1.1.2.1;Two-Dimensional Criteria;226
10.1.1.1.1.2.2;Color Doppler;226
10.1.1.1.1.2.3;Continuous-Wave Doppler;228
10.1.1.1.1.2.4;Pulsed Doppler;228
10.1.1.1.2;Tricuspid Stenosis;229
10.1.1.1.2.1;Etiology;229
10.1.1.1.2.1.1;Rheumatic;229
10.1.1.1.2.1.2;Carcinoid;229
10.1.1.1.2.1.3;Eosinophilic;229
10.1.1.1.2.1.4;Metabolic and Others;229
10.1.1.1.2.2;Assessment of Severity;229
10.1.1.2;Pulmonic Valve;231
10.1.1.2.1;Pulmonic Stenosis;231
10.1.1.2.1.1;Assessment of Severity;231
10.1.1.2.2;Pulmonic Regurgitation;232
10.1.1.2.2.1;Assessment of Severity;233
10.1.1.2.2.1.1;Color Doppler;233
10.1.1.2.2.1.2;Continuous-Wave Doppler;233
10.1.1.2.2.1.3;Pulsed Doppler;234
10.1.1.3;Conclusion;235
10.1.2;Bibliography;235
11;Nihoyannopoulos_Ch10_O.pdf;236
11.1;Chapter 10;236
11.1.1;Pulmonary Hypertension Clinical Echocardiography;236
11.1.1.1;Clinical Background;236
11.1.1.1.1;Pathophysiology;236
11.1.1.1.2;Clinical Classification;237
11.1.1.1.3;Prognosis;238
11.1.1.2;Role of Echocardiography in Pulmonary Hypertension;238
11.1.1.2.1;Screening for Pulmonary Hypertension;238
11.1.1.2.1.1;Definition of Pulmonary Hypertension;238
11.1.1.2.1.2;Other Signs to Look for;240
11.1.1.2.1.3;Estimation of Pulmonary Vascular Resistance;240
11.1.1.2.1.4;Management of Mild Pulmonary Hypertension Detected by Echocardiography;242
11.1.1.2.2;Etiology of Pulmonary Hypertension;242
11.1.1.2.2.1;Congenital Heart Disease;242
11.1.1.2.2.2;Left Heart Disease;242
11.1.1.2.2.3;Other Causes;243
11.1.1.2.3;Estimation of Severity of Pulmonary Hypertension;244
11.1.1.2.3.1;Two-Dimensional and M-Mode Echocardiography;244
11.1.1.2.3.1.1;Pericardial Effusion;244
11.1.1.2.3.1.2;Right Atrial Enlargement and Pressure;244
11.1.1.2.3.1.3;Right Ventricular Size and Function;245
11.1.1.2.3.1.4;Interventricular Septal Shift;245
11.1.1.2.3.1.5;Left Ventricular Size and Function;247
11.1.1.2.3.1.6;Patent Foramen Ovale;247
11.1.1.2.3.2;Doppler Assessment;247
11.1.1.2.3.2.1;Tricuspid Regurgitation Velocity and Calculated Systolic Pulmonary Arterial Pressure;247
11.1.1.2.3.2.2;Pulmonary Arterial Mean and Diastolic Pressure;248
11.1.1.2.3.3;Assessment of Right Ventricular Function;250
11.1.1.2.3.3.1;Right Ventricular Doppler Index;250
11.1.1.2.3.3.2;Tricuspid Regurgitation Severity;250
11.1.1.2.3.3.3;Tissue Doppler Imaging of Right Ventricle;251
11.1.1.2.3.4;Assessment of Left Ventricular Function;251
11.1.1.2.3.4.1;Left Ventricular Filling;251
11.1.1.2.3.4.2;Cardiac Index;251
11.1.1.2.4;Serial Echocardiographic Monitoring;251
11.1.1.2.5;Detecting Complications;252
11.1.1.3;Role of Other Imaging Modalities;254
11.1.1.4;Conclusions;256
11.1.2;Bibliography;256
12;Nihoyannopoulos_Ch11_O.pdf;257
12.1;Chapter 11;257
12.1.1;Criteria for Operative Intervention in Valvular Heart Disease Based on Echocardiography;257
12.1.1.1;Aortic Stenosis;257
12.1.1.1.1;Gradients in Aortic Stenosis;258
12.1.1.1.2;Valve Area in Aortic Stenosis;258
12.1.1.1.3;Criteria for Operation for Aortic Stenosis in Asymptomatic Patients;259
12.1.1.2;Aortic Regurgitation;259
12.1.1.2.1;LV Size and Function in Aortic Regurgitation;260
12.1.1.3;Mitral Stenosis;261
12.1.1.4;Mitral Regurgitation;266
12.1.1.5;Summary;269
12.1.2;Bibliography;269
13;Nihoyannopoulos_Ch12_O.pdf;270
13.1;Chapter 12;270
13.1.1;Clinical Echocardiography Prosthetic Valves;270
13.1.1.1;Introduction;270
13.1.1.2;Classification of Valves;270
13.1.1.2.1;Mechanical Valves;270
13.1.1.2.2;Biological Valves;270
13.1.1.2.3;Position and Sizing;272
13.1.1.3;Complications;273
13.1.1.4;Criteria for Use;274
13.1.1.5;Echocardiography;274
13.1.1.5.1;Appearance;275
13.1.1.5.1.1;Does the Valve Rock?;275
13.1.1.5.1.2;Check the Occluder;276
13.1.1.5.2;Forward Flow;276
13.1.1.5.3;Regurgitation;276
13.1.1.6;Detection of Early Failure;278
13.1.1.7;Detection of Obstruction;279
13.1.1.7.1;Mitral Position;279
13.1.1.7.2;Aortic Position;280
13.1.1.7.3;Tricuspid Position;280
13.1.1.7.4;Cause of Obstruction;280
13.1.1.8;Regurgitation;281
13.1.1.8.1;Is It Pathological?;281
13.1.1.8.2;Quantification;281
13.1.1.9;Endocarditis;283
13.1.1.10;Timing of Echocardiography;284
13.1.1.10.1;Preoperative;284
13.1.1.10.1.1;Planning a Ross procedure;284
13.1.1.10.1.2;Planning a Stentless Valve;284
13.1.1.10.1.3;Endocarditis;284
13.1.1.10.1.4;Planning a Homograft;284
13.1.1.10.1.5;Other Valves;284
13.1.1.10.1.6;Right Ventricular Function;285
13.1.1.10.2;Perioperative;285
13.1.1.10.3;Baseline Study;285
13.1.1.10.4;Late After Surgery;285
13.1.1.10.5;When Is TOE Necessary?;285
13.1.1.11;Conclusions;286
13.1.1.12;Glossary;286
13.1.1.13;Appendix: Normal Ranges for Replacement Heart Valves: Mean (Standard Deviation);286
13.1.2;Bibliography;287
14;Nihoyannopoulos_Ch13_O.pdf;288
14.1;Chapter 13;288
14.1.1;The Use of Echocardiography in the Diagnosis and Treatment of Patients with Infective Endocarditis;288
14.1.1.1;Introduction;288
14.1.1.2;Diagnosis of Endocarditis: The Duke Criteria and the Importance of Imaging;288
14.1.1.3;Echocardiographic Evidence of Infective Endocarditis;289
14.1.1.3.1;Vegetation;290
14.1.1.3.2;Periannular Extension of Infection (Myocardial Abscess Formation);292
14.1.1.3.3;Fistula Formation;293
14.1.1.3.4;Perforation;294
14.1.1.3.5;New Valvular Regurgitation;294
14.1.1.3.6;Dehiscence of Prosthetic Valve;295
14.1.1.4;The Use and OverUse of Echocardiography to Make the Diagnosis of IE;295
14.1.1.4.1;Use of Echocardiography in Patients Suspected of IE;295
14.1.1.4.2;Overuse of Echocardiography;295
14.1.1.4.3;TTE vs. TEE;296
14.1.1.4.4;Cost Effectiveness of Diagnostic Imaging Strategies;296
14.1.1.5;Echocardiography to Predict Complications and Guide Therapeutic Decision Making;296
14.1.1.6;Special Considerations in Patients with IE;297
14.1.1.6.1;Prosthetic Valve IE;297
14.1.1.6.2;Right-Sided IE;297
14.1.1.6.3;Intracardiac-Device-Related Infections;298
14.1.1.6.4;Consideration for Multiple Echocardiographic Evaluations;298
14.1.1.7;Other Imaging Modalities in IE;298
14.1.1.8;Conclusions;299
14.1.2;References;299
15;Nihoyannopoulos_Ch14_O.pdf;300
15.1;Chapter 14;301
15.1.1;Pericardial Effusion, Tamponade, and Constriction;301
15.1.1.1;Anatomy, Function, and Physiology of the Pericardium;301
15.1.1.2;Diseases of the Pericardium;301
15.1.1.2.1;Congenital Absence of the Pericardium;301
15.1.1.2.2;Pericardial Cyst;301
15.1.1.2.3;Pericardial Tumors;301
15.1.1.2.4;Pericardial Effusion and Tamponade;302
15.1.1.2.4.1;Etiologies;302
15.1.1.2.4.2;Clinical Features;302
15.1.1.2.4.3;Echocardiographic Features;303
15.1.1.2.4.4;Echo-Guided Pericardiocentesis;305
15.1.1.2.4.5;Differentiating Pericardial Effusion from Pleural Effusion;307
15.1.1.2.5;Pericardial Constriction;307
15.1.1.2.5.1;Pathophysiology and Etiologies;307
15.1.1.2.5.2;Clinical Features;308
15.1.1.2.5.3;Echocardiographic Findings;308
15.1.1.2.5.4;Differentiating Constriction from Restriction;311
15.1.1.2.5.5;Differentiating Constriction from Chronic Obstructive Lung Disease;311
15.1.1.2.5.6;Diagnosing Constriction in Atrial Fibrillation;312
15.1.1.2.6;Effusive-Constrictive Disease;312
15.1.1.2.7;Role of CT and MR Imaging in Pericardial Disease;312
15.1.1.2.8;Conclusion and Practical Tips;313
15.1.2;Bibliography;314
16;Nihoyannopoulos_Ch15_O.pdf;315
16.1;Chapter 15;316
16.1.1;Clinical Echocardiography;316
16.1.1.1;Introduction;316
16.1.1.2;Regional Wall Motion Abnormality: How Does It Occur? The Mechanism for RWMA;316
16.1.1.2.1;Wall Motion vs. Systolic Wall Thickening for the Assessment of CAD;317
16.1.1.3;Basic Anatomy and Echocardiographic Findings;317
16.1.1.4;Assessment of Regional Wall Motion;320
16.1.1.5;Acute Myocardial Infarction;321
16.1.1.5.1;Echocardiographic Assessment in AMI;322
16.1.1.6;Acute Coronary Syndromes;324
16.1.1.6.1;Echocardiography in Acute Coronary Syndromes;324
16.1.1.7;Improving Endocardial Definition;324
16.1.1.7.1;Harmonic Imaging;324
16.1.1.7.2;Left Ventricular Opacification Using Contrast Agents;325
16.1.1.7.3;Automated Endocardial Border Tracking;325
16.1.2;References;327
17;Nihoyannopoulos_Ch16_O.pdf;328
17.1;Chapter 16;328
17.1.1;Stress Echocardiography;328
17.1.1.1;Pathophysiology;328
17.1.1.2;Stress Testing;328
17.1.1.2.1;Selection of Stress Method;328
17.1.1.2.1.1;Which Stressor?;329
17.1.1.3;Acquisition;331
17.1.1.3.1;Equipment;331
17.1.1.3.1.1;Harmonic Imaging;331
17.1.1.3.1.2;Contrast Imaging;331
17.1.1.3.2;Image Acquisition;331
17.1.1.3.2.1;Digital Image Acquisition;331
17.1.1.3.2.2;The “Roadmap” for Good Acquisition;332
17.1.1.4;Interpretation;333
17.1.1.4.1;Semiquantitative Interpretation;333
17.1.1.4.2;Structured Review;334
17.1.1.4.3;Resting Function;334
17.1.1.4.4;Defining an Ischemic Response;335
17.1.1.4.5;The Magnitude of Ischemia;337
17.1.1.4.6;Rules for Qualitative Interpretation;337
17.1.1.4.7;Pitfalls in the Standard Performance of Stress Echocardiography;337
17.1.1.4.8;Quantitative Interpretation;339
17.1.1.5;Accuracy;344
17.1.1.5.1;Clinical Factors Influencing Accuracy;344
17.1.1.5.2;Accuracy of Stress Echocardiography;344
17.1.1.5.3;Exercise Versus Pharmacologic Stress;345
17.1.1.5.4;Selection of the Optimal Pharmacologic Stress;345
17.1.1.6;Comparison with Other Approaches;345
17.1.1.6.1;Comparison with the Exercise ECG;345
17.1.1.6.2;Difficult Subgroups for Standard Exercise Testing (LBBB, LVH, Women);346
17.1.1.6.3;Clinical Implications of Superiority of Exercise Echo Versus Exercise ECG;346
17.1.1.6.4;Comparison with Other Stress-Imaging Approaches;346
17.1.1.6.5;Accuracy of Stress Echocardiography Versus Perfusion Scintigraphy;347
17.1.1.6.6;When to Choose Stress Echocardiography Versus Scintigraphy (and Vice Versa);347
17.1.1.6.7;Stress Echocardiography Versus Magnetic Resonance Imaging;348
17.1.1.7;Echocardiographic Determination of Myocardial Viability;348
17.1.1.7.1;Use of Echocardiographic Techniques to Predict Functional Recovery;348
17.1.1.7.2;Comparison with Other Approaches for the Detection of Myocardial Viability;348
17.1.1.8;Prognostic Value of Stress Echocardiography;349
17.1.1.8.1;Significance of a Negative Stress Echocardiogram;350
17.1.1.8.2;Significance of a Positive Stress Echocardiogram;350
17.1.1.8.3;Prognostic Assessment After Myocardial Infarction;350
17.1.1.8.4;Prediction of Perioperative Cardiac Risk in Patients Undergoing Major Noncardiac Surgery;351
17.1.1.9;Use of Stress Echocardiography in Noncoronary Heart Disease;352
17.1.1.9.1;Stress Echo in Valvular Heart Disease;352
17.1.1.10;Conclusions;352
17.1.2;References;352
18;Nihoyannopoulos_Ch17_O.pdf;354
18.1;Chapter 17;354
18.1.1;Principles of Myocardial Viability Implications for Echocardiography;354
18.1.1.1;Introduction;354
18.1.1.2;Historical Perspective;354
18.1.1.3;Pathophysiology;355
18.1.1.3.1;Observations in Humans with Chronic Reversible Ischemic Dysfunction;355
18.1.1.3.2;Insights Gained from Animal Models of Chronic Reversible Ischemic Dysfunction;359
18.1.1.3.3;The Physiological Spectrum of Myocardial Viability;359
18.1.1.4;Implications for the Clinical Identification of Viable Myocardium;361
18.1.1.4.1;Basic Principles for the Identification of Viable Myocardium (Table 17.2);361
18.1.1.4.2;The Working Hypothesis;362
18.1.1.5;Role of Echocardiography;363
18.1.1.5.1;How Echo Is Useful;363
18.1.1.5.1.1;Echocardiography at Rest;364
18.1.1.5.1.2;Myocardial Contrast Echocardiography;365
18.1.1.5.1.3;Stress Echocardiography;366
18.1.1.6;Conclusions;367
18.1.2;Bibliography;368
19;Nihoyannopoulos_Ch18_O.pdf;369
19.1;Chapter 18;369
19.1.1;Echocardiography for Assessing Acute Myocardial Infarction;369
19.1.1.1;Introduction;369
19.1.1.2;Acute Chest Pain;369
19.1.1.3;Workup in Acute Chest Pain Syndromes;370
19.1.1.4;Diagnosis of MI;371
19.1.1.5;Extent of MI;371
19.1.1.6;Stress Echocardiography in the Emergency Room;373
19.1.1.7;Prognosis After MI;374
19.1.1.8;Regional Left Ventricular Function;374
19.1.1.9;Compensatory Hyperkinesia and Remote Asynergy (Remodeling);376
19.1.1.10;Quantitating Left Ventricular Function;377
19.1.1.11;Ischemic Mitral Regurgitation;379
19.1.1.11.1;Mechanisms;379
19.1.1.12;Left Ventricular Diastolic Function;380
19.1.1.13;Left Ventricular Spatial Flow Pattern;381
19.1.1.14;Left Ventricular Thrombi;382
19.1.1.15;Myocardial Viability;382
19.1.1.16;Residual Myocardial Ischemia;382
19.1.1.17;Future Developments;384
19.1.1.18;Clinical Recommendations and Implications;384
19.1.2;Bibliography;385
20;Nihoyannopoulos_Ch19_O.pdf;386
20.1;Chapter 19;386
20.1.1;Mechanical Complications of Myocardial Infarction;386
20.1.1.1;Rupture of LV Free Wall;386
20.1.1.1.1;Echocardiographic Findings;387
20.1.1.1.2;Transesophageal Echocardiography and AMI Complications;388
20.1.1.2;LV Pseudoaneurysm;389
20.1.1.2.1;Echocardiographic Findings;389
20.1.1.3;Ventricular Septal Rupture;390
20.1.1.3.1;Echocardiographic Findings;391
20.1.1.4;Papillary Muscle Rupture;394
20.1.1.4.1;Echocardiographic Findings;394
20.1.1.5;Left Ventricular Aneurysm and Thrombus Formation;395
20.1.1.6;Summary;397
20.1.2;Bibliography;397
21;Nihoyannopoulos_Ch20_O.pdf;399
21.1;Chapter 20;399
21.1.1;Cardiomyopathies;399
21.1.1.1;Introduction;399
21.1.1.2;Hypertrophic Cardiomyopathy;399
21.1.1.2.1;Definitions;399
21.1.1.2.2;Pathology;399
21.1.1.2.3;Pathophysiology;399
21.1.1.2.4;Diagnosis;401
21.1.1.2.5;The Role of Echocardiography;401
21.1.1.2.5.1;Patterns of LV Hypertrophy;404
21.1.1.2.5.2;Diagnostic Difficulties;406
21.1.1.2.5.3;The Mitral Apparatus;410
21.1.1.2.5.4;The Aortic Valve;410
21.1.1.2.6;Doppler Echocardiography;410
21.1.1.2.6.1;Diastolic Events;411
21.1.1.2.6.2;Systolic Events;412
21.1.1.2.7;The Role of Tissue Doppler Imaging;415
21.1.1.2.8;Predictors of Prognosis;418
21.1.1.3;Dilated Cardiomyopathy;419
21.1.1.3.1;Idiopathic (Primary) Dilated Cardiomyopathy;419
21.1.1.3.1.1;The Role of Echocardiography;420
21.1.1.3.1.2;Doppler Echocardiography;421
21.1.1.3.1.2.1;Mitral Regurgitation;421
21.1.1.3.1.2.2;Estimate of LV Pressures;421
21.1.1.3.1.2.3;Intracardiac Flow and Risk o.f Embolization;422
21.1.1.3.1.3;Tissue Doppler Imaging;422
21.1.1.3.1.4;Family Screening;423
21.1.1.3.2;Myocarditis;423
21.1.1.3.3;Cardiac Toxins;423
21.1.1.3.4;Cardiomyopathy Associated with Pregnancy and Parturition;424
21.1.1.3.5;Isolated Left Ventricular Noncompaction;425
21.1.1.4;Restrictive Cardiomyopathy;426
21.1.1.4.1;Types of Restrictive Cardiomyopathies;426
21.1.1.4.2;Cardiac Amyloidosis;426
21.1.1.4.3;Eosinophilic Endomyocardial Disease;427
21.1.1.4.4;Idiopathic (Primary) Restrictive Cardiomyopathy;430
21.1.1.4.5;Restrictive Physiology;430
21.1.1.4.6;Distinction Between Restrictive Cardiomyopathy and Constrictive Pericarditis;430
21.1.1.5;Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy;431
21.1.1.5.1;Definitions and Pathophysiology;431
21.1.1.5.2;Criteria for Diagnosis of ARVD/C;432
21.1.1.5.3;Echocardiographic Characteristics;432
21.1.1.6;Conclusions;434
21.1.2;References;434
22;Nihoyannopoulos_Ch21_O.pdf;435
22.1;Chapter 21;435
22.1.1;Echocardiography in Heart Failure;435
22.1.1.1;Clinical Staging and Etiology of Heart Failure: Role of Echocardiography;435
22.1.1.2;Quantification of Systolic Dysfunction;438
22.1.1.3;Quantification of Diastolic Dysfunction;439
22.1.1.4;Indices for Assessing Diastolic Dysfunction;439
22.1.1.4.1;Mitral Inflow Velocities;439
22.1.1.4.2;Pulmonary Venous Doppler Velocities;440
22.1.1.4.3;Mitral Annular Velocities;441
22.1.1.4.4;Flow Propagation;441
22.1.1.4.5;Other Doppler Variables in Hemodynamic Assessment;441
22.1.1.5;Diastolic Function Assessment and Risk Stratification;441
22.1.1.6;Echocardiography for Guiding Management Strategies in Heart Failure;442
22.1.1.6.1;Therapeutic and Surgical Interventions;442
22.1.1.6.2;Echocardiography in Critical Care Units;442
22.1.1.6.3;Role of Echocardiography in Cardiac Resynchronization;442
22.1.1.7;Echocardiography and Heart Failure Screening;443
22.1.1.8;Summary and Future Directions;444
22.1.2;References;445
23;Nihoyannopoulos_Ch22_O.pdf;446
23.1;Chapter 22;446
23.1.1;Cardiac Resynchronization Therapy;446
23.1.1.1;Introduction;446
23.1.1.2;What Is Cardiac Dyssynchrony?;446
23.1.1.3;Types of Mechanical Dyssynchrony;447
23.1.1.3.1;AtrioVentricular Dyssynchrony;447
23.1.1.3.2;Interventricular Dyssynchrony;448
23.1.1.3.3;Intraventricular Dyssynchrony;449
23.1.1.4;How to Assess Intraventricular Dyssynchrony: Prediction of Responders;449
23.1.1.4.1;Echocardiographic Assessment and Quantification of Dyssynchrony;449
23.1.1.4.1.1;M-Mode Echocardiography;449
23.1.1.4.1.1.1;Summary;449
23.1.1.4.1.2;Two-Dimensional Echocardiography;449
23.1.1.4.1.3;Real-Time 3D Echocardiography in the Assessment of Mechanical Dyssynchrony;450
23.1.1.4.1.3.1;Evaluation of Global and Regional Volumes and Function;451
23.1.1.4.1.3.2;RT3DE and Intraventricular Dyssynchrony Assessment;451
23.1.1.4.1.3.3;Dyssynchrony Index;452
23.1.1.4.1.3.4;Summary;453
23.1.1.4.1.4;Tissue Velocity Imaging and Deformation Parameters;453
23.1.1.4.1.4.1;Summary;453
23.1.1.4.1.4.2;Summary;455
23.1.1.4.1.4.3;Summary;457
23.1.1.4.1.4.4;Summary;458
23.1.1.5;Determining Optimal Lead Placement During Implantation;458
23.1.1.6;AtrioVentricular (AV) Optimization;458
23.1.1.7;Evaluating the Reverse Remodeling of the Heart During Follow-Up;458
23.1.1.7.1;Reversal of LV Dilatation (Reversed Remodeling);459
23.1.1.7.2;Improved Diastolic Function;459
23.1.1.7.3;Effect of CRT on Mitral Regurgitation;459
23.1.1.8;Conclusions;459
23.1.2;References;459
24;Nihoyannopoulos_Ch23_O.pdf;461
24.1;Chapter 23;462
24.1.1;Intracardiac Masses;462
24.1.1.1;Left Ventricular Thrombi;462
24.1.1.2;Myxomas;465
24.1.1.3;Other Benign Tumors;466
24.1.1.4;Malignant Tumors;467
24.1.1.5;Scanning Techniques;467
24.1.1.6;Limitations;467
24.1.2;References;467
25;Nihoyannopoulos_Ch24_O.pdf;469
25.1;Chapter 24;469
25.1.1;Aortic Disorders;469
25.1.1.1;Aortic Imaging;469
25.1.1.1.1;Introduction;469
25.1.1.1.2;Transthoracic Imaging;469
25.1.1.1.3;Transesophageal Imaging;469
25.1.1.2;Aortic Aneurysm;471
25.1.1.2.1;Definition;471
25.1.1.2.2;Etiologies;471
25.1.1.2.2.1;Pseudoaneurysms;471
25.1.1.2.2.2;Aortic Rupture;471
25.1.1.2.3;Imaging;472
25.1.1.3;Aortic Dissection;472
25.1.1.3.1;Imaging;472
25.1.1.3.2;Pathophysiology;472
25.1.1.3.3;Etiologies;473
25.1.1.3.4;Classification;473
25.1.1.3.5;Clinical Presentation;474
25.1.1.3.6;Echocardiographic Findings;474
25.1.1.3.6.1;The Intimal Flap;474
25.1.1.3.6.2;False Lumen;474
25.1.1.3.6.3;Coronary Arteries;474
25.1.1.3.6.4;Aortic Regurgitation;475
25.1.1.3.6.5;Pericardial Effusion;475
25.1.1.3.6.6;Surgery;475
25.1.1.4;Intramural Hematoma;475
25.1.1.4.1;Imaging;476
25.1.1.4.2;Clinical Significance;478
25.1.1.5;Penetrating Aortic Ulcers;478
25.1.1.5.1;Pathophysiology;478
25.1.1.5.2;Clinical Significance;479
25.1.1.5.3;Imaging;479
25.1.1.6;Aortic Trauma;479
25.1.1.6.1;Pathophysiology;479
25.1.1.6.2;Imaging;480
25.1.1.7;Aortic Atheromatous Disease;480
25.1.1.7.1;Pathophysiology;480
25.1.1.7.2;Classification;481
25.1.1.7.3;Clinical Significance;481
25.1.1.7.4;Imaging;482
25.1.2;References;482
26;Nihoyannopoulos_Ch25_O.pdf;484
26.1;Chapter 25;484
26.1.1;Source of Embolus;484
26.1.1.1;Introduction;484
26.1.1.1.1;Epidemiology;484
26.1.1.1.2;Potential Cardiovascular Sources of Embolus;484
26.1.1.1.3;When to Use Echocardiography to Investigate for a Potential Cardiac Source of Embolus;485
26.1.1.1.4;Transthoracic vs. Transesophageal Echocardiography;486
26.1.1.2;Left Atrium;487
26.1.1.2.1;Anatomy;487
26.1.1.2.2;Left Atrial Appendage Doppler;490
26.1.1.2.3;Echocardiographic Assessment of the Left Atrium (Figs. 25.2–25.8);490
26.1.1.3;Left Atrial Thrombus (Figs. 25.4, 25.5, 25.8);492
26.1.1.3.1;Factors Associated with Left Atrial Thromboembolism in Atrial Fibrillation;492
26.1.1.4;Left Atrial Spontaneous Echo Contrast;493
26.1.1.4.1;Spontaneous Echo Contrast and Thromboembolism;494
26.1.1.5;Left Atrial Tumors;494
26.1.1.5.1;Left Atrial Myxoma;494
26.1.1.6;Left Ventricular Thrombus;495
26.1.1.6.1;Echocardiographic Identification;495
26.1.1.6.2;Risk of Embolization;495
26.1.1.7;Valvular Vegetations;496
26.1.1.7.1;Echocardiographic Features;496
26.1.1.7.2;Factors Associated with Vegetation Embolism;497
26.1.1.8;Prosthetic Valves;497
26.1.1.9;Fibrinous Strands/Lambl’s Excrescences;497
26.1.1.10;Papillary Fibroelastoma;498
26.1.1.11;Mitral Stenosis;498
26.1.1.12;Mitral Annular Calcification;499
26.1.1.13;Mitral Valve Prolapse;499
26.1.1.14;Patent Foramen Ovale and Atrial Septal Aneurysm;499
26.1.1.14.1;Anatomy;499
26.1.1.14.2;Echocardiography;500
26.1.1.14.3;Potential Mechanisms of Stroke;501
26.1.1.14.4;Association of PFO with Embolic Events;501
26.1.1.14.5;Factors Associated with Increased Risk;502
26.1.1.14.6;Treatment;502
26.1.1.15;Thoracic Aortic Atheroma;503
26.1.1.15.1;Echocardiographic Assessment;503
26.1.1.15.2;Association of Thoracic Aortic Atheroma and Stroke;504
26.1.1.15.3;Emboli During Aortic Manipulation;504
26.1.1.15.4;Management of Patients with Aortic Atheroma;505
26.1.1.16;Overall Approach to Evaluation;505
26.1.1.16.1;Impact of Echocardiography on Patient Management;505
26.1.2;Bibliography;505
27;Nihoyannopoulos_Ch26_O.pdf;506
27.1;Chapter 26;507
27.1.1;Simple Congenital Heart Defects;507
27.1.1.1;Introduction;507
27.1.1.2;Segmental Approach to Cardiac Anatomy;507
27.1.1.3;Shunts and Septal Defects;507
27.1.1.3.1;Atrial Septal Defect;507
27.1.1.3.1.1;Anatomy and Physiology;507
27.1.1.3.1.2;Echocardiographic Evaluation;508
27.1.1.3.1.3;Cautions;509
27.1.1.3.2;Atrioventricular Septal Defect;509
27.1.1.3.2.1;Anatomy and Physiology;509
27.1.1.3.2.2;Echocardiographic Evaluation;511
27.1.1.3.2.3;Cautions;511
27.1.1.3.3;Ventricular Septal Defect;511
27.1.1.3.3.1;Anatomy and Physiology;511
27.1.1.3.3.2;Echocardiographic Evaluation;512
27.1.1.3.3.3;Cautions;512
27.1.1.3.4;Patent Ductus Arteriosus;513
27.1.1.3.4.1;Anatomy and Physiology;513
27.1.1.3.4.2;Echocardiographic Examination;513
27.1.1.3.4.3;Cautions;514
27.1.1.4;Valvular Abnormalities;514
27.1.1.4.1;Pulmonary Stenosis;514
27.1.1.4.1.1;Anatomy and Physiology;514
27.1.1.4.1.2;Echocardiographic Evaluation;514
27.1.1.4.1.3;Cautions;514
27.1.1.4.2;Aortic Stenosis;515
27.1.1.4.2.1;Anatomy and Physiology;515
27.1.1.4.2.2;Echocardiographic Evaluation;515
27.1.1.4.2.3;Cautions;516
27.1.1.4.3;Coarctation of the Aorta;516
27.1.1.4.3.1;Anatomy and Physiology;516
27.1.1.4.3.2;Echocardiographic Evaluation;516
27.1.1.4.3.3;Cautions;517
27.1.1.4.4;Ebstein Anomaly of the Tricuspid Valve;517
27.1.1.4.4.1;Anatomy and Physiology;517
27.1.1.4.4.2;Echocardiographic Evaluation;517
27.1.1.4.4.3;Cautions;518
27.1.2;References;518
28;Nihoyannopoulos_Ch27_O.pdf;519
28.1;Chapter 27;519
28.1.1;Echocardiographic Evaluation of Complex Congenital Heart Disease;519
28.1.1.1;Introduction;519
28.1.1.2;Tetralogy of Fallot;519
28.1.1.2.1;Pathology;519
28.1.1.2.2;Preoperative Evaluation;519
28.1.1.2.3;Surgical Repair;520
28.1.1.2.4;Postoperative Evaluation;520
28.1.1.3;Tetralogy of Fallot with Pulmonary Atresia;521
28.1.1.3.1;Pathology;521
28.1.1.3.2;Preoperative Evaluation;521
28.1.1.3.3;Surgical Repair;521
28.1.1.3.4;Postoperative Evaluation;521
28.1.1.4;Truncus Arteriosus;521
28.1.1.4.1;Pathology;521
28.1.1.4.2;Preoperative Evaluation;521
28.1.1.4.3;Surgical Repair;522
28.1.1.4.4;Postoperative Evaluation;522
28.1.1.5;Common Atrioventricular Canal Defect;522
28.1.1.5.1;Pathology;522
28.1.1.5.2;Preoperative Evaluation;522
28.1.1.5.3;Surgical Repair;523
28.1.1.5.4;Postoperative Evaluation;523
28.1.1.6;d-Loop Transposition of the Great Arteries;523
28.1.1.6.1;Pathology;523
28.1.1.6.2;Preoperative Evaluation;524
28.1.1.6.3;Surgical Repair;525
28.1.1.6.4;Postoperative Evaluation;525
28.1.1.7;Hypoplastic Left Heart Syndrome;526
28.1.1.7.1;Pathology;526
28.1.1.7.2;Preoperative Evaluation;526
28.1.1.7.3;Surgical Repair;526
28.1.1.7.4;Postoperative Evaluation;527
28.1.1.8;Shone Syndrome;527
28.1.1.9;Pulmonary Atresia with Intact Ventricular Septum;529
28.1.1.9.1;Pathology;529
28.1.1.9.2;Preoperative Evaluation;529
28.1.1.9.3;Surgical Repair;529
28.1.1.9.4;Postoperative Evaluation;530
28.1.1.10;Tricuspid Atresia;530
28.1.1.10.1;Pathology;530
28.1.1.10.2;Preoperative Evaluation;530
28.1.1.10.3;Surgical Repair;530
28.1.1.10.4;Postoperative Evaluation;531
28.1.1.11;Double Outlet Right Ventricle;531
28.1.1.11.1;Pathology;531
28.1.1.11.2;Surgical Repair;531
28.1.1.11.3;Preoperative Evaluation;532
28.1.1.11.4;Postoperative Evaluation;533
28.1.1.12;Summary;533
28.1.2;References;533
29;Nihoyannopoulos_Ch28_O.pdf;534
29.1;Chapter 28;534
29.1.1;Adult Congenital Heart Disease;534
29.1.1.1;General Principles;534
29.1.1.1.1;Sequential Segmental Analysis and Normal Anatomy;534
29.1.1.1.2;Transesophageal Echocardiography;535
29.1.1.1.3;Contrast Echocardiography;535
29.1.1.2;Atriums and Great Veins;536
29.1.1.2.1;Anomalous Venous Drainage;536
29.1.1.2.2;Cor Triatriatum;536
29.1.1.2.3;Atrial Septal Defects;537
29.1.1.2.4;Patent Foramen Ovale;541
29.1.1.2.5;Partial Atrioventricular Septal Defect (Ostium Primum ASD);541
29.1.1.2.6;Complete Atrioventricular Septal Defect;542
29.1.1.3;Atrioventricular Valves;543
29.1.1.3.1;Mitral Valve;543
29.1.1.3.2;Tricuspid Valve;543
29.1.1.3.2.1;Tricuspid Regurgitation;543
29.1.1.4;Atrioventricular Connections;544
29.1.1.4.1;Discordant Atrioventricular Connections;544
29.1.1.4.2;Tricuspid Atresia, Mitral Atresia, Double Inlet Left Ventricle;544
29.1.1.4.3;Palliated “Single-Pump” Disease;545
29.1.1.4.3.1;Pulmonary Artery Banding;545
29.1.1.4.3.2;Shunts and the Fontan Circulation;545
29.1.1.5;Ventricles;546
29.1.1.5.1;Ventricular Septal Defect;546
29.1.1.5.2;Left ventricular Outflow Obstruction;547
29.1.1.5.3;Right Ventricular Outflow Obstruction;548
29.1.1.5.4;Tetralogy of Fallot and Pulmonary Atresia with Ventricular Septal Defect;549
29.1.1.5.5;Aortic Root Enlargement and Aortic Regurgitation;551
29.1.1.5.6;Pulmonary Atresia with Multifocal Aortopulmonary Collaterals;551
29.1.1.6;Ventriculoarterial Connections;551
29.1.1.6.1;Transposition of the Great Arteries;551
29.1.1.6.2;Congenitally Corrected Transposition of the Great Arteries;553
29.1.1.7;The Great Arteries;553
29.1.1.7.1;Patent Ductus Arteriosus;553
29.1.1.8;Coronary Arteries;555
29.1.1.8.1;Coarctation of the Aorta;556
29.1.1.8.2;Common Arterial Trunk;557
29.1.1.8.3;Double Outlet Right Ventricle;557
29.1.1.8.4;Endocarditis;557
29.1.1.8.5;Pregnancy;558
29.1.2;Bibliography;558
30;Nihoyannopoulos_Ch29_O.pdf;559
30.1;Chapter 29;560
30.1.1;Intraoperative Echocardiography;560
30.1.1.1;Epicardial vs. Transesophageal Echocardiography;560
30.1.1.2;Essentials of the IOE Exam;560
30.1.1.3;Prepump IOE;560
30.1.1.4;Postpump IOE;561
30.1.1.5;Process and Completeness of the IOE Study;562
30.1.1.6;Indications for Intraoperative Echo;562
30.1.1.7;IOE in Mitral Valve Repair;562
30.1.1.8;IOE in Left Ventricular Outflow Tract Surgery;564
30.1.1.9;IOE in Coronary Atherosclerosis;566
30.1.1.10;IOE in Other Cardiac Conditions;567
30.1.1.11;Complications of Heart Surgery Definable by IOE;567
30.1.1.12;Pitfalls of IOE;568
30.1.1.13;Summary;568
30.1.2;Bibliography;569
31;Nihoyannopoulos_Ch30_O.pdf;571
31.1;Chapter 30;571
31.1.1;Contrast Echocardiography;571
31.1.1.1;Introduction;571
31.1.1.2;Basic Principles;571
31.1.1.2.1;Types of Contrast Agent;571
31.1.1.2.2;Contrast Microbubble Response to Ultrasound;571
31.1.1.2.3;Destructive Imaging Techniques;573
31.1.1.2.4;Nondestructive Imaging Techniques;574
31.1.1.3;Enhancement of Doppler Signals;576
31.1.1.4;Contrast Administration: Bolus or Infusion?;577
31.1.1.5;Left Ventricular Opacification;577
31.1.1.5.1;LV Thrombus and Masses;578
31.1.1.5.2;Global and Regional LV Function;579
31.1.1.5.3;Stress Echocardiography;581
31.1.1.6;Myocardial Perfusion;583
31.1.1.6.1;Stress Myocardial Perfusion;583
31.1.1.6.2;Acute Coronary Syndromes;588
31.1.1.6.3;Myocardial Viability Studies;589
31.1.1.7;Future of Contrast Echo;590
31.1.1.7.1;Drug Delivery;590
31.1.1.7.2;3D Contrast Studies;590
31.1.1.8;Conclusion;591
32;Nihoyannopoulos_Ch31_O.pdf;592
32.1;Chapter 31;592
32.1.1;Three-Dimensional Echocardiography;592
32.1.1.1;Three-Dimensional Imaging Techniques (Table 31.1);592
32.1.1.2;Clinical Uses (Table 31.3);595
32.1.1.3;Conclusion;604
32.1.1.4;Keypoints;605
32.1.2;References;605
33;Nihoyannopoulos_Ch32_O.pdf;608
33.1;Chapter 32;608
33.1.1;Ultrasound Stethoscopy;608
33.1.1.1;Introduction;608
33.1.1.2;A Historical Perspective;608
33.1.1.3;The Equipment;608
33.1.1.4;Clinical Uses;611
33.1.1.4.1;More Reliable Examination;611
33.1.1.4.2;Point of Care for Faster Decisions;612
33.1.1.4.3;Critical Care Environment;614
33.1.1.5;Screening;618
33.1.1.5.1;Abdominal Aortic Aneurysm Screening;618
33.1.1.5.2;LV Dysfunction Screening;618
33.1.1.5.3;Mitral Valve Prolapse Screening;618
33.1.1.5.4;Screening of Athletes;619
33.1.1.5.5;Screening for LV Hypertrophy;620
33.1.1.6;Cost Effectiveness;621
33.1.1.7;Training Requirements Using Ultrasound Stethoscopy;622
33.1.1.8;Future Directions;622
33.1.1.9;Conclusion;622
33.1.2;References;624
34;Nihoyannopoulos_Ch33_O.pdf;626
34.1;Chapter 33;626
34.1.1;Echo-Guided Interventions;626
34.1.1.1;Introduction;626
34.1.1.2;ACC/AHA/ASE Guidelines for the Clinical Application of Echocardiography;626
34.1.1.3;Echocardiographic Modalities Used to Guide Interventional Procedures;627
34.1.1.4;TTE-Guided Pericardiocentesis;627
34.1.1.5;Transseptal Catheterization;628
34.1.1.6;Percutaneous Balloon Valvuloplasty;628
34.1.1.7;Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy;631
34.1.1.8;Transesophageal Echocardiography in ASD and PFO Closure;633
34.1.1.9;TEE in Complex MV Procedures;633
34.1.1.10;Intracardiac Echocardiography;634
34.1.1.11;Percutaneous Transcatheter Aortic Valve Replacement;639
34.1.1.12;Real-Time 3D Echocardiography;639
34.1.1.13;Interventional Echocardiographic Collaboration;639
34.1.2;References;640
35;Nihoyannopoulos_Index_O.pdf;643