Handbook of Echo-Doppler Interpretation PDF
Preview Handbook of Echo-Doppler Interpretation
Handbook of Echo-Doppler Interpretation Dedication Thank you ... Denise, for unwavering love and support Katie, Kenny and Christian, for their love Mom and Dad, for a nurturing disciplined childhood. EKK To Randall, all my love and eternal gratitude for always believing in me. EFM Thanks to my supportive and loving family— Leslie, Sharon, Michael, Rachel, Danny and Matthew Alex. GDP Handbook of Echo-Doppler Interpretation SECOND EDITION Edmund Kenneth Kerut, MD FACC FASE Director, Echocardiography Laboratory Heart Clinic of Louisiana, Marrero, Louisiana Clinical Associate Professor of Medicine, Division of Cardiology Tulane University School of Medicine, New Orleans, Louisiana Adjunct Professor of Engineering, Department of Agricultural and Biological Engineering Mississippi State University, Mississippi State University, Mississippi Cardiovascular Research Laboratory, Division of Cardiology, Department of Medicine Louisiana State University Health Sciences Center, New Orleans, Louisiana Elizabeth F. Mcllwain, MHS, RDCS Assistant Clinical Professor, Cardiopulmonary Science School of Allied Health Professions Louisiana State University Health Sciences Center New Orleans, Louisiana Gary D. Plotnick, MD, FACC Professor of Medicine Assistant Dean for Student Affairs University of Maryland School of Medicine Baltimore, Maryland Blackwell Futura © 1996 by Futura Publishing Company © 2004 by Futura, an imprint of Blackwell Publishing Blackwell Publishing, Inc./Futura Division, 3 West Main Street, Elmsford, New York 10523, USA Blackwell Publishing, Inc., 350 Main Street, Maiden, Massachusetts 02148-5020, USA Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Blackwell Science Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia All rights reserved. No part of this publication may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review. 0405060754321 ISBN: 1-4051-1903-9 Library of Congress Cataloging-in-Publication Data Kerut, Edmund Kenneth. Handbook of echo-doppler interpretation / Edmund Kenneth Kerut, Elizabeth F. Mcllwain, Gary D. Plotnick. — 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN 1-4051-1903-9 1. Doppler echocardiography. [DNLM: 1. Echocardiography, Doppler. WG 141.5.E2 K41h 2004] I. Mcllwain, Elizabeth F. II. Plotnick, Gary D. III. Title. RC683.5.U5K47 2004 616.1'207543—dc22 2003024704 A catalogue record for this title is available from the British Library Acquisitions: Steve Korn Production: Julie Elliott Typesetter: Graphicraft Limited, Hong Kong, in 9/12pt Minion Printed and bound in Denmark by Narayana Press, Odder For further information on Blackwell Publishing, visit our website: www. futuraco. com The publisher's policy is to use permanent paper from mills that operate a sustainable forestry policy, and which has been manufactured from pulp processed using acid-free and elementary chlorine-free practices. Furthermore, the publisher ensures that the text paper and cover board used have met acceptable environmental accreditation standards. Notice: The indications and dosages of all drugs in this book have been recommended in the medical literature and conform to the practices of the general community. The medications described do not necessarily have specific approval by the Food and Drug Administration for use in the diseases and dosages for which they are recommended. The package insert for each drug should be consulted for use and dosage as approved by the FDA. Because standards for usage change, it is advisable to keep abreast of revised recommendations, particularly those concerning new drugs. Contents Preface to the Second Edition, vi 11 Cardiomyopathy and Heart Failure, 160 List of Abbreviations, vii 12 Pericardium and Effusions, 187 1 Basic Principles of Ultrasound Physics, 1 13 Ischemic Heart Disease and Myocardial Infarction, 202 2 Principles of Instrumentation and Echo-Doppler Modalities, 7 14 Critical Care, 219 3 Basics of Fluid Mechanics and 15 Operating Room, 230 Hemodynamic Equations, 26 16 Congenital Heart Disease, 240 4 Echo Examination and Echo Anatomy, 37 17 Source of Embolism, 269 5 Ventricular Measurements and 18 Endocarditis, 291 Systolic Function, 54 19 Aorta and Aortic Dissection, 304 6 Diastolic Function, 64 20 Masses and Tumors, 320 7 Aortic Valve, 81 21 Selected Topics, 333 8 Mitral Valve, 99 Appendices, 343 9 Right Heart, Pulmonary Artery, and Ventricular Septum, 123 Further reading, 353 10 Prosthetic Heart Valves, 138 Index, 387 V Preface to the Second Edition We wrote this second edition of the Handbook in an within the third chapter to complement the discus- attempt to help physicians and sonographers learn sion of hemodynamics. An extensive discussion of practical and useful ultrasound concepts that can be anatomy and the echo examination is then presented applied daily in the echocardiography laboratory. in Chapter 4. Chapters 5 and 6 discuss ventricular Our goal is to help improve the quality of day-to-day function, followed by Chapters 7 through 10 which echocardiographic studies as performed in the real cover various aspects of valvular disorders. Chapters world. We have broadly expanded subject content to 11 through 20 cover multiple topics of clinical relev- serve as a study guide for both the physician prepar- ance to the echocardiographer and include multiple ing for the ASEeXAM and the sonographer studying images and drawings to illustrate points made within for the RDCS or RCS examination. Addition of new the text. Chapter 21 covers such divergent subjects as subject matter and expanded discussion of all subjects nonbacterial thrombotic endocarditis, drug related covered in the first edition attempt to achieve this pur- valvular disease, reliability of color Doppler assess- pose. Over 550 photographs and illustrative drawings ment of valvular regurgitation and optimal timing of are included in this new edition. biventricular pacemakers using Doppler parameters. The first two chapters present new subject topics, We hope the reader will find the additional informa- namely ultrasound physics and machine instrumenta- tion and expanded discussion useful. tion. A section on fluid mechanics has been added The Authors VI List of Abbreviations A atrial contraction causing late diastolic ARtvi TVI of an aortic regurgitant jet by filling continuous wave Doppler A area ARVC arrhythmogenic right ventricular A anterior cardiomyopathy A' mitral annular velocity during atrial AS aortic stenosis contraction ASA atrial septal aneurysm AA ascending aorta ASD atrial septal defect AAA abdominal aortic aneurysm ASE American Society of Echocardiography Ac atrial contraction reversed flow in ASH asymmetric septal hypertrophy pulmonary vein AT acceleration time AC atrial contraction reversed flow in AV atrioventricular pulmonary vein AV aortic valve ACEi angiotensin converting enzyme AVA aortic valve area inhibitor AVC aortic valve closure ACUTE Assessment of Cardioversion Using AVD atrioventricular delay Transesophageal Echocardiography AVco atrioventricular interval from closure [study] to opening A/D analog/digital AV programmed long sensed AV delay tlong Adt mitral A wave deceleration time A V\ programmed short sensed AV delay s AHA American Heart Association AV, optimized AV programmed delay opt AIDS acquired immunodeficiency syndrome AV. TVI at the level of the aortic valve TVI AIH aortic intramural hematoma AV, peak Doppler velocity at the level of the velocity A cross-sectional area of a color Doppler aortic valve jet jet AVP aortic valve prolapse AL anterior leaflet ALPM anterolateral papillary muscle BAV bicuspid aortic valve Am TDE mitral annular motion late diastolic velocity c velocity of sound AML anterior mitral leaflet CABG coronary artery bypass grafting Amv area of mitral valve orifice CCU coronary care unit Ao aorta CHF congestive heart failure AO aorta Cl cardiac index AQ acoustic quantification Cm specific heat of tissue AR aortic regurgitation CMP cardiomyopathy AR, Ar atrial contraction reversed flow in CO cardiac output pulmonary veins COPD chronic obstructive pulmonary disease ARpeak peak velocity of aortic regurgitation by CRT cathode ray tube continuous wave Doppler CS coronary sinus VII VIII List of Abbreviations CT computerized axial tomography / intensity CW continuous wave Doppler IA innominate artery Cx circumflex coronary artery ICE intracardiac echocardiography CXR chest X-ray ICT isovolumic contraction time ICU intensive care unit d distance IE infective endocarditis D diastolic flow of pulmonary veins / temporal average intensity of the 2-D two-dimensional 'm largest half-cycle DA descending aorta IMH intramural hematoma dB decibels IMI inferior myocardial infarction DGC depth gain compensation IMP index of myocardial performance Dl dimensionless index In innominate vein DIC disseminated intravascular coagulation pulse average intensity 'pa DSC digital scan convertaor IRT isovolumic relaxation time DT deceleration time reflected intensity coefficient 'r/'i dyn dyne spatial average intensity 'sa spatial average pulse average intensity E early diastolic filling sapa spatial average temporal average E' mitral annular early velocity 'sata intensity E/A ratio of E and A velocities spatial average temporal peak intensity EBCT electron beam computed tomography 'satp spatial peak intensity ECG electrocardiogram 'sp spatial peak pulse average intensity EKG electrocardiogram sppa spatial peak temporal average EDV end-diastolic volume 'spta intensity EF ejection fraction Spatial peak temporal peak intensity El eccentricity index 'sptp temporal average intensity Em TDE mitral annular motion early 'ta temporal peak intensity diastolic velocity 'tP IVC inferior vena cava EOA effective orifice area IVCD interventricular conduction delay EPSS E-point septal separation IVDA intravenous drug abuse ER emergency room IVRT isovolumic relaxation time ERO effective regurgitant orifice IVS interventricular septum ESV end-systolic volume ET ejection time L left EV eustachian valve L long axis of left ventricle EVA effective valve area LA left atrium F force LAA left atrial appendage f frequency LAD left anterior descending coronary artery FDA Federal Drug Administration FFT fast Fourier transform LAP left atrial filling pressure FR frame rate LAV left atrial volume FS fractional shortening LBBB left bundle branch block LC left common carotid HCM hypertrophic cardiomyopathy LCX left circumflex coronary artery HF heart failure LM left main coronary artery HIFU high intensity focused ultrasound LPA left pulmonary artery HOCM hypertrophic obstructive LS left subclavian artery cardiomyopathy LUPV left upper pulmonary vein HV hepatic vein LV left ventricle List of Abbreviations ix LVEDD left ventricular end-diastolic PASP pulmonary artery systolic pressure dimension PAear pulmonary artery early diastolic LVEDP left ventricular end-diastolic pressure velocity LVESD left ventricular end-systolic dimension PAED pulmonary artery end-diastolic velocity LVET left ventricular ejection time PAMP pulmonary artery mean pressure LVFW left ventricular free wall PAPS primary antiphospholipid syndrome LVH left ventriclur hypertrophy PCWP pulmonary capillary wedge pressure LVID left ventricular internal dimension PD pulse duration LVOT left ventricular outflow tract PDA patent ductus arteriosus «-VOT cross-sectional area at the level of the PEP pre-ejection phase area LVOT PFO patent foramen ovale >-VOT flow through the LVOT (stroke PHT pressure half-time flow volume of the LVOT) P incident pressure amplitude t LVOTTVI TVI at the level of the LVOT PISA proximal isovelocity surface area «-VOT peak Doppler velocity at the level of the PL posterior leaflet veloeity LVOT PMBV percutaneous mitral balloon LVSP left ventricular systolic pressure valvuloplasty PML posterior mitral leaflet MAC mitral annulus calcification PMPM posteromedial papillary muscle MAIVF mitral-aortic intervalvularfibrosa PPH primary pulmonary hypertension MCE myocardial contrast echocardiography Pr reflected pressure amplitude Ml mechanical index PR pulmonary regurgitation Ml myocardial infarction PRF pulses per second MPA main pulmonary artery PRP pulse repetition period MR mitral regurgitation PS pulmonic stenosis MRI magnetic resonance imaging PT pulmonary trunk MS mitral stenosis PTT partial thromboplastin time MSA mitral separation angle PV pulmonic valve MV mitral valve PV pulmonary vein MVA mitral valve area PVC pulmonary valve closure MVG mean valve gradient PVC premature ventricular contraction MVP mitral valve prolapse PVR pulmonary vascular resistance MV area of the mitral annulus PW posterior wall (left ventricular) area flow through the MV orifice (stroke PW pulsed wave Doppler MVflow volume of the mitral orifice) PW pulsed wave tissue Doppler MVG myocardial velocity gradient Q flow N Newtons Q quality factor NBTE nonbacterial thrombotic endocarditis QA time from paced ventricular spike to long NSR normal sinus rhythm end of a wave NYHA New York Heart Association QAopt resultant optimized QA interval Nw Womersley number QAshort time from paced ventricular spike to end of A wave P pressure Qp pulmonary flow P posterior Qs systemic flow Pa Pascals PA pulmonary artery r radius PAAU penetrating atherosclerotic aortic ulcer R right PADP pulmonary artery diastolic pressure R amplitude reflection coefficient
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