Making Sense of Echocardiography. A Hands-on Guide

Cover
Half Title
Series Page
Title Page
Copyright Page
Dedication
Contents
Preface
Acknowledgements
Author
Acronyms and Abbreviations
PART I: Essential principles
	1. History of echocardiography
	2. Cardiac anatomy and physiology
	3. Physics and instrumentation
		ELEMENTARY PHYSICS
			Figure 3.1 An ultrasound wave.
			Table 3.1 Propagation velocities in various body tissues
		ULTRASOUND PROPAGATION
			Figure 3.2 Specular reflection and backscatter.
		ULTRASOUND TRANSDUCERS
			Figure 3.3 Structure of an ultrasound transducer.
	4. Doppler physics
		DOPPLER PRINCIPLES
		SPECTRAL DOPPLER
			Figure 4.1 The Doppler effect.
			Figure 4.2 Spectral Doppler display (showing mitral regurgitation).
			Continuous wave Doppler
			Pulsed-wave Doppler
				Figure 4.3 Continuous wave Doppler imaging, showing mitral stenosis and regurgitation.
				Figure 4.4 Pulsed-wave (PW) Doppler imaging, showing sample volume. Abbreviation: LV: Left ventricle.
				Figure 4.5 Pulsed-wave Doppler imaging in the left ventricular outflow tract.
		FLUID DYNAMICS
	5. Myocardial mechanics
	6. Service provision
PART II: Cardiac imaging techniques
	7. The standard transthoracic echo study
	8. Transoesophageal echo
	9. Stress echo
		PRINCIPLES OF STRESS ECHO
		INDICATIONS FOR STRESS ECHO
			CONTRAINDICATIONS TO A STRESS ECHO STUDY
		PATIENT PREPARATION
		ACQUIRING THE STRESS ECHO IMAGES
			Figure 9.1 Stress echo ‘quad screen’ view.
			Figure 9.2 Stress echo wall motion scores. Abbreviation: WMSI: Wall motion score index.
		STRESS PROTOCOLS
			Dobutamine stress
			Vasodilator stress
		STRESS ECHO AND VALVULAR DISEASE
		AFTER THE STRESS ECHO STUDY
		Further reading
	10. Contrast echo
	11. Tissue Doppler imaging
		PERFORMING TDI
			TDIPulsed-wave TDI
				Figure 11.1 Positioning of sample volume for pulsed-wave tissue Doppler imaging (TDI) of the mitral annulus.Abbreviations: LA: Left atrium, LV: Left ventricle.
				Figure 11.2 Pulsed-wave trace of medial mitral annulus (septal wall) obtained with tissue Doppler imaging(TDI).
			colour TDI
			Figure 11.3 Colour tissue Doppler imaging. Abbreviation: LV: Left ventricle.
		CLINICAL APPLICATIONS OF TDI
			LV systolic function
			Myocardial deformation
				Table 11.1 Reference intervals for S′ and e′ obtained using tissue Doppler imaging
			RV systolic function
			LIMITATIONS OF TDI
		Further reading
	12. Speckle tracking
		BASIC PRINCIPLES
			Figure 12.1 Tracking the kernel location between frames. (a) In Frame 1, the kernel (red box) identifies thespeckle pattern of interest. (b) In the second frame of the cine loop, the software then looks for the best matchwithin the search area (white box).
			Figure 12.2 The normal curves for (a) longitudinal velocity, (b) longitudinal strain, (c) longitudinal strain rateand (d) radial strain. Note that the longitudinal velocity and longitudinal strain rate curves are almost mirrorimages, and also that longitudinal strain and radial strain are also almost mirror images of each other.
			ROTATIONAL MECHANICS
		SEGMENTAL AND GLOBAL VALUES
		CLINICAL APPLICATIONS OF SPECKLE TRACKING
		Further reading
	13. 3D echo
		3D TECHNOLOGY
			Figure 13.1 The ultrasound beam from a 3D matrix array transducer is steered in two different planes to createa pyramidal volume dataset.
		ACQUISITION MODES
			Real-time (live) 3D imaging
				Figure 13.2 Live 3D image (right-hand panel) of a parasternal long-axis view obtained from a single beat.
			Multi-beat imaging
				Figure 13.3 Live 3D zoom view. The left-hand panel shows the crop box placed on the structure of interest(mitral valve) on a pre-acquired image. The right-hand panel shows the live 3D zoom view of the mitral valve asviewed from the left atrium.
				Figure 13.4 Multiplane imaging. Simultaneous display of four-, two- and three-chamber (apical long-axis)views from a single acquisition from the apex. Contrast has been administered to improve endocardialdefinition.
			LIMITATIONS AND FUTURE DIRECTIONS
			Further reading
		SELECTING AN ACQUISITION MODE
		THE 3D EXAMINATION
			Table 13.1 Recommended views for assessing cardiac structures in 3D echo
		POST-PROCESSING
			Figure 13.5 (a) Volume-rendered full-volume image acquired over four cardiac cycles. Structures within thevolume dataset are not easy to visualize without post-processing. (b) The dataset has been cropped to view afive-chamber view. (c) The dataset has been cropped and rotated to show mitral, tricuspid and aortic valves.
		IMAGE DISPLAY
			Volume rendering
				Figure 13.6 Volume-rendered displays. (a) 2D tomographic slice of a prosthetic mitral valve. (b) Live 3Dimage from a similar angle. (c) Live 3D zoom view (cropped and rotated to show the surgical view).
			Surface rendering
				Figure 13.7 Surface-rendered display. Semiautomatic tracking of the endocardium using dedicated softwareto create a cast of the left ventricle. Systolic and diastolic volumes are calculated by the software.
			2D tomographic slices
				Figure 13.8 Multiple short-axis views obtained by transecting a full-volume dataset of the left ventricle.
		3D ECHO ARTIFACTS
			Stitching artifact
			Figure 13.9 Stitching artifacts caused by respiratory motion in a ventilated patient.
			Dropout artifact
		CLINICAL APPLICATIONS OF 3D ECHO
			97Assessment of ventricular size and function
			Assessment of morphology and function
			Guiding interventional procedures
		LIMITATIONS AND FUTURE DIRECTIONS
		Further reading
	14. Intravascular ultrasound and epicardial echo
	15. Alternative cardiac imaging techniques
PART III: Clinical cases
	16. The left ventricle and its systolic function
	17. Coronary artery disease and regional left ventricular function
	18. Left ventricular diastolic function
	19. The left atrium
	20. The aortic valve
		valveECHO VIEWS OF THE AORTIC VALVE
			Figure 20.1 M-mode of normal aortic valve. Abbreviations: Ao: aorta, LA: Left atrium, NCC: Non-coronarycusp, RCC: Right coronary cusp.
		AORTIC STENOSIS
			Causes of aortic stenosis
				Table 20.1 Clinical features of aortic stenosis
			Clinical features of aortic stenosis
			Echo assessment of aortic stenosis
				2D and M-mode
					Figure 20.2 Moderate aortic stenosis. Abbreviations: LA: Left atrium, LV: Left ventricle.
				Colour Doppler
				CW and PW Doppler
					Figure 20.3 Doppler assessment of valve gradient in moderate aortic stenosis. Abbreviations: AVA: Aorticvalve area, PG: Pressure gradient, Vmax: Peak velocity, Vmean: Mean velocity, VTI: Velocity time integral.
					PEAK-TO-PEAK AND INSTANTANEOUS GRADIENTS
					COMMON PITFALLS
					Associated features
					Severity of aortic stenosis
						Table 20.2 Indicators of aortic stenosis severity
				Management of aortic stenosis
					Echo surveillance
					Drug therapy
		AORTIC REGURGITATION
			Causes of aortic regurgitation
			Clinical features of aortic regurgitation
				Table 20.3 Clinical features of aortic regurgitation
			Echo assessment of aortic regurgitation2D
			Echo assessment of aortic regurgitation
				2D and M-mode
				Figure 20.4 Aortic regurgitation causing ‘fluttering’ of anterior mitral valve leaflet.
			Colour Doppler
				Figure 20.5 Aortic regurgitation (colour Doppler).
			CW and PW Doppler
				Figure 20.6 Aortic regurgitation (CW Doppler).
			Regurgitant volume
			Proximal isovelocity surface area assessment
			Associated features
			Severity of aortic regurgitation
				Table 20.4 Indicators of aortic regurgitation severity
			MANAGEMENT OF AORTIC REGURGITATION
		Further reading
	21. The mitral valve
		ECHO VIEWS OF THE MITRAL VALVE
			Figure 21.1 M-mode of normal mitral valve. Abbreviations: LV: Left ventricle, MV: Mitral valve, RV: Rightventricle.
			Figure 21.2 Mitral valve scallops, as seen in the parasternal short-axis view.
		Mitral stenosis
			MITRAL ANNULAR CALCIFICATION
			Clinical features of mitral stenosis
				Table 21.1 Clinical features of mitral stenosis
			Echo assessment of mitral stenosis
				2D and M-mode
				Figure 21.3 Rheumatic mitral valve. Abbreviations: Ao: Aorta, LA: Left atrium, LV: Left ventricle.
				Colour Doppler
				CW and PW Doppler
					Figure 21.4 Severe mitral stenosis and coexistent mitral regurgitation. Abbreviations: MV: Mitral valve, MVA:Mitral valve area, P1/2t: Pressure half-time, PG: Pressure gradient, Vmax: Peak velocity, Vmean: Mean velocity,VTI: Velocity time integral.
				Continuity equation
				COMMON PITFALLS
				Associated features
				Severity of mitral stenosis
			Management of mitral stenosis
				Drug therapy
				Surgery
		Mitral regurgitation
			Table 21.2 Indicators of mitral stenosis severity
			Table 21.3 Carpentier classification of mitral leaflet motion
			ISCHAEMIC MITRAL REGURGITATION
			Clinical features of mitral regurgitation
			palpitations and syncope. In describing MVP, comment onTable 21.4 Clinical features of mitral regurgitation (MR)
			Echo assessment of mitral regurgitation
				2D and M-mode
				MITRAL VALVE PROLAPSE
				Colour Doppler
					Figure 21.5 Mitral regurgitation. Abbreviations: LA: Left atrium, LV: Left ventricle.
					Figure 21.6 Mitral valve prolapse with eccentric (anterior) jet of mitral regurgitation. Abbreviations: LA: Leftatrium, LV: Left ventricle.
				CW and PW Doppler
					Figure 21.7 Mitral regurgitation.
					Figure 21.8 Normal pulmonary vein flow (transoesophageal echo).
	22. The right ventricle
	23. The right atrium
	24. The tricuspid valve
	25. The pulmonary valve
	26. Pulmonary hypertension
	27. Heart valve repair and replacement
	28. Endocarditis
	29. The cardiomyopathies
	30. The pericardium
	31. The aorta
	32. Cardiac masses
	33. Congenital heart disease
	34. Common echo requests
Appendix: Echo resources
Index