The Echocardiography Companion: Study Guide and Review

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Contents
1: Echo Physics
	Learning Objectives
	General Considerations
	1.1	 US Transducer
	Fig. 1.4 Phased array transducer.
	1.2	 US Wave and Pulses
	1.3	 US-Tissue Interaction
		Fig. 1.7 US-tissue interaction.
		Fig. 1.8 The Doppler principle.
	1.4	 Image Formation
		1.4.1	 PW Doppler
		1.4.2	 CW Doppler
		Fig. 1.9 Spectral Doppler display.
		1.4.3	 Color Doppler
	1.5	 Image Resolution
		1.5.1	 Spatial Resolution (Fig. 1.10)
			Fig. 1.10 Components of spatial resolution.
			1.5.1.1	 Axial Resolution
			1.5.1.2	 Lateral Resolution
		1.5.2	 Temporal Resolution
	1.6	 US Artifacts
		1.6.1	 Location Artifacts
			1.6.1.1	 Axial Direction (Fig. 1.11)
			1.6.1.2	 Lateral Direction
		1.6.2	 Attenuation Artifacts
	Further Reading
2: TTE and Chamber Quantification
	2.1	 Standard Echocardiographic Views
		2.1.1	 Parasternal Window
			Parasternal Long Axis View (PLAX)(Fig. 2.2, Video 2.1)
				Fig. 2.2 PLAX view.
			Fig. 2.1 Echo windows.
			Imaging points:
			Chambers
			Fig. 2.3 Aortic Root M-mode.
			Fig. 2.4 Mitral Valve M-mode.
			Fig. 2.5 Basal LV M-mode.
			Doppler
			Parasternal Right Ventricular Inflow(Tricuspid Tilt)(Fig. 2.6, Video 2.2)
				Fig. 2.6 RV inflow view.
				Chambers
			Parasternal Right Ventricular Outflow(Fig. 2.7, Video 2.3)
				Fig. 2.7 RV outflow view.
				Chambers
				Valves
				Doppler
			Parasternal Short Axis View (PSAX)
			PSAX—AV/Great Vessels(Fig. 2.8, Videos 2.4A and 2.4B)
				Fig. 2.8 PSAX view AV level.
				Chambers
				Valves
				Doppler
			PSAX—Mitral Leaflets Level(Fig. 2.9, Video 2.5)
				Fig. 2.9 PSAX view MV level.
				Chambers
				Valves
				Doppler
			PSAX—Papillary Muscle Level(Fig. 2.10, Video 2.6)
				Fig. 2.10 PSAX view papillary muscles level.
				Chambers
			PSAX—Apex Level(Fig. 2.11, Video 2.7)
				Fig. 2.11 PSAX view apical level.
				Chambers
				Valves, Doppler
		2.1.2	 Apical Window
			Apical Four Chamber View(Fig. 2.12, Video 2.8)
				Fig. 2.12 Apical 4-chamber View.
			Apical Five Chamber View(Fig. 2.13, Video 2.9)
				Fig. 2.13 Apical 5-chamber view.
			Apical Two Chamber View(Fig. 2.14, Video 2.10)
				Fig. 2.14 Apical 2-chamber view.
				Chambers
		2.1.3	 Subcostal Window
		2.1.4	 Suprasternal Window
	2.2	 Additional Imaging Techniques
		2.2.1	 Agitated Saline (Bubble) Injection
		2.2.2	 Ultrasound Enhancing Agents—UEA (“Contrast STUDY”)
		2.2.3	 Strain Imaging
	Further Reading
3: Transesophageal Echocardiography
	3.1	 Indications
	3.2	 Risks/Possible Complications of TEE
	3.3	 Contraindications to TEE
	3.4	 Post Procedure
	3.5	 Instrument Settings (Fig. 3.1)
	3.6	 Image Display
	3.7	 Standard Echocardiographic Views
		3.7.1	 General Imaging Considerations
		3.7.2	 Deep Trans-Gastric Window (Fig. 3.2, Video 3.1)
		3.7.3	 Trans-Gastric Window
		3.7.4	 Mid Esophageal Window
		3.7.5	 Upper Esophageal Window
		3.7.6	 Thoracic Aorta Imaging
	Further Reading
4: Left Ventricular Systolic Function
	4.1	 Measuring Stroke Volume and Cardiac Output
		4.1.1	 VTI Based Method (Fig. 4.1)
		4.1.2	 2D LV Volume Based Method (Fig. 4.2)
		4.1.3	 3D LV Volume Based Method (Fig. 4.3)
	4.2	 Measuring Ejection Fraction
		4.2.1	 Volume Based Method
		4.2.2	 Visual Estimation
		4.2.3	 EF Related Measurements
	4.3	 Measuring LV Contractility
		4.3.1	 Tissue Doppler Imaging (TDI) (Fig. 4.4)
		4.3.2	 Strain Imaging
		4.3.3	 dP/dT
		4.3.4	 Myocardial Performance Index (MPI) (Fig. 4.7)
	4.4	 Assessing LV Segmental Function
	4.5	 Stress Testing
	Further Reading
5: Left Ventricular Diastolic Function
	5.1	 Echocardiographic Evaluation of Diastolic Function
	5.2	 Diastolic Stress Test
	Further Reading
6: Right Ventricular Function and Pulmonary Hypertension
	6.1	 RV Anatomy and Measurements
		6.1.1	 RV Blood Supply
	6.2	 RV Systolic Function Assessment
		6.2.1	 Qualitative Parameters
		6.2.2	 Quantitative Parameters (Table 6.1)
	6.3	 RV Diastolic Function
	6.4	 Ventricular Interdependence (Fig. 6.4, Video 6.1)
	6.5	 Acute Pressure Overload
	6.6	 Pulmonary Hypertension (PH)
		6.6.1	 Definition
		6.6.2	 Echocardiographic Assessment
	Further Reading
7: Hemodynamics in the Echo Lab
	7.1	 The Echocardiographic Swan Ganz Catheter
		7.1.1	 Intra-Cardiac Pressures
		7.1.2	 Cardiac Output
		7.1.3	 Vascular Resistance
	7.2	 Sample Case in Echocardiographic Hemodynamics
	Further Reading
8: Aortic Valve
	8.1	 Aortic Stenosis (AS)
		8.1.1	 Etiology
		8.1.2	 Echocardiographic Assessment
		8.1.3	 Diagnostic Criteria
		8.1.4	 Discordance Between Calculated AVA and Measured Pressure Gradients (Fig. 8.6)
		8.1.5	 Compensatory Mechanisms-Adverse Consequences on the Heart
		8.1.6	 Surveillance and Follow-up
		8.1.7	 Management
		8.1.8	 Differential Diagnosis for Increased Gradients Across LVOT/AV Not Due to the AV
	8.2	 Aortic Insufficiency (AI)
		8.2.1	 Etiology
		8.2.2	 Echocardiographic Assessment (Fig. 8.10)
		8.2.3	 Diagnostic Criteria (Table 8.1)
		8.2.4	 Compensatory Mechanisms-Adverse Consequences on the Heart
		8.2.5	 Surveillance and Follow-up
		8.2.6	 Management
	8.3	 Congenital Variants
		8.3.1	 Bicuspid AV
		8.3.2	 Quadricuspid AV
		8.3.3	 Unicuspid AV
	Further Reading
9: Mitral Valve
	9.1	 Mitral Stenosis (MS)
		9.1.1	 Etiology
		9.1.2	 Echocardiographic Assessment
		9.1.3	 Diagnostic Criteria (Table 9.1)
		9.1.4	 Compensatory Mechanisms-Adverse Consequences on the Heart
		9.1.5	 Surveillance and Follow-Up
		9.1.6	 Management
		9.1.7	 Rare conditions Mimicking Mitral Stenosis
	9.2	 Mitral Regurgitation (MR)
		9.2.1	 Etiology
		9.2.2	 Echocardiographic Assessment
		9.2.3	 Diagnostic Criteria (Table 9.6)
		9.2.4	 Compensatory Mechanisms-Adverse Consequences on the Heart
		9.2.5	 Surveillance and Follow-Up
		9.2.6	 Management
		9.2.7	 MR Management in Special Scenarios
	Further Reading
10: Tricuspid and Pulmonic Valves
	10.1	 Tricuspid Stenosis (TS)
		10.1.1	 Etiology
		10.1.2	 Echocardiographic Assessment
		10.1.3	 Diagnostic Criteria
		10.1.4	 Surveillance and Follow-Up
		10.1.5	 Management
		10.1.6	 Differential Diagnosis
	10.2	 Tricuspid Regurgitation (TR)
		10.2.1	 Etiology
		10.2.2	 Echocardiographic Assessment
		10.2.3	 Diagnostic Criteria (Table 10.1)
		10.2.4	 Surveillance and Follow-Up
		10.2.5	 Management
	10.3	 Pulmonic Stenosis (PS)
		10.3.1	 Etiology
		10.3.2	 Echocardiographic Assessment
		10.3.3	 Diagnostic Criteria
		10.3.4	 Management
		10.3.5	 Differential Diagnosis
	10.4	 Pulmonic Insufficiency (PI)
		10.4.1	 Etiology
		10.4.2	 Echocardiographic Assessment
		10.4.3	 Diagnostic Criteria
		10.4.4	 Surv eillance and Follow-Up
		10.4.5	 Management
	Further Reading
11: Prosthetic Valves
	11.1	 Echocardiographic Evaluation Post Valve Replacement
	11.2	 Normal Echocardiographic Findings with PHV
	11.3	 Anticoagulation Post Valve Replacement
	11.4	 PHV Complications
	11.5	 Prosthetic Aortic Valve Assessment
		11.5.1	 Prosthetic Aortic Valve: Increased Gradient
		11.5.2	 Prosthetic Aortic Valve: Regurgitation
	11.6	 Prosthetic Mitral Valve Assessment
		11.6.1	 Prosthetic Mitral Valve: Increased Gradient
		11.6.2	 Prosthetic Mitral Valve: Regurgitation
	11.7	 Prosthetic Tricuspid Valve Assessment
		11.7.1	 Prosthetic Tricuspid Valve: Increased Gradient
		11.7.2	 Prosthetic Tricuspid Valve: Regurgitation
	11.8	 Prosthetic Pulmonic Valve Assessment
		11.8.1	 Prosthetic Pulmonic Valve: Increased Gradient
		11.8.2	 Prosthetic Pulmonic Valve: Regurgitation
	Further Reading
12: Cardiomyopathies
	12.1	 Hypertrophic Cardiomyopathy (HCM)
		12.1.1	 Definition
		12.1.2	 Etiology
		12.1.3	 HCM Mimics and Differential Diagnosis
		12.1.4	 HCM Morphologic Variants (Fig. 12.2)
		12.1.5	 Echocardiographic Assessment
		12.1.6	 Pathophysiology of HCM, SAM, LVOTO, and MR
		12.1.7	 HCM Physiologic Variants: Obstructive and Non-Obstructive
		12.1.8	 Clinical Manifestations
		12.1.9	 Management
		12.1.10 Screening
	12.2	 Restrictive Cardiomyopathy (RCM)
		12.2.1	 Definition
		12.2.2	 Etiology
		12.2.3	 Clinical Manifestations
		12.2.4	 Echocardiographic Assessment
		12.2.5	 Management
	12.3	 Dilated Cardiomyopathy (DCM)
		12.3.1	 Definition
		12.3.2	 Etiology
		12.3.3	 Clinical Manifestations
		12.3.4	 Echocardiographic Assessment (Fig. 12.9, Videos 12.4A and 12.4B)
		12.3.5	 Management
	12.4	 Ventricular Non-Compaction
		12.4.1	 Clinical manifestations
		12.4.2	 Echocardiographic Assessment
		12.4.3	 Management
	12.5	 Right Sided Cardiomypathies
		12.5.1	 Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
		12.5.2	 Differential Diagnosis for Right Sided Cardiomyopathies
	Further Reading
13: Pericardial Disease
	13.1	 General Characteristics of the Pericardium
		13.1.1	 Anatomy of the Pericardium
		13.1.2	 Physiology of the Pericardium
	13.2	 Acute Pericarditis (AP)
		13.2.1	 Etiology
		13.2.2	 Clinical Manifestations and Diagnosis
		13.2.3	 Management
		13.2.4	 Recurrent Pericarditis
	13.3	 Pericardial Effusion (PEff)
		13.3.1	 Etiology
		13.3.2	 Echocardiographic Assessment
		13.3.3	 Management
	13.4	 Cardiac Tamponade
		13.4.1	 Clinical Manifestations
		13.4.2	 Echocardiographic Assessment (Fig. 13.3, Videos 13.2A and 13.2B)
		13.4.3	 Special Situations
		13.4.4	 Management
	13.5	 Constrictive Pericarditis (CP)
		13.5.1	 Etiologies
		13.5.2	 Clinical Manifestations
		13.5.3	 Echocardiographic Assessment (Fig. 13.5, Videos 13.4A and 13.4B)
		13.5.4	 Other Imaging Modalities
		13.5.5	 Cath Hemodynamic Assessment
		13.5.6	 Constriction vs. Restriction
		13.5.7	 Management
	13.6	 Congenital Absence of the Pericardium
		13.6.1	 Clinical Manifestations
		13.6.2	 Echocardiographic Assessment
		13.6.3	 Management
	13.7	 Pericardial Cyst
	13.8	 Pericardial Malignancy
		13.8.1	 Primary
		13.8.2	 Secondary
	Further Reading
14: Aortic Disease
	14.1	 General Characteristics of the Aorta (Ao)
	14.2	 Anatomy of the Thoracic Aorta (Fig. 14.1)
	14.3	 Aortic Atherosclerosis
	14.4	 Aortic Aneurysm
	14.5	 Sinus of Valsalva Aneurysm (SOVA)
	14.6	 Acute Aortic Syndromes (AAS)
		14.6.1	 Aortic Dissection (AD)
		14.6.2	 Intramural Hematoma (IMH)
		14.6.3	 Penetrating Aortic Ulcer (PAU)
	14.7	 Coarcation of Aorta
	14.8	 Chest Trauma/Transection of Aorta
	Further Reading
15: Congenital Heart Disease
	15.1	 Atrial Septal Defects (ASD)
		15.1.1	 Interatrial Septum (IAS) Formation
		15.1.2	 Clinical Presentation
		15.1.3	 Types of ASD
		15.1.4	 Shunt Assessment with  Echocardiography (Fig. 15.5)
		15.1.5	 Management
	15.2	 Ventricular Septal Defects (VSD)
		15.2.1	 Anatomy of Interventricular Septum (IVS) (Fig. 15.6):
		15.2.2	 Classification of VSDs
		15.2.3	 Echocardiographic Assessment — General Principles (Fig. 15.7)
		15.2.4	 Types of VSD
		15.2.5	 Management
	15.3	 Patent Ductus Arteriosus (PDA)
	15.4	 Tetrology of Fallot (TOF) (Fig. 15.12)
	15.5	 Transposition of the Great Arteries (TGA) (Fig. 15.13)
		15.5.1	 D-TGA
		15.5.2	 L-TGA (Congenitally Corrected TGA)
		15.5.3	 Echocardiographic Assessment (Fig. 15.14, Videos 15.5A, 15.5B, 15.5C and 15.5D)
	15.6	 Truncus Arteriosus
	15.7	 Ebstein’s Anomaly (Fig. 15.15, Videos 15.6A and 15.6B)
	15.8	 COR-Triatriatum
	15.9	 Fontan Procedure/Circulation
	15.10	 Blalock-Taussig-Thomas Shunt
	Further Reading
16: Cardiac Masses
	16.1	 Cardiac Tumors
		16.1.1	 Benign Tumors
		16.1.2	 Malignant Tumors
		16.1.3	 Cardiac Metastasis
	16.2	 Non-tumor Massess
	16.3	 Normal Variants
	Further Reading
17: Interventional Echocardiography
	17.1	 Imaging for Structural Heart Disease Interventions
	17.2	 Real-Time 3 Dimensional Echocardiography
	17.3	 SHD Interventions
	17.4	 Approach to the Left Heart
	17.5	 Specific Procedures
		17.5.1	 TAVR
		17.5.2	 Mitral Clip Repair
		17.5.3	 Mitral Balloon Valvuloplasty (BMV)
		17.5.4	 Left Atrial Appendage (LAA) Closure
	Further Reading
Index