Textbook of Clinical Echocardiography, 6e

Cover
Textbook of Clinical Echocardiography
Copyright Page
Preface
Acknowledgments
GLOSSARY: Abbreviations Used in Figures, Tables, and Equations
Key Equations
1 Principles of Echocardiographic Image Acquisition and Doppler Analysis
	Ultrasound Waves
	Ultrasound Tissue Interaction
		Reflection
		Scattering
		Refraction
		Attenuation
	Transducers
		Piezoelectric Crystal
		Types of Transducers
		Beam Shape and Focusing
		Resolution
	Ultrasound Imaging Modalities
		M-Mode
		Two-Dimensional Echocardiography
			Image Production
			Instrument Settings
			Imaging Artifacts
		Three-Dimensional Echocardiography
		Echocardiographic Imaging Measurements
	Doppler Echocardiography
		Doppler Velocity Data
			Doppler Equation
			Spectral Analysis
			Continuous-Wave Doppler Ultrasound
			Pulsed-Wave Doppler Ultrasound
			Doppler Velocity Instrument Controls
			Doppler Velocity Data Artifacts
		Color Doppler Flow Imaging
			Principles
			Color Doppler Instrument Controls
			Color Doppler Imaging Artifacts
		Tissue Doppler
	Bioeffects and Safety
		Bioeffects
		Safety
	The Echo Exam
	Suggested Reading
2 Normal Anatomy and Flow Patterns on Transthoracic Echocardiography
	Basic Imaging Principles
		Tomographic Imaging
		Nomenclature of Standard Views
		Image Orientation
		Examination Technique
		Technical Quality
		Echocardiographic Image Interpretation
	Transthoracic Tomographic Views
		Parasternal Window
			Long-Axis Views
			Right Ventricular Inflow and Outflow Views
			Short-Axis Views
		Apical Window
			Four-Chamber View
			Two-Chamber View
			Long-Axis View
			Other Apical Views
		Subcostal Window
		Suprasternal Notch Window
		Other Acoustic Windows
	M-Mode Recordings
		Aortic Valve and Left Atrium
		Mitral Valve
		Left Ventricle
		Other M-Mode Recordings
	Normal Intracardiac Flow Patterns
		Basic Principles
			Laminar Versus Disturbed Flow
			Flow-Velocity Profiles
		Clinical Quantitative Doppler Methods
			Measurement of Volume Flow
			Velocity-Pressure Relationships
			Spatial Pattern of Flow
		Normal Antegrade Intracardiac Flows
			Left Ventricular Outflow
			Right Ventricular Outflow
			Left Ventricular Inflow
			Right Ventricular Inflow
			Left Atrial Filling
			Right Atrial Filling
			Descending Aorta
		Normal Color Doppler Flow Patterns
			Impact of Color Doppler Physics
			Normal Ventricular Outflow Patterns
			Normal Ventricular Inflow Patterns
			Normal Atrial Inflow Patterns
			Physiologic Valvular Regurgitation
	Aging Changes on Echocardiography
	The Diagnostic Echocardiogram
		Core Elements
		Additional Components
	The Echo Exam
	Suggested Reading
		General
		Left Ventricle
		Right Ventricle
		Left Atrium
		Doppler Flows
3 Transesophageal Echocardiography
	Protocols and Risks
	Tomographic Views
		Esophageal Position
			Four-Chamber Plane
			Two-Chamber Plane
			Long-Axis Plane
			Other Long-Axis Image Planes
			Short-Axis Plane
		Transgastric Position
			Short-Axis Plane
			Two-Chamber Plane
			Four-Chamber Plane
			Long-Axis Plane
		Descending Thoracic Aorta
	Valve Anatomy and Function
		Aortic Valve
		Mitral Valve
		Pulmonic Valve
		Tricuspid Valve
	Chamber Anatomy and Filling Patterns
		Left Ventricle
		Left Atrium
		Right Ventricle
		Right Atrium
	IMAGING SEQUENCE
	The Echo Exam
	Suggested Reading
4 Specialized Echocardiography Applications
	Three-Dimensional Echocardiography
		Image Acquisition
		Image Display
		Examination Protocol
		Quantitation From 3D Images
		Clinical Utility
		Limitations
	Myocardial Mechanics
		Tissue Doppler Strain and Strain Rate
		Speckle Tracking Strain Imaging
		Clinical Utility
		Dyssynchrony, Twist, and Torsion
	Contrast Echocardiography
		Contrast Agents
		Applications
		Limitations and Safety
	Intracardiac Echocardiography
		Instrumentation
		Technique
		Applications
		Limitations and Safety
	The Echo Exam
	Suggested Reading
		General
		3D Echocardiography
		Myocardial Mechanics
		Contrast Echocardiography
		Intracardiac Echocardiography
5 Clinical Indications and Quality Assurance
	Types of Echocardiographic Studies
	Basic Principles of Diagnostic Testing
		Reliability of a Diagnostic Test
			Accuracy
			Precision
			Expertise
		Integration of Clinical Data and Test Results
			Predictive Value
			Likelihood Ratio
			Pre-test and Post-test Probability
		Cost-Effectiveness
		Clinical Outcomes
	Indications and Appropriateness Criteria
	Indications for Diagnostic Echocardiography
		Transthoracic Echocardiography
		Transesophageal Echocardiography
		Stress Echocardiography
	Point of Care Cardiac Ultrasound Studies
		Instrumentation
		Applications
		Providers
		Safety and Limitations
	Quality Assurance in Echocardiography
		Sonographer Education and Training
		Physician Education and Training
		Echocardiography Reporting
		Echocardiography Laboratory Structure
	The Echo Exam
	Suggested Reading
		Types of Echocardiography
		Diagnostic Testing Principles
		Indications for Echocardiography
		Point of Care Echocardiography
		Sonographer Education and Training
		Physician Education and Training
		Laboratory Quality Assurance
6 Left and Right Ventricular Systolic Function
	Basic Principles
		Cardiac Cycle
		Physiology of Systolic Function
		Ventricular Volumes and Geometry
		Cardiac Output
		Response to Exercise
	Imaging the Left Ventricle
		Qualitative Evaluation of Systolic Function
		Quantitative Evaluation of Systolic Function
			Linear Dimensions
			2D and 3D Ventricular Volumes
			Left Ventricular Wall Stress, Strain, and Strain Rate Imaging
			Left Ventricular Speckle Tracking Strain Imaging
		Left Ventricular Geometry and Mass
		Limitations and Alternate Approaches
			Endocardial Definition
			Geometric Assumptions
			Accuracy and Reproducibility
			Alternate Approaches
	Doppler Evaluation of Left Ventricular Systolic Function
		Stroke Volume Calculation
		Sites for Stroke Volume Measurement
			Left Ventricular Outflow
			Mitral Valve
			Right Heart
		Differences in Transvalvular Volume Flow Rates
		Other Doppler Measures of Systolic Function
			Ejection Acceleration Times
			Rate of Ventricular Pressure Rise (dP/dt)
		Limitations and Alternate Approaches
	Echo Approach to Right Ventricular Systolic Function
		Right Ventricle Size
		Right Ventricular Systolic Function
		Patterns of Ventricular Septal Motion
		Limitations and Alternate Approaches
	Pulmonary Vasculature
		Pulmonary Systolic Pressure Estimates
			Tricuspid Regurgitant Velocity
			Pulmonic Regurgitant Velocity
		Estimation of Right Atrial Pressure
		Pulmonary Vascular Resistance
			Pulmonary Artery Velocity Curve
			Pulmonary Vascular Resistance Calculations
		Limitations and Alternate Approaches
	The Echo Exam
	Suggested Reading
		Left Ventricular Anatomy and Physiology
		Echocardiographic Measures of Left Ventricular Function
		Right Ventricular Size and Systolic Function
		Noninvasive Pulmonary Pressures
7 Ventricular Diastolic Filling and Function
	Basic Principles
		Phases of Diastole
		Parameters of Diastolic Function
			Ventricular Relaxation
			Ventricular Compliance
			Ventricular Diastolic Pressures
			Ventricular Diastolic Filling (Volume) Curves
			Atrial Pressures and Filling Curves
		Normal Respiratory Changes
		Causes of Diastolic Dysfunction
	ANATOMIC Parameters
		Left Ventricular Changes
		Left Atrial Volumes
		Other Imaging Parameters
	Doppler Evaluation of LV Filling
		Nomenclature and Measurements
		Volumetric Flow Rates
		Doppler Data Recording
	Tissue Doppler Myocardial Imaging
	Left Atrial Filling
		Nomenclature and Measurements
		Doppler Data Recording
	Other Approaches
		Isovolumic Relaxation Time
		Propagation Velocity
		Rate of Left Ventricular Relaxation (−dP/dt)
		LV and LA Myocardial Mechanics
	CONFOUNDING FACTORS
		Physiologic Factors
			Respiration, Heart Rate, and PR Interval
			Age
			Preload
		Pathophysiology
			LV Systolic Function
			Mitral Valve Disease
			Cardiac Rhythm and Atrial Contractile Function
	Clinical Classification of Diastolic Dysfunction
		Estimates of Diastolic Filling Pressures
		Mild Diastolic Dysfunction
		Moderate Diastolic Dysfunction
		Severe Diastolic Dysfunction
	Right Ventricular Diastolic Function
		Right Ventricular Filling
		Doppler Data Recording
		Physiologic Factors That Affect Right Ventricular Filling
		Right Atrial Filling
	Alternate Approaches
	Diastolic Function Reporting
	The Echo Exam
	Suggested Reading
8 Coronary Artery Disease
	Basic Principles
		Coronary Artery Anatomy
		Evaluation of Left Ventricular Wall Motion
			Transthoracic Imaging
			Transesophageal Imaging
		Sequence of Events in Ischemia
		Evaluation of Global and Regional Ventricular Function
	Myocardial Ischemia
		Basic Principles of Stress Echocardiography
		Exercise Echocardiography
		Dobutamine Stress Echocardiography
			Evaluation for Ischemia
			Evaluation for Myocardial Viability
		Other Stress Modalities
		Limitations and Technical Aspects
		Alternate Approaches
		Clinical Utility
			Diagnosis of Coronary Artery Disease
			Extent and Location of Ischemic Areas
			Prognostic Implications
	Myocardial Infarction
		Basic Principles
		Echocardiographic Imaging
		Limitations and Alternate Approaches
		Clinical Utility
			Diagnosis in the Emergency Department
			Evaluation of Interventional Therapy
			Myocardial Viability
			Mechanical Complications of Myocardial Infarction
	End-Stage Ischemic Cardiac Disease
		Differentiation From Other Causes of Left Ventricular Systolic Dysfunction
		Echocardiographic Approach
		Limitations and Alternate Approaches
	The Echo Exam
	Suggested Reading
		General
		Exercise Echocardiography
		Dobutamine Stress Echocardiography
		Chest Pain in the Emergency Department
		Complications of Acute Myocardial Infarction
9 Cardiomyopathies, Hypertensive and Pulmonary Heart Disease
	Dilated Cardiomyopathy
		Basic Principles
		Echocardiographic Approach
		Limitations and Technical Considerations
		Clinical Utility
		Alternate Approaches
	Hypertrophic Cardiomyopathy
		Basic Principles
		Echocardiographic Approach
			Asymmetric Left Ventricular Hypertrophy
			Left Ventricular Diastolic Function
			Dynamic Subaortic LV Outflow Tract Obstruction
				Imaging.
				Doppler Evaluation.
				Latent Outflow Obstruction.
			Mitral Valve Abnormalities
		Limitations and Technical Considerations
		Clinical Utility
			Diagnosis and Screening
			Evaluation of Medical Therapy
			Selection of Patients for Implantable Cardiac Defibrillators
			Monitoring of Alcohol Septal Ablation
			Surgical Therapy
		Alternate Approaches
	Restrictive Cardiomyopathy
		Basic Principles
		Echocardiographic Approach
			Anatomic Features
			Diastolic Function
		Limitations and Technical Considerations
		Clinical Utility
		Alternate Approaches
	Other Cardiomyopathies
		Arrhythmogenic Right Ventricular Dysplasia
		Left Ventricular Noncompaction
	Advanced Heart Failure Therapies
		Cardiac Resynchronization Therapy
		Left Ventricular Assist Devices
		Total Artificial Heart
		Cardiac Transplantation
			Cardiac Allograft Structure and Function
			Acute Transplant Rejection
			Post-Transplant Monitoring
		Limitations, Technical Considerations, and Alternate Approaches
	Hypertensive Heart Disease
		Basic Principles
		Echocardiographic Approach
			Ventricular Hypertrophy
			Diastolic Function
			Systolic Function
			Other Echocardiographic Findings
		Limitations and Technical Considerations
		Clinical Utility
			Diagnosis and Prognosis
			Evaluation of Heart Failure Symptoms in a Patient With Hypertension
		Alternate Approaches
	Pulmonary Heart Disease
		Chronic Versus Acute Pulmonary Disease
		Echocardiographic Approach
			Pulmonary Pressures
			Right Ventricular Pressure Overload
			Secondary Tricuspid Regurgitation
		Limitations and Technical Considerations
		Clinical Utility
		Alternate Approaches
	The Echo Exam
	Suggested Reading
10 Pericardial Disease
	Pericardial Anatomy and Physiology
	Pericarditis
		Basic Principles
		Echocardiographic Approach
		Clinical Utility
	Pericardial Effusion
		Basic Principles
		Diagnosis of Pericardial Effusion
			Diffuse Effusion
			Loculated Effusion
			Distinguishing From Pleural Fluid
		Clinical Utility
	Pericardial Tamponade
		Echocardiographic Approach
			Right Atrial Systolic Collapse
			Right Ventricular Diastolic Collapse
			Reciprocal Changes in Ventricular Volumes
			Respiratory Variation in Diastolic Filling
			Tissue Doppler Early Diastolic Velocity
			Inferior Vena Cava Dilation
		Clinical Utility
			Diagnosis of Pericardial Tamponade
			Echo-Guided Pericardiocentesis
	Pericardial Constriction
		Basic Principles
		Echocardiographic Approach
			Imaging
			Doppler Examination
			Constrictive Pericarditis Versus Restrictive Cardiomyopathy
		Clinical Utility
	The Echo Exam
	Suggested Reading
		General
		Pericarditis
		Pericardial Effusion
		Pericardial Tamponade
		Pericardial Constriction
		Other
11 Valvular Stenosis
	Basic Principles
		Approach to the Evaluation of Valvular Stenosis
		Fluid Dynamics of Valvular Stenosis
			High-Velocity Jet
			Relationship Between Pressure Gradient and Velocity
			Distal Flow Disturbance
			Proximal Flow Patterns
	Aortic Stenosis
		Diagnostic Imaging of the Aortic Valve
			Calcific Aortic Stenosis
			Bicuspid Aortic Valve
			Rheumatic Aortic Stenosis
			Congenital Aortic Stenosis
			Differential Diagnosis
		Quantitation of Aortic Stenosis Severity
			Maximum Aortic Jet Velocity
			Pressure Gradients
			Continuity Equation Valve Area
				Potential Pitfalls.
				Outflow Tract Diameter.
				Outflow Tract Velocity.
			Other Measures
		Coexisting Valvular Disease
		Response of the Left Ventricle
		Clinical Applications
			Decisions About Timing of Intervention
			Disease Progression and Prognosis in Asymptomatic Aortic Stenosis
		Evaluation of Low Flow Aortic Stenosis
			Aortic Stenosis With Left Ventricular Systolic Dysfunction
			Low Flow Aortic Stenosis With a Normal LV Ejection Fraction
	Mitral Stenosis
		Diagnostic Imaging of the Mitral Valve
			Rheumatic Disease
			Mitral Annular Calcification
			Differential Diagnosis
		Quantitation of Mitral Stenosis Severity
			Pressure Gradients
			Mitral Valve Area
				Direct Imaging of Valve Area.
				Pressure Half-Time Valve Area.
				Continuity Equation Mitral Valve Area.
			Technical Considerations and Potential Pitfalls
		Consequences of Mitral Stenosis
			Left Ventricular Response
			Left Atrial Enlargement and Thrombus
			Pulmonary Hypertension
			Mitral Regurgitation
			Other Coexisting Valvular Disease
		Clinical Applications in Specific Patient Populations
			Disease Stages, Hemodynamic Progression, and Timing of Intervention
			Patients Undergoing Balloon Mitral Commissurotomy
	Tricuspid Stenosis
	Pulmonic Stenosis
	The Echo Exam
	Suggested Reading
		Guidelines
		Aortic Stenosis
		Mitral Stenosis
		Tricuspid Stenosis
		Pulmonic Stenosis
12 Valvular Regurgitation
	Basic Principles
		Etiology of Valvular Regurgitation
		Fluid Dynamics of Valvular Regurgitation
		Volume Overload
		Detection of Valvular Regurgitation
		Valvular Regurgitation in Normal Individuals
	Approaches to Quantitation of Regurgitant Severity
		Color Doppler Imaging
			Jet Size and Shape
			Vena Contracta
			Proximal Flow Convergence
		CW Doppler Approach
		Distal Flow Reversals
		Volume Flow at Two Intracardiac Sites
		Limitations and Alternate Approaches
	Aortic Regurgitation
		Diagnostic Imaging of the Valve Apparatus
		Left Ventricular Response
		Indirect Signs of Aortic Regurgitation
		Evaluation of Aortic Regurgitant Severity
			Screening Examination
			Vena Contracta
			Aortic Flow Reversal
			CW Doppler
			Regurgitant Volume and Fraction
		Clinical Utility
			Diagnostic Utility for Aortic Regurgitation
			Timing of Surgical Intervention for Chronic Asymptomatic Aortic Regurgitation
	Mitral Regurgitation
		Diagnostic Imaging of the Mitral Valve Apparatus
		Response of the Left Ventricle, Left Atrium, and Pulmonary Vasculature
		Evaluation of Mitral Regurgitant Severity
			Screening Examination
			Vena Contracta
			Proximal Isovelocity Surface Area
			Regurgitation Volume and Orifice Area
			Pulmonary Vein Flow Reversal
		Clinical Utility
			Diagnosis and Severity of Mitral Regurgitation
			Clinical Follow-Up and Timing of Intervention
			Decision Making Concerning Type of Intervention
	Tricuspid Regurgitation
		Diagnostic Imaging of the Tricuspid Valve Apparatus
		Right Ventricular and Right Atrial Dilation
		Evaluation of Tricuspid Regurgitation Severity
		Clinical Utility
	Pulmonic Regurgitation
	The Echo Exam: Valve Regurgitation
	Suggested Reading
		General
		Mitral Regurgitation
		Aortic Regurgitation
		Tricuspid and Pulmonic Regurgitation
		Alternate Approaches
13 Prosthetic Valves
	Basic Principles
		Types of Prosthetic Valves
			Bioprosthetic Valves
			Homograft Valves
			Mechanical Valves
			Valved Conduits
		Mechanisms of Prosthetic Valve Dysfunction
			Primary Structural Failure
			Thromboembolic Complications
			Endocarditis
		Technical Aspects of Echo Evaluation
	Echocardiographic Approach
		Imaging
			Bioprosthetic Valves
			Mechanical Valves
			Microcavitation
			Valved Conduits
		Normal Doppler Findings
			Prosthetic Valve “Clicks”
			Antegrade Flow Patterns and Velocities
			Normal Regurgitation
		Prosthetic Valve Stenosis
			Pressure Gradients
			Valve Areas
				Aortic.
				Mitral.
		Prosthetic Valve Regurgitation
			Detection
			Severity and Etiology
		Other Echocardiographic Findings
	Limitations and Alternate Approaches
	Clinical Utility
		Baseline Prosthetic Valve Function After Implantation
		Prosthetic Valve Stenosis
		Transcatheter Valve Implantation
		Patient-Prosthesis Mismatch
		Prosthetic Valve Regurgitation
		Prosthetic Valve Endocarditis
		Prosthetic Valve Thrombosis
	The Echo Exam
	Suggested Reading
		Guidelines
		Prosthetic Valve Hemodynamics
		Surgical Prosthetic Valve Dysfunction
		Transcatheter Aortic Valves
14 Endocarditis
	Basic Principles
	Echocardiographic Approach
		Valvular Vegetations
			Transthoracic Echocardiography
				Aortic Valve.
				Mitral Valve.
				Tricuspid Valve.
				Pacer Lead Infections.
			Transesophageal Imaging
			Diagnostic Accuracy
		Valve Dysfunction
		Paravalvular Abscess and Intracardiac Fistula
		Other Echocardiographic Findings
	Limitations and Technical Considerations
		Active Versus Healed Vegetations
		Nonbacterial Thrombotic Endocarditis
		Diagnosis With Underlying Valve Disease
		Prosthetic Valves and Intracardiac Devices
	Clinical Utility
		Suspected Endocarditis
		Known Endocarditis
		Alternate Approaches
	The Echo Exam
	Suggested Reading
		Guidelines
		Reviews and Book Chapters
		Selected Clinical Studies
15 Cardiac Masses and Potential Cardiac Source of Embolus
	Basic Principles
	Valve Vegetations
	Cardiac Tumors
		Nonprimary
		Primary
			Benign Primary Cardiac Tumors
			Malignant Primary Cardiac Tumors
		Technical Considerations and Alternate Approaches
	Left Ventricular Thrombus
		Predisposing Conditions
		Identification of Left Ventricular Thrombi
		Clinical Implications
		Alternate Approaches
	Left Atrial Thrombus
		Predisposing Factors
		Identification of Left Atrial Thrombi
		Prognosis and Clinical Implications
		Alternate Approaches
	Right-Sided Heart Thrombi
	Cardiac Source of Embolus
		Basic Principles
		Identifiable Cardiac Sources of Emboli
		Predisposing Conditions
		Indications for Echocardiography in Patients With Systemic Embolic Events
	The Echo Exam
	Suggested Reading
		Cardiac Source of Embolus
		Cardiac Masses and Tumors
		Intracardiac Thrombi
16 Diseases of the Great Arteries
	Basic Principles
	Echocardiographic Approach
		Transthoracic Approach
			Echocardiographic Imaging
			Doppler Flows
			Limitations of Transthoracic Imaging of the Aorta
		Transesophageal Approach
			Echocardiographic Imaging
			Doppler Flows
			Limitations of Transesophageal Imaging of the Aorta
	Aortic Dilation and Aneurysm
	Aortic Dissection
		Transthoracic Imaging
		Transesophageal Imaging
			Complications of Aortic Dissection
			Postoperative Evaluation After Surgery on the Ascending Aorta
	Aortic Intramural Hematoma
	Aortic Pseudoaneurysm
	Traumatic Aortic Disease
	Sinus of Valsalva Aneurysm
	Atherosclerotic Aortic Disease
		Aortic Atherosclerosis as a Potential Source of Embolus
		Aortic Atherosclerosis as a Marker of Coronary Artery Disease
	Pulmonary Artery Abnormalities
	Alternate Approaches
	The Echo Exam
	Suggested Reading
		Guidelines
		Aortic Aneurysm and Dissection
		Aortic Intramural Hemorrhage
		Inherited Connective Tissue Disorders
		Aortic Atheroma
		Aortic Surgery
17 The Adult With Congenital Heart Disease
	Basic Principles
		Stenosis
		Regurgitation
		Shunts
		Connections
	Congenital Stenotic Lesions
		Congenital Aortic Valve Stenosis
		Subaortic Stenosis
		Congenital Obstructions to Right Ventricular Outflow
	Congenital Abnormalities of the Aorta and Coronary Arteries
		Aortic Coarctation
		Sinus of Valsalva Aneurysm
		Coronary Arteriovenous Fistula
		Anomalous Origins of the Coronary Arteries
	Congenital Regurgitant Lesions
		Ebstein Anomaly of the Tricuspid Valve
		Cleft Mitral Valve
	Intracardiac Shunts
		Atrial Septal Defects
			Anatomy
			Transthoracic Imaging
			Contrast Echocardiography
			Transesophageal Imaging
		Ventricular Septal Defects
			Anatomy
			Imaging
			Doppler Findings
		Patent Ductus Arteriosus
	Other Conditions Manifesting in Adulthood
		Corrected Transposition of the Great Arteries
		“Incidental” Congenital Anomalies
	Common Types of Palliated Adult Congenital Heart Disease
		Classification of Types of Procedures
		Tetralogy of Fallot
		Complete Transposition of the Great Arteries
		Fontan Physiology
	Limitations of Echocardiography and Alternate Approaches
		Measurement of RV Volumes and Ejection Fraction
		Calculations of Shunt Ratios
		Imaging Cardiac Anatomy
		Intracardiac Hemodynamics
	Integrating the Diagnostic Approach
	The Echo Exam
	Suggested Reading
18 Intraoperative and Interventional Echocardiography
	Basic Principles
		Indications
		Preoperative Diagnosis
		Hemodynamics
		Surgical Manipulation and Instrumentation
		Time Constraints
	Echocardiographic Approach
		Views
		Sequence
		Reporting and Image Storage
	Limitations and Technical Considerations
		Image Plane Orientation
		Doppler Interrogation Angle
		Technical Issues in the Operating Room and Interventional Suite
		Optimization of Instrument Settings
	Clinical Utility of Intraoperative TEE
		Monitoring Ventricular Function
		Valvular Heart Disease
			Mitral Valve Repair
			Valve Stenosis
			Endocarditis
			Prosthetic Valve Dysfunction
		Aortic Disease
			Aortic Dissection
			Aortic Atheroma
		Cardiomyopathies
			Hypertrophic Cardiomyopathy
			Ventricular Assist Devices
			Heart Transplantation
		Congenital Heart Disease
	Clinical Utility in Transcatheter and Hybrid Procedures
		Atrial Septal Defect Closure
		Transcatheter Valve Implantation
		Transcatheter Mitral Valve Repair
		Other Transcatheter Interventions
	The Echo Exam
	Suggested Reading
		General
		Monitoring Ventricular Function and Noncardiac Surgery
		Cardiac Surgery
		Ventricular Assist Devices
		Transcatheter Procedures
		Percutaneous Valve Implantation
Appendix A Normal Values for Echocardiographic Measurements
Appendix B Evidence Tables