Spectrum Of Adult

A simplified summary of the major types of the major adult CHD are listed in Table 5. Mitral valve prolapse, BAVs (and congenital forms of aortic stenosis), patent foramen ovale, atrial septal defects, and Marfan syndrome have been discussed previously, and are not covered in this chapter. Ventricular septal defects (VSDs) are the commonest congenital heart defect in children. Fig. 6. Subcostal and apical views (apex down orientation) for segmental analysis. The standard echocardiography...

Justina C Wu MD PhD

Case Vignette 1, Elderly Patient Case Vignette 2, Younger Patient Suggested Work-Up for Source of Embolus Suggested Reading A 75-yr-old female with a history of hyperlipi-demia, smoking, and hypertension awoke with acute right arm and leg numbness and right facial weakness that lasted for 30 h before she presented to the emergency room. She had no history of chest pain, shortness of breath, or other symptoms. She was evaluated by the neurology service, who felt she had suffered an embolic...

Echocardiography Introduction

The presentation of J.R. is typical of patients with their first episode of AF. AF is the most common sustained arrhythmia and is characterized by a loss of organized atrial electrical and mechanical activity. The associated loss of the atrial systolic contribution to left ventricular filling leads to reduced ventricular filling and depressed cardiac output with resultant symptoms of dyspnea and fatigue. In addition, atrial stasis predisposes to the formation of atrial thrombi, most commonly in...

Foreword

Echocardiography occupies a pivotal position in contemporary cardiovascular medicine. The results of the echocardiographic examination have almost assumed a position alongside the vital signs and the electrocardiogram in the evaluation of the patient with or suspected of having cardiovascular disease. The ubiquity and utility of this examination have even given rise, among some medical trainees, to a mentality that seeks the results of the echocardiographic evaluation before seeing the patient...

Info

Ultrasound Principles

Resolution of tissue interfaces, in particular, the endocardial border. Harmonic imaging is an option on many modern ultrasound machines (Fig. 5 please see companion DVD for corresponding video). However, image quality is not always improved by harmonic imaging, and in some patients, fundamental imaging provides better overall image quality. Echocardiography is dependent on the operator applying the transducer to the chest of the patient and obtaining images in real-time. The quality of the...

Bernard E Bulwer MD MSc and Scott D Solomon MD

Dilated Cardiomyopathy Case Presentation Restrictive and Infiltrative Cardiomyopathy Case Presentation Hypertrophic Cardiomyopathy Case Presentation Hypertensive Cardiomyopathy Case Presentation Cardiomyopathies are a varied group of heart diseases that are characterized by abnormalities of the heart muscle. Although these generally exclude those secondary to coronary artery disease, hypertension, congenital, valvular, or pericardial pathology, this definition has loosened, and terms such as...

Hr

Annotated parasternal short-axis view mitral valve level (PSAX). Fig. 28. Annotated parasternal short-axis view mitral valve level (PSAX). Fig. 29. Parasternal short axis (PSAX) view midventricle papillary muscle level. (See companion DVD.) Mid-ventricular or papillary muscle level

Case Vignette 2 Continued

Echocardiography Images

A neck MRI magnetic angiogram study (MRA) and hypercoagulability work-up in the patient was negative. A TEE showed a normal interatrial septum with a PFO, but no atrial septal aneurysm was detected. He was treated with aspirin, and is considering either Coumadin or percutaneous PFO closure in the future is further neurological events occur. Suggested Work-Up for Source of Embolus The utility and yield of echocardiography in searching for a presumed cardiac source of embolus will vary with...

Suggested Reading

Fedullo PF, Auger WR, Kerr KM, Rubin LJ. Chronic thromboembolic pulmonary hypertension. N Engl J Med 2001 345 1465-1472. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999 353 1386-1389. Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Ann Intern Med 2002 136 691-700. Goldhaber SZ. Pulmonary embolism. In Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's...

Rvot

Hematopoiesis And Corresponding Cancer

Midesophageal aortic valve long axis (I). (Please see companion DVD for corresponding video.) Fig. 26. Midesophageal ascending aortic short axis view (O). (Please see companion DVD for corresponding video.) Fig. 26. Midesophageal ascending aortic short axis view (O). (Please see companion DVD for corresponding video.) Mid esophageal aortic valve short axis Fig. 28. Midesophageal aortic valve short axis (H). (Please see companion DVD for corresponding video.) Fig. 28. Midesophageal...

Plax

Fig. 16. (A) Pericardial vs (B) pleural effusion. Parasternal long axis views showing the anatomical relationships of pericardial vs pleural effusions (arrows) and their relationship to the descending thoracic aorta (dtAo). Note the small pericardial effusion (arrow at upper left) in B. Confusion between pericardial fluid and ascites can occur in the subcostal view, which can be resolved by defining the diaphragmatic border. Quantitation of pericardial fluid by echocardiography is imprecise,...

Case Presentation

Mitral Valve Hyperechoic

A 32-yr-old female presented with a 1-mo history of fatigue, intermittent fevers, and dyspnea on exertion. One day before her doctor's appointment, she noted transient monocular blindness that resolved within 1 h. On physical exam, she had both a holosystolic apical and late diastolic positional rumble, diminished S1, and an end-diastolic plopping sound heard in late systole. She was sent for an echocardiogram to rule out cardiac source of embolus (Fig. 1 please see companion DVD for...

Carolyn Y Ho MD

Pressure Volume Relationship Heart

Case Presentation Physiology of Diastole Diastolic Dysfunction Standard Echocardiographic Assessment of Diastolic Function Advancements in the Assessment of Diastolic Function Comprehensive Echocardiographic Assessment of Diastolic Function Suggested Reading A 63-yr-old female presents to her primary care physician complaining of increased exertional dyspnea. Her exercise tolerance has been slowly declining for the past several months and she occasionally notes orthopnea and paroxysmal...

Fetal Short Axis Pulmonary Artery

Lvot Images

Annotated parasternal short-axis view pulmonary artery view (PSAX). (Level just superior to still frame shown in Fig. 24 see companion DVD.) Fig. 26. Annotated parasternal short-axis view pulmonary artery view (PSAX). (Level just superior to still frame shown in Fig. 24 see companion DVD.) Parasternal short-axis view Mitral Valve Level Fig. 27. Parasternal short axis view mitral valve level (PSAX). (See companion DVD.) Left ventricular outflow tract (LVOT) Left ventricular outflow...

La

Transesophageal Echocardiography

Aortic measurements by transesophageal echocardiography of mid esophageal aortic valve long-axis and the descending aortic short-axis (insert) still frames. Mild dilatation of the proximal ascending aorta is seen in this study. Fig. 9. Aortic measurements by transesophageal echocardiography of mid esophageal aortic valve long-axis and the descending aortic short-axis (insert) still frames. Mild dilatation of the proximal ascending aorta is seen in this study. Fig. 10. Midesophageal...

Conventional Approach To Cardioversion Of Atrial Fibrillation

Although no prospective, randomized studies have been performed to determine the optimal INR or duration of precardioversion warfarin, historical data suggested 3-4 wk of warfarin (INR 2.0-3.0) before elective cardioversion is sufficient. The use of this conservative strategy comes at the cost of a delay in cardioversion for the vast majority of patients who could otherwise undergo early and safe cardioversion. This 1-mo delay exposes the patient to prolonged precardioversion warfarin therapy...

Lvi Dd And Lvi Ds

Lvidd Echo

Evaluation and management of chronic asymptomatic mitral regurgitation. N Engl. J Med 2001 345 740-746. Adapted from Otto CM. Evaluation and management of chronic asymptomatic mitral regurgitation. N Engl. J Med 2001 345 740-746. and small errors in measurement easily lead to large errors in calculation. Therefore, they should be applied in the context of the patient, without reliance on a single measure. two-dimensional echocardiography parameters for grading mr severity...

Echocardiography Evaluation of Aortic Regurgitation

Ehlers Danlos Syndrome Echocardiography

Reimold, MD Echocardiography Assessment in Patients With Aortic Regurgitation Assessment of Aortic Valve Morphology Anatomy of Aortic Valve Echocardiographic Evaluation of Aortic Valve Morphology Impact of Aortic Regurgitation on the Left Ventricle Doppler Echocardiographic Evaluation of the Patient With Aortic Regurgitation Quantitative Measures of Aortic Regurgitation Suggested Reading Aortic regurgitation occurs when a fraction of the blood ejected from the...

Echobright Region On Echocardiogram

Mode Aortic Regurgitation

Anavekar, md, Marcus Averbach, MD, and Bernard E. Bulwer, MD, mSc Echocardiographic Characteristics Complications Summary A 43-yr-old female with a past history of obesity, hypertension, and smoking was admitted with acute inferior myocardial infarction and underwent cardiac catheterization and balloon angioplasty with intracoronary stenting for blockage to her right coronary artery. over the following week she experienced pleuritic chest pains that went largely ignored until chills...

Direction Of Flow In Color Doppler

Direction Blood Flow Color Doppler

Start 15 sec 30 sec 45 sec 60 sec G 270 180 90 0s perceived incorrectly as counterclockwise and velocity, incorrectly, as 1 revolution per minute location (depth) to be interrogated. On the ultrasound machine, this is accomplished by placing a cursor over a specific area on the 2D image (Fig. 10). What the ultrasound machine is actually doing is emitting a pulse, then waiting the exact amount of time it would take that pulse to travel to the cursor location and return to the transducer. In PW...

Aortico Pulmonary Window

Patent Ductus Arteriosus Echo Images

Pulmonary artery banding was also performed to reduce volume and pressure effects of a previous unrestricted VSD. Note the increased echodensity (A). Flow acceleration indicating band stenosis was noted on color flow Doppler evaluation (B), and stenosis gradient was quantified by CW Doppler (C) revealing a peak velocity of 2.8 m s (peak gradient of mmHg). Fig. 17. Pulmonary artery banding was also performed to reduce volume and pressure effects of a previous unrestricted VSD. Note the...

Pediatric Echo Views

Midesophageal right ventricular inflow-outflow M . Please see companion DVD for corresponding video. Fig. 18. Midesophageal right ventricular inflow-outflow M . Please see companion DVD for corresponding video. Fig. 21. Midesophageal ascending aortic long axis view P . Fig. 21. Midesophageal ascending aortic long axis view P . Mid esophageal ascending aortic long axis

Mitral Regurgitation Jet Area

Left Atrium Volume

Values from cardiac ultrasound laboratory, Massachusetts General Hospiiall Fig. 14. Left ventricle dimensions in mitral regurgitation. Values from cardiac ultrasound laboratory, Massachusetts General Hospital. Values from cardiac ultrasound laboratory, Massachusetts General Hospiiall Fig. 14. Left ventricle dimensions in mitral regurgitation. Values from cardiac ultrasound laboratory, Massachusetts General Hospital. mitral valve surgery Tables 6 and 7 . In chronic compensated MR, cardiac output...

Infiltrate Cardiomyopathy

Infiltrative Cardiomyopathy

Arrhythmogenic Right Ventricular Cardiomyopathy Autosomal dominant Autosomal recessive Naxos disease mal de Meleda Primary idiopathic Loeffler's Endomyocardial fibrosis Secondary Infiltrative Amyloidosis Sarcoidosis Storage Diseases Hemochromatosis Glycogen storage Lysosomal storage Fig. 1. Cardiomyopathies classification. fibroelastosis Mitochondrial diseases Ischemic Hypertensive Valvular Metaboliic Connective tissue Stress-related Takotsubo Myocardial Stunning Fig. 2. Cardiomyopathies three...

Apical Four Chamber

Apical four-chamber view A4C . A, see companion DVD. Fig. 38. Apical four-chamber view anterior superior tilt also known as apical five-chamber A5C view. See companion DVD. Fig. 38. Apical four-chamber view anterior superior tilt also known as apical five-chamber A5C view. See companion DVD. Septomarginal trabecula Moderator band

Jpsax

Parasternal Long Axis Volume Overload

A higher magnification of the parasternal short axis view at the aortic valve level of the patient with the pulmonary saddle embolus arrow described in Fig. 1. Please see companion DVD for corresponding video. and indirect evidence of the diagnosis in patients with pulmonary embolus Table 1 . Thrombi can be visualized within the venous system from the inferior vena cava, through the right atrium, the RV, the right ventricular outflow tract, and the pulmonary arteries until just distal...

Psax View At The Aortic Valve Level Tricuspid Valve Cusps

Coronary Cusp

I I I LV Minor chord, i - IA Afp Dkim. I I Fig. 16. Left ventricular M-mode dimensions. M-mode delivers superior image resolution compared to 2D, but variations in cardiac topography and morphology frequently leads to off-axis measurements. Some newer instrument models are equipped with software for postprocessing measuring M-mode from selected 2D images to overcome this frequent pitfall. However, it is logistically simpler to obtain 2D measurements leading...

Bicuspid Aortic Valve

Bicuspid Aortic Valve

Calcific senile degeneration of aortic valve showing echo-bright reflection arrows . Fig. 3. Calcific senile degeneration of aortic valve showing echo-bright reflection arrows . Therefore, the 2D characteristics of the aortic valve can provide important clues to the etiology of aortic stenosis Table 1 . Doppler measurements across the aortic valve are essential to the determination of the severity of aortic stenosis. As the aortic valve narrows, the velocity of blood flow across the...

Mitral Valve Stenosis Area Lvot

Mitral Stenosis And Pressure Half Time

Apical four-chamber views of severe longstanding mitral stenosis in a 44-yr-old Vietnamese female. A Note marked thickening and calcification of mitral valve leaflets arrows and subvalvular apparatus accompanied by marked distortion in left heart chamber architecture. B This patient had severe pulmonary hypertension with grossly dilated right heart chambers and severe tricuspid regurgitation arrow . Fig. 5. Measurement of pressure gradients in mitral stenosis. Tracing the...

Summary

Echocardiography

Echocardiography can, in conjuction with positive blood cultures, help establish the diagnosis of IE Table 1 . It is also important in assessing complications and guiding further management and follow-up of patients with this condition. Both transthoracic and transesophagel echocardiography play important roles each with its own advantages and disadavantages. Echocardiographic findings, however, must always be Fig. 19. A 38-yr-old male with acute bacterial endocarditis requiring aortic root...

Sinus Venosus Septal Defect

The sinus venosus ASD is an interatrial communication that arises near the junction of the vena cava with the right atrium Fig. 9 please see companion DVD for corresponding video . Therefore, this defect can present in two distinct morphologies. More commonly, the defect is located superiorly at the site of the SVC drainage to the right atrium but can be present inferiorly at the junction of the IVC and right atrium. In either case, these defects may be difficult to define anatomically via...

Asd Color Doppler

Echo Color Flow Images

4SdB 3-A1 1 2 CW Focus -160mm CVi Gon 6dB 4SdB 3-A1 1 2 CW Focus -160mm CVi Gon 6dB Fig. 5. Quantification of shunt flow Qp Qs requires measurement see Anatomic and Echocardiography Overview section . Systemic flow calculation requires measurement of left ventricular outflow tract diameter A and the velocity time integral VTI by PW Doppler B . along with bicuspid aortic valves. The lesion results from the incomplete development of the septum secundum, leaving a central patency between the right...

T T

Constrictive Pericarditis Echo

Contributes to resting diastolic pressures within the heart and it may also limit acute cavity dilation. Although these effects may be modest in normal individuals, in states of pericardial pathology they can have a profound impact on the heart's hemodynamic performance. Of particular import is that the relative stiffness of the parietal pericardium causes the intrapericardial pressure to rise rapidly with an acute increase in volume. Conversely, a chronic, slow accumulation of pericardial...

Premature Closure Of Mitral Valve Picture

Cardiac Ultrasound Parasternal View

Bicuspid aortic valves may have a visible raphe the fusion ridge of two aortic leaflets. The aortic orifice often exhibits an ovoid or fish mouth appearance during systole. PSAX, parasternal short axis view. Please see companion DVD for corresponding video. Fig. 5. Bicuspid aortic valves may have a visible raphe the fusion ridge of two aortic leaflets. The aortic orifice often exhibits an ovoid or fish mouth appearance during systole. PSAX, parasternal short axis view. Please see...

Midcavity Gradient On Echocardiography

Echocardiography Procedure

No clear etiological relationship to hypertrophic cardiomyopathy. Nevertheless, the prominent septal knuckle found in DUST may cause dynamic outflow tract obstruction Fig. 24 . Mitral Regurgitation in Hypertrophic Cardiomyopathy A posteriorly directed jet of mitral regurgitation typically accompanies SAM of the mitral valve for reasons explained previously Figs. 18 and 19 . It temporally follows the onset of LVOT obstruction and care should be taken not to confuse its Doppler velocity profile...

Carpentier Mechanism Of Mitral Regurgitation

Pulmonary Vein Flow Reversal

Pulmonary vein systolic flow reversal. Pulsed Doppler examination right upper pulmonary vein flow in severe mitral regurgitation shows reversal of pulmonary vein systolic flow, as depicted by the negative S-wave. Fig. 30. Mitral E-point velocity. A Pulsed Doppler of normal mitral inflow characteristically shows an early diastolic E-wave followed by the atrial A wave. B In severe mitral regurgitation MR , marked E-wave dominance is seen gt 1.2 m s , reflecting a marked increased in...

Mitral Valve Replacement

Mitral Regurgitation Echocardiograpy

A 72-yr-old man 2 wk after coronary artery bypass graft mitral valve repair, left ventricle aneurysm resection. Fig. 39. Prosthetic mitral valve paravalvular leak. Prosthetic mitral valve dysfunction leading to prosthetic mitral regurgitation can occur secondary to thrombus formation or pannus ingrowth that can interfere with normal valve closure. This is most often seen with mechanical valves compared to bioprosthetic valves. The most common type of regurgitation following mitral...

Intravenous Agitated Saline And

Foream Ovale Heart

Color flow Doppler demonstrates the presence of the coronary sinus ASD with left-to-right shunt. Note also the small shunt arising from a patent foramen ovale PFO . should be used to confirm the presence of this defect and associated pathology Fig. 10 . Intravenous injection of agitated saline contrast into the left arm can be used to evaluate the site of drainage of the left SVC Fig. 11 .

Redundant Interatrial Septum

Interatrial Septum

A Parasternal short-axis PSAX and apical four-chamber views A4C show flow acceleration and left-to-right shunt across this secundum atrial septal defect on color Doppler examination. B Color flow Doppler applied to the interatrial septum from the subcostal window shows left-to-right shunt across interatrial septum. This view provides a better alignment for Doppler evaluation of shunt flow. C Continuous-wave Doppler examination of the atrial septal defect. Peak...

Angle Correction Pisa

Measure the angle of the isovelocity hemisphere compared to mitral valve leaflets as above 2, Divide angle by 180 . Note Angle correction factor can be ignored in this example as the bottom diameter of PISA hemisphere is almost 180 Continuity Equation in Mitral Stenosis Pitfalls Atrial fibrillation need to average over 5 to 10 cardiac cycles Doppler beam alignment dependent, especially with eccentric jets for Fig. 12 . The area at that point is calculated with the equation for the area of a...

Left Ventricular Noncompaction

Apical Left Venticle

Relaxation abnormality diastolic Fig. 32. Apical hypertrophic cardiomyopathy vs left ventricular LV noncompaction. The apical variant of hypertrophic cardiomyopathy should not be confused with LV noncompaction. The latter exhibits a spongiform appearance-reflecting deep tra-beculations within the endocardium. Fig. 32. Apical hypertrophic cardiomyopathy vs left ventricular LV noncompaction. The apical variant of hypertrophic cardiomyopathy should not be confused with LV noncompaction. The...

B

Mode Mitral Valve Stenosis

Calculation of trans-aortic gradients by continuous-wave Doppler. Fig. 9. Calculation of trans-aortic gradients by continuous-wave Doppler. In some situations, patients present with severe aortic stenosis calculated AVA lt 1.0 cm2 and low trans-valvular gradients lt 30 mmHg . These patients have low ejection fractions and low cardiac output Fig. 6 . In this situation, the calculated AVA may be small secondary to the low flow state, and should be interpreted with caution. These patients...

Poor Plax And Sax Views

Classification Dissection

Parasternal long-axis PLAX view showing aortic root dissection flap that prolapses into the left ventricular outflow tract during diastole. It was accompanied by new onset aortic regurgitation. Please see companion DVD for corresponding video. Fig. 1. Parasternal long-axis PLAX view showing aortic root dissection flap that prolapses into the left ventricular outflow tract during diastole. It was accompanied by new onset aortic regurgitation. Please see companion DVD for corresponding...

Coronary Sinus Dilation

Normal Echocardiogram Results

Midesophageal four-chamber views A,B obtained from a 51-yr-old male with TOF with previous palliative surgery show a significant residual VSD arrows with left-to-right shunt. Note the moderate dilation of right cardiac chambers. Midesophageal long-axis views of the same VSD arrows, C,D . Please see companion DVD for corresponding video. Fig. 28. Tetralogy of fallot. Midesophageal views showing residual stenosis restenosis arrow, A of right ventricular outflow...

Echocardiography

Chamber Echocardiography

Transesophageal echocardiography revealed a large mass attached to the posterior mitral valve leaflet. Histological examination revealed that it was a melanoma, arising from an extracardiac primary. Please see companion DVD for corresponding video. Fig. 18. Apical four-chamber A4C view showing compression of the right heart chambers from a large pleural mesothelioma. Please see companion DVD for corresponding video. Fig. 18. Apical four-chamber A4C view showing compression of the right...

Echo Premature Ventricular Contractio

Echocardiography Images

Planimetry by TEE, when transthoracic study suboptimal A3C, apical three-chamber view A5C, apical five-chamber view AF, atrial fibrillation CW, continuous wave 2D, two-dimensional LVOT, left ventricular outflow tract PLAX, parasternal long axis SSN-suprasternal notch TEE, transesophageal echocardiography VTI, velocity time integral PVC, premature ventricular contraction. A3C, apical three-chamber view A5C, apical five-chamber view AF, atrial fibrillation CW, continuous wave 2D, two-dimensional...

Sinus Coronary Venous Visualization By Transesophageal Echocardiography

Mid Esphageal Views

This rare type of ASD presents an interatrial communication via an unroofed coronary sinus. Therefore, the defect is seen at the site of origin of the coronary sinus. A persistent left SVC is associated with this defect and can often be seen to drain into the coronary sinus or left atrium. This defect may not be visualized on routine trans-thoracic echocardiography. However, the defect may be suggested by the constellation of right heart overload, a dilated coronary sinus, and the presence of a...

Color M-mode Flow Propagation Velocity

Restrictive Physiology Cardiac Cath

Color M-mode flow propagation velocity. Color M-mode propagation velocities in a patient with normal left and abnormal right diastolic function. Vp, color M-mode color flow propagation velocity normal Vp cm s gt 45 diastolic dysfunction lt 45 . Fig. 14. Color M-mode flow propagation velocity. Color M-mode propagation velocities in a patient with normal left and abnormal right diastolic function. Vp, color M-mode color flow propagation velocity normal Vp cm s gt 45 diastolic dysfunction...

Normal Laa Flow Echo

Transesophageal Echocardiography

A Images showing pectinate muscle morphology on transesphageal echocardiography TEE . Note their identical echo-reflectivity pattern compared the left atrial appendage LAA wall. B Views of LAA containing thrombi in patients with atrial fibrillation AF . Note the presence of spontaneous echocontrast. C Views of LAA containing thrombi arrows in a patient with AF, visualized in both subcostal view top panels and on TEE bottom panels . Spontaneous echo contrast was also seen in bottom...

Impaired Relaxation

Transmitral Flow

Measuring mitral valve inflow see Technical Issues in Measuring MV Inflow section for explanation . E-wave velocities tend to increase . Deceleration of mitral inflow is directly related to MV area and inversely related to ventricular compliance as MV area or compliance decrease, E-wave deceleration time increases . Mitral inflow patterns are highly modulated by filling pressures and loading conditions, particularly LV preload. A rise in LA pressure is associated with an increase in...

Enddiastole

Septal leaflets-TRICUSPID VALVE Anterior leaflets Anterior leaflet MITRAL VALVE Posterior leaflet lateral annulus MITRAL VALVE medial annulus Fig. 33. Annotated apical four-chamber view A4C . Coarse trabecu-lations with -Septo-marginal Moderator bj nd showing leaflet . insertion levels - ' Papillary Fig. 34. Defining morphological left and right ventricles on two-dimensional 2D echocardiography A4C . The confluence of the interventricular and interatrial septa and the septal insertions of the...

Companion DVD

Phased Array Ultrasonic Screen Image

The companion DVD-ROM contains a video playback application with more than 200 individual video clips corresponding to the chapters in this book. The application is compatible with most Mac and PC computers. You will need a computer with a DVD-ROM drive, as the DVD will not operate in a CD-ROM drive. The individual video clips are cited in the text along with the figure to which they correspond by number. In addition, descriptive captions are provided in the DVD, and these will appear when you...

Secundum

Echocardiography Images

Secundum ASDs are one of the most frequently encountered congenital cardiac defects in clinical practice Fig. 4. Agitated saline contrast echocardiography in this 28-yr-old female who complained of migraine headaches shows good opacification of right heart chambers. Clear evidence of right-to-left shunting appearance of saline bubbles into left heart chambers occurred early during rest. She was diagnosed with a secundum atrial septal defect. Please see companion DVD for corresponding video.

How To Image Ivc On Echocardiogram

Ivc Collaspe

Inferior vena cava respirophasic movments inspiratory collapse Corresponding right atrial pressures mmHg 1.5-2.5 gt 1.5 gt 2.5 gt 2.5 with dilated intrahepatic veins Complete collapse lt 50 collapse lt 50 collapse No collapse aBased on inferior vena cava measurements using subcostal window. These adverse echocardiography markers may identify a subset of individuals who may benefit from the use of more aggressive therapy in the management of PE, including thrombolytic therapy or pulmonary...

Echocardiogram Ie

Echocardiography Images

Treat bacteremia no echocardiography needed It must be emphasized that echocardiography cannot distinguish between infective and noninfective or acute and chronic vegetations, or the causative organism. For these reasons, echo-cardiography alone should not be relied on to provide a definite diagnosis of IE. It must be emphasized that echocardiography cannot distinguish between infective and noninfective or acute and chronic vegetations, or the causative organism. For these reasons,...

JtLJLuPLAX

Lambl Excrescences

A 75-yr-old female with cardiovascular risk factors and acute neurological deficits. High parasternal long-axis view showing calcified atherosclerotic plaque. Fig. 1. A 75-yr-old female with cardiovascular risk factors and acute neurological deficits. High parasternal long-axis view showing calcified atherosclerotic plaque. Fig. 2. Midesophageal zoomed image of the left atrial appendage LAA at omni 90 showing well-defined thrombus in a patient with atrial fibrillation. Fig. 2....

Echocardiogram Eroa

PLAX, PSAX PLAX, PSAX PLAX and A3C, A5C Ascah 1985 AV MV , Kitabatake 1985 AV PV , Rokey 1986 AV MV MV, mitral valve PLAX, parasternal long-axis PSAX, parasternal short-axis AV, aortic valve A5C, apical five-chamber view A3C, apical three-chamber view A4C, apical four-chamber view LVOT, left ventricular outflow tract TTE, transthoracic echocardiography CSA, cross-sectional area EROA, effective regurgitant orifice area. assessment of mitral valve area in a patient with mitral stenosis can be...

What Color Is The Mr Jet In Plax

Echo Color Flow Images

Moderate 0.3-0 - 69 cm Severe gt 0.7 cm Fig. 21. Vena contracta width measurement. Table 9 Vena Contracta Width Measurements in MR 1. Relatively quick and easy to assesses using standard windows 2. Good for extremes of MR mild and severe MR 3. Assesses basic size of defect 4. Relatively independent of flow rate, driving pressure, or entrainment Coanda effect 5. Not influenced by the presence of another regurgitant leak, for example, aortic regurgitation 6. No need for correction for convergence...

Tee Echocarigraphy

Echocardiography Hand Book

Bulwer, MD, mSc and Stanton K Shernan, MD Transesophageal Echocardiography Figs. 1 and 2 Anatomical and Spatial Relationships Figs. 3-7 Order of Examination Summary Order of Examination Detailed Stages Suggested Reading This primer is an atlas illustrating basic nomenclature and standard views adopted by the American Society of Echocardiography ASE and the Society of Cardiovascular Anesthesiologists SCA in the performance of a comprehensive intra-operative multiplane transesophageal...

Sjjfc Humana Press

2007 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 www.humanapress.com For additional copies, pricing for bulk purchases, and or information about other Humana titles, contact Humana at the above address or at any of the following numbers Tel. 973-256-1699 Fax 973-256-8341, E-mail orders humanapr.com or visit our Website http humanapress.com No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic,...

Psax View Of Aortic Valve

Five Chamber Echocardiography

Acquired in the apical five-chamber, right parasternal long axis, or suprasternal views to obtain the highest velocities across the valve. The maximum velocity obtained is highly dependent on accurate transducer positioning, and will be underestimated when Doppler beam angle deviates from that of blood flowing through the stenotic valve Fig. 8 . A nonimaging probe can be used if inadequate envelopes are found with the duplex imaging transducer. The calculation of transvalvular pressure...

Echocardiography Assessment of Ventricular Systolic Function

Echocardiography Infarct

Solomon, MD, Rajesh Janardhanan, MD, MRCP Echocardiographic Assessment of LV Size LV Parameters by 2D Echocardiography Limitations of 2D Assessment of LV Systolic Function Qualitative and Semi-Quantitative Measures of LV Systolic Function Qualitative Grades of LV Systolic Function Limitations of Regional Wall Motion Assessment Quantitative Measures of LV Systolic Function Limitations of Volumetric Measures EF of LV Systolic Function Assessment of Myocardial...

Suprasternal longaxis view

Coronary Arteries Territories Echo

Suprasternal long-axis view. Fig. 58. Coronary artery territories. Fig. 58. Coronary artery territories. Diastolic Function f set normal Pi art Tunc RV Thickness Sys fx RV se g fx Left Atrium AR piM time Peak Velocity Peak Gradient Mean Gradient Aortic root size 2D Pulmonary Artery Ig-No Evidence of Endocarditis Bl5c Evidence of Intracardiac Tt iromt

Lv

Catheterization and coronary angiography, which revealed significant three-vessel disease. Two years previously, he underwent placement of an implantable cardioverter defibrillator with biventricular pacing following episodes of ventricular tachycardia. His additional medical problems included hypertension, dyslipidemia, chronic obstructive pulmonary disease, and chronic renal impairment. On physical examination, he was tachypneic respiratory rate gt 40 breaths min with a regular pulse of 62...

Echocardio Graphy Simpson Methode

Right Ventricle Measurements

BSA, body suface area PLAX, parasternal long-axis LVIDd, left ventricular internal diameter at end diastole LVIDs, left ventricular internal diameter at end systole PSAX, parasternal short-axis A4C, apical four chamber. M-mode or 2D, essentially subtract ventricular cavity volume from the total ventricular volume to obtain the shell or myocardial volume Fig. 15 . This value Fig. 13. Geometric models to estimate left ventricle LV volumes by two-dimensional echocardiography use short-axis area...

Parasternal Short Axis Views

Aortic Valve Short Axis

Parasternal short-axis view, mitral position. This view represents a breadloaf slice through the heart at the level of the mitral valve. From this view, you can see the mitral valve in cross-section fishmouth view with anterior and posterior leaflets arrows indicating the wide open early diastolic position. Please see companion DVD for corresponding video. right of the screen moving leftward, the aortic valve AV right coronary AV leaflet superiorly and noncoronary leaflet inferiorly and...

Rv

Right ventricular inflow view. From this view, we can see a longitudinal view of the right ventricle RV and right atrium RA . The RA is to the right and bottom posterior and the RV is above anterior and left. This view allows visualization of the tricuspid valve, as well as assessment of tricuspid regurgitation and measurement of tricuspid regurgitant velocity. Please see companion DVD for corresponding video.

Pediatric Echo Training

Echocardiography Images

Protocol and Nomenclature in Transthoracic Echocardiography Bernard E. Bulwer, MD, MSc and Jose Rivero, MD Transducer Scan Plane and Index Mark Two-Dimensional Echocardiographic Imaging Planes Apical Four-Chamber View Apical Five-Chamber View Apical Two-Chamber View Apical Three-Chamber View Subcostal Views Suprasternal Views Examination Report Summary The transducer probe is the component that houses the piezoelectric crystals see Chapter 1 and emits and receives the sound waves Fig. 1 . The...

Pseudonormal Mv Inflow

Isovolumic Relaxation Time

Table modified from Garcia MJ, Thomas JD, Klein AL. New Doppler echocardiography applications for the study of diastolic function. J Am Coll Cardio 1998 32 865-875. Unless atrial mechanical failure present. AR, pulmonary venous peak atrial contraction reversal velocity EDT, early left ventricular filling deceleration time IVRT, isovolumic relaxation time S D, systolic-to-diastolic pulmonary venous flow ratio. Table modified from Garcia MJ, Thomas JD, Klein AL. New Doppler echocardiography...

Pisa Echocardiography

Echocardiography Images

Proximal or first isovelocity adjacent Fig. 12. Proximal isovelocity surface area PISA principle in mitral stenosis. Narrow sector scan of mitral stenotic jet using color flow Doppler in the apical four-chamber A4C view. The flow convergence zone exhibits a hemisphere of isovelocity proximal isovelocity . The PISA principle stipulates that unobstructed flow convergence equates to concentric acceleration the presence of concentric rings of flow acceleration that results when flow accelerates...

Ra

Echocardiography Images

When present, the Eustachian valve arrow can be well visualized in the right ventricular inflow view see Chapter 3, Fig. 20 . This patient's tricuspid valves were thickened and immobile owing to the carcinoid syndrome. echobright and irregular, whereas fat usually appears as a less echodense, homogenous mass with smoother edges. Myxomatous mitral valves, when severely thickened, have been mistaken for tumors. Within the left atrial appendage, pectinate muscles appear as small multiple...

Posterior Lv Wall Motion Is Dyskinetic Reasons

Coronary Arteries Territories Echo

Pseudo-dyskinesis in 54-yr-old male with end-stage liver disease. Left ventricular walls in this 54-yr-old male with end-stage cirrhosis owing to chronic alcohol use and hepatitis C virus infection was normal during diastole A-C . Apparent hypokinesis dyskinesis in the postero-inferior walls B,D, arrows was a result of external pressure from tense ascites secondary to his end-stage liver disease. Please see companion DVD for corresponding video. echocardiographic findings in acute mi...

A4c

Echocardiography Images Apical

A Parasternal long-axis view PLAX and apical four-chamber view A4C showing a partial flail of posterior mitral valve leaflet. Note that tip of leaflet points toward the left ventricle indicating that flail is incomplete top panels . Marked turbulence with this valvulopathy are seen on color flow Doppler examination. Note that the mitral regurgitant jet is anteriorly directed. M-mode examination shows that flail affected the posterior leaflet only. Please see companion DVD for...

Suprasternal View Image For Subclavian Bifurcation

Short Axis Echo Septal Defects Types

A4C, apical four-chamber A5C, apical five-chamber AV, atrioventricular PLAX, parasternal long-axis PSAX, parasternal short-axis RVOT, right ventricular outflow tract TEE, transesophageal echocardiography. A4C, apical four-chamber A5C, apical five-chamber AV, atrioventricular PLAX, parasternal long-axis PSAX, parasternal short-axis RVOT, right ventricular outflow tract TEE, transesophageal echocardiography. Define anatomical site type and size Figs. 11-17 please see companion DVD for...

Impaired Propagation Velocity In

Hypertrophy Interventricular Septum

Dilated cardiomyopathy Mitral regurgitation. Mitral annular dilatation, lateral papillary muscle displacement, and apical tethering prevent normal leaflet coaptation. The result is typically mitral regurgitation MR with a centrally directed jet. Worsening MR heralds a worse prognosis. Color M-mode Doppler across the mitral valve apical four-chamber view during diastole provides a spatio-temporal display of blood velocities across the vertical interrogation line. This parameter may be...

Rv Svavsv

Diastolic Reversal Aorta

SVAV 0.785 x LVOT x VTIlvdt im pw, SVmv 0.785 x Dmv 2 x YWntbypin Regurgitation Severity by RV mL beat Moderate 30 -59 mL beat Severe gt 60 mL beat Moderate 30-49 Severe gt 50 Fig. 15. Aortic regurgitant volume and fraction. diastole and is proportional to regurgitant severity. Grading of aortic regurgitation severity using the regurgitant orifice area is as follows mild, less than 0.10 cm2 moderate, between 0.10 and 0.30 cm2 and severe, more than 0.30 cm2. Calculation of the regurgitant...

Pericardial Disease

Pericardial Fat Pad

Lilly, MD Case Presentation Introduction Anatomy Physiology Acquired Pericardial Disease Acute Pericarditis Chronic Constrictive Pericarditis Pericardial Effusions and Compressive Syndromes Conclusion of Case Presentation Suggested Reading A 59-yr-old woman presents with a history of diabetes mellitus, hypertension, and end-stage renal disease. She presented with several weeks of fevers, sweats, fatigue, and progressive exertional dyspnea. On initial...

Left Ventricular Remodeling

Three-dimensional 3D images showing gross distortion of left ventricular geometry post-myocardial infarction. 3D representation of progressive remodeling of the left ventricle in a patient with a large anterior-apical myocardial infarction. Note the progressive distortion of the ventricular geometry with time A-C . Fig. 6. Three-dimensional 3D images showing gross distortion of left ventricular geometry post-myocardial infarction. 3D representation of progressive remodeling of the left...

Effects Of Cancer On The Heart

Pericardial Effusion Fluid Removal

Mass Effect Extracardiac Compression or Intracavitary Obstruction Even tumors that do not directly involve the heart and pericardium can occasionally be seen by echocardiography. Anterior mediastinal masses cysts, thymomas, teratomas, lymphomas can compress the right ventricular outflow tract, whereas posterior masses sarcomas or pleural tumors can compress the left atrium and ventricle. Figure 18 is an example of a pleural mesothelioma impinging on the right atrium and right ventricular inflow...

Ww Subcostal

Mkitral Valve Inflow

Localized pericardial effusion with cardiac compression. This patient who underwent a previous pericardial window creation for malignant effusions presented with hypotension. An apical four-chamber view A reveals multiple, loculated fluid collection at the ventricular apex, lateral to the left ventricle LV , posterior to the left atrium, and adjacent to the right atrium see arrows . B M-mode echocardiography through the LV apex shows a region of loculated effusion see arrow . C A...

Edmund A Bermudez Md Mph and Ming Hui Chen MD MMSc

Echo Protocol

Introduction Indications Stress Protocols Interpretation Pitfalls Stress echocardiography is a common diagnostic procedure used in the evaluation of coronary artery disease. In fact, stress echocardiography is now a widely accepted test utilized for the diagnosis, prognostication, and risk stratification of ischemic heart disease Fig. 1 . Imaging is most often coupled with treadmill stress, however, it can be easily coupled with pharmacological stress, bicycle exercise, or pacing. In skilled...

Adult Congenital Heart Disease In General Echocardiography Practice

Loop Transposition Great Vessels

The spectrum of adult congenital heart defects seen in echocardiography practice varies according to institutional practice and expertise. Half a century ago, survival with severe congenital heart disease was less common. Today, nearly 80 of such patients in industrialized societies now survive into adulthood. Most are followed up in centers that specialize in adult congenital heart diseases CHDs , but it is not uncommon for such adults to be seen in general echocardiography practice. Most CHDs...

Tumors Involving The Heart And Pericardium

Crista Terminalis Echocardiography

Primary tumors arising in the heart are rare, and only 25 of these are malignant. Ninety percent or more are Fig. 11. These images show a floppy myxomatous anterior mitral valve leaflet that prolapsed into the left atrium during systole, which can create a tumor-like appearance. Marked mitral regurgitation was present. Fig. 11. These images show a floppy myxomatous anterior mitral valve leaflet that prolapsed into the left atrium during systole, which can create a tumor-like appearance. Marked...

Pw Pressure On Echo

Prolate Ellipsoid

Two-dimensional-guided M-mode measurements and derived indices. M-mode is simple, reproducible, and accurate when ventricular geometry is normal. It provides good endocardial resolution. The ejection fraction EF, Teich is an automated calculation based on the Teichholz method see Table 4 . Fig. 3. Two-dimensional-guided M-mode measurements and derived indices. M-mode is simple, reproducible, and accurate when ventricular geometry is normal. It provides good endocardial resolution. The...

Papillary Muscle Echo

Posterior Mitral Jet

Apical 2-C hamber Parasternal Apical Long Axis Fig. 5. Coronary artery territories and segments. Anatomical left ventricular segments used in reporting regional wall motion American Heart Association classification and their corresponding blood supply. Significant overlap and congenital variations in coronary blood supply can occur. individual myocytes, and thereby causes a wall motion abnormality in the respective segment. At least a 70 reduction in cross-sectional diameter is required before...

Subcostal view

Large Fibrinous Left Pleural Effusion

Lipomatous hypertrophy arrow of the interatrial septum. Please see companion DVD for corresponding video. Fig. 6. A false tendon straight arrow appears as a mobile string a few millimeters in width that bowstrings the ventricular cavity. Note the attachments to the interventricular septum ivs and the base of the papillary muscle pm . Note the appearance of the true tendon chorda tendinae curved arrow . Fig. 6. A false tendon straight arrow appears as a mobile string a few millimeters in...

Intramural Hematoma

Tee Aortic Dissection

An aortic intramural hematoma IMH is a hemorrhage limited to the medial layer of the aortic wall without intimal disruption Figs. 3 and 15A,B please see companion DVD for corresponding video for Fig. 15 . Although the pathogenesis of IMH remains unclear, rupture of the vasa vasorum located within the medial layer of the aorta and rupture of an atherosclerotic plaque are considered to be the initiating events that lead to IMH. TEE is an important imaging modality for the diagnosis of IMH. The...

Echocardiograghy For Rheumatic Mitral Stenosis

Echocardiography Pulmonary Stenosis

Echocardiography features of rheumatic mitral stenosis. A Diastolic doming of the thickened anterior mitral valve leaflet hockey stick appearance, curved arrow is indicative of restricted anterior leaflet motion. Note the thickened subvalvular structures, including the chordae arrow . Note also the posterior pericardial effusion PE . B A systolic frame showing thickened mitral valve leaflets. C Commissural fusion arrowheads and bilateral leaflet thickening curved arrows resulting in...

Echocardiogram Blood Flow Normal Mv

Normal Mitral Valve Echocardiogram

During diastole, the myxomatous leaflets can be measured. Thickened leaflets more than 5 mm support the diagnosis of classic MVP. Please see companion DVD for corresponding video. Fig. 6. Bileaflet prolapse is easily visualized in the apical four-chamber A4C view. However, the mitral valve profile is normally exaggerated in this view and may lead to overdiagnosis of mitral valve prolapse left panel . Severe mitral regurgitation was present right panel . Please see companion DVD for...

J Apical 3Chamber

Echocardiogram Ejection Fraction

A Pseudo-aneurysm postmyocardial infarction post-MI . This 64-yr-old woman suffered an inferior MI and required implantable cardioverter defibrillator placement. Her apical two-chamber images show a narrow-necked cavity left panel that communicated with the left ventricular cavity. No intracavitary thrombus was seen. Surgical removal confirmed it was a pseudo-aneurysm. B Pseudo-aneurysm anatomy. A post-MI pseudoaneurysm of the left ventricular wall is essentially a contained ruptured...

Segment Left Ventricle Model ASE

Heart Apical Wall

Parasternal Long-Axis I Apical Long-Axis Parasternal Long-Axis I Apical Long-Axis Fig. 10. The American Society of Echocardiography ASE issued a 16-segment left ventricle model for wall motion assessment. The American Heart Association's AHA 17-segment model has an additional apical segment cap added to harmonize left ventricular segment nomenclature with nuclear cardiology and cardiac magnetic resonance imaging. A A 16-segment model of left ventricular segments ASE . B A 17-segment model of...

Basilar Inferior Wall Hypokinesis

Echocardiography With Definity Contrast

A 72-yr-old female patient underwent dobutamine infusion with atropine to achieve targeted heart rate. Baseline echocardiography images showed borderline left ventricular hypertrophy with preserved systolic function. Minimal septal hypokinesis was noted. With increasing doses of dobutamine, augmentation of all segments accompanied by decrease in left ventricular cavity size up to a heart rate of 110 bpm. However, at heart rates more than 115 bpm, left ventricular dilatation accompanied...

Pisa

Pisa Nystquist Mitral Valve

3 D Isovelocity 2nd Isovelocity 1ST Isovelocity PISA Fig. 24. Proximal isovelocity surface area PISA . severity itself, but should be further integrated with global cardiac function and the patient's clinical status. Newer methods of assessing MR severity show promise, e.g., 3D echocardiography and power Doppler imaging, but are not yet routinely used in clinical practice Fig. 34 please see companion DVD for corresponding video . Precise determination of the mechanism of MR results is necessary...