The Practice of Clinical Echocardiography

THE PRACTICE OF CLINICAL ECHOCARDIOGRAPHY
Copyright
Contributors
Preface
Acknowledgments
Glossary
Chapter 1
	1 - The Diagnostic Echocardiography Laboratory: Structure, Standards, and Quality Improvement
		QUALITY IN CONTEXT
		Structure and Standards
			Laboratory Structure
			IMAGING PROCESS
		Quality Improvement
			Patient Selection and Appropriate Use Criteria
			Reproducibility and Variability
		Echocardiography outside the Echocardiography Laboratory
		Quality in an Era of Health Care Reform
Chapter 2
	2 - 3D Echocardiography: Principles of Image Acquisition, Display, and Analysis
		ULTRASOUND IMAGING SYSTEM FUNCTION
		Resolution in 3D Echo
			Spatial Resolution
			Temporal Resolution
				Single-Beat or Multibeat Acquisition
				Parallel Beamforming
				Interpolation of Images or Image Sectors
				Frame Reordering
				Virtual Array
				Multiline Transmission
				High-Pulse Repetition Frequency
			Relationship Between Spatial and Temporal Resolution
		3D Echo Data Acquisition
			2D Image Optimization
			3D Acquisition Modes
				Simultaneous Multiplane Mode
				Pyramidal Size
				“Zoom”
				Narrow Sector
				Wide Sector
			Color Flow Doppler
			Challenges with 3D Echo Acquisition
				Temporal Versus Spatial Resolution
				ECG-Gating and Breath-Hold
		3D Image Optimization
			Gain
			Brightness
			Smoothing
			Colorization
		3D Image Display
			Data Set Cropping
				Autocrop
				Box Crop
				Plane Crop
				Two-Plane Crop
			Postacquisition Display
				Volume Rendering
				Surface Rendering
				2D Tomographic Slices
		3D Echo Analysis
			Multiplanar Reconstruction
			Modeling
			Color Doppler
		3D Echo Acquisition and Analysis Protocols
			Left Ventricle
				Acquisition
				Presentation
				Analysis
				Limitations
			Right Ventricle
				Acquisition
				Presentation
				Analysis
				Limitations
			Left Atrium
				Acquisition
				Presentation
				Analysis
				Limitations
			Mitral Valve
				Acquisition
				Presentation
				Analysis
				Limitations
			Aortic Valve
				Acquisition
				Presentation
				Analysis
				Limitations
			Tricuspid Valve
				Acquisition
				Presentation
				Analysis
				Limitations
			3D Color Doppler Acquisition
				Acquisition
				Presentation
				Analysis
				Limitations
Chapter 3
	3 - The Comprehensive Diagnostic Transesophageal Echocardiogram: Integrating 2D and 3D Imaging, Doppler Quantitation, and Advanced A...
		DIAGNOSTIC TRANSESOPHAGEAL ECHOCARDIOGRAPHY
			Indications for Transesophageal Echocardiography
			Training and Personnel
			Patient Preparation and Sedation
			Esophageal Intubation
			Probe Manipulation and Standard Imaging Views
			Image Formatting and Display
		Transesophageal Imaging Views
			Left and Right Ventricles
			Atria and Left Atrial Appendage
			Aortic Valve and Aorta
			Mitral Valve
			Tricuspid and Pulmonic Valves
			Three-Dimensional Echocardiography
		Clinical Applications of Transesophageal Echocardiographic Imaging
			Atrial Fibrillation and Cardiac Source of Embolus
			Native and Prosthetic Valve Evaluation
			Infective Endocarditis
			Acute Aortic Syndromes
			Adult Congenital Heart Disease
			Intraoperative Monitoring and Critical Care
		Proposed Sequence of a Comprehensive Transesophageal Echocardiographic Study
Chapter 4
	4 - Intraoperative and Procedural Echocardiography: Basic Principles
		EVALUATION OF INTRAOPERATIVE VENTRICULAR FUNCTION
			Diastolic Function
			Left Ventricular Diastolic Function
			End-Diastolic Area and End-Systolic Area
		Left Ventricular Volumes
			Global Systolic Function
				Cardiac Output
				Left Ventricular Outflow Tract
				Pulmonary Artery
				Right Ventricular Outflow Tract
				Practical Considerations
				Ejection Fraction and Stroke Volume
				Tissue Doppler Imaging
				Speckle Tracking Imaging
				Right Ventricular Function
			Regional Wall Motion
		Intraoperative Cardiac Function in Specific Clinical Entities
			Separation from Cardiopulmonary Bypass
				Intracardiac Air
				Cardiac Output
			Off-Pump Coronary Bypass Surgery
			Positioning of Intravascular Devices
				Pulmonary Artery Catheters
				Intraaortic Balloon Pump
				Left Ventricular Assist Device
				Right Ventricular Assist Device
				Total Artificial Heart
				Venovenous Extracorporeal Membrane Oxygenation (ECMO)
				Coronary Sinus Cannulation
				Femoral Venous Cannula
			Transplant Surgery
				Heart Transplantation
				Lung Transplantation
				Liver Transplantation
		Alternate Techniques
			Epicardial/Epiaortic Echocardiography
		Postoperative Outcomes and Cost-Effectiveness
Chapter 5
	5 - Intracardiac Echocardiography
		BASIC PRINCIPLES
			Available Intracardiac Echocardiography Systems
			Advantages of Intracardiac Echocardiography
			Limitations of Intracardiac Echocardiography
		Imaging Sequence and Standard Views
		Typical Uses of Intracardiac Echocardiography
			Atrial Septal Defect Closure
			Transseptal Puncture
			Mitral Valvuloplasty
			Electrophysiology Procedures
			Imaging of Complications
		Conclusion
Chapter 6
	6 - Point of Care Cardiac Ultrasound: Scope of Practice, Quality Assurance, and Impact on Patient Outcomes
		TECHNOLOGY
		Health Care Providers
		Training
		Imaging
		Clinical Utility and Scope of Practice
			Adjunct to the Physical Examination
			Measurements of Cardiac Structures
			Urgent Need for Cardiac Ultrasound
				Obstructive Shock
				Cardiogenic Shock
				Distributive Shock and Hypovolemic Shock
			Fluid Responsiveness
			Undifferentiated Hypotension
			Acute Respiratory Failure
			Procedural Guidance
			Teaching
			Remote or International Locations
		Impact on Outcomes
		Quality Assurance and Integration in Practice
		Future Developments
		Summary
Chapter 7
	7 - Quantitative Evaluation of Left Ventricular Structure, Wall Stress, and Systolic Function
		Definitions and Theoretical Considerations
		Assessment of Left Ventricular Mass, Volume, and Geometry
			M-Mode Echocardiography
				Mass
				Volume
				Relative Wall Thickness
			Two-Dimensional Echocardiography
				Mass
				Geometry
				Doppler Echocardiography
		Assessment of Left Ventricular Systolic Function
			Ejection Fraction
				Hemodynamic Determinants of the Ejection Fraction
			Fractional Shortening and Related Indices
			Stress-Shortening Relations
				Midwall Stress-Shortening Analysis
			Pressure-Volume Analysis
		Potential Limitations
Chapter 8
	8 - Myocardial Mechanics: Velocities, Strain, Strain Rate, Cardiac Synchrony, and Twist
		Velocities by Color Doppler
			Velocities by Pulsed Doppler
		Deformation Imaging
			Basic Concepts
			Strain and Strain Rate by Tissue Doppler Imaging
			Physical Principles of Speckle Tracking Echocardiography
			Strain and Strain Rate by Speckle Tracking Echocardiography
			Left Ventricular Rotation and Twist
		Limitations of Velocity and Strain Imaging
			Angle Dependency
			Inadequate Tracking
			Noise Reduction versus Spatial and Temporal Resolution
			Movement of Sample Volume Relative to Myocardium
			Reverberations
			Load Dependency
			Limitations of Left Ventricular Rotation and Twist
			Transmural Strain Gradient
			Intervendor Variability in Strain
		Normal LV Physiology
			Systolic Velocities
			Diastolic Velocities
		Myocardial Ischemia
		Cardiac Synchrony
			Mechanisms of Left Ventricular Intraventricular Dyssynchrony
			Effect of Left Bundle Branch Block on Left Ventricular Function
			Dyssynchrony and Risk of Ventricular Arrhythmias
			Strain Imaging in Subclinical Left Ventricular Dysfunction
			Right Ventricular Function
Chapter 9
	9 - Left Ventricular Diastolic Function
		BASIC PRINCIPLES
			Physiology of Diastolic Function
			Effect of Aging on Diastolic Function
				Mitral Inflow Pattern
				Pulmonary Venous Flow
				Color M-Mode Doppler
				Tissue Doppler Imaging
				Assessment of Left Ventricular Filling Pressure: E/e′ Ratio
		Assessment of Diastolic Function in Special Circumstances
			Sinus Tachycardia
			Atrial Fibrillation
			Mitral Regurgitation
		Supportive Echocardiographic Findings of Diastolic Dysfunction
			Left Atrial Enlargement and Abnormal Left Atrial Function
			Pulmonary Hypertension
		Evaluation of Diastolic Function in the Clinical Setting
			Grading of Left Ventricular Diastolic Function
			Estimation of Left Ventricular Filling Pressures
		New Technologies for the Assessment of Diastolic Function
			Diastolic Stress Echocardiography
			Strain
			Left Ventricular Twist and Torsion
			Acknowledgements
Chapter 10
	10 - Digital Image Processing and Automated Image Analysis in Echocardiography
		Digital Image Storage, Communication, and Compression
			Digital Images
			Storage Formats and Image Communication
				Digital Imaging and Communications in Medicine
				General-Purpose Formats
			Image Compression
		Medical Image Processing
			Image Enhancement: Level Manipulations, Filtering
			Image Interpretation: The Interpretation Pyramid
				Cardiac Image Interpretation
				Rules for a Well-Behaved Automated Border Detection Method
		Automated Border Detection in Echocardiography
			Problems and Pitfalls
			Practical Considerations
				Acquisition and Image Quality
				Contour Definitions and Consistency
				Choice of Detection Technique
		Overview of Automated Border Detection Methods
			Feature-Driven Methods
			Structure-Based Method: Tissue Tracking
			Object-Based Methods: Geometric Modeling
			Pattern Matching
			3D Active Surface Detection
			Population Model–Based Method: Active Appearance Models
			Classification and Automated Localization
		Comparison Between Automated Border Detection Methods
			Future Promise: Intelligent Ultrasound Systems
Chapter 11
	11 - The Role of Echocardiographic Evaluation in Patients Presenting with Acute Chest Pain to the Emergency Department
		BASIC AND PRINCIPLES
		ECHOCARDIOGRAPHY AND THE PHYSIOLOGY OF ACUTE ISCHEMIA
		Technical Aspects of Echo­cardiography in the Emergency Department
			Image Acquisition
		Clinical Applications
			Triage of Patients with Chest Pain
			Strain Imaging
			Stress Echocardiography
			Use of Myocardial Contrast
			Assessment of the Need for Urgent Coronary Angiography
			Risk Stratification and Long-Term Outcomes
			Point of Care Cardiac Ultrasound in the Emergency Department
			Use of Echocardiography in Chest Pain Units and Clinical Algorithms
			Cost Effectiveness
		Evaluation of Nonischemic Causes of Chest Pain
			Aortic Dissection
			Pulmonary Embolus
			Pericarditis
			Aortic Stenosis
		Limitations
			Ischemia Evaluation
			Image Quality
			Personnel Availability
		Summary
Chapter 12
	12 - Echocardiography in the Coronary Care Unit: Management of Acute Myocardial Infarction, Detection of Complications, and Prognosti...
		APPLICABLE MODES OF ECHOCARDIOGRAPHY IN THECORONARY CARE UNIT
		Echocardiography in the Diagnosis and Localization of Acute Myocardial Infarction
			Diagnostic Role of Echocardiography
			Localization of Infarction
			Right Ventricular Infarction
		Detecting Complications of Acute Myocardial Infarction
			Hemodynamic Assessment of Myocardial Infarction Using Doppler Echocardiography
			Postinfarction Pericardial Effusion
			Acute Mitral Regurgitation
			Ventricular Septal Rupture
			Rupture of the Ventricular Free Wall
			Pseudoaneurysm
			Infarct Expansion and True Aneurysm Formation
			Left Ventricular Thrombus
		Risk Stratification after Myocardial Infarction
			Left Ventricular Systolic Function
			Regional Wall Motion Score
			Left Ventricular Diastolic Function
			Left Atrial Volume
			Left Ventricular Remodeling
			Stress Echocardiography
			Coronary Flow Reserve
			Mitral Regurgitation
Chapter 13
	13 - Stress Echocardiography for Coronary Ischemia
		PHYSIOLOGIC AND PATHOPHYSIOLOGIC PRINCIPLES
			The Ischemic Cascade
		Determinants of Myocardial Oxygen Demand and Supply
		INDICATIONS AND CONTRAINDICATIONS FOR STRESS ECHOCARDIOGRAPHY
			Indications
				Use of Exercise Stress Echocardiography to Assess Preoperative Risk in Noncardiac Surgery
			Contraindications
			Cost-Effectiveness
		Stress Protocols
			General Considerations
			Equipment and Personnel
			Patient Preparation
			Exercise Stress Testing
			Exercise Stress Protocols
				Treadmill Protocols
				Bicycle Protocols
				Handgrip
			Exercise Stress Echocardiography with Medical Therapy
			Outcome Assessment of Stress Echocardiography
				Symptoms, Angina, and Perceived Effort
				Heart Rate
				Heart Rate Recovery
				Blood Pressure
				Functional Capacity
				Electrocardiographic Changes
				Echocardiographic Imaging
				Duke Treadmill Score
				Other Important Stress Echocardiographic Outcomes
			Termination of Stress Echocardiography
		Sensitivity, Specificity, and Prognostic Value
		Future Developments
			Strain Echocardiography
			3D Echocardiography
Chapter 14
	14 - Nonexercise Stress Echocardiography for Diagnosis of Coronary Artery Disease
		PHARMACOLOGIC STRESSORS AND TEST PROTOCOLS
			Dobutamine Stress Echocardiography
				Dipyridamole Stress Echocardiography
				Ergonovine
		Pacing Stress Echocardiography
		Diagnostic Accuracy of Nonexercise Stress Echocardiography for Diagnosing Significant Coronary Artery Disease
		Assessment of Myocardial Viability
		New Techniques in Stress Echocardiography
			Three-Dimensional Stress Echocardiography
			Coronary Flow Velocity Reserve
			Tissue Doppler Imaging and Two-Dimensional Speckle Tracking Strain Echocardiography
Chapter 15
	15 - Aortic Stenosis: Disease Severity, Progression, and Timing of Intervention
		DISEASE STAGES
		Valve Morphology
		Hemodynamic Severity
			Aortic Velocity and Mean Pressure Gradient
			Continuity Equation Aortic Valve Area
				Left Ventricular Outflow Tract Velocity
				Left Ventricular Outflow Tract Diameter
			Stroke Volume Index
			Velocity Ratio
			Transesophageal Echocardiography Planimetry Valve Area
		Clinical Challenges in Assessment of Aortic Stenosis Severity
			Measurement Precision and Variability
			Effect of Transaortic Flow
			Anatomic Versus Effective Aortic Valve Area
			Pressure Recovery
			Discordance between Different Measures of Aortic Stenosis Severity
			Adjustment for Body Size
			Concurrent Hypertension
		Left Ventricular Changes in Aortic Stenosis
			Left Ventricular Hypertrophy and Remodeling
			Diastolic Function
			Systolic Function
			Stroke Volume Index
			Longitudinal Function
		Associated Findings
			Aortic Regurgitation
			Concomitant Subvalvular Obstruction
			Mitral Annular Calcification and Mitral Regurgitation
			Coronary Artery Disease
			Pulmonary Hypertension
		Alternative Diagnostic Modalities
			Exercise Stress Testing
			Cardiac Catheterization
				Gradients
				Aortic Valve Area
			Computed Tomography
			Cardiac Magnetic Resonance Imaging
		Clinical Approach
			Prognostic Value
			Strategies to Mitigate or Halt Progression
		Timing of Aortic Valve Replacement
			Symptomatic Patients
			Asymptomatic Patients
			Low-Gradient Aortic Stenosis with Reduced Ejection Fraction (Stage D2)
			Low-Gradient Aortic Stenosis with Preserved Ejection Fraction (Stage D3)
			Patients with Indications for other Cardiac Surgery
Chapter 16
	16 - Transcatheter Aortic Valve Implantation: Role of Echocardiography in Patient Selection, Procedural Planning and Monitoring, and Evaluation of Outcomes
		PATIENT SELECTION
			Severity of Aortic Stenosis
			High-Risk Assessment
			Specific Associated Conditions
				Bicuspid Aortic Valve
				Mitral Regurgitation
				Left Ventricular Hypertrophy and Obstruction
				Ascending Aortic Aneurysm
				Exuberant Aortic Atheroma
				Intracardiac Masses
		Planning of the Procedure
			Measuring the Aortic Annulus and Prosthesis Sizing
			Distance Between Plane of Aortic Annulus and Coronary Ostia
			Basal Septal Hypertrophy
			Aortic Valve Calcification
		Guiding the Procedure—Intraprocedural Complications
			Transesophageal Guidance
				Before Implantation
				Balloon Valvuloplasty
				Prosthesis Positioning and Deployment
			Is Transesophageal Echocardiography Mandatory During Transcatheter Aortic Valve Implantation
			Immediate Complications
				Annulus Rupture
				Pericardial Effusion and Tamponade
				Coronary Obstruction and Myocardial Infarction
				Prosthesis Malposition and Malfunction and Severe Aortic Regurgitation
				Acute Mitral Regurgitation
				Cardiogenic Shock
		Short-Term and Midterm Outcome
			Hemodynamic Performance of Implanted Prosthesis
			Paravalvular Regurgitation
			Thrombosis
			Endocarditis
			Prosthesis Degeneration
		Conclusion
Chapter 17
	17 - Aortic Valve Regurgitation: Quantitation of Disease Severity and Timing of Surgical Intervention
		ETIOLOGY
			Leaflet Abnormalities
			Aortic Regurgitation Severity
				Color Doppler Echocardiography
					Semiquantitative Methods
					Quantitative Methods
				Pulsed Wave Doppler
				Continuous Wave Doppler
					Deceleration Time of Regurgitant Flow
				Integrating Doppler Indexes of Severity
				Alternative Approaches
		Left Ventricle Size and Systolic Function
			Dimensions and Contractile Function of the Left Ventricle
			Contractile Reserve Evaluation
		Aortic Root and Ascending Aorta Evaluation
			Aortic Valve and Root Function
		Natural History and Serial Testing in Chronic Aortic Regurgitation
		Management and Timing of Surgery
			Medical Treatment
			Indications for Surgery
				Symptomatic Patients with Left Ventricular Dysfunction
				Symptomatic Patients with Normal Left Ventricular Systolic Function
				Asymptomatic Patients with Reduced Ejection Fraction
				Asymptomatic Patients with Normal Ejection Fraction
				Concomitant Aortic Root Disease
		Selecting and Guiding Surgical Treatment
			Role of Echocardiography
			Surgical Implications
		Results of Surgery and Follow-up
		Acute Aortic Regurgitation
			Acute Type A Aortic Dissection
			Infective Endocarditis
			Other Uncommon Causes of Acute Aortic Regurgitation
		Summary and Future Perspectives
Chapter 18
	18 - Mitral Regurgitation: Valve Anatomy, Regurgitant Severity, and Timing of Intervention
		ANATOMY AND PATHOPHYSIOLOGY
		Mitral Valve Anatomy
			Embryology and Components of the Mitral Valve
				Mitral Annulus
				Mitral Leaflets
		Chordae Tendineae and Papillary Muscles
			Mechanism of Mitral Regurgitation
				Primary Mitral Regurgitation
				Secondary Mitral Regurgitation
				Carpentier Classification Nomenclature
				Mitral Regurgitation Mechanisms Summary
		Quantitation of Mitral Regurgitation
			Color Doppler Methods
				Distal Jet Area Method
				Vena Contracta Width Method
				Proximal Isovelocity Surface Area Method
				Geometric Factors That Influence the Proximal Isovelocity Surface Area Method
				Technical Factors
				Different Reference Values for Effective Regurgitant Orifice Area based on the Cause of Mitral Regurgitation
			Volumetric Methods Using Pulsed Doppler
			Supportive Echo And Doppler Data
				Pulmonary Venous Flow Pattern: Systolic Flow Reversal
				Holosystolic versus Nonholosystolic Mitral Regurgitation
				Peak E Wave Velocity
				Continuous Wave Doppler Pattern
				Valve Morphology and Left-Sided Chamber Size
			Role of Three-Dimensional Echocardiography
			Importance of Hemodynamic and Physiologic Factors
				Summary of Approach to Grading Mitral Regurgitation: Importance of Integrative Method
				Integrative Approach to Quantitation of Mitral Regurgitation Severity
		Timing of Surgical Intervention
			Disease Course
			Timing of Intervention
				Therapy for Primary Mitral Regurgitation
				Therapy for Secondary Mitral Regurgitation
			Clinical Correlates
Chapter 19
	19 - Transesophageal Echocardiography for Surgical Repair of Mitral Regurgitation
		THE TEAM APPROACH TO ECHOCARDIOGRAPHY-GUIDED MITRAL REPAIR
		Essential Anatomy
		Mitral Valve Disease
			Degenerative (Myxomatous) Disease
			Infective Endocarditis
			Rheumatic Disease
			Radiation Necrosis
			Dystrophic Calcification
			Papillary Muscle Rupture
			Secondary Valve Disease
		Transesophageal Imaging of the Mitral Valve
			Standard Multiplane Imaging
			Principles of Axial Imaging
			Three-Dimensional Imaging
		Prerepair Transesophageal Echocardiography
			Degenerative Disease
			Endocarditis
			Rheumatic Disease
			Papillary Muscle Rupture
			Secondary Disease
			Disease Combinations
		Surgical Techniques of Image-Guided Mitral Repair
			Degenerative Disease
			Endocarditis
			Rheumatic Disease
			Papillary Muscle Rupture
			Secondary Disease
		Postrepair Transesophageal Echocardiography
			Leaflet Structure and Function
			Residual Mitral Regurgitation
			New Mitral Stenosis
			Ventricular Dysfunction
			Systolic Anterior Motion
Chapter 20
	20 - Transcatheter Mitral Valve Repair: Role of Echocardiography in Patient Selection, Procedural Guidance, and Evaluation of Outcome...
		PERCUTANEOUS THERAPIES FOR MITRAL REGURGITATION
			OVERVIEW
			Edge-to-Edge Mitral Valve Repair
			Use of Echocardiography in Patient Selection
		Determining the Cause of Mitral Regurgitation
			Degenerative Mitral Regurgitation
			Functional Mitral Regurgitation
			Mixed Mitral Regurgitation
		Determining Mitral Regurgitation Severity
			Moderate to Severe Mitral Regurgitation
			Severe Mitral Regurgitation
		Echocardiographic Markers to Determine Suitability for Edge-to-Edge Mitral Valve Repair
		Procedural Guidance
			Transseptal Puncture
			Navigation in the Left Atrium
			Guiding Catheter and Delivery System Steering
			Device Alignment to the Mitral Valve
			Device Advancement Into Left Ventricle
			Leaflet Grasping
			Device Release and Determination of Residual Mitral Regurgitation
			Consideration for Additional Clips
			Retrieval of Delivery Catheters
			Atrial Septal Defect Check
			Evaluation of Possible Complications
		Evaluation of Outcomes
		Alternative Imaging Techniques
		Recent Advances and Future Directions
Chapter 21
	21 - Mitral Stenosis: Patient Selection, Hemodynamic Results, Complications, and Long-Term Outcome with Balloon Mitral Commissurotomy
		BASIC PRINCIPLES AND ECHOCARDIOGRAPHIC APPROACH
			Diagnosis
			Evaluation of Severity
			Assessment of Hemodynamic Consequences
			Assessment of Consequences on the Left Atrium
			Assessment of Valve Anatomy
			Mitral Regurgitation
			Associated Lesions
			Thromboembolic Complications
			Use of the Different Echocardiographic Techniques
			Before Balloon Mitral Commissurotomy
				Valve Function
				Valve Anatomy
				Exercise Echocardiography
			During Balloon Mitral Commissurotomy
			Early after Balloon Mitral Commissurotomy
			During Follow-Up
			Results of Balloon Mitral Commissurotomy
				Failure and Complications
				Immediate Results
				Late Results
					The Elderly
					Young Patients
					Pregnant Women
			Implications For Patient Selection
				Contraindications
				Choice of Procedure
				Timing of the Procedure
			Research Applications
				Stress Echocardiography
				Evaluation of Atrioventricular Compliance
				Evaluation of Valve Anatomy
Chapter 22
	22 - Endocarditis: The Role of Echocardiography in Diagnosis and Clinical Decision-Making
		BASIC PRINCIPLES AND ECHOCARDIOGRAPHIC APPROACH
		Technical Details, Quantitation, and Data Analysis
		Diagnosis of Endocarditis
			General Considerations
			Evaluation of Patients with Bacteremia
			Evaluation of Patients with Prosthetic Valves
			Evaluation of Patients with Cardiac Implantable Electronic Devices
		Utility in Management
		Utility in Follow-Up
		Research Applications
		Potential Limitations and Future Directions
		Alternate Approaches
Chapter 23
	23 - Fluid Dynamics of Prosthetic Valves
		PRINCIPLES OF FLUID DYNAMICS
			Conservation of Mass
			Mechanical Energy
			Bernoulli’s Equation
			The Control Volume Energy Analysis
			Mechanisms of Mechanical Energy Loss
				Viscous Losses
				Turbulent Losses
				Valvular Regurgitation
			Mechanical Energy Conversion and Loss in a Stenosis
		Applications of Fluid Dynamics to Prosthetic Heart Valves
			Pressure Drop
			Doppler Gradient
			Effective Orifice Area
			Regurgitant Volume
			Mechanical Energy Losses
			Novel Energy Loss Parameters
			In Vivo Evaluation of Prosthetic Valves
		Hemodynamics of Native Valves
		Hemodynamics of Specific Prosthetic Valve Designs
			Mechanical Valves
			Bioprosthetic Valves
			Transcatheter Valves
				Antegrade Flow Fields
				Normal Regurgitant Flow
		Future Directions
Chapter 24
	24 - Echocardiographic Recognition and Quantitation of Prosthetic Valve Dysfunction
		PROSTHETIC VALVE COMPLICATIONS AND DYSFUNCTION
			Prosthesis-Patient Mismatch
			Prosthetic Valve Thrombosis and Pannus
			Structural Valve Deterioration
				Infective Endocarditis
		Basic Principles for Doppler Echocardiographic Evaluation of Prosthetic Valve Function
			Timing of Echocardiographic Follow-Up
			Clinical Data
		Recognition and Quantitation of Prosthetic Valve Stenosis
			Leaflet Morphology and Mobility
			Quantitative Parameters
				Transprosthetic Velocity and Gradient
				Transprosthetic Jet Contour and Acceleration Time
				Effective Orifice Area
				Doppler Velocity Index
		Recognition and Quantitation of Prosthetic Valve Regurgitation
			Prosthetic Aortic Valve Regurgitation
				Parameters of the Severity of Prosthetic Aortic Valve Regurgitation
				Color Doppler Parameters
				Spectral Doppler Parameters
				Quantitative Parameters
				Integrative, Multiparametric Approach for the Evaluation of Prosthetic Aortic Valve Regurgitation
			Prosthetic Mitral Valve Regurgitation
				Imaging Considerations
				Parameters of the Severity of Prosthetic Mitral Valve Regurgitation
			Indirect Signs and Consequences of Prosthetic Valve Regurgitation
		Role of Stress Echocardiography
		Prosthetic Right Heart Valves
			PROSTHETIC TRICUSPID VALVE STENOSIS
			PROSTHETIC TRICUSPID VALVE REGURGITATION
			PROSTHETIC PULMONIC VALVES
		Interpretation of Doppler Echocardiographic Data
			High Transprosthetic Gradients
				Prosthetic Aortic Valves
				Prosthetic Mitral Valves
			Low Flow States
			Perioperative Evaluation
		Doppler Echocardiography for the Management of Specific Prosthetic Valve–Related Complications
			Prosthetic Valve Thrombosis
			Prosthetic Valve Endocarditis
		SUMMARY
Chapter 25
	25 - Dilated Cardiomyopathy: The Role of Echocardiography in Diagnosis and Patient Management
		CLASSIFICATION OF DILATED CARDIOMYOPATHY
		EPIDEMIOLOGY
		CLINICAL PRESENTATION
		Echocardiographic Features of Dilated Cardiomyopathy
			Left Ventricular Systolic Function
			Tissue Doppler Imaging, Strain, and Strain Rate
			Left Ventricular Systolic Function and Prognosis
			Left Ventricular Size and Shape
			Left Ventricular Diastolic Function
			Secondary Mitral Regurgitation
			Left Ventricular Contractile Reserve
			Right-Sided Involvement
		Familial Screening
		Other Cardiac Conditions that Appear Similar to Dilated Cardiomyopathy
			Left Ventricular Noncompaction
			Stress-Induced Cardiomyopathy
			Myocarditis
		Cardiac Resynchronization Therapy
			Intraventricular Dyssynchrony
				M-mode
				Tissue Doppler Imaging
				Speckle Tracking Imaging
				Three-Dimensional Echocardiography
			Interventricular Delay
			Response to CRT
			Changes in Diastolic Function with Cardiac Resynchronization Therapy
			Management of Nonresponders
			Targeted Left Ventricular Lead Placement
			Guidelines and Cardiac Resynchronization Therapy
		Heart Failure Risk Scores
Chapter 26
	26 - Hypertrophic Cardiomyopathy: Echocardiography in Diagnosis and Management of Patients
		GENETICS
		Diagnosis
			Diagnostic Criteria
			Family Screening
		Differential Diagnosis
			Mimics of Hypertrophic Cardiomyopathy
			Storage Diseases
			Athlete’s Heart
			Septal Hypertrophy in the Elderly
		Left Ventricular Hypertrophy
			Distribution and Patterns of Hypertrophy
			Technical Factors
		Left Ventricular Outflow Tract Obstruction
			Pathophysiology
			Mitral Leaflet Systolic Anterior Motion
			Doppler Assessment
			Technical Aspects
		Mitral Regurgitation
		Stress Testing and Other Methods of Provocation
			Types of Exercise in Patients with HCM
				Other methods of provocation
		Hypertrophic Cardiomyopathy Subtypes
			Asymmetric Apical Hypertrophic Cardiomyopathy
			Midventricular Obstruction and Apical Aneurysms
			Hypertrophic Cardiomyopathy of the Elderly
		Diastolic Dysfunction
			Factors Contributing to Impaired Diastolic Function
			Assessment of Diastolic Function
			Asynchronous Relaxation
			Left Atrial Size and Function
		Newer Echocardiographic Techniques
			Strain Imaging
			Three-Dimensional Echocardiography
		Management of Left Ventricular Outflow Tract Obstruction
			Surgical Myectomy
				Role of Intraoperative Echocardiography
				Outcomes after Myectomy
			Septal Ethanol Ablation
			Comparison of Treatment Strategies
		Echocardiographic Predictors of Clinical Outcome
Chapter 27
	27 - Restrictive Cardiomyopathy: Diagnosis and Prognostic Implications
		2D Echocardiographic and Doppler Features
			M-Mode Imaging
			2D Imaging
			Spectral Doppler Imaging
			Findings
				Mitral Inflow Pulsed Wave Doppler
				Pulmonary Vein Pulsed Wave Doppler
				Tissue Doppler of the Mitral Annulus
				Color M-Mode
				Tissue Doppler and Longitudinal Strain
				Limitations and Pitfalls of Pulsed Wave Doppler and Color M-Mode
			2D Speckle Tracking Strain Imaging
		Specific Restrictive Cardiomyopathies
			Amyloidosis
				Definition
				Cardiac Features
				Clinical Presentation
					Echo Doppler
					Magnetic Resonance Imaging
					Nuclear Imaging
			Idiopathic Restrictive Cardiomyopathy
			Hypereosinophilic Syndrome and Endomyocardial Fibrosis
			Hemochromatosis
			Sarcoidosis
			Storage Disorders63
				Gaucher Disease
				Glycogen Storage Disorder: Pompe Disease
				Fabry Disease
			Drug-Induced Restrictive Cardiomyopathy
			Postradiation Cardiomyopathy
			Other Causes of Restrictive Cardiomyopathy
		Differentiating Between Restrictive Cardiomyopathy and Constrictive Pericarditis
Chapter 28
	28 - Pericardial Disease
		PERICARDIAL ANATOMY AND FUNCTION
			ANATOMY OF THE PERICARDIUM
			PERICARDIAL FLUID
			FUNCTIONS OF THE PERICARDIUM
		Pericardial Pressure and Normal Respiratory Effects on Hemodynamics
			Anatomy of the Pericardium
				Pericardial Fluid
				Functions of the Pericardium
			Pathophysiologic Principles in Compressive Pericardial Disease
			Echocardiographic Evaluation for Pericardial Disease
		Constrictive Pericarditis
			Definition and Etiology
			Pathology and Pathophysiology
			Clinical Presentation and Treatment
			Echocardiographic Diagnosis
				Abnormal Ventricular Septal Motion: Ventricular Septal Shift and Shudder
					Ventricular Septal Shift
					Ventricular Septal Shudder
				Respiratory Variation in the Hepatic Vein Doppler Profile: Prominent Diastolic Flow Reversals in Expiration
					Annulus Reversus
					Annulus Paradoxus
				Respiratory Variation in Mitral Inflow Velocity
					Other Doppler Findings
					Strain Imaging
			Differentiation from Restrictive Cardiomyopathy
		Effusive-Constrictive Pericarditis and Transient Constrictive Pericarditis
		Pericardial Effusion
			Echocardiographic Diagnosis
		Pericardial Tamponade
			Definition and Etiology
			Pathophysiology
			Echocardiographic Diagnosis
				Characterization of the Pericardial Effusion
				Cardiac Chamber Collapse
					Right Atrial Compression, Inversion, or Collapse
					Right Ventricular Compression, Inversion, or Collapse
					Left Heart Chamber Collapse
				Plethora of the Inferior Vena Cava
				Respiratory Variation in Right- and Left-Heart Filling
				Combining Chamber Collapse with Abnormal Hepatic Venous Flow: Test Performance Characteristics
			Regional Tamponade
			Echocardiographically Guided Pericardiocentesis
				Contraindications
				Procedural Steps
		Acute Pericarditis
		Congenital Absence of the Pericardium
		Pericardial Cysts
Chapter 29
	29 - Cardiac Transplantation: Pretransplant and Posttransplant Evaluation
		EVALUATION BEFORE CARDIAC TRANSPLANTATION
			Risk Assessment in Heart Failure
		Structure and Function of the Cardiac Allograft
			Transplant Operative Technique
			Left Ventricular Wall Thickness and Systolic and Diastolic Function
			Right Heart Structure and Function
		Structure and Function of the Cardiac Allograft during Acute Rejection
		Posttransplant Monitoring
			Routine Follow-Up
			Pericardial Effusion
			Echocardiographic Guidance for Endomyocardial Biopsy
		Diagnosis of Cardiac Allograft Vasculopathy
			Coronary Angiography with Intravascular Ultrasound
			Stress Echocardiography
			Myocardial Perfusion Imaging
Chapter 30
	30 - Echocardiography in Mechanical Circulatory Support: Normal Findings, Complications, and Speed Changes
		BASIC PRINCIPLES OF MECHANICAL CIRCULATORY SUPPORT AND THE ECHOCARDIOGRAPHIC APPROACH
			TYPES OF CARDIAC ASSIST DEVICES
				Implanted Ventricular Assist Devices
				Percutaneous Mechanical Circulatory Support Devices
			Preimplant Assessment
			Periprocedural Guidance
		Postimplant Surveillance and Complications
			Overfilling
			Underfilling
			Valvular Dysfunction
			Speed Change Studies
				Optimization of Device Settings
				Optimization of Percutaneous Mechanical Circulatory Support Position
				Ramp Studies
				Ventricular Recovery
			Left Ventricular End-Diastolic Diameter and Septal Orientation
			Ventricular Function
			Aortic Valve Opening
			Pericardium
			Cannulae
			Optimization Studies
			Ramp Studies
			Weaning and Turndown Studies
Chapter 31
	31 - Right Ventricular Anatomy, Function, and Echocardiographic Evaluation
		BASIC PRINCIPLES AND ECHOCARDIOGRAPHIC APPROACH
			Right Ventricular Anatomy
		Technical Details, Quantitation, and Data Analysis
			Transthoracic Echocardiographic Views
			Transesophageal Echocardiographic Views
			Intracardiac Echocardiographic Views
		Quantitative Evaluation
			Right Ventricular Wall Thickness and Size
			Right Ventricular Systolic Function
			Right Ventricular Diastolic Function
		Clinical Utility and Outcome Data
		Research Applications
		Potential Limitations and Future Directions
		Alternate Approaches
Chapter 32
	32 - Pulmonary Hypertension: Role of Echocardiography in Diagnosis and Patient Management
		GENERAL PRINCIPLES
		Estimating Right Atrial Pressure
			Estimating the Right Ventricular–to–Right Atrial Pressure Difference from the Tricuspid Regurgitation Profile
			Pulmonary Regurgitation Profile
			Pulmonary Acceleration Time
			Midsystolic Notching of the Right Ventricular Outflow Doppler
			Factors that Affect Pulmonary Artery Pressure in Normal Individuals
		Identifying the Cause for Pulmonary Hypertension
			General Classification
			Pulmonary Arterial Hypertension
			Pulmonary Hypertension Due to Congenital Heart Disease
			Pulmonary Hypertension Due to Left Heart Disease
			Pulmonary Hypertension Due to Lung Disease
			Pulmonary Hypertension Due to Chronic Pulmonary Thromboembolic Disease
			Acute Pulmonary Hypertension
		Effect of Pulmonary Hypertension on the Right Heart
			Measurement of Right Ventricular Function in the Setting of Pressure Loading
			Right Ventricular Dimensions
			Right Ventricular Wall Thickness
			Right Ventricular Systolic Function
			Three-Dimensional Analysis of Right Ventricular Systolic Function
			Right Ventricular Diastolic Function
			Ventricular Septal Motion
		Estimating Pulmonary Vascular Resistance
		Exercise Stress Echocardiography and Pulmonary Hypertension
		Diagnostic Approach for a Patient with Suspected Pulmonary Hypertension
Chapter 33
	33 - Right-Sided Valve Disease in Adults
		Tricuspid Regurgitation
			Background
			Basic Principles and Echocardiographic Approach to Diagnosis
			Technical Details, Quantitation, and Data Analysis
				Determining the Cause of Tricuspid Regurgitation
		Determining the Severity of Tricuspid Regurgitation
			Clinical Utility and Outcomes Data
			Potential Limitations
		Tricuspid Stenosis
			Background
			Basic Principles and Echocardiographic Approach
			Technical Details, Quantitation, and Data Analysis
			Clinical Utility and Outcomes Data
			Alternate Approaches
		Pulmonic Valve Stenosis
			Background
			Basic Principles and Echocardiographic Approach
			Technical Details, Quantitation, and Data Analysis
			Clinical Utility and Outcomes Data
			Alternate Approaches
		Pulmonic Valve Regurgitation
			Background
			Basic Principles and Echocardiographic Approach
			Technical Details, Quantitation, and Data Analysis
			Clinical Utility and Outcomes Data
			Alternate Approaches
Chapter 34
	34 - Aortic Dissection and Trauma: Value and Limitations of Echocardiography
		PATHOPHYSIOLOGY OF AORTIC DISSECTION
			Anatomy and Histology
			Mechanical and Shear Stresses
		Spectrum of Acute Aortic Syndromes
			Aortic Dissection
				Classification
				Time Course
				Sequelae
			Intramural Hematoma
			Penetrating Aortic Ulcer
			Aortic Trauma
		Imaging Acute Aortic Syndromes
			Computed Tomography
			Magnetic Resonance Imaging
			Transthoracic Echocardiography
			Transesophageal Echocardiography
				Safety of Transesophageal Echocardiography
				Complications of Dissection
				Intramural Hematoma
				Penetrating Aortic Ulcer
				Aortic Trauma
			Inconclusive Transesophageal Echocardiographic Results
		Surgical Considerations
			Aortic Regurgitation
			Mitral Regurgitation
			Perfusion of Distal Vascular Beds
			Endovascular Repair Considerations
		Follow-up of Patients after Aortic Dissection
		Conclusions
Chapter 35
	35 - Echocardiographic Findings in Systemic Diseases Characterized by Immune-Mediated Injury
		SYSTEMIC LUPUS ERYTHEMATOSUS
			Background
			Cardiovascular Involvement
				Valve Disease, Intracardiac Thrombosis, and Thromboembolism
		Atherosclerosis
			Myocardial Disease
				Pericardial Disease
				Pulmonary Hypertension
		Primary Antiphospholipid Syndrome
			Background
			Cardiovascular Involvement
				Valve Disease, Intracardiac Thrombosis, and Thromboembolism
				Pulmonary Hypertension
				Atherosclerosis
				Myocardial Disease
		Rheumatoid Arthritis
			Background
			Cardiovascular Involvement
				Atherosclerosis
				Pericardial Disease
				Valve Disease
				Myocardial Disease
				Pulmonary Hypertension
		Ankylosing Spondylitis
			Background
			Cardiovascular Involvement
				Aortitis and Valve Disease
				Conduction Abnormalities
				Myocardial and Pericardial Disease
				Atherosclerosis
		Scleroderma
			Background
			Cardiovascular Involvement
				Atherosclerosis
				Myocardial Disease
				Pulmonary Hypertension
				Pericardial Disease
				Valve Disease
		Polymyositis and Dermatomyositis
			Background
			Cardiovascular Involvement
				Myocardial Disease
				Pericardial Disease
				Atherosclerosis, Valve Disease, and Pulmonary Hypertension
		Mixed Connective Tissue Disease
			Background
			Cardiovascular Involvement
				Pulmonary Hypertension
				Pericardial Disease
				Valve Disease and Myocardial Disease
				Atherosclerosis
		Selected Arteritides Affecting the Aorta and Branches
		Takayasu Arteritis
			Background
			Cardiovascular Involvement
				Vascular Disease
				Heart Disease
				Diagnostic Imaging
				Therapy
		Giant Cell Arteritis
			Background
			Cardiovascular Involvement
				Vascular Disease
				Heart Disease
				Diagnostic Imaging and Therapy
		Behcet Disease
			Background
			Cardiovascular Involvement
				Vascular Disease
				Heart Disease
				Diagnostic Imaging and Therapy
Chapter 36
Chapter 37
	37 - Echocardiography in Athletes
		IMPACT OF EXERCISE ON CARDIAC STRUCTURE AND FUNCTION
		Effect of Different Exercise Types
		Left Ventricle
			Left Ventricular Structure
			Left Ventricular Systolic Function
			Left Ventricular Diastolic Function
		Right Ventricle
			Right Ventricular Structure
			Right Ventricular Function
		Atria
		Aorta
		Electrical Remodeling
		Detraining Effects
		Screening Echocardiography in Athletes
			Guideline Recommendations
		Stress Echocardiography
			Technical Considerations and Physiologic Differences
			Acute Effects of Exercise
		Alternative Imaging Modalities
		Clinical Imaging Dilemmas
			Valve Disease in Athletes
			Endurance Athlete or Dilated Cardiomyopathy
			Athletic Remodeling or Pathologic Ventricular Hypertrophy
			Endurance Athlete or Right Ventricular Cardiomyopathy
			Determining Whether an Athlete Can Continue to Compete Safely
Chapter 38
	38 - Echocardiography in Patients with Inherited Connective Tissue Disorders
		FORMS OF CONNECTIVE TISSUE DISORDERS
			Marfan Syndrome
			Ehlers-Danlos
			Homocystinuria
			Other Fibrillinopathies
			Loeys-Dietz Syndrome
			Bicuspid Aortic Valve
			Turner Syndrome
			Familial Thoracic Aortic Aneurysm and Dissection
		Histopathology
		Echocardiographic Findings
			Normal Aortic Measurements
			Aortic Dilation
			Aortic Dissection
			Other Aortic Manifestations
			Mitral Valve Prolapse
			Left Ventricle
				Diastolic Function
				Systolic Function
			Pulmonary Artery
		Natural History
			Methods of Assessment
			Limitations of Assessment
		Therapeutic Strategies
			Pharmacologic
			Surgical
		Alternate Diagnostic Approaches
Chapter 39
	39 - Aging Changes Seen On Echocardiography
		BASIC PRINCIPLES AND ECHOCARDIOGRAPHIC APPROACH
			Normal Changes in Cardiac Structure
				Left Ventricular Wall Thickness and Chamber Dimensions
					Left Ventricular Mass
		Aortic Root Diameter
			Left Atrial Size
				Left Ventricular Dimensions
				Right Ventricular Dimensions
				Cardiac Chamber Dimensions
				Cardiac Valves
				Valve Circumference
				Valve Thickness
				Valvular Calcification
			Normal Changes in Cardiac Function
				Left Ventricular Systolic Function
				Left Ventricular Diastolic Function
				Right Ventricular Systolic Function
				Cardiac Response to Pressor Stress
				Cardiac Response to Exercise Stress
		Clinical Outcome Data
			Valvular Heart Disease
				Aortic Valve Sclerosis
				Mitral Annular Calcification
				Mitral Annular Calcification and Valvular Dysfunction
				Mitral Annular Calcification and Other Pathology
				Mitral Annular Calcification and Conduction Abnormalities
				Mitral Annular Calcification and Atrial Fibrillation
				Mitral Annular Calcification and Thromboembolism
				Mitral Annular Calcification and Endocarditis
				Mitral Annular Calcification and Renal Dysfunction
				Aortic Valve Sclerosis and Mitral Annular Calcification and Cardiovascular Outcomes
			Left Ventricular Hypertrophy and Mass
			Basal Septal Hypertrophy in the Elderly
			Left Atrial Size and Outcomes
			Heart Failure
			Coronary Artery Disease and Stress Testing
				Safety
			Cardiogenic Thromboembolism
			Transesophageal Echocardiography: Considerations in the Elderly
			Cardiac Amyloidosis
Chapter 40
	40 - Echocardiographic Evaluation of the Patient with a Systemic Embolic Event
		CARDIAC EMBOLISM
		Cardioembolic and Cryptogenic Stroke
		Basic Principles and Echocardiographic Approach
		Technical Aspects
			Transesophageal Echocardiography Versus Transthoracic Echocardiography
		Clinical Utility and Outcome Data
			Myocardial Infarction, Left Ventricular Dysfunction, and Thrombus
			Valvular Vegetations and Strands
			Intracardiac Tumors
			Left Atrial Thrombus and Spontaneous Echo-Contrast
			Atrial Septum Abnormalities
				Detection of Patent Foramen Ovale
				Stroke Risk
				Possible Associated Factors
				Prevention of Recurrent Embolism
			AORTIC ATHEROSCLEROTIC PLAQUES
				Therapy and Prevention of Recurrent Events
		Potential Limitations and Alternate Approaches
Chapter 41
	41 - The Role of Echocardiography in Patients with Atrial Fibrillation and Flutter
		PREVALENCE AND IMPACT OF ATRIAL FIBRILLATION
		Atrial Remodeling Associated with Atrial Fibrillation
		Echocardiography in the Workup of Patients with Atrial Fibrillation and Flutter
		Atrial Size
			Atrial Function
		Stroke and Atrial Fibrillation
			Role of the Left Atrial Appendage
				Appendage Morphology
				Appendage Function
				Appendage Tissue Changes
			Hemostatic Changes
			Transesophageal Echocardiography in Management of Atrial Fibrillation
			Valvular Versus Nonvalvular Atrial Fibrillation
		Intraprocedural Echocardiography
			Atrial Fibrillation Catheter Ablation
				Intracardiac Echocardiography
				Transesophageal Echocardiography
			Atrial Flutter Ablation
			Left Atrial Appendage Closure
Chapter 42
	42 - Cardiac Tumors
		CLASSIFICATION AND DIAGNOSTIC APPROACH
			Histology-Based Likelihood
			Age at Presentation
			Location
			Noninvasive Tissue Characterization
		Papillary Fibroelastoma
			Clinical Setting
			Gross Pathology
			Location
			Clinical Manifestations
			Echocardiographic Diagnosis
			Other Imaging Modalities
			Differential Diagnosis
		Cardiac Myxoma
			Clinical Setting
			Location
			Gross Appearance
			Echocardiographic Features
			Other Imaging Modalities
			Differential Diagnosis
			Lipoma And Lipomatous Hypertrophy
			Hemangioma
			Rhabdomyoma
			Cardiac Fibroma
			Cardiac Paraganglioma
		Malignant Primary Cardiac Tumors
			Sarcoma
			Primary Cardiac Lymphoma
			Mesotheliomas
		Metastatic Malignant Tumors
			Direct Extension
			Hematogenous Spread
			Lymphatic Spread
			Intraluminal Venous Extension
		Differential Diagnosis
		Procedural Guidance
Chapter 43
	43 - Heart Disease in Pregnancy
		PHYSIOLOGIC CHANGES DURING PREGNANCY
			BLOOD VOLUME
			Systemic Vascular Resistance
			Cardiac Output
		Echocardiographic Findings in Normal Pregnancy
			Cardiac Chamber Size
			Doppler Flows
			Systolic and Diastolic Function
			Interpretation of Echocardiographic Findings During Pregnancy
		Pregnancy Risks
			Cardiac Shunts
			Tetralogy of Fallot
			Coarctation of the Aorta
			Ebstein Anomaly
			Transposition of the Great Arteries
			Fontan Circulation
			Cyanotic Heart Disease
			Aortic Valve Disease
			Mitral Valve Disease
			Prosthetic Heart Valves
			Aortopathies
			Cardiomyopathies
		Fetal and Neonatal Risk
		Management Principles
			Antepartum
			Labor and Delivery
			Postpartum
		Management of Complications
Chapter 44
	44 - Congenital Shunts
		Patent Foramen Ovale
			Anatomy and Pathophysiology
			Imaging
			Management
		Atrial-Level Shunts
			Anatomy and Pathophysiology
			Management
		Secundum Atrial Septal Defect
			Anatomy and Pathophysiology
			Imaging
			Management
		Primum Atrial Septal Defects
			Anatomy and Pathophysiology
			Imaging
			Management
		Sinus Venosus Defects
			Anatomy and Pathophysiology
			Imaging
			Management
		Unroofed Coronary Sinus
			Anatomy and Pathophysiology
			Imaging
			Management
		Anomalous Pulmonary Venous Return
			Anatomy and Pathophysiology
			Imaging
			Management
		Ventricular Septal Defects
			Pathophysiology and Nomenclature
			Anatomy and Imaging
			Sequelae and Management
		Ruptured Sinus of Valsalva Aneurysm
			Anatomy and Pathophysiology
			Imaging
			Management
		Patent Ductus Arteriosus
			Anatomy and Pathophysiology
			Imaging
			Management
		Coronary Artery Fistula
			Anatomy and Pathophysiology
			Imaging
			Management
Chapter 45
	45 - Left Heart Anomalies
		COR TRIATRIATUM
		Congenital Mitral Valve Disease
			Cleft Mitral Valve
		Supramitral Ring
			Double-Orifice Mitral Valve
			Parachute Mitral Valve
			Congenital Disorders of Papillary Arrangement
		Left Ventricular Noncompaction
		Congenital Left Ventricular Outflow Obstruction
			Subaortic Obstruction
			Valvular Congenital Aortic Disease
			Supravalvular Aortic Stenosis
		Aortic Arch Anomalies
			Double Aortic Arch
			Right Aortic Arch
			Cervical Aortic Arch
			Interrupted Aortic Arch
		Coarctation of the Aorta
		Coronary Artery Anomalies
			Anomalies of Coronary Origin
			Anomalous Coronary Artery Origin from the Opposite Sinus
			Anomalous Coronary Artery Origin from the Pulmonary Artery
			Coronary Cameral Fistulas
		Hypoplastic Left Heart Syndrome
Chapter 46
	46 - Right Heart Anomalies
		PULMONIC VALVE AND SUBPULMONIC STENOSIS
			Pulmonic Valve Stenosis
				Background
				Natural History and Clinical Presentation
				Echocardiography of Pulmonic Valve Stenosis
		Indications for Intervention and Assessment After Intervention
			Subpulmonic Stenosis
				Background
				Pathophysiology and Clinical Presentation
				Echocardiography of Subpulmonic Stenosis
				Indication for Surgical Repair
		Tetralogy of Fallot
			Background
			Morphology and Anatomic Variants
			Surgical Repair and Residuae
			Clinical Presentation and Physical Examination
			Echocardiography of Tetralogy of Fallot
				Right Ventricular Outflow Tract and Pulmonic Valve
				Pulmonic Regurgitation
				Branch Pulmonary Arteries
				Right Ventricular Size and Function
				Tricuspid Regurgitation
				Left Heart in Tetralogy of Fallot
			Outcomes and Surgical Management in Repaired Tetralogy of Fallot
		Ebstein Anomaly
			Background and Morphology
			Clinical Presentation and Physical Examination
			Echocardiography of Ebstein Anomaly
			Surgical Repair and Outcomes
Chapter 47
	47 - Complex Conotruncal Anomalies
		CONOTRUNCAL DEVELOPMENT
		NOMENCLATURE OF CONGENITAL HEART DEFECTS
		Genetics Considerations
			Nomenclature of Congenital Heart Defects
		AORTOPATHY IN CONOTRUNCAL ANOMALIES
		Specific Complex Conotruncal Anomalies
			Truncus Arteriosus
			Double-Outlet Ventricle
				Double-Outlet Right Ventricle
				Double-Outlet Left Ventricle
			Anatomically Corrected Malposition of the Great Arteries
			Aortopulmonary Window
		Summary
Chapter 48
	48 - Transposition of the Great Arteries
		COMPLETE TRANSPOSITION OF THE GREAT ARTERIES
			Surgical Approaches
			Evaluation of the Postoperative Patient
				Evaluation of the Patient after the Atrial Switch Procedure (Mustard or Senning Procedure)
		Baffle Complications
			Evaluation of the Systemic Right Ventricle and Tricuspid Valve
				Evaluation of Tricuspid Regurgitation
					Evaluation of Left Ventricular Outflow Tract Obstruction
					Evaluation of the Patient after an Arterial Switch Operation
				Evaluation of the Patient after a Rastelli Operation
		Congenitally Corrected Transposition of the Great Arteries
			Anatomy and Definitions
				Epidemiology
				Surgical Repair
			Late Outcomes and Echocardiographic Evaluation
			Anatomic Repair
				Echocardiographic Evaluation of Postoperative Problems after Anatomic Repair
Chapter 49
	49 - Single Ventricles: Echocardiographic Assessment after the Fontan Operation
		BASIC PRINCIPLES
			Congenital Heart Defects Associated with Single Ventricle Physiology
			Surgical Evolution after the Fontan Operation
				Ventricular Function before and after Fontan
		Preparation for the Scan
		Sequential and Segmental Approach
			Terminology
			Technical Aspects
		Echocardiographic Evaluation
			The Fontan Connections
				Inferior Vena Cava to Fontan
				Superior Vena Cava to Fontan
				Fontan to Branch Pulmonary Arteries
			Pulmonary Venous Return
			Atrioventricular Valve Function
			Ventricular Systolic Function
				Qualitative Assessment
				Quantitative Assessment
				Nongeometric Indices
			Ventricular Diastolic Function
			Outflow Tracts
		Summary