Feigenbaum’s Echocardiography

801 Pages·2009·157.569 MB·English

by  William F. Armstrong MD, Thomas Ryan MD

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Feigenbaum’s
Echocardiography
Seventh Edition
William F. Armstrong, MD
ProfessorofMedicine
Director,EchocardiographyLaboratory
UniversityofMichiganHealthSystem
AnnArbor,Michigan
Thomas Ryan, MD
JohnG.&JeanneBonnetMcCoyChairin
CardiovascularMedicine
ProfessorofInternalMedicine
DivisionofCardiovascularMedicine
TheOhioStateUniversityMedicalCenter
Director,TheOhioStateUniversityHeartCenter
Columbus,Ohio
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LibraryofCongressCataloging-in-PublicationData
Armstrong,WilliamF.
Feigenbaum’sechocardiography/WilliamF.Armstrong,ThomasRyan.—7thed.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-7817-9557-9
1.Echocardiography. I.Ryan,Thomas,1953– II.Feigenbaum,Harvey. III.Title.
IV.Title:Echocardiography.
[DNLM:1.Echocardiography—methods. 2.HeartDiseases—diagnosis.
WG141.5.E2A739f2010]
RC683.5.U5F442010
616.1(cid:2)207543—dc22
2009034420
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ToHarveyFeigenbaum,ourfriend,colleague,andmentor,
withoutwhomnoneofthiswouldhavebeenpossible.
iii
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Contents
Preface xiv
Acknowledgments xv
Chapter1 HistoryofEchocardiography 1
HarveyFeigenbaum,MD
DevelopmentofVariousEchocardiographicTechnologies 2
RecordingEchocardiograms 5
CardiacSonographers 5
EchocardiographicEducationandOrganizations 6
References 7
Chapter2 PhysicsandInstrumentation 9
PhysicalPrinciples 9
InteractionBetweenUltrasoundandTissue 10
TheTransducer 12
ManipulatingtheUltrasoundBeam 14
Resolution 16
CreatingtheImage 17
TransmittingUltrasoundEnergy 19
DisplayOptions 20
TradeoffsinImageCreation 22
SignalProcessing 22
TissueHarmonicImaging 23
Artifacts 25
DopplerEchocardiography 26
PrinciplesofDopplerUltrasound 26
DopplerFormats 29
ColorFlowImaging 32
TechnicalLimitationsofColorDopplerImaging 33
DopplerArtifacts 34
TissueDopplerImaging 35
BiologicEffectsofUltrasound 35
SuggestedReadings 37
Chapter3 SpecializedEchocardiographicTechniquesandMethods 39
ImagingDevicesandMethods 39
M-ModeEchocardiography 39
Two-dimensionalEchocardiography 40
ColorB-ModeScanning 40
DopplerInterrogation 40
ColorFlowDopplerImaging 43
ColorDopplerM-ModeImaging 43
DopplerTissueImaging 45
SpeckleTracking 48
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Contents v
TissueCharacterization 50
AcquisitionofCardiacUltrasoundInformation 51
TransthoracicEchocardiography 51
Hand-CarriedUltrasound 52
DedicatedSingle-LineInterrogationTransducers 52
TransesophagealEchocardiography 53
Three-dimensionalEchocardiography 55
EpicardialImaging 61
IntracardiacEchocardiography 62
IntravascularUltrasound 63
TheDigitalEchoLaboratory 63
SuggestedReadings 66
Chapter4 ContrastEchocardiography 67
SourceofUltrasoundContrast 67
ContrastAgents 67
Safety 69
ClinicalUse 69
UltrasoundInteractionwithContrastAgents 70
DetectionMethods 71
MachineSettings 71
IntermittentImaging 72
LowMechanicalIndexImaging 72
OtherMechanicalFactorsAffectingContrastDetection 72
DopplerImaging 73
ContrastArtifacts 73
DetectionandUtilizationofIntracavitaryContrast 76
IntramuralCavityFlow,Trabeculation,IncompleteFilling 77
EnhancementofDopplerSignals 78
ShuntDetection 81
DetectionofMiscellaneousConditions 84
MyocardialPerfusionContrastEchocardiography 85
SuggestedReadings 89
Chapter5 TheEchocardiographicExamination 91
SelectingtheTransducers 93
PatientPosition 93
PlacementoftheTransducer 95
AnApproachtotheTransthoracicExamination 96
ParasternalLong-AxisViews 96
ParasternalShort-AxisViews 97
ApicalViews 102
TheSubcostalExamination 106
SuprasternalViews 107
OrientationofTwo-DimensionalImages 108
EchocardiographicMeasurements 111
LeftVentricularWallSegments 112
M-ModeExamination 113
TransesophagealEchocardiography 114
TransesophagealEchocardiographicViews 115
EchocardiographyasaScreeningTest 120
TraininginEchocardiography 120
SuggestedReadings 120
Chapter6 EvaluationofSystolicFunctionoftheLeftVentricle 123
GeneralPrinciples 123
LinearMeasurements 123
IndirectM-ModeMarkersofLeftVentricularFunction 125
Two-dimensionalMeasurements 126
AssessmentofLeftVentricularFunctionwithThree-dimensionalEchocardiography 128
DeterminationofLeftVentricularMass 131
PhysiologicVersusPathologicHypertrophy 132
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vi Contents
RegionalLeftVentricularFunction 133
QuantitativeTechniques 133
NonischemicWallMotionAbnormalities 135
PrematureVentricularContractions 139
PacedRhythms 139
VentricularPreexcitation 139
PostoperativeCardiacMotion 140
PosteriorCompression 141
PericardialConstriction 142
DopplerEvaluationofGlobalLeftVentricularFunction 142
MyocardialPerformanceIndex 143
OtherTechniquesforDeterminationofLeftVentricularSystolicFunction 144
DeterminationofLeftVentriculardP/dt 145
NewerandAdvancedMethodsforEvaluatingLeftVentricularFunction 146
StrainandStrainRateImaging 148
Ventriculartorsion 155
Conclusion 155
SuggestedReadings 156
Chapter7 EvaluationofLeftVentricularDiastolicFunction 159
NormalDiastolicFunction 159
StagesofDiastolicDysfunction 160
NormalDiastolicFunction 160
ImpairedRelaxation,GradeI 161
Pseudonormalization,GradeII 162
RestrictiveFilling(Reversible),GradeIII 162
RestrictiveFilling(Irreversible),GradeIV 163
Echo-DopplerParametersofDiastolicFunction 163
IsovolumicRelaxationTime 163
MitralInflow 164
ColorM-modeFlowPropagationVelocity(Vp) 165
TissueDopplerMitralAnnularVelocity 166
PulmonaryVenousFlowPatterns 167
LeftAtrialVolume 169
TheValsalvaManeuver 171
OtherMarkersofDiastolicDysfunction 171
AComprehensiveApproachtoDiastolicDysfunction 172
EstimatingLeftVentricularFillingPressures 175
StressTestingtoAssessDiastolicFunction 175
TheDifferentialDiagnosisofHeartFailurewithNormalEjectionFraction 180
EvaluationofDiastolicDysfunctioninSpecificPatientGroups 180
SinusTachycardia 180
AtrialFibrillation 181
MitralValveDisease 181
HypertrophicCardiomyopathy 181
PrognosisinPatientswithDiastolicDysfunction 181
SuggestedReadings 182
Chapter8 LeftandRightAtrium,andRightVentricle 185
LeftAtrium 185
LeftAtrialDimensionsandVolume 185
LeftAtrialFunction 188
AtrialSeptum 190
PulmonaryVeins 193
RightAtrium 196
RightAtrialThrombi 199
RightAtrialBloodFlow 200
RightVentricle 203
RightVentricularDimensionsandVolumes 204
RightVentricularOverload 209
RightVentricularDysplasia 213
SuggestedReadings 214
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Contents vii
Chapter9 Hemodynamics 217
UseofM-ModeandTwo-DimensionalEchocardiography 217
QuantifyingBloodFlow 218
ClinicalApplicationofBloodFlowMeasurement 221
MeasuringPressureGradients 223
ApplicationsoftheBernoulliEquation 228
DeterminingPressureHalf-Time 233
TheContinuityEquation 236
ProximalIsovelocitySurfaceArea 237
MyocardialPerformanceIndex 239
SuggestedReadings 240
Chapter10 PericardialDiseases 241
ClinicalOverview 241
EchocardiographicEvaluationofthePericardium 241
DetectionandQuantitationofPericardialFluid 242
DirectVisualizationofthePericardium 246
DifferentiationofPericardialfromPleuralEffusion 248
CardiacTamponade 248
EchocardiographicFindingsinCardiacTamponade 249
DopplerFindingsinTamponade 251
PericardialConstriction 254
EchocardiographicDiagnosis 254
DopplerEchocardiographicFindingsinConstriction 256
EffusiveConstrictivePericarditis 257
ConstrictivePericarditisVersusRestrictiveCardiomyopathy 258
MiscellaneousPericardialDisordersandObservations 259
PostoperativeEffusions 259
Echocardiography-GuidedPericardiocentesis 260
CongenitalAbsenceofthePericardium 261
PericardialCysts 261
SuggestedReadings 262
Chapter11 AorticValveDisease 263
AorticStenosis 263
DopplerAssessmentofAorticStenosis 266
OtherApproachestoQuantifyingStenosis 275
DefiningtheSeverityofAorticStenosis 275
DobutamineEchocardiographyintheEvaluationofAorticStenosis 276
NaturalHistoryofAorticStenosis 276
ClinicalDecisionMaking 278
AorticRegurgitation 280
AppropriatenessCriteria 280
M-ModeandTwo-dimensionalImaging 280
EstablishingaDiagnosisofAorticRegurgitation 283
EvaluatingtheSeverityofAorticRegurgitation 286
AcuteversusChronicAorticRegurgitation 291
AssessingtheLeftVentricle 291
MiscellaneousAbnormalitiesoftheAorticValve 293
SuggestedReadings 293
Chapter12 MitralValveDisease 295
AnatomyoftheMitralValve 295
PhysiologyofMitralValveDisease 297
MitralStenosis 297
Two-DimensionalEchocardiographyinRheumaticMitralStenosis 298
CongenitalMitralStenosis 301
M-ModeEchocardiography 301
TransesophagealEchocardiography 302
RoleofThree-DimensionalEchocardiography 303
AnatomicDeterminationofSeverity 303
DopplerEchocardiographicDeterminationofSeverity 304
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viii Contents
ExerciseGradients 307
SecondaryFeaturesofMitralStenosis 307
AtrialFibrillation 309
SecondaryPulmonaryHypertension 310
DecisionMakingRegardingIntervention 310
MitralRegurgitation 310
DopplerEvaluationofMitralRegurgitation 311
FlailLeaflets 313
FunctionalMitralRegurgitation 318
DeterminationofMitralRegurgitationSeverity 320
OtherConsiderationsinAssessingMitralRegurgitation 324
MitralValveProlapse 326
MiscellaneousMitralValveAbnormalities 330
CalcificationoftheMitralAnnulus 331
TumorsoftheMitralValve 331
AneurysmsoftheMitralValve 332
EndocarditisandValvePerforation 334
AnularDehiscence 334
RadiationDamage 334
CarcinoidandDietDrugValvulopathy 334
SuggestedReadings 335
Chapter13 TricuspidandPulmonaryValves 337
ClinicalOverview 337
PulmonaryValve 337
PulmonaryValveStenosis 341
PulmonaryValveRegurgitation 342
MiscellaneousAbnormalitiesofthePulmonaryValve 343
EvaluationoftheRightVentricularOutflowTract 344
TricuspidValve 345
DopplerEvaluationoftheTricuspidValve 346
TricuspidStenosis 348
TricuspidRegurgitation 348
PacemakerandCatheter-InducedTricuspidRegurgitation 349
IschemicHeartDisease 350
QuantitationofTricuspidRegurgitation 351
DeterminationofRightVentricularSystolicPressure 353
OtherSpecificConditionsResultinginTricuspidandPulmonaryValveDisease 355
CarcinoidHeartDisease 355
EndocardialFibroelastosis 357
EbsteinAnomaly 357
TricuspidValveResection 357
CardiacBiopsy 359
TumorsandOtherMasses 359
SuggestedReadings 359
Chapter14 InfectiveEndocarditis 361
ClinicalPerspective 361
EchocardiographicCharacteristicsofVegetation 361
DiagnosticAccuracyofEchocardiography 366
EvolutionoftheDiagnosticCriteria 367
ComplicationsofEndocarditis 368
PrognosisandPredictingRisk 374
ProstheticValveEndocarditis 375
InfectedIntracardiacDevices 377
Right-SidedEndocarditis 378
ApproachtothePatientwithEndocarditis 379
SuggestedReadings 383
Chapter15 ProstheticValves 385
TypesofProstheticValves 385
NormalProstheticValveFunction 386
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Contents ix
ApplicationofEchocardiographytoPatientswithProstheticValves 392
GeneralApproachtoProstheticValves 394
ProstheticAorticValves 397
ProstheticMitralValves 402
SpecificCausesofDysfunction 402
Obstruction 402
InfectiveEndocarditis 409
MechanicalFailure 415
Right-SidedProstheticValves 415
ValvedConduits 419
MitralValveRepair 419
SuggestedReadings 424
Chapter16 EchocardiographyandCoronaryArteryDisease 427
ClinicalOverview 427
PathophysiologyofCoronarySyndromes 427
DetectionandQuantitationofWallMotionAbnormalities 431
RoleoftheThree-dimensionalEchocardiography 436
DopplerTissueImagingandSpeckleTracking 437
OtherMethodsforEvaluatingIschemicMyocardium 438
EchocardiographicEvaluationofClinicalSyndromes 438
AnginaPectoris 438
AcuteMyocardialInfarction 438
NaturalHistoryofWallMotionAbnormalities 444
PrognosticImplications 446
DopplerEvaluationofSystolicandDiastolicFunctioninAcuteMyocardial
Infarction 446
ComplicationsofAcuteMyocardialInfarction 448
PericardialEffusion 448
InfarctExpansion/AcuteRemodeling 450
Free-WallRupture 450
VentricularThrombus 451
RightVentricularInfarction 451
AcuteMitralRegurgitation 453
VentricularSeptalRupture 455
CardiogenicShock 457
ChronicCoronaryArteryDisease 457
LeftVentricularAneurysm 457
LeftVentricularPseudoaneurysm 460
ChronicRemodeling 462
MuralThrombus 462
MitralRegurgitation 464
ChronicIschemicDysfunction 465
DirectCoronaryVisualization 468
KawasakiDisease 470
DirectVisualizationofAtherosclerosis 470
SuggestedReadings 471
Chapter17 StressEchocardiography 473
PhysiologicBasis 473
Methodology 475
Treadmill 475
BicycleErgometry 476
DobutamineStressEchocardiography 477
DipyridamoleandAdenosine 478
Three-dimensionalStressEchocardiography 478
ChoosingamongtheDifferentStressModalities 479
InterpretationofStressEchocardiography 479
CategorizationofWallMotion 482
WallMotionResponsetoStress 484
LocalizationofCoronaryArteryLesions 484
CorrelationwithSymptomsandElectrocardiographicChanges 485
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x Contents
DetectionofCoronaryArteryDisease 486
RoleofMyocardialPerfusionImaging 488
ComparisonwithNuclearTechniques 491
ApplicationsofStressEchocardiography 492
PrognosticValueofStressEchocardiography 492
StressEchocardiographyAfterMyocardialInfarction 495
StressEchocardiographyAfterRevascularization 496
PreoperativeRiskAssessment 498
StressEchocardiographyinWomen 499
AssessmentofMyocardialViability 501
StressEchocardiographyinValvularHeartDisease 502
DiastolicStressEchocardiography 503
SuggestedReadings 505
Chapter18 DilatedCardiomyopathies 507
ClinicalandEchocardiographicOverview 507
DilatedCardiomyopathy 507
DopplerEvaluationofSystolicandDiastolicFunction 512
AssessmentofDiastolicFunction 514
MyocardialPerformanceIndex 516
SecondaryFindingsinDilatedCardiomyopathy 517
EtiologyofDilatedCardiomyopathy 518
DeterminationofPrognosisinDilatedCardiomyopathy 521
TheRoleofEchocardiographyinBasicandAdvancedTherapy 523
BiventricularPacingforCongestiveHeartFailure 523
CardiacTransplantationandOtherAdvancedSupport 527
VentricularAssistDevices 530
Myocarditis 534
PeripartumCardiomyopathy 536
ChagasMyocarditis 536
SuggestedReadings 537
Chapter19 HypertrophicandOtherCardiomyopathies 539
Overview 539
HypertrophicCardiomyopathy 539
EchocardiographicEvaluationofHypertrophicCardiomyopathy 539
AssessmentoftheLeftVentricularOutflowTractinObstructiveCardiomyopathy 541
MitralRegurgitationinHypertrophicCardiomyopathy 546
VariantsofHypertrophicCardiomyopathy 547
Mid-CavitaryObstruction 548
ScreeningofFamilyMembers 549
ConditionsMimickingHypertrophicCardiomyopathy 550
End-StageHypertrophicCardiomyopathy 553
HypertrophicCardiomyopathyTherapy 554
InfiltrativeandRestrictiveCardiomyopathy 554
EchocardiographicEvaluationofRestrictiveCardiomyopathy 555
CardiacAmyloid 556
RestrictiveCardiomyopathy 556
ConstrictiveVersusRestrictiveHeartDisease 556
EndocardialFibroelastosisandHypereosinophilicSyndrome 559
SuggestedReadings 560
Chapter20 CongenitalHeartDiseases 561
TheEchocardiographicExamination:ASegmentalApproachtoAnatomy 562
CardiacSitus 562
VentricularMorphology 563
GreatArteryConnections 564
AbnormalitiesofRightVentricularInflow 565
AbnormalitiesofLeftVentricularInflow 566
PulmonaryVeins 566
LeftAtrium 567
MitralValve 570