343T.P. Abraham (ed.), Case Based Echocardiography,DOI: 10.1007/978-1-84996-151-6, © Springer-Verlag London Limited 2011

Index

AAbdominal aortic aneurysm (AAA), 338American Society of Echocardiography

Guidelines 2003, 193Amyloid cardiomyopathy, 328Aorta

abdominal, 338, 339atherosclerosis disease, 254conditions affecting, 253functional assessment, 266imaging, 255thoracic, 252vascular function, 267

Aortic dissectionclassification, 261–265thrombus, false lumen, 265transesophageal echo view, 264type A proximal, 262type B cross-section, 263

Aortic plaque, 259–260Aortic pulse velocity waveform, 268Aortic regurgitation

etiologies of, 193grading and assessment, 193

Aortic stenosisetiologies of, 192grading severity, 192low gradient and low output, 191

Aortic valvepathology, 109–110prosthesis, 242pulse Doppler measurement, 42

Aortic valve area (AVA), 186Asymmetric septal hypertrophy, 271Atherosclerotic disease, 254Athlete’s heart, left ventricular

hypertrophy, 29Atrial myxoma, 312Atrial septal defect (ASD) closure

ICE, 305large secundum ASD, TEE view, 303–304

Atropine, 144–145Attenuation, 2Augmentation index (AI), 341AV optimization protocol, 172Axial resolution, 4

BBall-cage prosthesis, 238Beam characteristics, 3Bicaval orthotopic heart transplant, 329Bicuspid aortic valve, 192Bileaflet mitral prosthesis, 239Bioprosthetic valves

characteristics, 235, 237tricuspid valve replacement, 226

Biplane method of disks, 25Biplane Simpson method, 33–34Burkitt B cell lymphoma, 315

CCardiac masses and tumors

benign, 311Burkitt B cell lymphoma, 315categories, 311fibroma, 314lipomatous hypertrophy TEE bicaval view,

317malignant, 312mimickers, 315–316myxoma, 312papillary fibroelastoma, 313–314sarcoma, 315valvular papillary fibroelastoma, 314

Cardiac optimizationAV optimization, 172PV optimization, 170–171scheduling requirements, 169VV optimization, 172

Cardiac tamponadeechocardiographic features, 287transvalvular flow, 288

344 Index

Cardiomyopathyamyloid, 328constrictive vs. restrictive, 296dilated

causes, 324echocardiography, 324IVC diameter, 326mitral regurgitation, 325ventricular thrombus, 327

hypertrophic cardiomyopathy (see also Hypertrophic cardiomyopathy)

asymmetric septal hypertrophy, 271characteristics, 271conditions mimicking, 275diagnostic criteria, 271ejection dynamics, 275LVOT obstruction, 272patterns, 272provocative maneuvers, 272

stress cardiomyopathyapical thrombus, 281apical variant, 278basal variant, 280characteristics, 277diagnosis, 277echocardiographic evaluation, 277mid-ventricular variant, 279RV involvement, 280

Carotid Duplexcolor doppler, 335ECA vs. ICA, 337indications, 333plaque analysis, 335protocol, 334sample diagnostic criteria, 334stenosis, 338subclavian stenosis, 337waveform morphology, 336

Carotid intima-media thickness (CIMT), 339–340

Carotid stenosis, 338Cinefluoroscopy, 240Circumferential strain profile, 78Clicks, 238Color-coded tissue Doppler (TDI) imaging,

64, 164Color flow Doppler imaging, 15, 240Color flow imaging, 6Color M-mode flow propagation velocity,

54–55Comprehensive Doppler assessment

right ventricle echocardiography, 179right ventricle hemodynamics, 180

Congenital heart defects (CHD)atrial septal defect closure, 303–305patent ductus arteriosus closure, 308–309ventricular septal defect closure, 306–307

Constrictive pericarditisvs. restrictive cardiomyopathy, 296tissue and pulsed wave Doppler, 293ventricular filling, 291, 292

Continuous wave (CW) Doppler, 6Contrast agents

administration methods, 121definition, 117FDA recommendations, 123indications, clinical practice, 118–120routine study, 120safety, 122stress, 121–122techniques, problems, and solutions, 122in use, 118

Contrast echocardiography, 121, 123

D2DE. See Two-dimensional echocardiography3DE. See Three-dimensional echocardiographyDeBakey aortic dissection classification, 261Definity, 118Diastole phases, 47–48Diastolic dysfunction

echocardiographic parameterscolor M-mode flow propagation

velocity, 54–55mitral inflow velocities, 49–51morphologic and functional

correlations, 48–49pulmonary vein inflow velocities, 51–52tissue Doppler velocities, 53–54

left atrium (LA), 57–58and left ventricular filling pressures, 55–57patient evaluation

differential diagnosis and subtypes, 58–59

elevated filling pressures, 59–60grading, 61–62

physiology, 47–48Diastolic dyssynchrony measurement, 161Diastolic function, 47Dilated cardiomyopathy

causes, 324echocardiography, 324IVC diameter, 326mitral regurgitation, 325ventricular thrombus, 327

Dobutamine, 144–145

Index 345

Doppler-derived strain rateamplitude, 74magnitude, 73velocity gradient, 68

Doppler echocardiography, 62D strain speckle tracking, 164Dynamic left ventricular outflow tract

obstruction, 187–190

EEccentricity index, right ventricle

assessment, 1782D echocardiography, 53D echocardiography, 7External carotid artery (ECA), 337

FFibroma, 314Flow-mediated dilatation (FMD), 341Frame rate, 4Frequency, 2

GGlobal LV systolic function, 33–34Grading diastolic dysfunction, 61–62

HHeart failure with normal ejection fraction

(HFnlEF)causes, 57patient evaluation

differential diagnosis and subtypes, 58–59

elevated filling pressures, 59–60grading, 61–62

Heart transplantationechocardiography, 322transplant rejection, 323

Hemolysis, 246Hypertrophic cardiomyopathy (HCM)

asymmetric septal hypertrophy, 271characteristics, 271conditions mimicking, 275diagnostic criteria, 271ejection dynamics, 275LVOT obstruction, 272patterns, 272provocative maneuvers, 272systolic anterior motion, 272

apical hypertrophic cardiomyopathy, 273left ventricular outflow tract, 274mitral regurgitation, 273mitral valve leaflet, 274

IImaging artifacts

range ambigity, 11reverberation, 10shadowing, 10side lobes, 11suboptimal images, 9

Infective prosthetic endocarditis, 245–246

Internal carotid artery (ICA), 337Interventricular dyssynchrony, 162–163Intraoperative transesophageal echocardiography,

107, 113, 115adjuvant procedure during mitral valve

surgery, 115aortic valve pathology, 109–110intraoperative diastolic function

assessment, 114major vessels, 112mid-esophageal bicaval view, 105mid-esophageal level, 104, 106mitral valve pathology, 108–109prosthetic valves, 111

LLeft atrial pressure (LAP), 46Left atrium (LA), 57–58Left ventricular dyssynchrony

algorithm, 165echocardiographic techniques, 164measuremnet, 152pitfalls, 166resynchronization, 149–151

Left ventricular ejection fraction (LVEF), 33Left ventricular end diastolic pressure

(LVEDP), 46Left ventricular opacification (LVO), 122Left ventricular (LV) quantification

direct 2D methods, 24mass calculation, 28–29M-mode dimensions, 24pathologic vs. physiologicl LVH, 29systolic function, 33–35volumetric assessment, 25–27wall thickness, 30

Left ventricular systolic functionglobal, 33–34regional, 34–35

Length-area volumetric method, 26Levovist, 118Loculated pericardial effusion, 285–286Longitudinal resolution, 4LVEF. See Left ventricular ejection fraction

346 Index

MMechanical dyssynchrony assessment

diastolic dyssynchrony, 161interventricular dyssynchrony, 162–163left ventricular

measurement, 152resynchronization, 149–151

ROC curve analysis, 1564-segmental model, 159–16012-segmental model, 157–158TDI curve, 153–156

Mechanical prosthetic valvesacoustic shadowing, 238characteristics, 235–236

Microcavitation, 247Mid-esophageal view, TEE

artifact, 101four chamber, 88left atrial appendage, 93long axis, 88pulmonary artery, 92pulmonary valve, 92right ventricular outflow tract, 92short axis, 90two chamber, 88

Mitral inflow velocities, 49–51Mitral prolapse regurgitation

color Doppler jet area assessment, 206fluid dynamics and measurement, 199mechanisms of, 198multiple mechanisms of, 205normal anatomy, 197qualitative and quantitative parameters,

215–216quantitative measures, 208–209vena contracta, 207

Mitral stenosis, 196Doppler assessment, 212–214echocardiographic features, 210planimetry, 211recommendations for classification, 216

Mitral valveanatomy

assessment, 216normal, 197real time 3D echocardiography., 203scallop, 200–202

pathology, 108–109prolapse, 195, 204prosthesis, 243

Mitral valve area (MVA), 196M-mode echocardiography, 164Modified Simpson biplane method, 25

Motion-mode echocardiography, 5Myocardial deformation, 65Myocardial perfusion (MCE), 122Myocardial relaxation, 47Myocardial stiffness, 47Myxoma, 312

NNoninvasive hemodynamic assessment

mitral regurgitation velocity, 41M-mode cursor, 44normal and abnormal relaxation

patterns, 45pulmonary to system blood flow ratio, 40pulmonary vascular resistance, 39pulse Doppler, aortic valve, 42stroke volume calculation, 38

Nyquist limit, 6

OOne cycle, 2Optison, 118

PPannus vs. thrombus, 244–245Papillary fibroelastoma, 313Patent ductus arteriosus (PDA) closure,

308–309Pathological left ventricular hypertrophy, 29Patient-prosthesis mismatch (PPM), 249Peak systolic pressure, 268Pericardial effusion

diagnosis, pitfalls, 295echocardiographic artifacts, 295left atrium, 284loculated, 285–286metastatic deposits, 286, 287pericardium, congenital absence, 284vs. pleural effusion, 284transesophageal echocardiography, 283

Pericardiocentesis, 289, 290Pericarditis

constrictivevs. restrictive cardiomyopathy, 296tissue and pulsed wave Doppler, 293ventricular filling, 291, 292

transesophageal echocardiogram, 290, 291Perivalvular leak and valve dehiscence, 246Planimetry

mitral stenosis assessment, 211mitral valve area measurement, 196

Point of maximal intensity (PMI), 17Pressure half-time method, 212

Index 347

Pressure recovery, 247–248Prosthesis malfunction

prosthetic aortic valve evaluation, 241prosthetic mitral valve evaluation, 242–243prosthetic valve regurgitation, 241prosthetic valve stenosis, 241pulmonic prosthetic valve, 242–243tricuspid prosthetic valve evaluation, 243

Prosthetic valve echocardiogramscolor flow Doppler, 2402D echo, 238–239spectral Doppler, 240

Prosthetic valves, 111aortic, 242bio, 235characteristics, 235–237mechanical, 235mitral, 242pulmonary, 243tricuspid, 245

Proximal isovelocity area (PISA) method, 196

Pulmonary artery systolic pressure, 46Pulmonary capillary wedge pressure

(PCWP), 46Pulmonary valve prosthesis, 243Pulmonary vascular resistance (PVR), 39Pulmonary vein inflow velocities, 51–52Pulmonic regurgitation

Doppler parameters, 220Doppler signal, 224

Pulmonic stenosis (PS)congenital, 229etiologies of, 219–220

Pulsed wave (PW) Doppler, 6Pulsed wave tissue Doppler imaging, 64, 164Pulse waveform velocity analysis, 268PV optimization protocol, 170–171

QQuantitative hemodynamic measurements, 46

RReal-time 3D echocardiography (RT3DE),

127–128, 164examination strategy, 128mitral valve anatomy, 203transthoracic and transesophageal, 129volumetric assessment of left ventricular,

26–27Regional LV systolic function

scoring system, 3516-segment model, 35

Relative wall thickness (RWT), 7Resolution, 4Reverberation artifacts, 10, 238Rheumatic mitral stenosis, 210Right atrial pressure (RAP), 46Right ventricle echocardiography

advanced echocardiographic variables, 182–183

comprehensive Doppler assessment, 1792D echocardiographic variables, 174eccentricity index, 178fractional area change, 175systolic dysfunction, 181three-dimensional echocardiography, 184tricuspid annular plane systolic excursion

(TAPSE), 177volumes and ejection fraction, 176

SSarcoma, 3154-Segmental model, 159–16012-Segmental model, 157–158Shadowing artifact, 10Side lobes artifact, 11SonoVue, 118Sound

definition, 1interactions with tissue, 2

Speckle tracking, 64–65, 75–77, 81Spectral Doppler, 6, 240Stanford aortic dissection classification, 261Stenotic mitral valve, 196Strain imaging, 164Strain rate profile, 64Stress cardiomyopathy (SCM)

apical thrombus, 281apical variant, 278basal variant, 280characteristics, 277diagnosis, 277echocardiographic evaluation, 277mid-ventricular variant, 279RV involvement, 280

Stress echocardiographycontraindications, 144dobutamine, 144indications, 143interpretation, 148monitoring requirements, 145myocardial viability, 147performance, 146–147purpose, 143side effects, 145

348 Index

termination criteria, 147visual assessment, 145–146

Struts, 238Subclavian stenosis, 337Subvalvular aortic stenosis, 192Supravalvular aortic stenosis, 192

TTakotsubo cardiomyopathy. See Stress

cardiomyopathyTAPSE. See Tricuspid annular plane systolic

excursionTDI. See Tissue Doppler imagingThoracic aorta, 252Three-dimensional echocardiography

(3DE), 128apical window, 133–1353D display, 1313D orientation, 131parasternal window, 132right ventricle assessment, 184

Tissue Doppler imaging (TDI), 8color-coded, 64dyssynchrony analysis, 79pulsed wave, 64wall motion, 80

Tissue Doppler velocities, 53–54Tissue synchronization imaging, 164Tissue velocity

interrogation, 66nomenclature, 65

Transducerdefinition, 3flow in, 6

Transesophageal echocardiography (TEE), 111, 224

aortic root, 91aortic valve, 90ascending aorta, 91indications, 86

anterior leaflet mass, 99anterior mitral valve leaflet mass,

99–100mitral regurgitation, 99mitral valve anterior leaflet, 98type I aortic dissection, 100type III aortic dissection, 100

interatrial septum, 94–95intraoperative, 107, 113, 115

adjuvant procedure during mitral valve surgery, 115

aortic valve pathology, 109–110intraoperative diastolic function

assessment, 114

major vessels, 112mid-esophageal bicaval view, 105mid-esophageal level, 104, 106mitral valve pathology, 108–109prosthetic valves, 111

left superior pulmonary vein, 93, 94mid-esophageal view

artifact, 101four chamber, 88left atrial appendage, 93long axis, 88pulmonary artery, 92pulmonary valve, 92right ventricular outflow tract, 92short axis, 90two chamber, 88

mitral valve, 89pitfalls, 101pulmonary valve, biplane imaging, 92small secundum ASD, 95–96transgastric views

biplane view, 97inferior vena cava, 98left ventricle, 96–97open tricuspid valve, 97right ventricular inflow and outflow, 98

tricuspid valve, 91–92Transthoracic echocardiogram, 229Transthoracic real-time 3D

echocardiography, 129density settings, 130modes of acquisition, 129

Tricuspid annular plane systolic excursion (TAPSE), 177

Tricuspid regurgitation (TR)echo parameters, 221etiologies of, 221

Tricuspid stenosis, 222Tricuspid valve prosthesis, 245Two-dimensional echocardiography (2DE), 127

apical four-chamber view, 231–233parasternal long axis right ventricular inflow

view, 225parasternal short axis view, 227–228right ventricular inflow view, 222–223, 226,

232–233subcostal four-chamber view, 234

Two-dimensional speckle tracking-derived strain measurement, 75

UUltrasound

apical views, 17–18contrast agents, 118

Index 349

administration methods, 121definition, 117FDA recommendations, 123indications, clinical practice, 118–120routine study, 120safety, 122stress, 121–122techniques, problems, and solutions, 122

definition, 1echocardiographic windows, 14image optimization, 21inferior vena cava view, 19parasternal short axis view, 16parasternal windows, 15right ventricular inflow view, 16subcostal views, 19suprasternal window, 20transducer, 3types of resolution, 4vascular imaging

abdominal aorta, 8–9, 338, 339carotid Duplex (see Carotid Duplex)conventions, 332diagnostic criteria, 332techniques, 332

Unicuspid aortic valve, 192Uniplane method of disks, 26

VValve bed abnormalities, 247Valvular papillary fibroelastoma, 314

Vascular imagingaugmentation index, 341brachial reactivity, 341carotid intima-media thickness, 339–340ultrasound

abdominal aorta, 8–9, 338, 339carotid Duplex (see Carotid Duplex)conventions, 332diagnostic criteria, 332techniques, 332

Velocity gradientDoppler-derived strain rate, 68strain rate measurements, 67

Vena contracta, mitral prolapse regurgitation, 207Ventricular assist devices (VADs)

aortic valve function, 321apical short axis, 320echocardiography, 319parasternal long axis, 320

Ventricular septal defect (VSD) closure, 306–307

Volumetric assessment of left ventricularbiplane method of disks, 25length-area method, 26real-time 3D echocardiography, 26–27uniplane method of disks, 26

VV optimization protocol, 172

WWavelength, 2Wave truncation, 171