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Table of Contents
Preface x
Abbreviations xi
List of Tables xiii
Valvular Heart Disease 1
Mitral Stenosis 2
Mitral Regurgitation 13
Mitral Valve Prolapse 23
Valvular Aortic Stenosis 32
Bicuspid Aortic Valve 35
Degenerative/Rheumatic 36
Aortic Regurgitation 43
Tricuspid Stenosis 52
Tricuspid Regurgitation 57
Tricuspid Valve Prolapse 65
Pulmonary Regurgitation 67
Infective Endocarditis 72
Prosthetic Heart Valves 81
Prosthetic Heart Valves 82
Bioprosthetic Valves 83
Mechanical Valves 89
Pericardial Disease 101
Pericarditis/Pericardial Effusion 102
Cardiac Tamponade 108
Constrictive Pericarditis 115
Hypertensive Heart Disease 121
Systemic Hypertension 122
Pulmonary Hypertension 129
Cardiomyopathies 135
Dilated Cardiomyopathy 136
Hypertrophic Cardiomyopathy 142
Restrictive Cardiomyopathy 154
Idiopathic Hypereosiniphilic Syndrome 156
Amyloidosis 158
Sarcoidosis 161
Hemochromatosis 163
Primary Hemochromatosis 163
Secondary Hemochromatosis 164
Ischemic Heart Disease 167
Ischemic Heart Disease 168
Post-infarction Pericarditis/Pericardial Effusion 174
Dressler's Syndrome 175
Left Ventricular True Aneurysm 175
Pseudoaneurysm/False Aneurysm 178
Left Ventricular Thrombus 180
Ventricular Septal Rupture 182
Papillary Muscle Dysfunction 184
Right Ventricular Infarction 187
Cardiogenic Shock 190
Cardiac Tumors 191
Myxoma 192
Papillary Fibroelastoma 198
Lipoma 199
Lipomatous Hypertrophy of the Interatrial Septum
200
Fibroma 200
Rhabdomyoma 201
Sarcomas 202
Angiosarcomas 202
Rhabdomyosarcomas 203
Secondary Tumors (Metastatic) 203
Pericardial Cysts 204
Extracardiac Tumors . 204
Carcinoid Heart Disease 205
Evaluation of the Left Atrium 209
Evaluation of Left Ventricular Systolic Function 213
Left Ventricular Diastolic Function 217
Congenital Heart Disease 227
Atrial Septal Defect 228
Atrioventricular Septal Defect 235
Ventricular Septal Defect 239
Patent Ductus Arteriosus . 244
Ebstein's Anomaly 249
Valvular Pulmonic Stenosis 253
Tetralogy of Fallot 258
Congenitally Corrected Transposition of Great
Arteries 263
Coarctation of the Aorta 267
Eisenmenger's Syndrome 272
Repairs and Palliations 276
Atrial Septal Defect Repair 276
Blalock-Hanlon (Atrial Septectomy) 276
Blalock-Taussig 277
Damus-Kaye-Stansel 278
Fontan 279
Glenn 280
Jatene (Arterial Switch) 281
Konno Rastan (Aortoventriculoplasty) 282
Mustard/Senning (Atrial switch) 283
Norwood 284
Pulmonary Artery Banding 285
Rastelli 286
Ross Procedure 287
Ventricular Septal Defect Repair 288
Waterston/Potts 289
Diseases of the Aorta 291
Aortic Aneurysms 292
Aortic Dissection 296
Sinus of Valsalva Aneurysm 302
Supravalvular Aortic Stenosis (SAS) 306
Cardiac Transplantation 307
Cardiac Transplantation 308
Miscellaneous 313
Acquired Immune Deficiency Syndrome (AIDS) 316
Acromegaly 316
The Aging Heart 317
Ankylosing Spondylitis 318
Anomalous Origin of the Left Coronary Artery from
the Pulmonary Artery 318
Aortic Atherosclerotic Plaques 319
Arrhythmogenic Right Ventricular Cardiomyopathy
319
Athlete's Heart 320
Beckwith-Wiedemann Syndrome 321
Beriberi Disease 321
Carnitine Deficiency 321
Chagas Disease 322
Cocaine 323
Congenital Absence of the Pericardium 323
Congestive Heart Failure 324
Cor Pulmonale 325
Cor Triatriatum 325
Cushing's Disease 326
Diabetes 326
Discrete Subaortic Stenosis 326
Diverticulosis of the Left Ventricle 327
Double Orifice Mitral Valve . 327
Ectopic Chordae/False Tendon/
Chordal Web/Aberrant Bands 328
Ehlers-Danlos Syndrome 328
Fabry's Disease 329
Flail Mitral Valve 329
Friedreich's Ataxia 330
Gaucher's Disease 330
Gerbode's Defect 331
Glycogen Storage Disease 331
Holt-Oram Syndrome 332
Hyperlipidemia 332
Hyperthyroidism 333
Hypothyroidism 333
Isolated Noncompaction of Ventricular Myocardium
333
Kawasaki Syndrome 334
Kearns-Sayre Syndrome 334
Left Bundle Branch Block 334
Leopard Syndrome 335
Lung Transplantation 335
Lyme Disease 335
Marfan's Syndrome 336
Mitral Valve Supravalvular Stenosing Ring 336
Morquio's Syndrome 337
Non-communicating Intramural Hemotoma 337
Noonan's Syndrome 338
Obesity 338
Osler-Weber-Rendu Disease 339
Parachute Mitral Valve 339
Penetrating Aortic Ulcer 340
Persistent Left Superior Vena Cava 340
Phen-Fen 340
Pompe's Disease 341
Pregnancy 341
Pulmonary Embolism 342
Pulsus (Mechanical) Alternans 342
Renal Failure 343
Rheumatoid Arthritis 343
Scimitar Syndrome 343
Scleroderma 344
Shone's Complex 344
Syncope 345
Systemic Lupus Erythematosus 345
Takayasu's Disease 346
Traumatic Heart Disease 346
Uhl's Anomaly (Parchment Heart) 347
ValvularStrands 347
Weight Reduction 347
Stress Echocardiography 349
Exercise Echocardiography 350
Dobutamine Stress Echocardiography 357
Transesophageal Echocardiography 363
Transesophageal Echocardiography 364
Contrast Echocardiography 371
Contrast Echocardiography 372
Prediction of Intracardiac Pressures 375
Prediction of Intracardiac Pressures 376
Values and Formulas 381
Doppler Formulas at a Glance 382
Left Ventricular Systolic Function 383
Isovolumic Relaxation Time (IVRT) 385
Left Ventricular Diastolic Function 386
Left Atrial Pressure, Pulmonary Wedge
Pressure 389
Valvular Stenosis 390
Valvular Regurgitation 395
Mitral Regurgitation 395
PISA Method: ERO and Regurgitant
Volume 395
Aortic Regurgitation 398
Shunts 400
Pulmonary Hypertension 400
Doppler Numbers at a Glance 402
Left Ventricular Systolic Function 402
Left Ventricular Diastolic Function 403
Valvular Stenosis 404
Valvular Regurgitation 406
Pulmonary Hypertension 410
Prosthetic Heart Valves 411
M-Mode Numbers at a Glance 414
2-D Numbers at a Glance 416
Aortic Diameter 416
Left Atrial Dimensions 416
Left Ventricular Dimensions 417
Right Atrial Dimensions 419
Right Ventricular Dimensions 419
Pulmonary Artery Dimensions (end-diastole)
420
Inferior Vena Cava (end-diastole) 420
Aortic Arch 420
Oxygen Saturations 420
Pressure Values 421
Echo/Doppler Measurements and Calculations:
A "How To" Section 423
M-Mode Measurements 424
Aortic Valve and Aortic Root 424
MitralValve 425
Left Ventricle 426
Standard 2-D Views 427
2-D Echocardiographic Measurements 429
Biplane Simpson's Method of Discs 431
Left Ventricular Mass 432
Mitral Valve Area (WA) by 2-D Planimetry
433
Normal Doppler Tracings 434
Doppler Measurements and Calculations 436
Bernoulli Equation (simplified) 436
Bernoulli Equation (lengthened) 436
Mean Pressure Gradient 437
RV Systolic Pressure (RVSP) 437
RV Systolic Pressure (RVSP) in the Presence
of a Ventricular Septal Defect (VSD) 438
Systolic Pulmonary Artery Pressure (SPAP)
in the Presence of a Patent Ductus Arteriosus
(PDA) 438
Mean Pulmonary Artery Pressure (MPAP)
Utilizing RVOT Acceleration Time 439
Pulmonary Artery End-Diastolic Pressure
(PAEDP) 439
IV Stroke Volume 440
Aortic Valve Area (AVA) by the Continuity
Equation 441
Mitral Valve Area (MVA) by the Continuity
Equation 443
Mitral Regurgitation 445
Aortic Regurgitation 447
Qp/Qs 450
Mitral Valve Area (MVA) by the
Pressure Half Time (PHT) Method 452
Mitral Valve Area (MVA) by the
Deceleration Time (DT) Method 453
Mitral Valve Area (MVA) by the PISA
(Proximal Isovelocity Surface Area) Method
454
Mitral Regurgitation(PISA) 455
Simplified PISA Methods 456
Left Ventricular Diastolic Function 458
Isovolumic Relaxation Time (IVRT) 460
Pulmonary Vein Flow 461
Valsalva Maneuver 462
Hepatic Vein Flow 463
Information Resources 464
List of Tables
Table l: Echo Score Index for Mitral Stenosis 8
Table 2: Mitral Stenosis Severity Scales 12
Table 3: Evaluation of Mitral Regurgitation by
Echocardiography: A Top Ten List 15
Table 4: Guide for Quantitating the Severity of Mitral
Regurgitation 20
Table 5: Mitral Regurgitation Severity Scales 22
Table 6: Aortic Stenosis Severity Scales 42
Table 7: Aortic Regurgitation Severity Scales 51
Table 8: Tricuspid Stenosis Severity Scales 56
Table 9: Tricuspid Regurgitation Severity Scales 64
Table 10: Pulmonary Regurgitation Severity Scales 71
Table 11: Duke Clinical Criteria for Diagnosis of Infective
Endocarditis 78
Table 12: Definitions of Terms Used in the Duke Criteria
for the Diagnosis of Infective Endocarditis
(IE) 79
Table 13: Normal Doppler Values for Bioprosthetic Valves
98
Table 14: Normal Doppler Values for Mechanical Valves
99
Table 15: Pericardial Effusion Severity Scales 107
Table 16: Echocardiographic Findings for Cardiac
Tamponade 114
Table 17: Echocardiographic Findings for Constrictive
Pericarditis 120
Table 18: Left Ventricular Hypertrophy Severity Scales 128
Table 19: Pulmonary Hypertension Severity Scales 134
Table 20: Classification of Restrictive Cardiomyopathy 154
Table 21: Normal Left Atrial Dimensions 211
Table 22: Normal 2-D Left Ventricular Dimensions, Areas
and Volumes 216
Table 23 Left Ventricular Systolic Function Doppler
Parameters 216
Table 24: Normal Diastolic Function 219
Table 25: Pulmonary Stenosis Severity Scale 257
Table 26: Congenital Cardiac Lesions Complicated by
Eisenmenger's 272
Table 27: Proposed Echocardiographic Indications of
Rejection in Cardiac Transplantation 311
Table 28: Proposed Abnormal Findings in Athlete's Heart
320
Table 29: Calculating Target Heart Rates 351
Table 30: Two-Phase Exercise Echo Protocol at a Glance
353
Table 31: Wall Motion Score Index 355
Table 32: Interpretation by Segmental Wall Motion Analysis
356
Table 33: Dobutamine Stress Echo Protocol at a Glance 358
Table 34: Transesophageal Echocardiography Cross
Sections 369
Table 35: Echocardiographic Contrast Agents 372
Table 36: Technical Guidelines for Left Ventricular
Opacification Harmonic Contrast Studies 373
Table 37: Mitral Inflow Velocities and Diastolic Parameters
in Normal Subjects 388
Table 38: Pulmonary Venous Flow Velocities in 85 Normal
Subjects, Stratified by Age in Decades 388
Table 39: Normal Doppler Data for Prosthetic Mitral Valves
411
Table 40: Normal Doppler Data for Prosthetic Aortic Valves
412
