Handbook of Echo-Doppler Interpretation

411 Pages·2004·36.162 MB·English

by  Edmund Kenneth Kerut, Elizabeth F. McIlwain, Gary D. Plotnick

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
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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
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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