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Contents
Chapter 1
INSTRUMENTATION
Physical Properties of Ultrasound 1
Transducers and the Production of Ultrasound Beams 3
Principles of M-mode and Two-dimensional
Echocardiography 7
Variables Involved in Real-time Sector Scanning 14
Signal Processing 15
Echocardiographic Imaging Controls 16
Factors Influencing Resolution 19
Potential Artifacts 22
Side Lobes 22
Reverberations 24
Shadowing 25
Near Field Clutter 26
Principles of Doppler Echocardiography 26
Doppler Display 32
Physiologic Information Obtained with Doppler
Echocardiography 35
Doppler Controls 36
Technical Limitations of Doppler Flow Imaging 40
Transthoracic Transducers 42
Transesophageal Transducers 43
Intravascular Transducers 45
Other Transducers 47
Contrast Echocardiography 47
Digital Echocardiography 49
Computer Manipulation of Echocardiographic
Recordings 51
Tissue Identification Using Ultrasound 52
Three-dimensional Echocardiography 53
Biologic Effects of Ultrasound 59
Chapter 2
THE ECHOCARDIOGRAPHIC EXAMINATION
Selection of Transducers 68
Position of the Patient 68
Placement of the Transducer 69
Two-dimensional Examination 71
Normal Variants 85
Terminology for Two-Dimensional
Echocardiography 85
Orientation of Two-Dimensional Images 87
Identification of Myocardial Wall Segments 88
M-mode Examination 90
Doppler Echocardiography 95
Doppler Flow Imaging 101
Transesophageal Echocardiography 106
Transesophageal Echocardiographic Views 107
Intravascular Ultrasonic Examination of the Heart 114
Intraoperative Echocardiography 115
Echocardiographic Monitoring of Invasive
Procedures 115
Digital Echocardiography 116
Stress Echocardiography 118
Contrast Echocardiography 119
Principles of Echocardiographic Measurements 123
Chapter 3
ECHOCARDIOGRAPHIC EVALUATION OF CARDIAC CHAMBERS
Left Ventricle 134
Intracavitary Dimensions, Areas and Volumes 134
Global Systolic Function 143
Regional Systolic Function 147
Diastolic Function 151
Wall Thickness, Mass, and Stress 155
Right Ventricle 158
Right Ventricular Dimensions. Areas, and Volumes 158
Global Systolic Function 160
Echocardiographic Findings with Right Ventricular
Overload 161
Diastolic Function 163
Left Atrium 166
Left Atrial Dimensions, Areas, and Volumes 166
Left Atrial Function 170
Right Atrium 173
Chapter 4
HEMODYNAMIC INFORMATION DERIVED FROM ECHOCARDIOGRAPHY
Echocardiographic Determination of Blood Flow 181
Aortic Flow 184
Pulmonary Artery Flow 187
Mitral Valve Flow 188
Left Atrial Flow 188
Tricuspid Valve Flow 192
Cardiac Output 194
Regurgitant Fraction 194
Shunt Ratios 194
Echocardiographic Detection of Stagnant Blood 194
Modified Bernoulli Equation and Intravascular
Pressures 195
Other Echocardiographic Findings with Altered
Intravascular Pressure 198
Elevated Left Ventricular Diastolic Pressure 198
Left Atrial Pressure 201
Pulmonary Hypertension 201
Right Ventricular Pressure 206
Right Atrial Pressure 210
Chapter 5
ECHOCARDIOGRAPHIC FINDINGS WITH ALTERED ELECTRICAL ACTIVATION
Abnormal Ventricular Depolarization 216
Bundle Branch Block 216
Wolff-Parkinson-White (WPW) Syndrome 219
Ectopic Rhythm 221
Ventricular Ectopy 221
Supraventricular Ectopy 225
Abnormal Ventricular Conduction 233
Pacemakers 233
Chapter 6
ACQUIRED VALVULAR HEART DISEASE
Mitral Valve Disease 239
Mitral Stenosis 239
Balloon Mitral Valvotomy 249
Mitral Regurgitation 251
Mitral Valve Prolapse 262
Papillary Muscle Dysfunction 269
Flail Mitral Valve 270
Aortic Valve Disease 273
Aortic Stenosis 273
Aortic Regurgitation 282
Tricuspid Valve Disease 292
Tricuspid Stenosis 292
Tricuspid Regurgitation 293
Pulmonary Valve Disease 297
Prosthetic Valves 297
Normal Function 300
Stenosis 302
Regurgitation 307
Complications 311
Endocarditis 315
Calcified Mitral Annulus 325
Chapter 7
CONGENITAL HEART DISEASE
The Echocardiographic Examination: A Segmental
Approach to Anatomy 351
Cardiac Situs 351
Ventricular Morphology 352
Great Artery Connections 353
Abnormalities of Right Ventricular Inflow 354
Right Atrium 354
Right Ventricular Inflow 354
Abnormalities of Left Ventricular Inflow 357
Pulmonary Veins 357
Left Atrium 358
Mitral Valve 360
Abnormalities of Right Ventricular Outflow 361
Right Ventricle 361
Pulmonary Valve 363
Pulmonary Artery 365
Abnormalities of Left Ventricular Outflow 366
Subvalvular Obstruction 366
Valvular Aortic Stenosis 368
Supravalvular Aortic Stenosis 370
Coarctation of the Aorta 371
Abnormalities of Cardiac Septation 374
Atrial Septal Defect 374
Ventricular Septal Defect 384
Endocardial Cushion Defect 392
Abnormal Vascular Connections and Structures 393
Patent Ductus Arteriosus 393
Abnormal Systemic Venous Connections 394
Abnormal Pulmonary Venous Connections 401
Abnormalities of the Coronary Circulation 404
Conotruncal Abnormalities 406
Tetralogy of Fallot 406
Transposition of the Great Arteries 407
Double-outlet Right Ventricle 415
Persistent Truncus Arteriosus 418
Abnormalities of Ventricular Development 419
Hypoplastic Left Heart Syndrome 420
Single Ventricle 420
Tricuspid Atresia 424
Echocardiographic Evaluation During and After
Surgery 426
Systemic Artery to Pulmonary Artery Shunts 426
Pulmonary Artery Bands 427
The Fontan Procedure 428
Left Ventricular Apex to Descending Aorta
Conduits 429
Right Ventricle to Pulmonary Artery Conduits 429
Fetal Echocardiography 431
Chapter 8
CORONARY ARTERY DISEASE
Detection of Ischemic Muscle 447
Segmental Wall Motion Abnormalities 447
Relationship of Wall Motion and Wall Thickening
Abnormalities to Coronary Artery Perfusion 451
Quantitation of Ischemic Muscle 452
Assessment of Overall Performance of the Ischemic
Left Ventricle 454
Detection of Reversible Ischemia 457
Stress Echocardiography 457
Coronary Artery Spasm 463
Coronary Reperfusion 463
Myocardial Infarction 465
Detecting and Assessing Myocardial Infarction 465
Prognosis Following Myocardial Infarction 466
Complications of Myocardial Infarction 466
Infarct Extension and Expansion 466
Ventricular Aneurysm 468
Ventricular Pseudoaneurysm 469
Ventricular Septal Defect 471
Mural Thrombi 476
Mitral Regurgitation 478
Right Ventricular Infarction 480
Examination of the Coronary Arteries 482
Coronary Atherosclerosis 482
Kawasaki Disease 487
Congenital Anomalies of the Coronary Arteries 487
Myocardial Perfusion Using Contrast
Echocardiography 490
Chapter 9
DISEASES OF THE MYOCARDIUM
Hypertrophic Cardiomyopathy 511
Asymmetric Hypertrophy 511
Left Ventricular Outflow Obstruction 514
Evaluation of Therapy 526
Idiopathic Dilated Cardiomyopathy 526
Restrictive Cardiomyopathy 528
Infiltrative Cardiomyopathy 532
Fibroplastic Cardiomyopathy 535
Myocardial Disease Associated with Neuromuscular
Disorders 535
Cardiac Abnormalities and Infectious Agents 536
Myocardial Dysfunction and Toxic Agents 538
Cardiac Abnormalities Resulting from Trauma 538
Effect of Systemic Illnesses on the Heart 538
Cardiac Transplantation 540
Chapter 10
PERICARDIAL DISEASE
Pericardial Effusion 556
Detection of Pericardial Fluid 556
Differentiation Between Pericardial and Pleural
Effusions 557
Quantitation of Pericardial Fluid 558
Cardiac Tamponade 561
Cardiac Motion with Pericardial Effusion 565
Etiology of Pericardial Effusion 570
Pericardiocentesis 573
Acute Pericarditis 574
Thickened Pericardium 577
Constrictive Pericarditis 577
Pericardial Cysts 583
Absent Pericardium 583
Chapter 11
CARDIAC MASSES
Normal Variants 589
Masses of Questionable Clinical Significance 589
Primary Cardiac Neoplasms 599
Noncardiac Neoplasms Invading the Heart 605
Extracardiac Masses 607
Intracardiac Thrombi 609
Other Masses 615
Ultrasonic Tissue Typing of Cardiac Masses 617
Manmade Objects in the Heart 617
Probe Patent Foramen Ovale 619
Summary 621
Chapter 12
DISEASES OF THE AORTA
Aortic Dilatation and Aneurysms 630
Aortic Dissection 631
Aortic False Aneurysms 643
Sinus of Valsalva Aneurysms 646
Traumatic Damage to the Aorta 648
Infections of the Aorta 652
Aorta-Left Ventricular Tunnel 652
Aortic Atherosclerosis 653
APPENDIX 658
INDEX 685
