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Cardiopulmonary Medicine from Imperial College Press Echocardiographyin Congenital Heart Disease Made Simple May24,2005 15:50 spi-b260:EchocardiographyinCongenitalHeartDiseaseMadeSimple fm This page intentionally left blank Siew Yen Ho Imperial College & Royal Brompton Hospital, UK Michael L. Rigby Royal Brompton Hospital, uk Robert H. Anderson Institute of Child Health, uk Cardiopulmonary Medicine from Imperial College Press Echocardiography in Congenital Heart Disease Made Simple Imperial College Press Published by Imperial College Press 57 Shelton Street Covent Garden London WC2H 9HE Distributed by World Scientific Publishing Co. Pte. Ltd. 5 Toh Tuck Link, Singapore 596224 USA office: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601 UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE Library of Congress Cataloging-in-Publication Data Ho, Siew Yen. Echocardiography in congenital heart disease made simple / by Siew Yen Ho, Michael L. Rigby, Robert H. Anderson. p. ; cm. Includes index. ISBN 1-86094-124-9 (alk. paper) 1. Congenital heart disease--Ultrasonic imaging. I. Rigby, Michael L. II. Anderson, Robert Henry. III. Title. [DNLM: 1. Echocardiography--Handbooks. 2. Heart Defects, Congenital--diagnosis--Handbooks. WG 39 H678e 2005] RC687.H6 2005 616.1'20437543--dc22 2004065845 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. First published 2005 Reprinted 2006 Copyright © 2005 by Imperial College Press All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the Publisher. For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. In this case permission to photocopy is not required from the publisher. Typeset by Stallion Press Email: [email protected] Printed in Singapore. May24,2005 15:50 spi-b260:EchocardiographyinCongenitalHeartDiseaseMadeSimple fm Contents Preface vii Abbreviations ix 1. The Normal Heart 1 2. The Normal Cross-sectional Echocardiographic Study 17 3. Basic Principles of Diagnosis 29 4. Isomeric Arrangement of the Atrial Appendages 48 5. Normal Septal Structures 60 6. Interatrial Communications 67 7. Atrioventricular Septal Defects 76 8. Ventricular Septal Defects 87 9. The Ventricular Outflow Tracts 104 10. Tetralogy of Fallot 120 11. Tetralogy of Fallot with Pulmonary Atresia 130 12. Hypoplastic Right and Left Ventricles 139 13. Double Outlet Right Ventricle 151 14. Common Arterial Trunk 164 15. Complete Transposition 175 16. Congenitally Corrected Transposition 187 17. Hearts with Univentricular Atrioventricular Connections 201 18. Ebstein Malformation 214 19. Aortic Coarctation and Interruption 219 20. The Arterial Duct 228 Index 233 v May24,2005 15:50 spi-b260:EchocardiographyinCongenitalHeartDiseaseMadeSimple fm This page intentionally left blank May24,2005 15:50 spi-b260:EchocardiographyinCongenitalHeartDiseaseMadeSimple fm Preface Echocardiographyhasprobablybecomethemostcommonlyuseddiagnostictool in congenital heart disease, with many a senior physician now lamenting the fact that their younger colleagues resort to the ‘echo’ machine before they even place thestethoscopeonthepatient’schest.Thistextbookaimstofacilitateunderstanding ofcardiacmalformationsasseenincross-sectionalviews,notwithstandingthatsome echocardiographic machines come equipped with software for three-dimensional reconstruction. The variation of structural malformations is legion and daunting to the beginner. With a systematic approach, and describing what we see, instead of speculatingonwhatwentwrongduringdevelopment,congenitalheartdefectsneed not be complicated. ThisslimvolumeistheculminationofmanyyearsofourshortcoursesonEcho- Anatomic Correlates at the Royal Brompton Hospital. Indeed it is produced in responsetocontinualrequestsfrommanyofourstudents.Withouttheirenthusiasm andoverwhelminginterestinlearningaboutcongenitalheartdefects,thistextbook wouldnothavecometofruition.Oneofus,SYH,wouldnothavefoundtheextra energytocompletethistaskhaditnotbeenforthegentleremindersfrommanyof aseriesofcommissioningeditorsatImperialCollegePress.ThepatienceofLenore Betts, the current editor, has paid off. WeareindebtedtoourclinicalcolleaguesattheRoyalBromptonfortheimages taken from patients under their care and to Manjit Josen and Jo Wolfendon who performed many of the echocardiograms. We are extremely grateful to the patients and their relatives for consenting to tissues and organs being used for education and research. We hope that this book provides ample evidence of the immense contribution that such donations make to diagnosis and treatment of current and future patients. vii May24,2005 15:50 spi-b260:EchocardiographyinCongenitalHeartDiseaseMadeSimple fm viii Preface We also express our thanks to the Cardiac Morphology team at the Royal Brompton for their support. Specifically, Karen McCarthy and Tony Philip helped in the initial phase of collating some of the images and Carina Lim printed final copies. Joy Quek, Senior Editor at World Scientific Publishing Co. managed the project. SYH prepared all the illustrations and all mistakes and omissions are her sole responsibility. S. Y. Ho (SYH) M. L. Rigby (MLR) R. H. Anderson (RHA) May24,2005 15:50 spi-b260:EchocardiographyinCongenitalHeartDiseaseMadeSimple fm Abbreviations AAo Ascending aorta AD Arterial duct Ao Aorta ASD Atrial septal defect ASL Antero-superior leaflet CS Coronary sinus DAo Descending aorta HV Hepatic vein IBL Inferior bridging leaflet ICV Inferior caval vein IND.V Indeterminate ventricle LA Left atrium LAA Left atrial appendage LSc Left subclavian artery LV Left ventricle MV Mitral valve OS Outlet septum PT Pulmonary trunk PV Pulmonary vein RA Right atrium RAA Right atrial appendage RV Right ventricle RVOT Right ventricular outflow tract S Septum SBL Superior bridging leaflet SMT Septomarginal trabeculation T Truncal valve TV Tricuspid valve VSD Ventricular septal defect ix

Description:
Congenital malformations of the heart are often dismissed as a form of complex heart disease, which is too difficult to understand, and is best referred to the specialists. The authors of this handbook, however, aim to dispel this myth. The advent of cross-sectional and, more recently, three-dimensi
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Cardiopulmonary Medicine from Imperial College Press Echocardiographyin Congenital Heart Disease Made Simple May24,2005 15:50 spi-b260:EchocardiographyinCongenitalHeartDiseaseMadeSimple fm This page intentionally left blank Siew Yen Ho Imperial College & Royal Brompton Hospital, UK Michael L. Rigby Royal Brompton Hospital, uk Robert H. Anderson Institute of Child Health, uk Cardiopulmonary Medicine from Imperial College Press Echocardiography in Congenital Heart Disease Made Simple Imperial College Press Published by Imperial College Press 57 Shelton Street Covent Garden London WC2H 9HE Distributed by World Scientific Publishing Co. Pte. Ltd. 5 Toh Tuck Link, Singapore 596224 USA office: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601 UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE Library of Congress Cataloging-in-Publication Data Ho, Siew Yen. Echocardiography in congenital heart disease made simple / by Siew Yen Ho, Michael L. Rigby, Robert H. Anderson. p. ; cm. Includes index. ISBN 1-86094-124-9 (alk. paper) 1. Congenital heart disease--Ultrasonic imaging. I. Rigby, Michael L. II. Anderson, Robert Henry. III. Title. [DNLM: 1. Echocardiography--Handbooks. 2. Heart Defects, Congenital--diagnosis--Handbooks. WG 39 H678e 2005] RC687.H6 2005 616.1'20437543--dc22 2004065845 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. First published 2005 Reprinted 2006 Copyright © 2005 by Imperial College Press All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the Publisher. For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. In this case permission to photocopy is not required from the publisher. Typeset by Stallion Press Email: [email protected] Printed in Singapore. May24,2005 15:50 spi-b260:EchocardiographyinCongenitalHeartDiseaseMadeSimple fm Contents Preface vii Abbreviations ix 1. The Normal Heart 1 2. The Normal Cross-sectional Echocardiographic Study 17 3. Basic Principles of Diagnosis 29 4. Isomeric Arrangement of the Atrial Appendages 48 5. Normal Septal Structures 60 6. Interatrial Communications 67 7. Atrioventricular Septal Defects 76 8. Ventricular Septal Defects 87 9. The Ventricular Outflow Tracts 104 10. Tetralogy of Fallot 120 11. Tetralogy of Fallot with Pulmonary Atresia 130 12. Hypoplastic Right and Left Ventricles 139 13. Double Outlet Right Ventricle 151 14. Common Arterial Trunk 164 15. Complete Transposition 175 16. Congenitally Corrected Transposition 187 17. Hearts with Univentricular Atrioventricular Connections 201 18. Ebstein Malformation 214 19. Aortic Coarctation and Interruption 219 20. The Arterial Duct 228 Index 233 v May24,2005 15:50 spi-b260:EchocardiographyinCongenitalHeartDiseaseMadeSimple fm This page intentionally left blank May24,2005 15:50 spi-b260:EchocardiographyinCongenitalHeartDiseaseMadeSimple fm Preface Echocardiographyhasprobablybecomethemostcommonlyuseddiagnostictool in congenital heart disease, with many a senior physician now lamenting the fact that their younger colleagues resort to the ‘echo’ machine before they even place thestethoscopeonthepatient’schest.Thistextbookaimstofacilitateunderstanding ofcardiacmalformationsasseenincross-sectionalviews,notwithstandingthatsome echocardiographic machines come equipped with software for three-dimensional reconstruction. The variation of structural malformations is legion and daunting to the beginner. With a systematic approach, and describing what we see, instead of speculatingonwhatwentwrongduringdevelopment,congenitalheartdefectsneed not be complicated. ThisslimvolumeistheculminationofmanyyearsofourshortcoursesonEcho- Anatomic Correlates at the Royal Brompton Hospital. Indeed it is produced in responsetocontinualrequestsfrommanyofourstudents.Withouttheirenthusiasm andoverwhelminginterestinlearningaboutcongenitalheartdefects,thistextbook wouldnothavecometofruition.Oneofus,SYH,wouldnothavefoundtheextra energytocompletethistaskhaditnotbeenforthegentleremindersfrommanyof aseriesofcommissioningeditorsatImperialCollegePress.ThepatienceofLenore Betts, the current editor, has paid off. WeareindebtedtoourclinicalcolleaguesattheRoyalBromptonfortheimages taken from patients under their care and to Manjit Josen and Jo Wolfendon who performed many of the echocardiograms. We are extremely grateful to the patients and their relatives for consenting to tissues and organs being used for education and research. We hope that this book provides ample evidence of the immense contribution that such donations make to diagnosis and treatment of current and future patients. vii May24,2005 15:50 spi-b260:EchocardiographyinCongenitalHeartDiseaseMadeSimple fm viii Preface We also express our thanks to the Cardiac Morphology team at the Royal Brompton for their support. Specifically, Karen McCarthy and Tony Philip helped in the initial phase of collating some of the images and Carina Lim printed final copies. Joy Quek, Senior Editor at World Scientific Publishing Co. managed the project. SYH prepared all the illustrations and all mistakes and omissions are her sole responsibility. S. Y. Ho (SYH) M. L. Rigby (MLR) R. H. Anderson (RHA) May24,2005 15:50 spi-b260:EchocardiographyinCongenitalHeartDiseaseMadeSimple fm Abbreviations AAo Ascending aorta AD Arterial duct Ao Aorta ASD Atrial septal defect ASL Antero-superior leaflet CS Coronary sinus DAo Descending aorta HV Hepatic vein IBL Inferior bridging leaflet ICV Inferior caval vein IND.V Indeterminate ventricle LA Left atrium LAA Left atrial appendage LSc Left subclavian artery LV Left ventricle MV Mitral valve OS Outlet septum PT Pulmonary trunk PV Pulmonary vein RA Right atrium RAA Right atrial appendage RV Right ventricle RVOT Right ventricular outflow tract S Septum SBL Superior bridging leaflet SMT Septomarginal trabeculation T Truncal valve TV Tricuspid valve VSD Ventricular septal defect ix

Description:
Congenital malformations of the heart are often dismissed as a form of complex heart disease, which is too difficult to understand, and is best referred to the specialists. The authors of this handbook, however, aim to dispel this myth. The advent of cross-sectional and, more recently, three-dimensi
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