A Practical Approach to Transesophageal Echocardiography

 

Description:

 

 

With updated content and new expert contributors, A Practical Approach to Transesophageal Echocardiography, Fourth Editionis every clinician’s go-to reference for TEE skill-building. The book is written concisely, so you can quickly digest and apply critical information in a real clinical setting. Numerous figures throughout each chapter and hundreds of video clips on the digital paint an important visual picture, illuminating the textual explanations and instructions.

 

 

Table of Contents:

 

SECTION I: ESSENTIALS OF 2D IMAGING

1. Principles and Technology of Two-Dimensional Echocardiography

INTRODUCTION

PHYSICAL PROPERTIES OF SOUND WAVES

Vibrations

Amplitude

Frequency and Wavelength

Propagation Velocity

WHAT IS SO SPECIAL ABOUT ULTRASOUND?

INTERACTIONS OF SOUND AND TISSUE

Reflection

Refraction

Attenuation

TRANSDUCER DESIGN AND BEAM FORMATION

Transducer Components

Formation of Ultrasound Waves: The Piezoelectric Crystal

The Three-Dimensional Ultrasound Beam

Resolution

Extraneous Sound Beams

SIGNAL RECEPTION AND PROCESSING

Cycling of Transducer Transmit and Receive Modes

Electrical Processing

DISPLAY FORMATS

The Golden Rule: Time Is Distance

Amplitude Mode

Brightness Mode

Motion Mode

2D Echocardiography

2D SCAN SYSTEMS

Linear Scanners

Sector Scanners

CREATING THE 2D IMAGE

Imaging a Sector

Image Quality and Dynamic Motion

Image Quality versus Dynamic Motion

ADVANCEMENTS

Harmonic Imaging

3D Imaging

TISSUE DOPPLER AND SPECKLE TRACKING

Tissue Doppler Imaging

Strain, Strain Rate, and Speckle Tracking

Speckle Tracking

SUMMARY

Review Questions

2. Two-Dimensional Examination

PROBE MANIPULATION

MULTIPLANE IMAGING ANGLE

PROBE INSERTION

GOALS OF THE EXAMINATION

THE COMPREHENSIVE EXAMINATION

Midesophageal Ascending Aortic Short-Axis View

Midesophageal Right Pulmonary Vein View

Midesophageal Ascending Aortic Long-Axis View

Midesophageal Aortic Valve Short-Axis View

Midesophageal Right Ventricular Inflow–Outflow

Midesophageal-Modified Bicaval Tricuspid Valve View

Midesophageal Aortic Valve Long-Axis View

Midesophageal Bicaval View

Midesophageal Right and Left Pulmonary Vein View

Midesophageal Five-Chamber View

Midesophageal Four-Chamber Views

Midesophageal Mitral Commissural View

Midesophageal Two-Chamber View

Midesophageal Left Atrial Appendage View

Midesophageal Left Pulmonary Vein View

Midesophageal Long-Axis View

Transgastric Basal Short-Axis View

Transgastric Midpapillary Short-Axis View

Transgastric Apical Short-Axis View

Transgastric Two-Chamber View

Transgastric Long-Axis View

Transgastric Right Ventricular Inflow View

Deep Transgastric Five-Chamber View

TG Right Ventricular Basal View

TG Right Ventricular Inflow–Outflow View

Descending Aorta Short-Axis View

Upper Esophageal Aortic Arch Long-Axis View

Upper Esophageal Aortic Arch Short-Axis View

Descending Aorta Long-Axis View

REAL-TIME BIPLANE VIEWS

THE ABBREVIATED CORE EXAMINATION

SUMMARY

Review Questions

3. Left Ventricular Systolic Performance and Pathology

MEASUREMENTS OF LV SIZE—WALL THICKNESS, CHAMBER SIZE, AND LV MASS

Left Ventricular Wall Thickness

Relative Wall Thickness

Chamber Size (LV Diameter)

Chamber Size (LV Volume)

Left Ventricular Mass

QUANTITATIVE MEASURES OF LEFT VENTRICULAR SYSTOLIC PERFORMANCE

OTHER MEASURES OF LEFT VENTRICULAR SYSTOLIC FUNCTION

Assessing Left Ventricular Systolic Function With Doppler Techniques

VENTRICULAR PATHOLOGY

Cardiomyopathies

Left Ventricular Hypertrophy

Left Ventricular True Aneurysm

Left Ventricular Pseudoaneurysm

CONCLUSION

Review Questions

4. Diagnosis of Myocardial Ischemia

ANATOMY AND PATHOPHYSIOLOGY OF THE MYOCARDIAL BLOOD SUPPLY

Coronary Anatomy

Variations in Coronary Anatomy and Main Distribution Types

Echocardiographic Assessment of Coronary Arteries

Detection of Coronary Artery Pathology

PHYSIOLOGIC BASIS FOR THE DETECTION OF ISCHEMIA

Clinical Syndromes of Myocardial Ischemia

ECHOCARDIOGRAPHIC ASSESSMENT OF ISCHEMIA

Anatomic Localization of Ischemia: The 17-Segment Model

Echocardiographic Imaging of the 17 Myocardial Segments

Coronary Perfusion of LV Segments

Assessment and Grading of Regional Wall Contraction Abnormalities

Important Methodologic Aspects of Wall Contraction Analysis and Potential Pitfalls

Limitations of Echocardiographic Detection of Myocardial Ischemia

Alternative Echocardiographic Methods for Detection of Ischemia

Right Ventricular Ischemia

COMPLICATIONS OF MYOCARDIAL ISCHEMIA

SUMMARY

Review Questions

SECTION II: ESSENTIALS OF DOPPLER ECHO

5. Doppler Technology and Technique

INTRODUCTION

DOPPLER FREQUENCY SHIFT

The Doppler Effect

Signal Frequency and Blood Flow

DOPPLER ANALYSIS

The Doppler Equation: Linking the Frequency Shift to Velocity

Implications of Beam Orientation

Clinical Caveats in Transesophageal Echocardiographic Doppler Examinations

Isolating the Doppler Frequency Shift

PRESENTATION OF DOPPLER DATA

Audible Broadcast

Spectral Display

DOPPLER TECHNIQUES

Pulsed-Wave Doppler

Continuous-Wave Doppler

Color Flow Mapping

SUMMARY

Review Questions

6. Quantitative Doppler and Hemodynamics

VOLUMETRIC FLOW CALCULATIONS

Doppler Measurements of Stroke Volume and Cardiac Output

Regurgitant Volume

Intracardiac Shunts

Valve Area: The Continuity Equation

INTRACARDIAC PRESSURES AND PRESSURE GRADIENTS: THE BERNOULLI EQUATION

Assessment of Valvular Disease

Measurement of Intracavitary Pressures

Vascular Resistance

Determination of Filling Pressures

HEART RHYTHM

SUMMARY

Review Questions

7. Echocardiographic Evaluation of Ventricular Diastolic Function

INTRODUCTION

BASICS OF DIASTOLIC PHYSIOLOGY

Intrinsic Myocardial Factors Affecting Diastolic Performance

Extrinsic Nonmyocardial Factors Affecting Diastolic Performance

PATHOPHYSIOLOGY OF DIASTOLIC DYSFUNCTION AND PROGRESSION OF DISEASE

ECHOCARDIOGRAPHIC EVALUATION OF LEFT VENTRICULAR DIASTOLIC FUNCTION

Two-Dimensional Echocardiography

Doppler Echocardiographic Evaluation of LV Filling

Influence of Physiologic Variables on Doppler Flow Profiles

Assessment of Diastolic Function in Special Clinical Scenarios

Right Ventricular Diastolic Function

Pericardial Diseases: Constrictive Pericarditis and Cardiac Tamponade

A PRACTICAL APPROACH TO DIASTOLIC FUNCTION ASSESSMENT IN THE PERIOPERATIVE PERIOD

SUMMARY

Review Questions

SECTION III: VALVULAR DISEASE

8. Mitral Regurgitation

INTRODUCTION

ANATOMY

NOMENCLATURE

ETIOLOGY AND MECHANISM OF MR

APPROACH TO THE TRANSESOPHAGEAL ECHOCARDIOGRAPHY EVALUATION OF MR

Where on the Mitral Valve Is the MR and What Is the Mechanism of MR?

How Severe Is the MR?

PITFALLS IN THE EVALUATION OF MR

SECONDARY (FUNCTIONAL) MR

CONCLUSION

Review Questions

9. Mitral Valve Stenosis

INTRODUCTION

MITRAL VALVE ANATOMY

ETIOLOGY OF MITRAL STENOSIS

TRANSESOPHAGEAL ECHOCARDIOGRAPHIC EVALUATION OF MITRAL STENOSIS

Two-Dimensional Echocardiography

Physiologic Assessments

Advanced Concepts That May Be Helpful in Difficult Cases

A PRACTICAL APPROACH TO THE EVALUATION OF MITRAL STENOSIS

Three-Dimensional Echocardiographic Evaluation of Mitral Stenosis

Use of Echocardiography for New Procedures

SUMMARY

Review Questions

10. Mitral Valve Repair

INDICATIONS

Primary versus Secondary Mitral Regurgitation

ECHOCARDIOGRAPHIC EVALUATION

The Prerepair Evaluation

Help in Planning the Surgical Procedure

MITRAL VALVE REPAIR TECHNIQUES

The Fundamental Goals of MV Repair for Type II Valve Dysfunction

7. Repair Technique of Type I Valve Dysfunction

8. Repair Technique of Type III Valve Dysfunction

Repair Technique for Carpentier Type I Valve Dysfunction

Repair Technique for Carpentier Type III Valve Dysfunction

Postrepair TEE Examination

Preweaning From Bypass TEE Examination

Postbypass TEE Examination

Identification of the Circumflex Coronary Artery Perfusion

Checking for Complete Deairing of the Left Ventricle

Residual Mitral Regurgitation

Postrepair Mitral Stenosis

Screening for Potential Complications

SUMMARY

Review Questions

11. Aortic Regurgitation

ETIOLOGY AND MECHANISMS OF AORTIC REGURGITATION

HEMODYNAMICS OF AORTIC REGURGITATION

ECHOCARDIOGRAPHIC EVALUATION OF THE AORTIC VALVE

RECOMMENDED VIEWS

APPROACHES TO THE QUANTITATIVE ASSESSMENT OF AORTIC REGURGITATION

Color Flow Doppler

Calculation of Regurgitant Volume, Fraction, and Orifice Area

Pulsed- and Continuous Wave Doppler

Special Clinical Situations

SUMMARY

REFERENCES

Review Questions

12. Aortic Stenosis

INTRODUCTION

PATHOPHYSIOLOGY

ECHOCARDIOGRAPHIC EVALUATION OF THE AORTIC VALVE

Quantitative Doppler Assessment of Aortic Stenosis

Planimetry of the Aortic Orifice

SPECIAL CONSIDERATIONS

Pressure Recovery

Systemic Hypertension and Arterial Compliance

Classical and “Paradoxical” Low-Flow, Low-Gradient Aortic Stenosis

Assessment of Aortic Stenosis Gradient in Aortic Regurgitation

Pre- and Postoperative Subaortic Obstruction

TECHNICAL CONSIDERATIONS

SUMMARY

Review Questions

13. Prosthetic Valves

INTRODUCTION

ROLE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE EVALUATION OF PROSTHETIC CARDIAC VALVES

TECHNICAL CONSIDERATIONS IN PERFORMING TEE EXAMINATIONS OF PROSTHETIC VALVES

ECHOCARDIOGRAPHIC CHARACTERISTICS OF THE INDIVIDUAL PROSTHETIC CARDIAC VALVE TYPES

Mechanical Heart Valves

Biologic Valves or Tissue Valves

CLINICAL CAVEATS FOR THE ECHOCARDIOGRAPHIC DIAGNOSIS OF PROSTHETIC VALVE DYSFUNCTION

CONCLUSION

Review Questions

14. Right Ventricle, Right Atrium, Tricuspid and Pulmonic Valves

INTRODUCTION

RIGHT VENTRICLE

Anatomy

Transesophageal Echocardiographic Views

Assessment of Right Ventricular Structure

Assessment of Right Ventricular Systolic Function

Assessment of Right Ventricular Diastolic Function

Assessment of Regional Right Ventricular Function

Hemodynamic and Extracardiac Manifestation of Right Ventricular Dysfunction

RIGHT ATRIUM

Anatomy

Transesophageal Echocardiographic Views

TRICUSPID VALVE

Anatomy

Transesophageal Echocardiographic Views

Tricuspid Regurgitation

Tricuspid Stenosis

Etiology of Tricuspid Valve Disease

PULMONIC VALVE

Anatomy

Transesophageal Echocardiographic Views

Pulmonic Regurgitation

Pulmonic Stenosis

REAL-TIME THREE-DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Review Questions

SECTION IV: CLINICAL CHALLENGES

15. Transesophageal Echocardiography for Coronary Revascularization

INTRODUCTION

SAFETY AND COMPLICATIONS

PREBYPASS EXAMINATION

Assessment of Ventricular Function

New Advances in Intraoperative Assessment of Global and Regional Cardiac Function

Monitoring of Ischemia Visualizing the Aortic Root, Coronary Arteries, and Coronary Blood Flow

Shortcomings of TEE

NEW RWMA AFTER CARDIOPULMONARY BYPASS

What Does it Signify?

What Should We Do?

ACUTE CARDIAC DYSFUNCTION: ASSESSMENT AND MANAGEMENT

Hypovolemia

Dynamic Mitral Regurgitation

Right Ventricular Dysfunction

Low Ejection Fraction

Unexpected Diagnosis of Coexisting Problems

Intracardiac Shunts; Patent Foramen Ovale or Atrial Septal Defect

Pleural Effusions

Previously Unknown Aortic Valve Pathology

Coexisting Mitral Valve Regurgitation—Combined CABG and MV Surgery

Use of 3D Echo in Coronary Artery Revascularization

TEE for Specific Surgical Situations

Role of TEE in Vascular Cannulations

Endoscopic Vein Harvesting (EVH)

Failure to Wean From CPB

Impella Endovascular Devices

Ventricular Assist Devices

SUMMARY

Review Questions

16. Intraprocedural Echocardiographic Guidance for Transcatheter Interventions in Aortic and Mitral Position

INTRODUCTION

TRANSCATHETER AORTIC VALVE REPLACEMENT

Current Devices

Procedural Performance (TAVR)

Key Points and Practical Approach

MITRAL VALVE INTERVENTIONS

Mitraclipø Intervention

TRANSAPICAL MITRAL VALVE REPLACEMENT

Steps for Transapical Mitral Valve Replacement

Echocardiographic Implications

TRANSAPICAL BEATING HEART MV REPAIR

Procedure and Guidance

Direct and Indirect Annuloplasty

CONCLUSION

Review Questions

17. Transesophageal Echocardiography of the Thoracic Aorta

ANATOMY AND TEE IMAGING

ACUTE AORTIC SYNDROMES

Acute Aortic Dissection

Intramural Hematoma

Penetrating Atherosclerotic Ulcer

Following Repair

Thoracic Aortic Aneurysms

AORTIC ATHEROMA

Intra-Aortic Balloon Pump Placement

CONCLUSION

Review Questions

18. Critical Care Echocardiography

INTRODUCTION

A PROPOSED APPROACH TO HEMODYNAMIC INSTABILITY

Step #1: Ultrasound Imaging of the Inferior Vena Cava and Abdominal Venous Flow

Step #2: CCUS in Patients With Reduced Mean Systemic Venous Pressure

Step #3: CCUS in Patients With Raised Right Atrial Pressure

Step #4: CCUS in Increased Resistance to Venous Return

HYPOXEMIA AND LUNG ULTRASOUND

LIMITATIONS

Caveats

CONCLUSION

Review Questions

19. Transesophageal Echocardiography for Congenital Heart Disease in the Adult

INTRODUCTION

INCIDENCE OF CONGENITAL HEART DISEASE AND PREVALENCE IN THE ADULT POPULATION

CLASSIFICATION OF CONGENITAL HEART DISEASE

Based on Severity of Disease

Based on the Presence or Absence of Cyanosis

Based on the Physiology of the Defect

GUIDELINES FOR TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN CONGENITAL HEART DISEASE

INDICATIONS FOR TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE ADULT WITH CONGENITAL HEART DISEASE

TEE for Diagnostic Applications

TEE During Cardiothoracic Surgery

TEE in the Cardiac Catheterization/Electrophysiology Laboratory

SELECTED CONGENITAL HEART DEFECTS

ATRIAL SEPTAL DEFECT

Anatomy

Pathophysiology

Management

Transesophageal Echocardiographic Evaluation

Goals of the Two-Dimensional Examination

Goals of the Doppler Examination

Goals of the Examination After Surgery

Goals of the Examination During Transcatheter Intervention

Applications of Three-Dimensional Imaging

VENTRICULAR SEPTAL DEFECT

Anatomy

Pathophysiology

Management

Transesophageal Echocardiographic Evaluation

Goals of the Two-Dimensional Examination

Goals of the Doppler Examination

Goals of the Examination After Surgery

Goals of the Examination During Transcatheter Intervention

Applications of Three-Dimensional Imaging

PATENT DUCTUS ARTERIOSUS

Anatomy

Pathophysiology

Management

Transesophageal Echocardiographic Evaluation

Goals of the Two-Dimensional Examination

Goals of the Doppler Examination

Goals of the Examination After Surgery

COARCTATION OF THE AORTA

Anatomy

Pathophysiology

Management

Transesophageal Echocardiographic Evaluation

Goals of the Two-Dimensional Examination

Goals of the Doppler Examination

Goals of the Examination After Surgery

AORTIC STENOSIS

Anatomy

Pathophysiology

Management

Transesophageal Echocardiographic Evaluation

Goals of the Two-Dimensional Evaluation

Goals of the Doppler Examination

Goals of the Examination After Surgery

Goals of the Examination During Transcatheter Intervention

Applications of Three-Dimensional Imaging

PULMONARY VALVE (PULMONIC) STENOSIS

Anatomy

Pathophysiology

Management

Transesophageal Echocardiographic Evaluation

Goals of the Two-Dimensional Evaluation

Goals of the Doppler Examination

Goals of the Examination After Surgery

Applications of Three-Dimensional Imaging

TETRALOGY OF FALLOT

Anatomy

Pathophysiology

Management

Transesophageal Echocardiographic Evaluation

Goals of the Two-Dimensional Examination

Goals of the Doppler Examination

Goals of the Examination After Surgery

Goals of the Examination During Transcatheter Intervention

Applications of Three-Dimensional Imaging

TRANSPOSITION OF THE GREAT ARTERIES

Anatomy

Pathophysiology

Management

Transesophageal Echocardiographic Evaluation

Goals of the Two-Dimensional Examination

Goals of the Doppler Examination

Goals of the Examination After Surgery

Goals of the Examination During Transcatheter Interventions

CONGENITALLY CORRECTED TRANSPOSITION OF THE GREAT ARTERIES

Anatomy

Pathophysiology

Management

Transesophageal Echocardiographic Evaluation

Goals of the Two-Dimensional Examination

Goals of the Doppler Examination

Goals of the Examination After Surgery

EBSTEIN ANOMALY

Anatomy

Pathophysiology

Management

Transesophageal Echocardiographic Evaluation

Goals of the Two-Dimensional Examination

Goals of the Doppler Examination

Goals of the Examination After Surgery

Goals of the Examination During Transcatheter Intervention

Applications of Three-Dimensional Imaging

SINGLE-VENTRICLE LESIONS OR UNIVENTRICULAR HEART

Anatomy

Pathophysiology

Management

Transesophageal Echocardiographic Evaluation

Goals of the Two-Dimensional Examination

Goals of the Doppler Examination

Goals of the Examination After Surgery

Goals of the Examination During Transcatheter Intervention

CONGENITAL CORONARY ARTERY ANOMALIES

Anatomy

Pathophysiology

Management

Transesophageal Echocardiographic Evaluation

Goals of the Two-Dimensional Examination

Goals of the Doppler Examination

Goals of the Examination After Surgery/Intervention

TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR NONCARDIAC SURGERY IN ADULTS WITH CONGENITAL HEART DISEASE

LIMITATIONS OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN CONGENITAL HEART DISEASE

SUMMARY

Review Questions

20. Cardiac Masses and Embolic Sources

INTRODUCTION

CARDIAC TUMORS

Myxoma

Lipoma

Papillary Fibroelastoma

Rhabdomyoma

Fibroma

Cardiac Sarcomas

Metastatic Tumors

Embolization

INTRACARDIAC THROMBUS

Practical Considerations in the Evaluation of Cardiac Masses

TEE in the Assessment of Cardiac Sources of Emboli

Probable Sources of Emboli With High Embolic Potential

Possible Sources of Emboli With Low Embolic Potential

Review Questions

SECTION V: MAN AND MACHINE

21. 3D TEE Imaging

INTRODUCTION

3D TECHNOLOGY

TEE Probes

3D Imaging

3D IMAGE ACQUISITION

Imaging Modes

POSTPROCESSING

Image Optimization

Image Artifacts

Cropping and Orientation

Measurements

QUANTIFICATION ANALYSIS MODELS

CLINICAL APPLICATIONS

Mitral Valve

Left and Right Ventricles

Aortic Valve

Tricuspid Valve and Pulmonic Valve

Aorta

Congenital Lesions

Masses

Hypertrophic Obstructive Cardiomyopathy

Interventional Procedures

ACKNOWLEDGMENTS

Review Questions

22. Common Artifacts and Pitfalls of Clinical Echocardiography

INTRODUCTION

NORMAL ANATOMIC VARIANTS IN TWO-DIMENSIONAL IMAGING

Crista Terminalis

Eustachian Valve or Chiari Network

Lipomatous Hypertrophy of the Atrial Septum

Coumadin Ridge

Pericardial Sinuses

Lambl Excrescences

Moderator Band and False Tendon

Pleural Effusion

TWO-DIMENSIONAL ECHOCARDIOGRAPHIC IMAGING ARTIFACTS

Suboptimal Image Quality

Acoustic Shadowing

Lateral Resolution

Side Lobe and Beam Width

Reverberation and Mirroring

Electronic Noise

ARTIFACTS IN SPECTRAL AND COLOR FLOW DOPPLER

Aliasing

Acoustic Shadowing in Color Flow

Nonparallel Beam Angle

Mirroring

Color Flow Reverberation and Gain-Related Anomalies

Beam Width Flow Artifacts

Range Ambiguity With Pulsed-Wave Doppler

THREE-DIMENSIONAL ECHOCARDIOGRAPHIC IMAGING ARTIFACTS

Artifacts Unique to Three-Dimensional TEE

SUMMARY

Review Questions

23. Techniques and Tricks for Optimizing Transesophageal Images

INTRODUCTION

TWO-DIMENSIONAL CONTROLS

Preprocessing Versus Postprocessing Controls

Transmit Power

Gain

Time Gain Compensation

Lateral Gain Compensation

Depth

Focus

Frequency

Dynamic Range

Compression

Reject

Persistence

Sector Size

Harmonics

COLOR CONTROLS

Region of Interest

Color Gain

Color Scale

Variance

Image Optimization

DIGITAL STORAGE SYSTEMS

SUMMARY

Review Questions

Appendices

A. Cardiac Cross Section Criteria

B. Cardiac Dimensions

C. Hemodynamic Calculations

D. Valve Prostheses

E. Classification of the Severity of Valvular Disease

Index

 

An aparitie	1 Aug. 2019
Autor	Albert C. Perrino , Scott T. Reeves
Dimensiuni	17.78 x 2.29 x 25.15 cm
Editura	LWW
Format	Paperback
ISBN	9781496383471
Limba	Engleza
Nr pag	592