Doppler echocardiography in infancy and childhood

444 Pages·2017·78.389 MB·English

by  Deeg, Karl-Heinz, Hofbeck, Michael, Rupprecht, Thomas

Michael Hofbeck
Karl-Heinz Deeg
Thomas Rupprecht
Doppler
Echocardiography in
Infancy and Childhood
123
Doppler Echocardiography in Infancy
and Childhood
Michael Hofbeck
Karl-Heinz Deeg • Thomas Rupprecht
Doppler Echocardiography in
Infancy and Childhood
Michael Hofbeck Thomas Rupprecht
Universitätskinderklinik Tübingen Klinikum Bayreuth GmbH
Abt. Kinderkardiologie Klinik für Kinderheilkunde/Jugendmedizin
Tübingen Bayreuth
Germany Germany
Karl-Heinz Deeg
Pediatric Clinic of the Sozialstiftung Bamberg
Bamberg
Germany
ISBN 978-3-319-42917-5 ISBN 978-3-319-42919-9 (eBook)
DOI 10.1007/978-3-319-42919-9
Library of Congress Control Number: 2017932903
© Springer International Publishing Switzerland 2017
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Preface
Echocardiography is the imaging modality of choice for the diagnosis of congenital heart dis-
ease in the neonatal period providing the possibility for exact noninvasive assessment of the
majority of cardiac malformations. In addition, functional echocardiography plays an impor-
tant role in the evaluation of critically ill children in neonatology and intensive care
medicine.
This book addresses trainees in paediatric cardiology, paediatricians and neonatologists
who are interested in the essentials of paediatric echocardiography. Since also rare cardiac
malformations are included, this book should also serve as a valuable tool for professionals
who are already skilled in echocardiography.
This book is written by Prof. Dr. Michael Hofbeck, a specialist in paediatric cardiology, and
Prof. Dr. K. H. Deeg, a paediatric cardiologist, neonatologist and paediatrician.
The focus of this book is the precise diagnosis of structural congenital heart disease includ-
ing its haemodynamic assessment. Since colour Doppler, pulsed wave and continuous wave
Doppler are integral parts of the haemodynamic assessment of congenital heart disease, these
modalities are described extensively for each cardiac malformation. The included videos are
intended to allow a better understanding of the temporal and spatial relationships in congenital
cardiac and vascular malformations.
The first chapter of this book addresses echocardiography and Doppler examination in the
normal heart including examination of the great vessels. Chapters 2, 3, 4, 5, 6, 7, 8, 9, 10, 11,
12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 and 23 contain a detailed description of the different
cardiac malformations, while Chaps. 24 and 25 are dedicated to neonatologists and paediatri-
cians, who perform targeted neonatal echocardiography in the setting of a neonatal ICU.
We are aware that paediatric echocardiography is a technique that requires training and
practise over a long time period. We hope that our book will serve as a good companion for
those who are willing to become familiar with this important and beautiful imaging modality.
Bamberg, Bayern, Germany Karl-Heinz Deeg
Tübingen, Germany Michael Hofbeck
v
Contents
1 The Normal Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 2D Echo and Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2.1 Parasternal Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2.2 Apical Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.2.3 Subcostal Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.2.4 Suprasternal Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
1.3 P ulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
1.3.1 Systemic Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
1.3.2 Tricuspid Valve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
1.3.3 Right Ventricular Outflow Tract and Pulmonary Artery . . . . . . . . . . . . 18
1.3.4 Pulmonary Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
1.3.5 Mitral Valve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
1.3.6 Left Ventricular Outflow Tract and Aorta . . . . . . . . . . . . . . . . . . . . . . . 23
1.4 D oppler Echocardiography in the Assessment of Haemodynamics . . . . . . . . . 25
1.5 C alculation of Gradients Across the Outflow Tracts and Aortic
and Pulmonary Valve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
1.6 D etermination of Right Ventricular and Pulmonary Arterial Pressure . . . . . . . 28
1.7 N oninvasive Determination of Stroke Volume and Cardiac Output . . . . . . . . . 29
1.8 C alculation of Valve Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
2 Atrial Septal Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.1 A natomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.2 T wo-Dimensional Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
2.3 C olour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
2.4 P ulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
3 Ventricular Septal Defect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
3.1 A natomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
3.2 T wo-Dimensional Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
3.3 C olour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
3.4 P ulsed Wave and Continuous Wave Doppler Sonography . . . . . . . . . . . . . . . . 58
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
4 Atrioventricular Septal Defect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
4.1 A natomy and Hemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
4.2 T wo-Dimensional Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
4.3 C olor Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
4.4 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
vii
viii Contents
5 P atent Ductus Arteriosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
5.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
5.2 Two-Dimensional Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
5.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
5.4 Pulsed Wave and Continuous Wave Doppler Sonography . . . . . . . . . . . . . . . . 82
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
6 A ortopulmonary Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
6.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
6.2 Two-Dimensional Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
6.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
6.4 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
7 P ulmonary Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
7.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
7.2 2D Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
7.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
7.4 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . 106
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
8 Pulmonary Atresia with Intact Ventricular Septum (PAiVS) . . . . . . . . . . . . . . . 111
8.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
8.2 2D Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
8.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
8.4 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . 119
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
9 Tricuspid Atresia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
9.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
9.2 Two-Dimensional Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
9.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
9.4 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . 129
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
10 Ebstein’s Anomaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
10.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
10.2 Two-Dimensional Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
10.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
10.4 Pulsed Wave and Continuous Wave Doppler Sonography . . . . . . . . . . . . . . 136
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
11 Tetralogy of Fallot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
11.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
11.2 Two-Dimensional Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
11.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
11.4 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . 151
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
12 Pulmonary Atresia and Ventricular Septal Defect . . . . . . . . . . . . . . . . . . . . . . . 157
12.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
12.2 2D Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
12.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
12.4 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . 163
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Contents ix
13 Truncus Arteriosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
13.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
13.2 T wo-Dimensional Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
13.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
13.4 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . 174
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
14 Double Outlet Right Ventricle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
14.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
14.2 Two-Dimensional Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
14.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
14.4 Pulsed Wave and Continuous Wave Doppler Echocardiography. . . . . . . . . . 186
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
15 Transposition of the Great Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
15.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
15.2 2D Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
15.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
15.4 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . 200
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
16 Functionally Univentricular Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
16.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
16.2 Surgical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
16.3 Echocardiography and Colour Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
16.4 PW and CW Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
17 Anomalous Pulmonary Venous Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
17.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
17.2 2D Echocardiography in Patients with Isolated TAPVC . . . . . . . . . . . . . . . . 225
17.3 2D Echocardiography in Patients with Complex TAPVC . . . . . . . . . . . . . . . 230
17.4 2D Echocardiography in Patients with PAPVC . . . . . . . . . . . . . . . . . . . . . . . 230
17.5 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
17.6 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . 234
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
18 Anomalies of Left Ventricular Inflow and Mitral Valve . . . . . . . . . . . . . . . . . . . 237
18.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
18.2 2D Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
18.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
18.4 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . 248
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
19 Aortic Stenosis, Regurgitation and Anomalies of the Left
Ventricular Outflow Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
19.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
19.2 2D Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
19.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
19.4 P W and CW Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
20 Hypoplastic Left Heart Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
20.1 A natomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
20.2 2D Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
x Contents
20.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
20.4 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . 277
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
21 C oarctation of the Aorta. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
21.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
21.2 2D Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
21.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
21.3.1 C oarctation of the Aorta in Neonates with a Patent
Ductus Arteriosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
21.3.2 C oarctation of the Aorta in Neonates with Restrictive
or Closed Ductus Arteriosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
21.3.3 C oarctation of the Aorta in Older Children . . . . . . . . . . . . . . . . . . 288
21.4 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . 290
21.4.1 F low Measurements of the Aorta . . . . . . . . . . . . . . . . . . . . . . . . . . 290
21.4.2 Doppler Flow Measurements in Systemic Arteries . . . . . . . . . . . . 293
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
22 I nterruption of the Aortic Arch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
22.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
22.2 2D Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
22.3 Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
22.4 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . 305
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
23 Vascular Rings and Anomalies of the Aortic Arch Vessels . . . . . . . . . . . . . . . . . 309
23.1 Anatomy and Haemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
23.1.1 Laterality of the Aortic Arch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
23.1.2 Subclavian Artery Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
23.1.3 Vascular Rings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
23.1.4 Pulmonary Artery Sling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
23.2 2D Echo and Colour Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . 316
23.2.1 Assessment of Laterality of the Aortic Arch . . . . . . . . . . . . . . . . . 317
23.2.2 Double Aortic Arch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
23.2.3 R ight Aortic Arch and Aberrant Left Subclavian Artery . . . . . . . . 320
23.2.4 S ubclavian Artery Anomalies Without Vascular Ring . . . . . . . . . . 322
23.2.5 P ulmonary Sling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
23.3 Pulsed Wave and Continuous Wave Doppler . . . . . . . . . . . . . . . . . . . . . . . . . 328
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
24 Echocardiographic Differential Diagnosis of Cyanotic Infants . . . . . . . . . . . . . 331
24.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
24.2 Cardiac Malformations Associated with Cyanosis . . . . . . . . . . . . . . . . . . . . 331
24.3 What Views Are Necessary for the Exclusion or Diagnosis
of Cyanotic Heart Disease? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332
24.3.1 Parasternal Long-Axis View Through the Left Heart . . . . . . . . . . . 333
24.3.2 P arasternal Short-Axis View Through the Right Heart . . . . . . . . . . 337
24.3.3 A pical or Subcostal Four-Chamber View . . . . . . . . . . . . . . . . . . . . 343
24.3.4 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Contents xi
25 Echocardiography for the Neonatologist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
25.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
25.2 Basic Knowledge in Doppler Echocardiography . . . . . . . . . . . . . . . . . . . . . . 351
25.2.1 2D Echocardiography and Colour Doppler . . . . . . . . . . . . . . . . . . . 352
25.2.2 M-mode Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354
25.2.3 Doppler Sonographic Flow Measurements . . . . . . . . . . . . . . . . . . . 356
25.3 Diagnosis of the Persistent Ductus of the Preterm Infant . . . . . . . . . . . . . . . 359
25.3.1 2D Image of a PDA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360
25.3.2 Colour Doppler of Pulmonary Artery Flow
in Patients with PDA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
25.3.3 LA/AO Ratio in PDA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 362
25.3.4 Doppler Sonographic Flow Measurements
in the Pulmonary Artery in PDA . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
25.3.5 Doppler Sonographic Flow Measurements
in the Aorta in PDA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
25.3.6 Doppler Sonographic Flow Measurements in the PDA . . . . . . . . . . 365
25.3.7 Doppler Sonographic Flow Measurements in Peripheral
Arteries of the Body in Patients with a PDA . . . . . . . . . . . . . . . . . . 366
25.3.8 Estimation of the Haemodynamic Relevance of a PDA . . . . . . . . . 366
25.3.9 Echocardiography and Doppler Sonography
After Closure of the PDA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
25.3.10 Measurement of Pulmonary Artery Pressure
in Patients with a PDA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
25.3.11 Unusual Problems Associated with a Patent Ductus Arteriosus . . . . .372
25.4 E valuation of the Patient with Pulmonary Hypertension (PH) . . . . . . . . . . . 372
25.4.1 Estimation of Pulmonary Arterial Pressure by
Tricuspid Regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
25.4.2 Echocardiographic Examination of a Patient
with Pulmonary Hypertension (PH) . . . . . . . . . . . . . . . . . . . . . . . . 377
25.5 Evaluation of an Infant with Cardiac Failure, Hypotension and Shock . . . . . 380
25.5.1 Diagnosing Cardiac Malformations as the Cause . . . . . . . . . . . . . . 380
25.5.2 Obstruction Within the Left Atrium and Mitral Valve Stenosis . . . 381
25.5.3 Critical (Severe) Aortic Stenosis of the Newborn . . . . . . . . . . . . . . 381
25.5.4 Hypoplastic Left Heart Syndrome (HLHS) . . . . . . . . . . . . . . . . . . . 383
25.5.5 Coarctation of the Aorta (COA) . . . . . . . . . . . . . . . . . . . . . . . . . . . 386
25.5.6 Interruption of the Aortic Arch (IAA) . . . . . . . . . . . . . . . . . . . . . . . 394
25.6 E valuation of an Infant with Cardiac Failure; Hypotension and Shock –
Evaluation After Exclusion of Structural Heart Disease . . . . . . . . . . . . . . . . 396
25.6.1 Myocardial Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396
25.6.2 Hypovolaemia and Hypervolaemia . . . . . . . . . . . . . . . . . . . . . . . . . 397
25.6.3 Large Left to Right Ductal Shunt . . . . . . . . . . . . . . . . . . . . . . . . . . 397
25.6.4 Pericardial Effusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
25.6.5 Cardiomyopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410
List of Videos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .413
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .439