Echocardiography in Congenital Heart Disease Made Simple (Cardiopulmonary Medicine from Imperial College Press)

259 Pages·2005·19.54 MB·English

by  Siew Yen Ho

Cardiopulmonary Medicine from
Imperial College Press
Echocardiographyin
Congenital Heart Disease
Made Simple
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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.
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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
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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
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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)
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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