LWBK739-FM_pi-xx:LWBK739-FM_pi-xx.qxd 1/1/11 7:35 PM Page i CLINICAL ECHOCARDIOGRAPHY REVIEW A Self-Assessment Tool LWBK739-FM_pi-xx:LWBK739-FM_pi-xx.qxd 1/1/11 7:35 PM Page ii LWBK739-FM_pi-xx:LWBK739-FM_pi-xx.qxd 1/1/11 7:35 PM Page iii CLINICAL ECHOCARDIOGRAPHY REVIEW A Self-Assessment Tool EDITORS Allan L. Klein, MD, FRCP(C), FACC, FAHA, FASE Professor of Medicine Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Director, Cardiovascular Imaging Research Director, Center for the Diagnosis and Treatment of Pericardial Diseases Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland, Ohio Craig R. Asher, MD, FACC Cardiology Fellowship Director Department of Cardiology Cleveland Clinic Florida Weston, Florida LWBK739-FM_pi-xx:LWBK739-FM_pi-xx.qxd 1/1/11 7:35 PM Page iv Acquisitions Editor:Frances DeStefano Product Manager: Leanne McMillan Production Manager: Alicia Jackson Senior Manufacturing Manager: Benjamin Rivera Marketing Manager: Kimberly Schonberger Design Coordinator: Holly McLaughlin Production Service: Aptara, Inc. © 2011 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business Two Commerce Square 2001 Market Street Philadelphia, PA 19103, USA LWW.com All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data Clinical echocardiography review : a self-assessment tool / editors, Allan L. Klein, Craig R. Asher. p. ; cm. Includes bibliographical references and index. Summary: “The book focuses on the time tested way of “the Socratic method” to teach the key concepts to busy clinical cardiologists, fellows, anesthesiologists and sonographers using a multiple choice question & answer format. The book will emphasize diagnostic interpretation rather than clinical management. This book is comprehensive with chapters ranging from fundamentals to new technologies. The format of each chapter is standardized with 3 types of questions. At the begin- ning, there are simple questions followed by an answer. Then, questions associated with a still frame graphic (M-Mode, 2-D or a 3-D) come next and are followed by an answer. Finally, questions are presented involving case studies associated with several questions based on movies and still frames”–Provided by publisher. ISBN-13: 978-1-60831-054-8 (alk. paper) ISBN-10: 1-60831-054-X (alk. paper) 1. Echocardiography–Examinations, questions, etc. I. Klein, Allan L. II. Asher, Craig R. [DNLM: 1. Echocardiography–Examination Questions. 2. Heart Diseases–ultrasonography–Examination Questions. WG 18.2] RC683.5.U5C567 2011 616.1(cid:2)207543076–dc22 2010031605 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST. 10 9 8 7 6 5 4 3 2 1 LWBK739-FM_pi-xx:LWBK739-FM_pi-xx.qxd 1/1/11 7:35 PM Page v A C K N O W L E D G E M E N T S We would like to thank Marilyn, Jared, Lauren, of effort into putting this book together. Finally we Jordan, Jean and Sam Klein and Diann, Drew, Laura would like to express our gratitude to Wolters Kluwer, and George Asher for their encouragement during our Lippincott Williams & Wilkins publishers, and in par- careers and support while editing this book. We would ticular Frances DeStefano and Leanne McMillan, for especially like to thank Marie Campbell who put a lot their guidance in making this book a great success. v LWBK739-FM_pi-xx:LWBK739-FM_pi-xx.qxd 1/1/11 7:35 PM Page vi LWBK739-FM_pi-xx:LWBK739-FM_pi-xx.qxd 1/1/11 7:35 PM Page vii C O N T E N T S Chapter 1 Physics of Ultrasound, Technique and Instrumentation 1 Victor Mor-Avi Chapter 2 Cardiac Ultrasound Artifacts 10 Juan-Carlos Brenes and Craig R. Asher Chapter 3 Transthoracic Echocardiography: M-Mode and Two-Dimensional 22 Gerard P. Aurigemma and Dennis A. Tighe Chapter 4 Three-dimensional Echocardiography 38 Lissa Sugeng, Sonal Chandra, and Lynn Weinert Chapter 5 Transesophageal Echocardiography 54 L. Leonardo Rodriguez Chapter 6 Sonographer Goal Oriented Technique 67 Annitta J. Morehead Chapter 7 Doppler and Hemodynamics 79 Muhamed Saric and Itzhak Kronzon Chapter 8 Tissue Doppler and Strain 122 Steve L. Liao and Mario J. Garcia Chapter 9 Contrast-Enhanced Ultrasound Imaging 134 Roxy Senior and Steven B. Feinstein Chapter 10 Systolic Function Assessment 148 Thomas H. Marwick Chapter 11 Diastology 169 Andrew O. Zurick, David Verhaert, and Allan L. Klein Chapter 12 Stress Echocardiography 193 Omar Wever-Pinzon and Farooq A. Chaudhry Chapter 13 Intraoperative Echocardiography 210 William J. Stewart Chapter 14 Dyssynchrony Evaluation/AV Optimization 223 Victoria Delgado and Jeroen J. Bax Chapter 15 Coronary Artery Disease 246 Ronald Mastouri and Stephen G. Sawada Chapter 16 Pulmonic and Tricuspid Valvular Disease 261 Brian P. Griffin vii LWBK739-FM_pi-xx:LWBK739-FM_pi-xx.qxd 1/1/11 7:35 PM Page viii viii / CONTENTS Chapter 17 Aortic and Mitral Valvular Disease 274 Sorin V. Pislaru and Maurice Enriquez-Sarano Chapter 18 Prosthetic Valves 291 Linda D. Gillam and Smriti Deshmukh Chapter 19 Endocarditis 305 Ying Sia and Kwan-Leung Chan Chapter 20 Cardiomyopathies 320 Marianela Areces and Craig R. Asher Chapter 21 Systemic Disease 339 Imran S. Syed, Charles J. Bruce, and Heidi M. Connolly Chapter 22 Pericardial Diseases 360 Partho P. Sengupta and James B. Seward Chapter 23 Aortic Diseases 374 Gian M. Novaro and Craig R. Asher Chapter 24 Atrial Fibrillation 391 Susie N. Hong-Zohlman, David I. Silverman, and Warren J. Manning Chapter 25 Right Ventricular Disease and Pulmonary Hypertension 404 Sherif F. Nagueh Chapter 26 Cyanotic Congenital Heart Disease 416 Nishant Shah and Richard A. Humes Chapter 27 Noncyanotic Congenital Heart Disease 436 Benjamin W. Eidem Chapter 28 Tumors/Masses 450 Shephard D. Weiner and Shunichi Homma Index 465 LWBK739-FM_pi-xx_LWBK739-FM_pi-xx.qxd 13/01/11 4:01 PM Page ix C O N T R I B U T O R S Marianela Areces, MD Kwan-Leung Chan, MD, FRCPC, FACC Department of Cardiology Cardiologist Cleveland Clinic Florida University of Ottawa Heart Institute and the Weston, Florida Ottawa Hospital Professor Department of Medicine Craig R. Asher, MD University of Ottawa Cardiology Fellowship Director Ottawa, Ontario Department of Cardiology Canada Cleveland Clinic Weston, Florida Sonal Chandra, MD Clinical Associate Gerard P. Aurigemma, MD Department of Cardiology Professor University of Chicago Departments of Medicine and Radiology Chicago, Illinois University of Massachusetts Medical School Farooq A. Chaudhry, MD, FACP, FACC, Director, Noninvasive Cardiology FASE, FAHA Department of Medicine/Division of Associate Professor of Medicine Cardiovascular Disease Columbia University College of Physicians and UMassMemorial Healthcare Surgeons Worcester, Massachusetts Associate Chief of Cardiology Director of Echocardiography Jeroen J. Bax, MD, PhD St. Luke’s Roosevelt Hospital Center Director of Noninvasive Imaging New York, New York Professor of Cardiology Heidi M. Connolly, MD Department of Cardiology Professor of Medicine Leiden University Medical Center College of Medicine Leiden, The Netherlands Consultant Division of Cardiovascular Diseases Juan-Carlos Brenes, MD, FACC, FASE Mayo Clinic Department of Cardiology Rochester, Minnesota Columbia University Victoria Delgado, MD, PhD Co-Director, Echocardiography Laboratory Staff Cardiologist Columbia University Division of Cardiology Department of Cardiology Mount Sinai Medical Center Leiden University Medical Center Miami Beach, Florida Leiden, The Netherlands Charles J. Bruce, MBChB, FCP (SA), Smriti Deshmukh, MD FACC, FASE Assistant Clinical Professor of Medicine Associate Professor of Medicine Department of Medicine, Division of Cardiology College of Medicine Columbia University Consultant Attending Cardiologist Division of Cardiovascular Diseases Department of Medicine Mayo Clinic The Presbyterian Hospital Rochester, Minnesota New York, New York ix LWBK739-FM_pi-xx:LWBK739-FM_pi-xx.qxd 1/1/11 7:35 PM Page x x / CONTRIBUTORS Benjamin W. Eidem, MD, FACC, FASE Shunichi Homma, MD Associate Professor MM Hatch Professor of Medicine Departments of Pediatrics and Pediatric Department of Medicine—Cardiology Cardiology Columbia University College of Physicians and Mayo Clinic Surgeons Rochester, Minnesota Attending Physician Department of Medicine—Cardiology Maurice Enriquez-Sarano, MD New York Presbyterian Hospital Professor of Medicine Columbia University Medical Center Division of Cardiovascular Diseases New York, New York Director Susie N. Hong-Zohlman, MD Valvular Heart Disease Clinic Research Fellow in Medicine Mayo Clinic and Foundation Department of Medicine Rochester, Minnesota Beth Israel Deaconess Medical Center Boston, Massachusetts Steven B. Feinstein, MD, FACC Professor of Medicine/Cardiology Richard A. Humes, MD Director of Echocardiography Professor Department of Medicine/Cardiology Department of Pediatrics Rush University Medical Center Wayne State University Chicago, Illinois Chief Division of Cardiology Children’s Hospital of Michigan Mario J. Garcia, MD, FACC, FACP Detroit, Michigan Professor of Medicine and Radiology Chief, Division of Cardiology Allan L. Klein, MD, FRCP(C), FACC, FAHA, FASE Montefiore Medical Center-Albert Einstein College Professor of Medicine of Medicine Cardiology Cleveland Clinic Lerner College of Medicine of Case Bronx, New York Western Reserve University Director, Cardiovascular Imaging Research Linda D. Gillam, MD, FACC, FAHA, FASE Director, Center for the Diagnosis and Treatment of Professor of Clinical Medicine Pericardial Diseases Columbia University Department of Cardiovascular Medicine College of Physicians & Surgeons Heart and Vascular Institute Medical Director, Cardiac Valve Program Cleveland Clinic Department of Medicine Cleveland, Ohio Columbia University Medical Center New York, New York Itzhak Kronzon, MD, FASE Professor of Medicine Associate Chairman of Cardiovascular Medicine Brian P. Griffin, MD, FACC Director of Cardiac Imaging Director Cardiovascular Medicine Training Lenox Hill Heart and Vascular Institute of New York Program New York, New York John and Rosemary Brown Chair in Cardiovascular Medicine Steve L. Liao, MD Department of Cardiovascular Medicine The James J. Peters Veteran Affairs Medical Center Heart and Vascular Institute Department of Medicine, Cardiovascular Division Cleveland Clinic Bronx, New York Cleveland, Ohio The Zena and Michael A. Weiner Cardiovascular Institute The Mount Sinai School of Medicine New York, New York