ASE’s Comprehensive Echocardiography

3rd Edition - February 18, 2021
Imprint: Elsevier
Editor: American Society of Echocardiography
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 6 9 8 3 0 - 6
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 7 0 9 3 6 - 1

Edited by a team of leading echocardiography experts and endorsed by the American Society of Echocardiography, ASE’S Comprehensive Echocardiography, 3rd Edition, covers the full… Read more

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Edited by a team of leading echocardiography experts and endorsed by the American Society of Echocardiography, ASE’S Comprehensive Echocardiography, 3rd Edition, covers the full spectrum of sonography of the heart in one succinct, authoritative resource. This highly regarded text provides must-know information on everything from basic foundations and principles to clinical application, written and edited by ASE members with expertise in each specific area. Case studies, numerous tables, high-quality images and videos highlight the latest uses of echocardiography, including the most recent 2D and 3D advances.

Instructions for online access
Cover image
Title page
Table of Contents
Copyright
Contributors
Preface
Acknowledgments
Section I. Physics and Instrumentation
1. General Principles of Echocardiography
Ultrasound
Transducer
Instrument
Artifacts
Virtual Beamforming
2. Three-Dimensional Echocardiography
Comparison Between Two- and Three-Dimensional Echocardiography Ultrasound Transducers
3. Doppler Principles
Doppler Effect
Color Doppler Displays
Spectral-Doppler Displays
Aliasing
Virtual-Beamforming
4. Tissue Doppler, Myocardial Work: Physics and Techniques
Tissue Doppler Imaging
Global Longitudinal Strain
Myocardial Work
Future Directions
5. Speckle-Tracking and Strain Measurements: Principles, Techniques, and Limitations
General Concepts
A Glance at the History: Tissue Doppler–Derived Strain
From the Present to the Future: Two- And Three-Dimensional Speckle-Tracking Echocardiography
6. Clinical Utility of Global Longitudinal Strain
Evaluation of Left Ventricular Systolic Function
Evaluation of the Right Ventricle
Evaluation of left Atrial Function
Section II. Transthoracic Echocardiography
7. Transthoracic Echocardiography: Nomenclature and Standard Views
Imaging Planes
Image Acquisition Windows
Scanning Maneuvers: Transducer Movement Descriptions
Transducer Orientation
Standard Views: Two-Dimensional Imaging
8. Technical Quality and Tips
Optimizing Two-Dimensional Images
Avoiding Apical Foreshortening
Optimizing Spectral Doppler Traces
Optimizing Color Doppler Images
Alternate Windows
Summary
9. Transthoracic Echocardiography Tomographic Views
Parasternal Window
Transthoracic Apical Window
Subcostal Window
Transthoracic Suprasternal Window
Off-Axis Views
10. M-Mode Echocardiography
Left Ventricle
Mitral Valve
Aortic Valve
Pulmonic Valve
Pericardial Disease
Cardiac Tamponade
Constrictive Pericarditis
11. Doppler Echocardiography: Normal Antegrade Flow Patterns
Basic Concepts
Technical Considerations For Optimal Doppler Recordings
Individual Flow Profiles
Emerging Applications Of Doppler: Intracardiac Flow Analysis
Section III. Transesophageal Echocardiography
12. Introduction to Transesophageal Echocardiography: Indications, Risks, Complications, and Protocol
Preprocedural Assessment
Anesthesia and Sedation
Movements of TEE Transducer
Transducer Insertion and Manipulation
Sample Protocol
13. Transesophageal Echocardiography Tomographic Views
Midesophageal Five-Chamber View
Midesophageal Four-Chamber View
Midesophageal Mitral Commissural View
Midesophageal Two-Chamber View
Midesophageal Long-Axis View
Midesophageal Aortic Valve Long-Axis View
Midesophageal Ascending Aorta Lax View
Midesophageal Ascending Aorta Short-Axis View
Midesophageal Right Pulmonary Vein View
Midesophageal Aortic Valve Short-Axis View
Midesophageal Right Ventricle Inflow–Outflow View
Midesophageal Modified Bicaval Tricuspid Valve View
Midesophageal Bicaval View
Midesophageal Right And Left Pulmonary Veins View
Midesophageal Left Atrial Appendage View
Transgastric Basal Short-Axis View
Transgastric Midpapillary Short-Axis View
Transgastric Apical Short-Axis View
Transgastric Right Ventricular Basal View
Transgastric Right Ventricular Inflow–Outflow View
Deep Transgastric Five-Chamber View
Transgastric Two-Chamber View
Transgastric Right Ventricle Inflow View
Transgastric Long-Axis View
Descending Aorta Short-Axis And Descending Long-Axis Views
Upper Esophageal Aortic Arch Long-Axis View
Upper Esophageal Aortic Arch Short-Axis View
14. Applications of Transesophageal Echocardiography
Diagnostic Applications
Intracardiac Thrombus And Mass Evaluation
Patent Foramen Ovale And Septal Defects
Endocarditis
Aortic Disease
Critical Care Applications Of Transesophageal Echocardiography
Intraoperative Applications Of Transesophageal Echocardiography
Intraprocedural And Structural Applications Of Transesophageal Echocardiography
Conclusions
15. Pitfalls and Artifacts in Transesophageal Echocardiography
Pitfalls Of Transesophageal Echocardiography
Transesophageal Echocardiography Artifacts
Conclusions
Section IV. Handheld Echocardiography
16. Cardiac Point-of-Care Ultrasound: Background, Instrumentation, and Technique
When a Stat Echo is Not Fast Enough
Pocus: Intents and Purposes
Instrumentation: Form Fits Function
Pocus: diversity in practice and outcomes
Pocus can Affect Referral for Echocardiography
Incidental findings: the achilles heel of pocus?
The Value of Lung Pocus Data in Echocardiography
Discrepancies Between Pocus and Echocardiographic Results
Conclusion
17. Focused Cardiac Ultrasound in Emergency Clinical Settings
Chest Pain
Hypotension
Dyspnea
Cardiac Arrest (Advanced Cardiac Life Support)
Section V. Contrast Echocardiography
18. Ultrasound-Enhancing Agents
Currently Available Second-Generation Ultrasound Contrast Agents
Ultrasound Contrast Agent Composition
Technical Considerations to Optimize Contrast Enhancement
Role of Health Care Professionals in Maintaining Ultrasound-Enhancing Agent Quality
Role of Sonographer/Nurse
Safety of Ultrasound Contrast Agents
19. Physical Properties of Microbubble Ultrasound Contrast Agents
Microbubble Contrast Agents
Contrast-Specific Imaging Techniques
Clinical Perspective
20. Applications of Ultrasound Contrast Agents
Clinical Applications
Summary
21. Use of Contrast in the Intensive Care Unit and Emergency Department
Contrast Use in the Intensive Care Unit
Contrast Use in the Emergency Department
Summary
22. Technical Aspects of Contrast Echocardiography
Indications
Available Types of Contrast Agents
Step-by-Step Protocol
Complications of Ultrasound-Enhancing Agents
Section VI. Left Ventricular Systolic Function
23. Left Ventricular Systolic Function: Basic Principles
Functional Anatomy of the Left Ventricle
Left Ventricular Volume and its Dynamic Geometry
Generating Left Ventricular Ejection from Contraction of Myofibrills
Cardiac Cycle
Determinants of Left Ventricular Performance
Response to Exercise
24. Global Left Ventricular Systolic Function: Ejection Fraction Versus Strain
Indications for Systolic Function Evaluation
Limitations of Ejection Fraction
The Role of Global Longitudinal Strain
Choice for Assessment Tool of Left Ventricular Systolic Function in Multimodality Era
Conclusions
25. Regional Left Ventricular Systolic Function
Assessment of Regional LV Systolic Dysfunction
Clinical Applications
26. Myocardial Strain in Valvular Heart Disease
Strain As An Additive To Ejection Fraction In Valvular Heart Disease
Strain In Mitral Regurgitation
Strain In Aortic Stenosis
Strain In Aortic Regurgitation
Section VII. Right Heart
27. Right Ventricular Anatomy
Coronary Flow To The Right Ventricle
Echocardiographic Assessment Of Right Ventricular Anatomy
Reference Values For Right Ventricular Structure
28. The Physiologic Basis of Right Ventricular Echocardiography
Structure And Anatomy Of The Right Ventricle
Right Ventricular Hemodynamics
Quantitative Assessment Of Right Ventricular Function
Coronary Blood Flow Of The Right Ventricle
Interventricular Dependence
Right Ventricular Diastolic Function
Rhythm Disturbances Originating From The Right Ventricle
Conclusion
29. Imaging the Right Heart: Limitations and Technical Considerations
Core Limitations Of Imaging
Challenges In Evaluating Rv Size And Structure
Pitfalls In Assessment Of Rv Function
Overcoming Technical Challenges Of Two-Dimensional Transthoracic Echocardiography With Advanced Imaging
Right Atrium
30. Assessment of Right Ventricular Systolic and Diastolic Function
Anatomy And Physiology
Quantitative Evaluation By Echocardiography
Right Ventricular Diastolic Function
Clinical Impact Of Right Ventricular Size And Function: Prognosis
Summary And Recommendations
31. Right Ventricular Hemodynamics
Flow
Pressure
Resistance
Right Heart Hemodynamic Measures
Secondary Indices Of Right Atrial Pressure
Summary
32. The Right Atrium
Anatomy
Physiology
Echocardiographic Views
Anatomic Variants
Right Atrial Size And Function
Clinical Implications Of Right Atrial Enlargement And Dysfunction
Right Atrium Pressure And Performance
Conclusions
33. Pulmonary Embolism
Diagnosis
Transthoracic Echocardiography
Transesophageal Echocardiography
Prognosis
Summary
Section VIII. Diastolic Function
34. Physiology of Diastole
Left Ventricular Relaxation
Left Ventricular Stiffness
Ventricular–Arterial Coupling
Diagnosis of Heart Failure with Preserved Ejection Fraction
35. Echo Doppler Parameters of Diastolic Function
Doppler Mitral Flow Velocity Patterns
Valsalva Maneuver
Pulmonary Venous Flow
Color M-Mode Flow Propagation Velocity
Tissue Doppler Annular Velocity
Myocardial Performance Index
Pulmonary Artery Systolic Pressures
Integration of Doppler Echocardiography Parameters
Conclusion
36. Clinical Recommendations for Echocardiography Laboratories for Assessment of Left Ventricular Diastolic Function and Filling Pressures
Estimation of Left Ventricular Filling Pressure and Left Ventricular Diastolic Function Grading
Stress Testing for Assessment of Diastolic Function
Estimation of Left Ventricular Filling Pressures in Patients With Atrial Fibrillation
Estimation of Left Ventricular Filling Pressures in Patients with Mitral Regurgitation
Prognostic Power of American Society of Echocardiography/European Association of Cardiovascular Imaging Diastolic Function Grade
37. Causes of Diastolic Dysfunction
Definitions
Diastolic Heart Failure Versus Heart Failure with Preserved Ejection Fraction
Comorbidities Associated with Heart Failure with Preserved Ejection Fraction
Diastolic Dysfunction in Restrictive Cardiomyopathy
Physiologic Changes Associated with Heart Failure with Preserved Ejection Fraction
Phenotyping Heart Failure with Preserved Ejection Fraction
Impact on Survival
Section IX. Left Atrium
38. Assessment of Left Atrial Size
Prognostic Value of Left Atrial Size
Conclusions
39. Assessment of Left Atrial Function
Left Atrial Function
Volumetric Methods
Spectral Doppler
Tissue Doppler Imaging
Deformation Analysis (Strain and Strain Rate Imaging)
Challenges to Measurement of Left Atrial Function
Section X. Ischemic Heart Disease
40. Ischemic Heart Disease: Which Test to Use?
Patient Selection for Noninvasive Testing
Selecting the Optimal Noninvasive Test for Ischemic Heart Disease Diagnosis: A Proposed Approach
General Approach: Functional Testing Strategies
Diagnostic Accuracy of Functional Testing Strategies
General Approach: Anatomical Strategies Using Coronary Computed Tomography Angiography
Diagnostic Accuracy of Coronary Computed Tomography Angiography
Integrating Functional and Anatomical Strategies
Summary
41. Ischemic Heart Disease: Basic Principles
Acute Effects Of Myocardial Ischemia
Echocardiographic Detection Of Myocardial Ischemia And Infarction
Myocardial Deformation During Cardiac Ischemia
Patterns Of Ischemia Based On Coronary Artery Involvement
False Indications Of Ischemia On Echocardiography
42. Acute Chest Pain Syndromes: Differential Diagnosis
Left Ventricle
43. Echocardiography in Acute Myocardial Infarction
Left Ventricular Thrombosis
Postinfarction Ventricular Septal Rupture
Left Ventricular Free-Wall Rupture
Acute Mitral Regurgitation And Papillary Muscle Rupture
Left Ventricular Outflow Tract Obstruction
Right Ventricular Infarction
44. Echocardiography in Stable Coronary Artery Disease
Diagnosis
Prognosis
Stress Echocardiography
Image Interpretation
Prognostic Value Of Stress Echocardiography
Speckle Tracking With Stress Echocardiography
Conclusion
45. Old Myocardial Infarction
Timing of Imaging
Risk Factors for Chronic Remodeling
Chronic Remodeling
Viability
Summary
46. End-Stage Cardiomyopathy Due to Coronary Artery Disease
Determining The Cause of Ventricular Dysfunction
Characterization of Left Ventricular Size and Function
Right Ventricle
Left Ventricular Aneurysm
Functional Mitral Regurgitation
47. Coronary Artery Anomalies
Classification of Coronary Artery Anomalies
Multimodality Imaging for Identification of Congenital Coronary Artery Anomalies
Imaging Protocol for Transthoracic Echocardiography
Incidence of Coronary Anomalies Diagnosed by Echocardiography
Perioperative Transesophageal Echocardiography
Conclusions
48. Coronary Artery Imaging
Instructions For Cfv Recording
Diagnostic Value Of Coronary Flow Velocity At Rest
Clinical Utility Of Coronary Flow Velocity Reserve
Conclusions
Section XI. Stress Echocardiography
49. Effects of Exercise, Pharmacologic Stress, and Pacing on the Cardiovascular System
Hemodynamic Effects
Mechanisms Of Ischemia
Left Ventricular Response To Stress
Comparisons Of Stressors
Hypertensive Response To Stress
Stress Echocardiography For Noncoronary Indications
Conclusions
50. Diagnostic Criteria and Accuracy
The Main Sign Of Ischemia: Regional Wall Motion Abnormalities
Stress Echocardiography In Four Equations
Diagnostic Results And Accuracy
False-Negative Results
False-Positive Results
Beyond Regional Wall Motion: The Abcde Protocol Of Stress Echocardiography
Toward Quantitative Stress Echocardiography
Conclusions
51. Stress Echocardiography: Methodology
General Test Protocol
Specific Test Protocols
Exercise
Dobutamine
Dipyridamole
Adenosine
Pacing
The Role of Contrast
52. Stress Echocardiography: Image Acquisition
53. Stress Echocardiography: Prognosis
Evaluation for Obstructive Coronary Artery Disease
Prognostic Implications of the Diastolic Stress Test
Stress Echocardiography In Hypertrophic Cardiomyopathy
Stress Echocardiography to Guide Risk Evaluation Before Major Noncardiac Surgery
Prognostic Role of Stress Echocardiography In Valvular Heart Disease
54. Echocardiography for the Assessment of Myocardial Viability in Ischemic Cardiomyopathy
Introduction and General Concepts
Assessment of Myocardial Viability by Echocardiography
Comparison of Methods Used for Viability Testing
Clinical Implications
55. Ultrasound-Enhanced Stress Echocardiography
Ultrasound-Enhancing Agents for Stress Echocardiography
Optimizing Ultrasound Enhancement During Stress Echocardiography
Physiologic Basis for Examining Myocardial Perfusion with UEAs
Technical Considerations and Components
Role of the Physician
Role of the Imaging Team
Advantages and Disadvantages of Real-Time Perfusion Echocardiography Versus Other Imaging Techniques
Acquisition of Real-Time Perfusion Echocardiography Images
Specific Stress Protocols
Dobutamine Stress Real-Time Perfusion and Left Ventricular Opacification Protocols
Vasodilator Stress Myocardial Perfusion Imaging
Pitfalls and Clinical Tips for all Real-Time Perfusion Echocardiography Stress Acquisitions and Interpretations
Future Directions
56. Stress Echocardiography for Valve Disease: Aortic Regurgitation and Mitral Stenosis
Stress Echocardiography Protocol
Aortic Regurgitation
Prognostic Value of Stress Echocardiography in Aortic Regurgitation
Mitral Stenosis
Prognostic Value of Changes in Transmitral Pressure Gradient and Systolic Pulmonary Artery Pressure
Impact on Clinical Decision Making
57. Stress Echocardiography: Comparison With Other Techniques
Aims of Noninvasive Coronary Imaging
Anatomy Versus Physiology
Coronary Artery Calcium Scoring
Computed Tomography Coronary Angiographyβ
Computed Fractional Flow Reserve Derived from Computed Tomography
Magnetic Resonance Coronary Angiography
Exercise Electrocardiography Stress Testing
Stress Echocardiography
Radionuclide Stress Myocardial Perfusion Imaging
Computed Tomography Perfusion
Cardiovascular Magnetic Resonance Perfusion
Conclusions
Section XII. Hypertrophic Cardiomyopathies
58. Pathophysiology and Variants of Hypertrophic Cardiomyopathy
Anatomic Variants
Pathophysiology
Physiologic Variants
End-Stage Hypertrophic Cardiomyopathy
59. Hypertrophic Cardiomyopathy: Pathophysiology, Functional Features, and Treatment of Outflow Tract Obstruction
Pathophysiology Of Left Ventricular Outflow Tract Obstruction
Mechanisms of Mitral Regurgitation
Functional Features of Obstructive Hypertrophic Cardiomyopathy
Echocardiographic and Doppler Assessment of Obstructive Hypertrophic Cardiomyopathy
Treatment Strategies for Obstructive Hypertrophic Cardiomyopathy
60. Differential of Hypertrophic Cardiomyopathy Versus Secondary Conditions That Mimic Hypertrophic Cardiomyopathy
Hypertensive Heart Disease
Athletes’ Hearts
Infiltrative Disorders of the Myocardium
Isolated Left Ventricular Non-Compaction Cardiomyopathy
Storage Diseases
Syndromic Hypertrophic Cardiomyopathy
61. Hypertrophic Cardiomyopathy: Assessment of Therapy
Pharmacotherapy
Surgical Myectomy
Alcohol Septal Ablation
62. Hypertrophic Cardiomyopathy: Screening of Relatives
Epidemiology of Hypertrophic Cardiomyopathy
Genetics of Hypertrophic Cardiomyopathy
Clinical Screening in Children and Adolescents
Clinical and Echocardiographic Screening in Adults
Findings in Hypertrophic Cardiomyopathy Gene Carriers
63. Apical Hypertrophic Cardiomyopathy
Morphology and Echocardiographic Features
Subtypes
Apical Aneurysms
Summary
64. The Role of Echocardiography in the Screening and Evaluation of Athletes
Exercise-Associated Cardiac Remodeling: the Left Ventricle
Exercise-Associated Cardiac Remodeling: Beyond the Left Ventricle
Detraining
Sudden Cardiac Death and Screening Strategies
Conclusions
65. Echocardiographic Assessment of Myocarditis
Cause of Myocarditis
Transthoracic Echocardiography
Electrocardiogram and Biomarkers
Cardiac Magnetic Resonance Imaging
Role of Endomyocardial Biopsy
Conclusion
Section XIII. Dilated and Other Cardiomyopathies
66. Dilated Cardiomyopathy: Etiology, Pathophysiology, and Echocardiographic Evaluation
Cause
Pathophysiology
Echocardiographic Features
Complementary Role of Alternative Modalities
Future Directions
Conclusion
Acknowledgment
67. Echocardiographic Predictors of Outcome in Patients With Dilated Cardiomyopathy
Left Ventricular Ejection Fraction and Dimensions
Left Ventricular Diastolic Dysfunction
Left Atrial Size
Secondary Mitral Regurgitation
Other Variables: Myocardial Viability, Ischemia, and Dyssynchrony
68. Right Ventricle in Dilated Cardiomyopathy
Pathophysiology of Right Ventricular Dysfunction
Echocardiographic Methods for Evaluating Right Ventricular Size and Function
Studies Evaluating Right Ventricular Function
Doppler S′
Conclusions and Recommendations
69. Restrictive Cardiomyopathy: Classification
70. Echocardiographic Diagnosis of Left Ventricular Noncompaction Cardiomyopathy
Clinical Spectrum Of Left Ventricular Noncompaction Cardiomyopathy
Diagnosis
Echocardiography
Conclusion
71. Hereditary and Acquired Infiltrative Cardiomyopathy
Clinical Spectrum
Diagnosis
Echocardiography
Speckle Tracking
Cardiac Magnetic Resonance
Endomyocardial Biopsy
Infiltrative Cardiomyopathy With The Dilated Phenotype
Conclusions
72. Endomyocardial Fibrosis
Cause
Epidemiology
Pathophysiology, Key Clinical Manifestations, And Disease Course
Physical Examination
73. Restriction Versus Constriction
Cause
Hemodynamics In Constriction And Restriction
Echocardiographic Differentiation Of Constriction And Restriction
74. Echocardiography in Arrhythmogenic Right Ventricular Cardiomyopathy
Two-Dimensional Echocardiography
Strain Quantification
Three-Dimensional Echocardiography
Other Imaging Modalities
Emerging Concepts Regarding Left Ventricular Involvement
Summary
75. Takotsubo Cardiomyopathy
76. Familial Cardiomyopathies
Friedreich Ataxia
Dystrophin Related Cardiomyopathies
Summary
77. Echocardiography in Cor Pulmonale and Pulmonary Heart Disease
Structural Abnormalities
Doppler Findings
Three-Dimensional Echocardiography
Myocardial Strain
Echocardiography And Prognosis
Echocardiography To Monitor Response To Therapy
Conclusion
Section XIV. Aortic Stenosis
78. Aortic Stenosis Morphology
Congenital Aortic Stenosis
Calcific (Degenerative) Aortic Stenosis
Rheumatic Aortic Stenosis
79. Quantification of Aortic Stenosis Severity
Normal Aortic Valve
Quantitative Diagnosis of Aortic Stenosis
Quantitative Doppler Assessment of Severity of Aortic Stenosis
Limitations And Pitfalls In The Echo Doppler Quantitation Of Aortic Stenosis
Planimetry Of Aortic Valve Orifice
Three-Dimensional Assessment Of The Aortic Valve Area
Other Methods Of Measuring Aortic Stenosis Severity
New Classification Scheme For Aortic Stenosis
Serial Evaluation Of Aortic Stenosis
Physiologic Consequences Of Aortic Stenosis
Aortic Valve Sclerosis
80. Asymptomatic Aortic Stenosis
Natural History of Severe Aortic Stenosis
Risk of Deferring Intervention
Features that Predict Increased Risk
Evolving Understanding of the Risk of the Intervention
Future Directions
81. Aortic Stenosis: Risk Stratification and Timing of Surgery
Assessment of Left Ventricular Systolic Function
Unmasking Symptoms in “Asymptomatic” Patients
Other Elements of Echocardiography-Based Risk Stratification
Conclusion
82. Low-Flow, Low-Gradient Aortic Stenosis With Reduced Left Ventricular Ejection Fraction
Usefulness of Dobutamine Stress Echocardiography for Assessment of as Severity and Degree of Myocardial Impairment
Assessing Stenosis Severity
Assessing the Degree of LV Myocardial Impairment
Therapeutic Management of Low-LVEF Low-Flow, Low-Gradient Aortic Stenosis
Conclusions
83. Low-Flow, Low-Gradient Aortic Stenosis With Preserved Left Ventricular Ejection Fraction
Clinical Presentation and Pathophysiology of Paradoxical Low-Flow, Low-Gradient Aortic Stenosis
Conclusion
84. Asymptomatic Severe Aortic Stenosis
Natural History of Asymptomatic Severe Aortic Stenosis
Stress Testing
Outcomes and Future Research
85. Subaortic Stenosis
Epidemiology
Morphology
Cause and Pathophysiology
Diagnosis
Treatment
Acknowledgments
Section XV. Aortic Regurgitation
86. Aortic Regurgitation: Etiologies and Left Ventricular Responses
Anatomy of the Aortic Valve
Etiology of Aortic Regurgitation
Mechanism of Aortic Regurgitation
Left Ventricular Remodeling
87. Aortic Regurgitation: Pathophysiology
Aortic Regurgitation Pathophysiology
Acute Aortic Regurgitation
Chronic Aortic Regurgitation
88. Quantitation of Aortic Regurgitation
Quantitation of Aortic Regurgitation
Conclusions
89. Risk Stratification: Timing of Surgery and Percutaneous Interventions for Aortic Regurgitation
Medical Therapy
Percutaneous Interventional Therapy
Left Ventricular Assist Devices
Surgical Therapy
Decision Algorithms for Surgical Treatment of Aortic Regurgitation
Severe Acute Aortic Regurgitation
Severe Chronic Aortic Regurgitation
Section XVI. Mitral Stenosis
90. Rheumatic Mitral Stenosis
Cause of Mitral Stenosis
Epidemiology
Pathophysiology
Physical Examination
Electrocardiography
Chest Radiography
Transthoracic Echocardiography
Transesophageal Echocardiography
Therapy
91. Quantification of Mitral Stenosis
Mitral Valve Area Measurements
Invasive Method
Echocardiography Methods
Mean Pressure Gradient Measurements
Secondary Changes Caused by Mitral Stenosis
92. Nonrheumatic Etiologies of Mitral Stenosis: Situations That Mimic Mitral Stenosis
Mitral Annular Calcification
Other Nonrheumatic Forms of Acquired Mitral Stenosis
93. Role of Hemodynamic Stress Testing in Mitral Stenosis
Indications for hemodynamic stress testing in mitral stenosis according to the most recent guidelines:
Valvular Stress Echocardiography
Exercise Stress Echocardiography
Dobutamine Stress Echocardiography
Summary
94. Consequences of Mitral Stenosis
Pulmonary Edema
Pulmonary Hypertension
Right Heart Failure
Atrial Arrhythmias
Atrial Thrombus
Low Cardiac Output
Other Valve Involvement
Pregnancy
Complications From Percutaneous Mitral Valvotomy
Valve Repair Surgery
Summary
Section XVII. Mitral Regurgitation
95. Etiologies and Mechanisms of Mitral Valve Dysfunction
Causes of Mitral Valve Disease
Mitral Valve Lesions
Mitral Valve Dysfunction
96. Mitral Valve Prolapse
Etiology
Arrhythmogenic Mitral Valve Prolapse
Diagnosis
Risk Stratification For Surgery
Surgical Mitral Valve Repair
Percutaneous Mitral Valve Repair
Summary
97. Secondary Mitral Regurgitation
Mechanisms
Echocardiographic Assessment of Secondary Mitral Regurgitation
Prognosis
Management of Ischemic Mitral Regurgitation
98. Quantification of Mitral Regurgitation
Echocardiographic Assessment of Mr
Two-Dimensional Proximal Isovelocity Surface Area Method
Two-Dimensional Volumetric Method
Three-Dimensional Echocardiography
Supportive Findings
Cardiac Magnetic Resonance Imaging Role in Mitral Regurgitation Assessment
Summary
Acknowledgments
99. Asymptomatic Severe Mitral Regurgitation
Approach to Asymptomatic Severe Mitral Regurgitation
Surgical Indications in Asymptomatic Patients
Watchful Waiting Versus Early Surgery
Global Longitudinal Strain and Severe Mitral Regurgitation
100. Role of Exercise Stress Testing in Mitral Regurgitation
Exercise Stress Echocardiography Protocol
Primary Mitral Regurgitation
Secondary (Ischemic) Mitral Regurgitation
Other Exercise Testing in Mitral Regurgitation
Section XVIII. Tricuspid and Pulmonic Valve Disease
101. Tricuspid Valve Complex: Anatomy by Two-Dimensional and Three-Dimensional Echocardiography
Tricuspid Valve Anatomy
Imaging of Tricuspid Valve With Two-Dimensional Echocardiography
Imaging of Tricuspid Valve With Three-Dimensional Echocardiography
102. Epidemiology, Etiology, and Natural History of Tricuspid Regurgitation
Epidemiology
Cause and Mechanisms of Tricuspid Regurgitation
Natural History
103. Quantification of Tricuspid Regurgitation
Color Jet Area
Vena Contracta Width
Continuous-Wave Doppler Spectral Tracing
Pulsed-Wave Doppler Flow in the Hepatic Vein
Proximal Isovelocity Surface Area Analysis
104. Indications for Tricuspid Valve Intervention
Severity of Tricuspid Regurgitation
Right Ventricular Function
Late Development of Tricuspid Regurgitation after Mitral Valve Surgery
105. Imaging for Surgical and Percutaneous Tricuspid Valve Procedures
Current Guidelines: Indications for Surgical Intervention and Outcomes
Surgical Tricuspid Valve Intervention
Transcatheter Tricuspid Valve Interventions
Examples of Procedural Guidance for Specific Devices
Future Perspective
Conclusions
106. Device Lead–Associated Tricuspid Regurgitation
Cardiac Implantable Electronic Devices and Tricuspid Regurgitation
Natural History of Cardiac Implantable Electronic Device–Induced Tricuspid Regurgitaton
Mechanisms of Cardiac Implantable Electronic Device–Induced Tricuspid Regurgitaton
Echocardiography in the Diagnosis of Cardiac Implantable Electronic Device–Induced Tricuspid Regurgitaton
Future Directions
107. Pulmonic Regurgitation: Etiology and Quantification
Pulmonic Regurgitation Evaluation Overview
Cause and Mechanism of Pulmonic Regurgitation
Semiquantitative Assessment of the Severity of Pulmonic Regurgitation
Color Doppler
Continuous-Wave Spectral Doppler
Pulsed-Wave Spectral Doppler
M-Mode Echocardiography
Impact of Pulmonic Regurgitation on Cardiac Chambers
108. Tricuspid and Pulmonic Stenosis
Tricuspid Stenosis
Pathophysiology
Diagnosis
Management
Pulmonic Valve Stenosis
Management
Section XIX. Prosthetic Valves
109. Classification of Prosthetic Valve Types and Fluid Dynamics
Different Types of Prosthetic Valves
Tissue Valves
Transcatheter Bioprosthetic Valves
Pressure Recovery
Localized High Gradient in Bileaflet Mechanical Valves
Prosthesis–Patient Mismatch
Conclusion
110. Aortic Prosthetic Valves
Standard Transthoracic Echocardiography Assessment of Aortic Prosthetic Valve Function
Diagnosis of Aortic Prosthetic Valve Dysfunction
Aortic Prosthetic Valve Regurgitation
Summary
111. Mitral Prosthetic Valves
Standard Tte Assessment of Mitral Prosthetic Valve Function
Diagnosis of Mitral Prosthetic Valve Dysfunction
Doppler Detection and Quantitation of Mitral Prosthetic Valve Regurgitation
Optimal Use of Transesophageal Echocardiography
Summary
112. Mitral Valve Repair
Pre–Cardiopulmonary Bypass Transesophageal Echocardiographicexamination
Post–Cardiopulmonary Bypass Transesophageal Echocardiographic Examination
Three-Dimensional Echocardiography for Mitral Valve Surgery
113. Tricuspid and Pulmonic Prosthetic Valves
Tricuspid Valve Prosthesis Dysfunction
Echocardiographic Assessment of Prosthetic Tricuspid Valve Function
Prosthetic Valve Regurgitation
Transesophageal Echocardiography in Patients with Prosthetic Tricuspid Valves
Three-Dimensional Echocardiography
Transcatheter Valve-In-Valve Implantation
Prosthetic Pulmonic Valves
Prosthetic Pulmonary Valve Regurgitation
Section XX. Infective Endocarditis
114. Infective Endocarditis: Role of Transthoracic Versus Transesophageal Echocardiography
Role of echocardiography: transthoracic versus transesophageal echocardiography
Complications of infective endocarditis
115. Echocardiography for Prediction of Cardioembolic Risk
Spectrum of Cardioembolism
Echocardiographic Evaluation
Specific Cardioembolic Clinical Situations
Conditions That Are Low or Uncertain Risk For Cardioembolism
Conclusion
116. Limitations and Technical Considerations in Infective Endocarditis
Echocardiography in Diagnosis of Native Valve Infective Endocarditis
Echocardiography in The Diagnosis of Prosthetic Valve Endocarditis
Echocardiography in Diagnosis of Infective Endocarditis Complications or Perivalvular Extension
117. Echocardiography and Decision Making for Surgery
Transthoracic Echocardiography Versus Transesophageal Echocardiography In Infective Endocarditis
Echocardiography and Surgical Decision Making In Infective Endocarditis
Conclusion
118. Intraoperative Echocardiography in Infective Endocarditis
Section XXI. Pericardial Disease
119. Normal Pericardial Anatomy
Phylogeny and Embryology
Basic Anatomy
Pericardial Thickness
Pericardial Fluid
Intrapericardial Pressure
Intrapericardial Versus Extrapericardial Heart Structures
Pericardial Fat
Pericardial Extensions
120. Pericarditis
Definition
Epidemiology
Etiology
Diagnostic Evaluation
Clinical Features
Electrocardiography
Chest Radiography
Laboratory Studies
Echocardiography
Magnetic Resonance Imaging
Computed Tomographic Imaging
Treatment
121. Pericardial Effusion and Cardiac Tamponade
Normal Anatomy of The Pericardium
Pericardial Effusion
Cardiac Tamponade
Echocardiography-Guided Pericardiocentesis
Summary
122. Constrictive Pericarditis
Demographics and Presenting Symptoms
Pathophysiology
Diagnostics
Echocardiography
Pulsed Doppler Studies
Tissue Doppler
Treatment
123. Effusive Constrictive Pericarditis
Epidemiology
Cause
Pathophysiology
Diagnostic Tests
Other Techniques
Treatment
124. Pericardial Cysts and Congenital Absence of the Pericardium
Pericardial Cysts
Absence of the Pericardium
Section XXII. Tumors and Masses
125. Primary Benign, Malignant, and Metastatic Tumors of the Heart
Tumor Classification and Frequency
Primary Benign Tumors
Primary Malignant Tumors
Metastatic Tumors
Summary
126. Left Ventricular Thrombus
Left Ventricular Thrombus With Impaired Left Ventricular Function
Left Ventricular Thrombus With Preserved Left Ventricular Function
Diagnostic Tests and the Role of Echocardiography
Prognosis and Treatment
Summary
127. Left Atrial Appendage Thrombus
Pathogenesis of Left Atrial Appendage Thrombus Formation
Transesophageal Echocardiographic Diagnosis of Left Atrial Thrombus
Additional Diagnostic Techniques
Cardiac Computed Tomography and Magnetic Resonance Imaging
Clinical Implications of the Diagnosis of Left Atrial Thrombus by Transesophageal Echocardiography
128. Right Heart Thrombi
Incidence
Risk Factors
Echocardiographic Imaging of Right Heart Thrombi
Right Heart Thrombi Morphology
Specific Echocardiography Imaging Strategies for Right Heart Thrombi
Tissue Characterization and Contrast Perfusion
Conventional Management Strategies
Contemporary Management Strategies
Conclusion
129. Normal Anatomic Variants and Artifacts
Crista Terminalis
Eustachian Valve
Chiari Network
Thebesian Valve
Lipomatous Hypertrophy Of The Atrial Septum
Fat Infiltration Of The Tricuspid Annulus
Pectinate Muscles In The Left Atrial Appendage
Prominent Ridge of Tissue Between the Left Atrial Appendage and the Left Upper Pulmonary Vein
Fluid in the Transverse Sinus
Caseous Calcification Of The Mitral Annulus
Artifacts of the Thoracic Aorta
Section XXIII. Diseases of the Aorta
130. Aortic Atherosclerosis and Embolic Events
Transesophageal Echocardiography And Aortic Plaque
Other Imaging Modalities
Clot Embolization Versus Cholesterol Embolization
High-Risk Plaque
Aortic Plaque and Embolic Events in Heart Surgery and Invasive Intravascular Procedures
Management Options
131. Aortic Aneurysm
Cause
Morphology
Diagnosis
Aortic Size
Biomechanical Information
Natural History And Complications
132. Sinus of Valsalva Aneurysm
Clinical Significance
Diagnosis
Treatment
Indications For Surgery
133. Aortic Dissection
History
Classifications of Aortic Dissection
Complications
Long-Term Changes
Diagnosis of Aortic Dissection
Echocardiography in Aortic Dissection
Therapy and Prognosis
134. Penetrating Atherosclerotic Ulcer and Intramural Hematoma
Intramural Hematoma
Clinical Presentation
Noninvasive Imaging Features
Management and Prognosis
Penetrating Atherosclerotic Ulcer
Prognosis and Management
135. Blunt Aortic Trauma
Pathophysiology and Classification
Demographics and Presenting Symptoms
Transesophageal Echocardiographic Findings
Diagnosis
Initial Management
Conclusion
136. Intraoperative Echocardiography
Intraoperative Transesophageal Echocardiography: The Thoracic Aorta
Epiaortic scanning: a solution to the “Blind Spot”
137. Postoperative Echocardiography of the Aorta
Postsurgical Imaging of the Aortic Root and Aorta
Common Aortic Surgical Techniques
Normal Postoperative Features
Complications After Aortic Repair
Composite Graft Dehiscence
Recommendations for Serial Imaging Techniques and Schedules
138. Aortitis
Classification
Giant Cell Arteritis
Imaging In Gca
Summary
Section XXIV. Adult Congenital Heart Diseases
139. Congenital Heart Disease: Basic Principles
140. Systematic Approach to Adult Congenital Heart Disease
History and Natural History
Location of the Scar: “The Scar is the Clue”
Segmental Analysis
Special Pediatric Views and Their Significance
The Role of Transesophageal Echocardiography in an Adult Patient with Congenital Heart Disease
Summary
141. Common Congenital Heart Defects Associated With Left-to-Right Shunts
Atrial Septal Defect
Ventricular Septal Defect
Atrioventricular Septal Defect
Patent Ductus Arteriosus
142. Obstructive Lesions
Anatomy of the Outflow Tracts and Thoracic Aorta
143. The Adult With Unrepaired Complex Congenital Heart Defects
Summary of The Sequential, Segmental Approach To Complex Congenital Heart Disease
Acyanotic Complex Congenital Heart Defects
Limitations in Echocardiographic Assessment of Complex Congenital Heart Disease and the Role of New Technology
144. Adult Congenital Heart Disease With Prior Surgical Repair
Historical Perspective And Timeline
Basic Concepts of Surgical Repair
Important Echocardiographic Considerations In The Postoperative Patient
Representative Case Examples
Section XXV. Systemic Diseases
145. Hypertension
Left Ventricular Size, Chamber Function, And Mass
Cardiac Mechanics
Arterial Dynamics
146. Diabetes Mellitus
Pathophysiology
Time Course Of Diabetes Mellitus: Anatomic And EchocardiographIC Overview
Twist And Torsion As Measures Of Cardiac Function In Diabetes
Right Ventricular Function
Predictors Of Treatment Success And Mortality
147. End-Stage Renal Disease
Epidemiology
Guidelines
148. Obesity
Pathophysiology
Cardiac Assessment By Echocardiography
Technical Issues Associated With Imaging
149. Rheumatic Fever and Rheumatic Heart Disease
Epidemiology
Diagnosis
Therapy
Conclusions
150. Systemic Lupus Erythematosus
Cause And Pathophysiology
Prevalence And Outcome
Diagnostic Approach
Cardiac Manifestations
151. Antiphospholipid Syndrome
Demographics And Presenting Symptoms
Pathophysiology
Diagnostic Approach
Cardiac Manifestations
Management
152. Carcinoid Heart Disease
Carcinoid Heart Disease
Echocardiographic Features Of Carcinoid Heart Disease
Valvular Interventions For Carcinoid Heart Disease
Summary
153. Amyloid
Other Amyloidogenic Proteins
Clinical Presentation
Echocardiographic Features
154. Sarcoidosis
Echocardiographic Findings of Cardiac Sarcoidosis
Novel Echocardiographic Techniques For The Detection Of Cardiac Sarcoidosis
Multimodality Imaging For Cardiac Sarcoidosis
Conclusion
155. Cardiac Involvement in Hypereosinophilic Syndrome
Idiopathic Hypereosinophilic Syndrome
Secondary Hypereosinophilic Syndrome
Demographics and Presenting Symptoms
Pathophysiology
Diagnosis
Treatment
156. Endocrine Disease
Hypothyroidism
Hyperthyroidism
Acromegaly
Hypercortisolism
Hyperaldosteronism
Conclusion
157. Chagas Cardiomyopathy
Epidemiology of Chagas Disease
Pathophysiology of Chagas Disease
Echocardiographic Findings in Acute Chagas Disease
Echocardiographic Findings in Indeterminate Chagas Disease (Stage A)
Echocardiographic Findings in Chronic Chagas Cardiomyopathy (Stages B-D)
158. Sickle Cell Disease
Left Ventricular Structure and Systolic Function
Left Ventricular Diastolic Dysfunction
Pulmonary Hypertension
Other Cardiac Findings
Screening Consideration
Limitations
159. Human Immunodeficiency Virus
Myocardial Disease
Pericardial Disease
Endocardial And Valvular Disease
Cardiac Tumors
Pulmonary Hypertension
Atherosclerosis
160. Cardiotoxic Effects of Cancer Therapy
Cancer Therapeutics–Related Cardiac Dysfunction
Anthracycline–Mediated Cardiac Dysfunction
Trastuzumab–Associated Cardiac Dysfunction
Combined Chemotherapy
Echocardiographic Evaluation of Patients Receiving Cancer Therapy
Conclusions
161. Pregnancy and the Heart
Physical Examination Findings In Normal Pregnancy
Physiologic Changes With Pregnancy
Echocardiographic Findings During Normal Pregnancy
Final Interpretation of Echocardiographic Findings In Uncomplicated Pregnancy
162. Cocaine
Pathophysiology
Clinical Assessment
Echocardiography
Cocaine Use In Pregnancy
Treatment
163. Incidental Noncardiovascular Findings on Echocardiography
Heart and Pericardium
Lungs and Pleural Space
Stomach and Colon
Conclusions
Section XXVI. Interventional Echocardiography
164. Evaluation of Patients Undergoing Transcatheter Aortic Valve Replacement
Patient Selection
Preprocedural Imaging
Procedural Imaging
Postprocedural Follow-Up
165. Mitral Valve Balloon Valvuloplasty
Patient Selection For Mitral Valve Balloon Valvuloplasty
Determining The Cause Of Mitral Stenosis
Determining Ms Severity
Conclusions
166. Percutaneous Mitral Edge-to-Edge Repair
Indications
Transesophageal Echocardiography
Procedure
Conclusions
167. Transcatheter Mitral Valve Replacement
Transcatheter Replacement of Failed Surgical Mitral Valve Repairs and Bioprostheses
Transcatheter Replacement of Native Mitral Valve
Transcatheter Mitral Valve Replacement for Noncalcific Native Mitral Valve Disease
168. Transcatheter Valve-in-Valve Implantation
Valve-in-Valve Procedure
Imaging
Procedural Guidance
Complications
Conclusion
169. Atrial and Ventricular Septal Defect Closure
Atrial Septal Defect Closure
Ventricular Septal Defect Closure
170. Transcatheter Closure of Cardiac Pseudoaneurysms
Pathophysiology of Left Ventricular Pseudoaneurysm
Echocardiographic Imaging
Other Imaging Modalities
Clinical Course and Treatment Options
Conclusion
171. Echocardiographic Imaging of Left Atrial Appendage Occlusion
Left Atrial Appendage Anatomy Specific to Left Atrial Appendage Occlusion
Surgical Left Atrial Appendage Closure
Common Steps for all Percutaneous Left Atrial Appendage Occlusion Procedures
Postprocedural Follow-Up Transesophageal Echocardiography
Conclusions
172. Periprosthetic Leaks
Closure Devices
Preprocedural Planning
Interventional Echocardiography
Intraprocedural Guidance
Postdeployment Detection of Complications
Follow-Up
Conclusion
173. Echocardiography-Guided Biopsy of Intracardiac Masses
Technique of Echocardiography Guidance
174. Vacuum Extraction of Intracardiac Masses
Angiovac
Other Devices
Conclusions
Section XXVII. Echocardiography in Heart Failure
175. Systematic Echocardiographic Approach to Left Ventricular Assist Device Therapy
The Left Ventricular Assist Device
Left Ventricular Assist Device Imaging Protocol
Left Heart Chamber Size and Function and Interventricular Septum Position
The Right Ventricle
The Aortic Valve
Mitral And Tricuspid Regurgitation
Inflow Cannula
Outflow Cannula
Recovery of The Myocardium
Echocardiographic Assessment of Left Ventricular Assist Device Complications
Ramp Studies
Summary
176. Extracorporeal Membrane Oxygenation, Impella, and Other Circulatory Mechanical Support
Mechanical Circulatory Support
Extracorporeal Membrane Oxygenation
Impella
Intraaortic Balloon Pump
Tandemheart
Rv Support
177. Post Heart Transplant Echocardiographic Evaluation
Screening
Perioperative Monitoring
Posttransplantation Surveillance
Early Allograft Failure
Acute Graft Rejection
Chronic Graft Rejection
178. Pulmonary Hypertension
Clinical Manifestations
Definitions of Pulmonary Hypertension: Invasive and Noninvasive
Echocardiography Assessment of Pressures
Definition of Physiologies
Echocardiographic Assessment of Physiologies
Acute Rises in Pulmonary Vascular Resistance
Echocardiography Prediction of Prognosis
Echocardiography Assessment of Therapy
Conclusion
179. Echocardiography in Patients With Heart Failure With Preserved Ejection Fraction
Pathophysiology
Phenotyping
Diagnostic Value
Prognostic Value
Conclusions
Index

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