Practical Echocardiography in the Adult: with Doppler and color-Doppler flow imaging

244 Pages·1990·15.35 MB·English

by  J. P. M. Hamer (auth.)

PRACTICAL ECHOCARDIOGRAPHY IN THE ADULT
with Doppler and color-Doppler flow imaging
Developments in
Cardiovascular Medicine
VOLUME 109
PRACTICAL
ECHOCARDIOGRAPHY
IN THE ADULT
with Doppler and color-Doppler flow imaging
by
J.P.M. HAMER
Thoraxcentre, Department of Cardiology,
University Hospital Groningen,
Groningen,
The Netherlands
KLUWER ACADEMIC PUBLISHERS
DORDRECHT / BOSTON / LONDON
Library of Congress CataIoging-in-Publication Data
Hamer, J. P. M.
Practical echocardiography in the adult: with Doppler and color
Doppler flow imaging / by J.P.M. Hamer.
p. cm. -- (Developments in cardiovascular medicine; v. 109)
ISBN ·13: 978·94·010·6734·8 e·ISBN·13: 978·94·009·0549·8
DOl: 10.1007/978-94-009-0549-8
1. Doppler echocardiography. 2. Transesophageal echocardiography.
3. Heart--Diseases--Diagnosis. I. Title. II. Series.
[DNLM: 1. Echocardiography, Doppler--in adulthood. 2. Heart
Diseases--diagnosis. 3. Heart Diseases--in adulthood. W1 DE997VME
v. 109 / WG 141.5.E2 H214P]
RC683.5.U5H35 1990
616.1·207543--dc20
DNLM/DLC
for Library of Congress 90-4146
ISBN·13:978-94-010-6734-8
Published by Kluwer Academic Publishers,
P.O. Box 17, 3300 AA Dordrecht, The Netherlands
Kluwer Academic Publishers incorporates
the publishing programmes of
D. Reidel, Martinus Nijhoff, Dr W. Junk and MTP Press.
Sold and distributed in the U.S.A. and Canada
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In all other countries, sold and distributed
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printed on acid free paper
All Rights Reserved
© 1990 by Kluwer Academic Publishers
Softcover reprint of the hardcover 1st edition 1990
No part of the material protected by this copyright notice may be reproduced or utilized
in any form or by any means, electronic or mechanical, including photocopying,
recording or by any information storage and retrieval system, without written permis
sion from the copyright owner.
Contents
Foreword xi
Preface xiii
Acknowledgements xv
CHAPTER 1. PRINCIPLES OF ULTRASOUND 1
Introduction 1
Terminology 2
Types of systems 2
Image quality 4
The ultrasound beam 4
frequency of the transducer 4
focus 5
axial resolution 5
lateral resolution 5
side lobes 6
reverberations 6
The medium 9
Manipulation of echoes 10
gain control 10
reject control 10
gray scale 10
CHAPTER 2. TRANS-THORACIC ECHOCARDIOGRAPHIC
EXAMINATION 13
Position of the patient, examiner and equipment 13
Standard transducer positions 15
vi
CHAPfER 3. TRANS-ESOPHAGEAL ECHOCARDIOGRAPHIC
EXAMINATION 25
Introduction 25
Indications 25
Information for the patient 26
Technique of introduction 27
Transducer positions 28
The esophagoscope 35
CHAPfER 4. CONTRAST ECHOCARDIOGRAPHY 37
CHAPfER 5. PHONOCARDIOGRAPHY AND PULSE RECORDING 41
Introduction 41
Phonocardiogram 42
Pulse recordings 43
Carotid pulse recording and systolic time intervals 43
Apexcardiogram 44
Liver pulse recording 45
CHAPfER 6. PRINCIPLES OF DOPPLER 47
Introduction .47
Continuous wave Doppler 47
Pulsed Doppler 50
Aliasing 51
Angle 51
Measurement of pressure differences 54
Color Doppler 54
Combined echo-Doppler examinations 57
CHAPfER 7. DOPPLER EXAMINATION 59
Introduction 59
Mitral valve 62
LV outflow tract 63
Aortic valve 64
Ascending and descending aorta 65
Pulmonic valve 66
Tricuspid valve 66
SVC, IVC and hepatic veins 67
CHAPTER 8. HEART DISEASE IN THE ADULT 69
LEFT VENTRICLE 69
The normal left ventricle 69
vii
Echocardiographic evaluation 69
transducer positions 69
measurements 71
Doppler evaluation 80
Pulse recordings 81
The abnormal left ventricle 81
Local abnormalities 81
wall motion 81
ischemic heart disease 81
conduction disturbances 81
RVoverload 81
wall thickness 82
hypertrophic (obstructive) cardiomyopathy 82
thrombi 89
tumors 90
myocardial infarction and aneurysm 90
Diffuse abnormalities 94
Other diseases with myocardial involvement 99
RIGHT VENTRICLE 101
The normal right ventricle 101
Echocardiographic evaluation 101
Doppler evaluation 012
The abnormal right ventricle 102
Right ventricular overload 102
volume overload 102
pressure overload 102
Wall thickness 103
Moderator band, double-chambered RV,
sub-valvular pulmonic stenosis 103
Pressure measurements 105
LEFT ATRIUM 108
The normal left atrium 108
Transducer positions 108
Size and measurements 108
The abnormal left atrium 110
Function 110
Enlargement 110
Contents 110
RIGHT ATRIUM and INFERIOR VENA CAVA 111
The normal right atrium 111
Transducer positions, size and measurements 111
Contents 111
viii
The abnormal right atrium 113
Enlargement 113
Contents 114
The inferior vena cava 114
Diameters 115
Contents 115
AORTIC VALVE AND ROOT 117
The normal aortic valve and root 117
In normal conditions 117
In abnormal conditions 118
The abnormal aortic valve and root 124
Congenital abnormalities 124
Aortic stenosis 125
under-estimation of the severity 132
over-estimation of the severity 134
Aortic insufficiency 136
direct features 136
indirect features 142
MITRAL VALVE 147
The normal mitral valve 147
Possible recordings of anatomical normal mitral leaflets 147
in normal conditions 147
in abnormal conditions 148
The abnormal mitral valve 151
Mitral insufficiency 151
diagnosis and severity 152
causes 153
Mitral stenosis 165
diagnosis and severity 165
further evaluation of the severity 170
under-estimation of the severity 171
PULMONIC VALVE 172
The normal pulmonic valve 172
Pulmonic stenosis 175
Sub-valvular pulmonic stenosis 177
Pulmonic insufficiency 178
TRICUSPID VALVE 179
The normal tricuspid valve 179
Tricuspid stenosis 179
Tricuspid insufficiency 180
PROSTHETIC VALVES 183
Evaluation of prosthetic valve function 183
ix
Endocarditis and prosthetic valves 186
THORACIC AORTA 188
Coarctation 188
Dissection 189
ENDOCARDITIS 193
PERICARDIAL DISEASES 194
Pericardial effusion 194
Constrictive pericarditis 198
Pericardial cysts 198
CONGENITAL CARDIAC ABNORMALITIES IN THE ADULT 199
Atrial septal defect and abnormal drainage of pulmonary veins 199
Ventricular septal defect 205
Patent ductus arteriosus (Bot alIi) 207
Ebstein's anomaly 208
INTRAC ARDIAC MASSES 209
Thrombi 209
Myxoma's 210
Malignancies 213
Questionable recordings 215
CHAPTER 9. ECHOCARDIOGRAPHIC REPORT 223
CHAPTER 10. ANATOMY, NOMENCLATURE AND
FUNCTION OF THE NORMAL HEART 227
ABBREVIATIONS 231
INDEX 233
Foreword
Since the introduction of ultrasound in cardiology in the mid fifties, echocar
diography has continued to grow and has finally become, in particular after the
introduction of Doppler modalities, the working horse of the cardiologist.
Although many books have been written on this subject Dr. Hamer's book is
a very valuable contribution, as it provides, in particular information for
practicing clinicians and technicians. Clearly written and nicely illustrated, this
book is a must for those interested in this field.
C.A. Visser
Professor of Echocardiology