Clinical Cases in the Echocardiography Lab

210 Pages·2019·9.992 MB·English

by  Atooshe Rohani

Clinical Cases in Cardiology
Series Editors: Ravi V. Shah · Siddique A. Abbasi · James L. Januzzi
Atooshe Rohani
Clinical Cases in the
Echocardiography
Lab
Clinical Cases in Cardiology
Series editors:
Ravi V. Shah
Boston, MA, USA
Siddique A. Abbasi
Providence, RI, USA
James L. Januzzi
Boston, MA, USA
Clinical cases are a key component in modern medical ed-
ucation, assisting the trainee or recertifying clinician to
work through unusual cases using best practice techniques.
Cardiology is a key discipline in this regard and is a highly
visual subject requiring the reader to describe often very
subtle differences in the presentation of patients and define
accurately the diagnostic and management criteria on which
to base their clinical decision-making. This series of concise
practical guides is designed to facilitate the clinical decision-
making process by reviewing a number of cases and defin-
ing the various diagnostic and management decisions open to
clinicians. Each title will be illustrated and diverse in scope,
enabling the reader to obtain relevant clinical information re-
garding both standard and unusual cases in a rapid, easy to
digest format.
More information about this series at http://www.springer.
com/series/14348
Atooshe Rohani
Clinical Cases
in the Echocardiography
Lab
Atooshe Rohani
Northern Ontario School of Medicine
Thunder Bay
ON
Canada
ISSN 2523-3009 ISSN 2523-3017 (electronic)
Clinical Cases in Cardiology
ISBN 978-3-030-16617-5 ISBN 978-3-030-16618-2 (eBook)
https://doi.org/10.1007/978-3-030-16618-2
© Springer Nature Switzerland AG 2019
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Acknowledgement
When I started my career as an echocardiologist, I was look-
ing for a book like this to help me in determining a precise
and evidence-based diagnosis in a challenging and busy echo-
cardiography lab, so I start writing this book as a personal
experience to guide echocardiologists, echocardiography fel-
lows, and whoever wants a practical guidance for making a
right diagnosis of challenging echocardiography cases.
I very much appreciate all of my patients in Quaem
Hospital, Mashhad, Iran, who gave me consent to present
their echocardiography pictures and movies in this book.
I would like to take the opportunity to acknowledge
Carolyn Leonzio and Heather Seed’s assistance for the
preparation of the proposal of this book.
My wish for you is that you will find this book helpful and
enjoy reading it as much as I enjoyed writing it.
v
Contents
Part I Aortic Valve (AV)
1 Quadricuspid Aortic Valve . . . . . . . . . . . . . . . . . . . . . . . . 3
1.1 Echo Pearls ............................... 3
References ................................... 5
2 Unicuspid Aortic Valve . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
3 Annulo-aortic Ectasia and Sinus of
Valsalva Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
3.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
4 Para-valvular Leak Secondary to
Metallic Aortic Valve Endocarditis . . . . . . . . . . . . . . . . . 15
4.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
5 Severe Aortic Regurgitation (AI) . . . . . . . . . . . . . . . . . . 19
5.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
6 Metallic Aortic Valve Obstruction . . . . . . . . . . . . . . . . . 23
6.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
7 Native AV Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
7.1 Echo Pearls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
vii
viii Contents
Part II M itral Valve (MV)
8 Parachute MV and Subvalvular Ring . . . . . . . . . . . . . . . 31
8.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
9 A Case of Flail MV, Review of Myxomatous Mitral
Valve Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
9.1 Mitral Valve Prolapse. . . . . . . . . . . . . . . . . . . . . . . 35
9.2 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
10 MV Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
10.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
11 Bioprosthetic MV obstruction . . . . . . . . . . . . . . . . . . . . . 45
11.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
12 Double Orifice MV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
12.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
13 Ischemic Mitral Regurgitation (MR) . . . . . . . . . . . . . . . 53
13.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
14 Metallic MV Paravalvular Leak . . . . . . . . . . . . . . . . . . . . 57
14.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
15 Metallic MV Obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . 61
15.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
16 MV Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
16.1 Physical Examination. . . . . . . . . . . . . . . . . . . . . . 65
16.2 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
17 Bioprosthetic MV Partial Dehiscence . . . . . . . . . . . . . . 69
17.1 Echo Pearls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Contents ix
18 Flail Posterior MV Leaflet in the
Context of Rheumatic Heart Disease . . . . . . . . . . . . . . 73
18.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
19 Left Atrial Appendage (LAA) Clot . . . . . . . . . . . . . . . . 77
19.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Part III T ricuspid Valve (TV)
20 Ebstein Anomaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
20.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
21 Papillary Fibroelastoma of TV . . . . . . . . . . . . . . . . . . . . . 87
21.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
22 TV Atresia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
22.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
23 TV Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
23.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
24 Metallic Tricuspid Valve Obstruction . . . . . . . . . . . . . . . 95
24.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
25 Bioprosthetic TV Obstruction . . . . . . . . . . . . . . . . . . . . . 99
Part IV Pulmonic Valve (PV)
26 Pulmonary Valve Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . 105
26.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
27 Sub-valvular Pulmonary Stenosis . . . . . . . . . . . . . . . . .109
27.1 E cho Pearls for Subvalvular PS. . . . . . . . . . . . . . 111
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
x Contents
28 Supra-valvular Pulmonary Stenosis . . . . . . . . . . . . . . .113
28.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
29 Severe Pulmonary Insufficiency (PI) . . . . . . . . . . . . . .117
29.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
29.1.1 S evere Pi Echocardiographic Signs . . . . 119
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
30 Pulmonary Valve Endocarditis . . . . . . . . . . . . . . . . . . .121
30.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Part V Left Ventricle (LV)
31 Non-compaction Cardiomyopathy . . . . . . . . . . . . . . . .127
31.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
32 Twenty Years After Hydatid Cyst Operation . . . . . . .131
32.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
33 Amyloid Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . .135
33.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
34 Apical Hypertrophic Cardiomyopathy (aHCM) . . . .139
34.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
35 Hypertrophic Obstructive Cardiomyopathy . . . . . . . .143
35.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147
36 Huge LV Apical Clot . . . . . . . . . . . . . . . . . . . . . . . . . . .149
36.1 Echo Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150
37 Source of Embolism to Brain . . . . . . . . . . . . . . . . . . . .151
37.1 Echo Pearls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152