A PPENDIX IV

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From: Contemporary Cardiology: Essential Echocardiography: A Practical Handbook With DVD Edited by: S. D. Solomon © Humana Press, Totowa, NJ

Reference Values

Recommendations for Chamber Qualification

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Table A1 Reference Limits and Partition Values of Left Ventricular Mass and Geometry Women Men Reference Mildly Moderately Severely Reference Mildly Moderately Severely rangeabnormalabnormalabnormalrange abnormalabnormal abnormal Linear method LVmass (g) 67–162 163–186 187–210 ≥211 88–224 225–258 259–292 ≥293 LVmass/BSA(g/m2)43–95 96–108 109–121 ≥122 49–115 116–131 132–148 ≥149 LVmass/height (g/m) 41–99 100–115 116–128 ≥12952–126 127–144 145–162 ≥163 LVmass/height (g/m) 18–4445–5152–58≥59 20–48 49–55 56–63 ≥64 Relative wall thickness (cm) 0.22–0.42 0.43–0.47 0.48–0.52 ≥0.53 0.24–0.42 0.43–0.46 0.47–0.51 ≥0.52 Septal Thickness (cm) 0.6–0.9 1.0–1.2 1.3–1.5 ≥1.6 0.6–1.01.1–1.3 1.4–1.6 ≥1.7 Posterior Wall Thickness (cm) 0.6–0.9 1.0–1.2 1.3–1.5 ≥1.6 0.6–1.01.1–1.3 1.4–1.6 ≥1.7 2D Method LVmass (g) 66–150 151–171 172–182 ≥193 96–200 201–227 228–254 ≥255 LVmass/BSA (g/m2)44–88 89–100 101–112 ≥113 50–102 103–116 117–130 ≥131 Bold italic values:recommended and best validated. (Adapted from ref. 1.) Table A2 Reference Limits and Partition Values of Left Ventricular Size Women Men Reference Mildly Moderately Severely Reference Mildly Moderately Severely rangeabnormalabnormalabnormalrange abnormalabnormal abnormal LVdimension LVdiastolic diameter 3.9–5.3 5.4–5.7 5.8–6.1 ≥6.2 4.2–5.9 6.0–6.3 6.4–6.8 ≥6.9 LVdiastolic diameter/BSA (cm/m2) 2.4–3.23.3–3.43.5–3.7≥3.8 2.2–3.1 3.2–3.4 3.5–3.6 ≥3.7 LVdiastolic diameter/height (cm/m) 2.5–3.2 3.3–3.4 3.5–3.6 ≥3.7 2.4–3.3 3.4–3.5 3.6–3.7 ≥3.8 LVvolume LVdiastolic volume (mL) 56–104 105–117 118–130 ≥131 67–155 156–178 179–201 ≥201 LVdiastolic volume/BSA (mL/m2) 35–7576–8687–96≥97 35–75 76–86 87–96 ≥97 LVsystolic volume (mL) 19–49 50–59 60–69 ≥70 22–58 59–70 71–82 ≥83 LVsystolic volume/BSA (mL/m2)12–3031–3637–42≥43 12–30 31–36 37–42 ≥43 Bold italic values:recommended and best validated. (Adapted from ref. 1.)

Table A3 Reference Limits and Values and Partition Values of Left Ventricular Function Women Men ReferenceMildly ModeratelySeverelyReferenceMildlyModerately Severely range abnormalabnormal abnormalrangeabnormal abnormal abnormal Linear method Endocardial Fractional Shortening (%) 27–45 22–26 17–21 ≤16 25–43 20–24 15–19 ≤14 Midwall Fractional Shortening (%) 15–23 13–14 11–12 ≤10 14–22 12–13 10–11 ≤10 2D method Ejection fraction (%) ≥55 45–54 30–44 <30≥55 45–54 30–44 <30 Bold italic values:recommended and best validated. (Adapted from ref. 1.)

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Appendix

Table A4

Reference Limits and Partition Values of Right Ventricular and Pulmonary Artery Size

Reference Mildly Moderately Severely range abnormal abnormal abnormal

RV Dimensions (cm)

Basal RV diameter (RVD no. 1) 2.0–2.8 2.9–3.3 3.4–3.8 ≥3.9 Mid RV diameter (RVD no. 2) 2.7–3.3 3.4–3.7 3.8–4.1 ≥4.2 Base-to-Apex Length (RVD no. 3) 7.1–7.9 8.0–8.5 8.6 – 9.1 ≥9.2

RVOT diameters (cm)

Above aortic valve (RVOT no. 1) 2.5–2.9 3.0–3.2 3.3–3.5 ≥3.6 Above pulmonic valve (RVOT no. 2) 1.7–2.3 2.4–2.7 2.8–3.1 ≥3.2

PA diameter (cm)

Below pulmonic valve (PA no. 1) 1.5–2.1 2.2–2.5 2.6–2.9 ≥3.0 Adapted from ref. 1.

Table A5

Reference Limits and Partition Values of Right Ventricular Size and Function as Measured in the Apical Four-Chamber View

Reference Mildly Moderately Severely range abnormal abnormal abnormal

RV diastolic area (cm²) 11–28 29–32 33–37 ≥38

RV systolic area (cm²) 7.5–16 17–19 20–22 ≥23

RV fractional area change (%) 32–60 25–31 18–24 ≥17 Adaptted from ref. 1.

Table A6 Reference Limits and Partition Values for Left Atrial Dimensions/Volumes Women Men Reference Mildly Moderately Severely Reference Mildly Moderately Severely range abnormalabnormal abnormalrange abnormalabnormal abnormal Atrial dimensions LA diameter (cm) 2.7–3.8 3.9–4.2 4.3–4.6 ≥4.73–4 4.1–4.6 4.7–5.2 ≥5.2 LA diameter/BSA (cm/m2) 1.5–2.3 2.4–2.6 2.7–2.9 ≥3.01.5–2.32.4–2.6 2.7–2.9 ≥3 RA minor axis dimension (cm) 2.9–4.5 4.6–4.9 5.0–5.4 ≥5.52.9–4.54.6–4.9 5.0–5.4 ≥5.5 RA minor axis dimension/BSA (cm/m2) 1.7–2.5 2.6–2.8 2.9–3.1 ≥3.21.7–2.52.6–2.8 2.9–3.1 ≥3.2 Atrial area LA area (cm2)≤20 20–30 30–40 >40≤20 20–30 30–40 >40 Atrial volumes LA volume (mL) 22–52 53–62 63–72 ≥7318–58 59–68 69–78 ≥79 LA volume/BSA (mL/m2) 22 ±6 29–33 34–39 ≥4022 ±629–33 34–39 ≥40 Bold italic values:recommended and best validated. (Adapted from ref. 1.)

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Appendix

REFERENCES

1. Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440–1463.

Index 453

I ^NDEX

AF, see Atrial fibrillation

Aliasing, Doppler ultrasound, 12, 13, 16

Aortic aneurysm, proximal aneurysm without dissection, 376

Aortic dissection, case presentation, 363 diagnostic pitfalls, 370

echocardiography indications, 77 epidemiology, 363

etiology, 364–366 localization, 365

pathophysiology, 363, 364

transesophageal echocardiography, 367–370 transthoracic echocardiography, 366, 367 Aortic intramural hematoma (IMH),

case presentation, 370

echocardiographic findings, 373, 375 Aortic regurgitation,

anatomy, 223, 224 Doppler ultrasound,

color flow Doppler, 225, 226, 228, 229 quantitative measures, 230, 231, 233, 234, 237 vena contracta measurement, 228, 229 etiology, 223, 224

grading, 233

left ventricular effects, 224, 225 valve morphology assessment, 223, 224 Aortic stenosis,

aortic valve area calculation, 214 Doppler ultrasound, 211–214 etiology, 209, 210

low-gradient stenosis, 216 pitfalls, 216–218

severity assessment, 214, 215

two-dimensional echocardiography, 210, 211 Aortic valve area (AVA), calculation, 214 Apical five-chamber view,

examination protocol, 43, 44 overview and uses, 30 Apical four-chamber view,

examination protocol, 43 overview and uses, 28–30

Apical long-axis view, overview and uses, 31, 32 Apical three-chamber view, examination protocol, 45

Apical two-chamber view, examination protocol, 44, 45 overview and uses, 30, 31

Arrhythmias, echocardiography indications, 86

Arrhythmogenic right ventricular cardiomyopathy/dyspla- sia, echocardiography, 186, 187

ASA, see Atrial septal aneurysm ASD, see Atrial septal defect

Athlete’s heart, hypertrophic cardiomyopathy differential diagnosis, 177, 182

Atrial fibrillation (AF),

cardioversion, 306, 307, 313–315 case presentation, 305

echocardiography indications, 306

mitral valve area assessment with pressure half-time, 247

risk factors, 306 stroke risks, 305, 306

thrombus patient management, 315, 316

transesophageal echocardiography of left atrial append- age,

facilitated early cardioversion, 313–316 hemodynamics, 308, 312

internal morphology, 307, 308 thrombi detection, 312, 313

topographical relationships and external anatomy, 307

Atrial septal aneurysm (ASA), management, 329

patent foramen ovale association, 327–329 stroke risks, 328, 329

Atrial septal defect (ASD), anatomy, 379, 381, 382 coronary sinus defect, 385, 386 echocardiography,

indications, 379

management guidelines, 387, 388

patent foramen ovale, see Patent foramen ovale primum defects, 385

right ventricular overflow, 382 secundum defects, 382–384 shunt flow quantification, 382 sinus venosus septal defect, 385 AVA, see Aortic valve area

454 Index Blood flow,

types in heart, 12, 13 velocity equation, 10 Cancer, see Cardiac masses

Cardiac masses, see also Embolic disease; Infective en- docarditis,

cancer effects on heart, late effects, 361 mass effect, 359

myocardial infiltration, 359 pericardial involvement, 361 valvular involvement, 361 case presentation, 347 differential diagnosis, artifacts, 351, 352 normal structures,

extracardiac, 349 intracardiac, 347–349 thrombi, 349, 350 tumors,

primary tumors, 352–354, 356 secondary tumors, 356, 357, 359 vegetation, 351

echocardiography indications, 86 Cardiac output (CO), calculation, 99, 103 Cardiac tamponade, see also Pericardial effusion,

echocardiography indications, 80

myocardial infarction association and echocardiography, 146

Cardiomyopathy,

arrhythmogenic right ventricular cardiomyopathy/dys- plasia, 186, 187

classification, 161–163 definition, 161

dilated cardiomyopathy, case presentation, 161, 162 echocardiography, 163, 165 hypertensive cardiomyopathy,

case presentation, 182

echocardiography, 182, 183, 185 hypertrophic cardiomyopathy,

apical variant, 176

athlete’s heart evaluation, 177, 182 case presentation, 170, 171 diastolic dysfunction, 175 echocardiography, 171, 173–176

left ventricular outflow tract obstruction, 173, 174 mitral valve,

regurgitation, 175

systolic anterior motion, 173, 174 septal ablation, 175, 176

left ventricular noncompaction, 185 restrictive cardiomyopathy,

case presentation, 166, 168 echocardiography, 168–170 stress-related cardiomyopathies, 185

Cardioversion,

thromboembolism risks, 306, 307 warfarin use guidelines, 307

Carpentier’s functional classification, see Mitral regurgita- tion

Central processing unit, function, 35 CHD, see Congenital heart disease Chemotherapy, cardiac effects, 361

Chest pain, echocardiography indications, 74, 77, 138 CO, see Cardiac output

Coarctation of the aorta, anatomy, 401 cardiac lesions, 401

echocardiographic findings, 401, 402

Congenital heart disease (CHD), see also specific diseases, coarctation of the aorta, 401, 402

Ebstein malformation, 404, 407 echocardiography,

indications, 86, 391, 392

transesophageal echocardiography, 397 transthoracic echocardiography, 393, 397 patent ductus arteriosus, 399, 401

persistent left superior vena cava, 408 segmental approach in analysis,

connecting segments, 393 overview, 391, 392 segment assignment, 393 tetralogy of Fallot, 402, 404

transposition of the great arteries, 407 ventricular septal defect, 397–399 Congestive heart failure, see Heart failure Contrast echocardiography,

applications, 72, 73 contrast agents,

preparation and administration, 112 types, 112

Doppler flow signal enhancement, 114 historical perspective, 111

imaging modes, 113

left ventricular opacification, 113, 114 mechanical index, 113

myocardial contrast echocardiography, 115 safety, 115

Diastole,

comprehensive echocardiographic assessment, dysfunction, 121

physiology, 119–121 Dilated cardiomyopathy,

case presentation, 161, 162 echocardiography, 163, 165 Display, ultrasound equipment, 35, 36

Dobutamine stress test, see Stress echocardiography Doppler ultrasound,

aliasing, 12, 13, 16 aortic regurgitation,

color flow Doppler, 225, 226, 228, 229

Index 455 quantitative measures, 230, 231, 233, 234, 237

vena contracta measurement, 228, 229 aortic stenosis, 211–214

applications, 72 caveats, 15, 16

coarctation of the aorta, 401, 402 color flow Doppler, 14, 21, 22 continuous-wave mode, 10, 13

contrast agent enhancement of flow signal, 114 diastolic dysfunction,

color M-mode Doppler imaging, 130 flow interrogation, 121, 122

mitral valve inflow patterns, classification, 122, 123 impaired relaxation, 123, 124 modification, 125

pseudonormal inflow, 124, 125 restrictive inflow, 125

technical issues in measurement, 122 pulmonary venous flow patterns,

components, 125

Doppler tissue imaging, 126, 129–130 isovolumic relaxation time, 126 technical issues in measurement, 125 mitral regurgitation,

color flow Doppler, 267, 268 color jet area, 268–270

continuous-wave get intensity and morphology, 273

effective regurgitant orifice area, 270 left ventricular systolic performance, 273 mitral E-point velocity, 273

proximal isovelocity surface area, 270–272 pulmonary vein systolic flow reversal, 272, 273 severity index integration, 273, 274

vena contracta width, 270

myocardial performance index, 108, 109 pressure gradient measurement, 14, 15 principles, 8–10, 20, 21

pulsed-wave mode, 10, 13 sampling rate, 10–12

ventricular systolic function, 103, 104, 108 Dyspnea, echocardiography indications, 80 Ebstein malformation,

anatomy, 404, 407 cardiac lesions, 404

echocardiographic findings, 404, 407 EF, see Ejection fraction

Effective regurgitant orifice area (EROA), measurement, 270, 272

Ejection fraction (EF), grading, 96

limitations of assessment, 99–101 M-mode echocardiography, 93, 94 reference values, 447

two-dimensional echocardiography, 99

Embolic disease,

atrial fibrillation and left atrial appendage thrombi, see Atrial fibrillation

cardiogenic embolism, case presentation, 323, 329

echocardiographic work-up for source finding, 329, 330

epidemiology, 323–325, 327–329

left ventricular thrombus and myocardial infarction, 144–146

pulmonary embolism, see Pulmonary embolism stroke,

case presentation, 319 epidemiology, 319–321 etiology, 321–323

transesophageal echocardiography, 330 EROA, see Effective regurgitant orifice area

Evidence-based medicine, echocardiography use, 71, 73, 74 Examination report, 45, 68, 69

Exercise echocardiography, see Stress echocardiography Fractional shortening (FS),

derivation, 98 reference values, 447

Free wall rupture, myocardial infarction association and echocardiography, 143, 144

FS, see Fractional shortening Harmonic imaging,

artifacts, 8 image quality, 7 Heart failure,

diastolic dysfunction, 121 echocardiography indications, 80

myocardial infarction association and echocardiography, 146

Hypertensive cardiomyopathy, case presentation, 182

echocardiography, 182, 183, 185 Hypertrophic cardiomyopathy,

apical variant, 176

athlete’s heart evaluation, 177, 182 case presentation, 170, 171 diastolic dysfunction, 175 echocardiography, 171, 173–177

left ventricular outflow tract obstruction, 173, 174 mitral valve,

regurgitation, 175

systolic anterior motion, 173, 174 septal ablation, 175, 176

IE, see Infective endocarditis

IMH, see Aortic intramural hematoma Infective endocarditis (IE),

case presentations, 285, 288, 289, 292, 295 complications, 298, 299

diagnosis, 286–288

456 Index echocardiographic findings, 298, 299

echocardiography indications, 82, 83, 86, 295 predisposing cardiac lesions, 288

surgery indications, 299

transesophageal echocardiography, 295, 296 Intramural hematoma, see Aortic intramural hematoma Isovolumic relaxation time (IVRT), diastolic function as-

sessment, 126

IVRT, see Isovolumic relaxation time LAA, see Left atrial appendage Left atrial appendage (LAA),

thrombus formation, 305, 306

transesophageal echocardiography in atrial fibrillation, facilitated early cardioversion, 313–316

hemodynamics, 308, 312 internal morphology, 307, 308 thrombi detection, 312, 313

topographical relationships and external anatomy, 307

Left atrium size,

assessment in mitral regurgitation, 267 reference values, 449

Left ventricle size,

importance of assessment, 91, 92

left ventricular mass measurement, 101, 102 M-mode echocardiography, 92–94

reference values, 446

two-dimensional echocardiography, 98 Left ventricle wall motion,

grading, 96, 97

limitations of assessment, 97, 98

Left ventricular noncompaction, echocardiography, 185 Left ventricular opacification (LVO), contrast

echocardiography, 113, 114

Left ventricular outflow tract obstruction, hypertrophic cardiomyopathy, 173, 174

Left ventricular thrombus, myocardial infarction associa- tion and echocardiography, 144–146

Left ventricular wall,

myocardial infarction motion abnormalities, 135, 136, 138

thickness reference values, 446 LVO, see Left ventricular opacification

Marfan’s syndrome, echocardiographic evaluation, 376 MCE, see Myocardial contrast echocardiography Mechanical index (MI), contrast echocardiography, 113 MI, see Mechanical index; Myocardial infarction Mitral regurgitation,

case presentations,

endocarditis following repair, 283 flail leaflet, 261

mitral valve replacement, 279, 282, 283 myocardial infarction, 259, 261

prolapse, 256

rheumatic mitral regurgitation, 263, 265 trace regurgitation, 255, 256

Doppler ultrasound,

color flow Doppler, 267, 268 color jet area, 268–270

continuous-wave get intensity and morphology, 273 effective regurgitant orifice area, 270

left ventricular systolic performance, 273 mitral E-point velocity, 273

proximal isovelocity surface area, 270–272 pulmonary vein systolic flow reversal, 272, 273 severity index integration, 273, 274

vena contracta width, 270

echocardiography indications, 255, 256 etiology, 255, 256

mitral valve prolapse, 256–259

myocardial infarction association and echocardiography, 139, 140, 147

sequelae, 259

severity classification, 265, 266 surgical considerations,

anatomy, 274

Carpentier’s functional classification, type I, 275, 277

type II, 277 type IIIa, 277, 278 type IIIb, 278

intraoperative valve analysis, 279 transesophageal echocardiography, 279 two-dimensional echocardiography,

left atrium size, 267

left ventricular performance, 266, 267 Mitral stenosis,

case presentation, 239 etiology, 240, 241

left atrium morphology, 241 mitral valve area assessment,

continuity equation, 248, 249 planimetry, 246, 247

pressure half-time, 247, 248

proximal isovelocity surface area, 250–252

morphology of valve and supporting structure, 240, 241 pressure gradients, 242, 244–246

pulmonary arterial pressure, 241, 242 Mitral valve,

area assessment, see Mitral stenosis hypertrophic cardiomyopathy,

regurgitation, 175

systolic anterior motion, 173, 174 inflow patterns and diastolic dysfunction,

classification, 122, 123 impaired relaxation, 123, 124 modification, 125

pseudonormal inflow, 124, 125 restrictive inflow, 125

technical issues in measurement, 122

morphology of valve and supporting structure, 240, 241 M-mode echocardiography,

applications, 72

color M-mode Doppler imaging of diastolic function, 130

Index 457 left ventricle size, 92–94

overview, 20

MPI, see Myocardial performance index Murmurs, see specific conditions

Myocardial contrast echocardiography (MCE), principles, 115

Myocardial infarction (MI), case presentation, 133 coronary artery anatomy, 136 echocardiography indications,

cardiac tamponade, 146 free wall rupture, 143, 144 heart failure, 146

left ventricular thrombus, 144–146 mitral regurgitation, 139, 140, 147 overview, 139

pericarditis, 146

pseudoaneurysm, 143, 146, 147 ventricular septal defect, 140–143

left ventricular wall motion abnormalities, 135, 136, 138 Myocardial ischemia, echocardiography indications, 74 Myocardial performance index (MPI), Doppler ultrasound,

108, 109

Myocardial viability, assessment, 102 Myxoma, see Cardiac masses Parasternal long-axis view,

examination protocol, 38–42 overview and uses, 25 Parasternal short-axis view,

examination protocol, 41, 43 overview and uses, 28

PASP, see Pulmonary arterial systolic pressure Patent ductus arteriosus (PDA),

anatomy, 399

echocardiographic findings, 399, 401 Patent foramen ovale (PFO),

atrial septal aneurysm association, 327–329 echocardiography, 324, 325, 327, 386, 387 embolic disease, 323–325, 327

management, 329, 387, 388 PDA, see Patent ductus arteriosus PE, see Pulmonary embolism

Pericardial effusion, see also Cardiac tamponade, case presentation, 191, 208

clinical presentation, 203, 206

echocardiographic findings, 203, 204, 206–208 echocardiography indications, 77, 80

etiology, 201–203 pathophysiology, 202 Pericarditis,

acute pericarditis,

echocardiographic findings, 197 etiology, 194–197

chronic constrictive pericarditis, clinical presentation, 197, 198 echocardiographic findings, 198–200 echocardiography indications, 80

myocardial infarction association and echocardiography, 146

Pericardium,

anatomy, 191–193 physiology, 193, 194 tumor effects, 361

Persistent left superior vena cava, features, 408 PFO, see Patent foramen ovale

PISA, see Proximal isovelocity surface area

Pressure half-time, mitral valve area assessment, 247, 248 Proximal isovelocity surface area (PISA), mitral regurgita-

tion assessment, 250–252, 270–272 Pseudoaneurysm, myocardial infarction association and

echocardiography, 143, 146, 147 Pulmonary arterial systolic pressure (PASP),

calculation, 343, 344

pulmonary embolism risk assessment, 341 Pulmonary artery size, reference values, 448 Pulmonary embolism (PE),

case presentation, 333 echocardiography,

findings, 334–338, 340, 341 indications, 77

mortality, 334 pathophysiology, 334

pulmonary arterial systolic pressure, 341 risk assessment and management, 341, 342 Pulmonary hypertension,

classification, 341, 343

pulmonary arterial systolic pressure calculation, 343, 344

tricuspid regurgitation velocity, 343, 344

Pulmonary venous flow, Doppler patterns and diastolic dysfunction,

components, 125

technical issues in measurement, 125 Restrictive cardiomyopathy,

case presentation, 166, 168 echocardiography, 168–170 Right ventricle inflow view,

examination protocol, 42 overview and uses, 27, 28 Right ventricle,

chamber dimensions, 110 morphology, 109

reference values, 448

Right ventricular outflow, examination protocol, 42 SAM, see Systolic anterior motion

Stress echocardiography,

advantages and disadvantages, 157, 158, 160 exercise testing, 151

indications, 72, 149–151 interpretation, 154–157

pharmacological testing, 151, 153 recommendations for testing, 149, 150 vasodilator and pacing stress, 153, 154

458 Index Stress-related cardiomyopathies, echocardiography, 185

Stroke, see Embolic disease Stroke volume, derivation, 99 Subcostal position,

examination protocol, 45 views, 32

Superior vena cava, persistent, 408 Suprasternal position,

examination protocol, 45 views, 32, 33

Syncope, echocardiography indications, 86

Systolic anterior motion (SAM), mitral valve and hyper- trophic cardiomyopathy, 173, 174

TEE, see Transesophageal echocardiography Tetralogy of Fallot,

anatomy, 402

echocardiographic findings, 402, 404 natural history, 402

palliative surgery, 402 pathophysiology, 402

Three-dimensional echocardiography, applications, 73

left ventricular mass measurement, 101, 102 Thrombus, see Embolic disease

Transducer, function, 35 index mark, 38 maneuvers, 38 positions, see Views scan plane, 37

Transesophageal echocardiography (TEE), anatomical relationships, 418, 420 aortic dissection, 367–370 cardiogenic emboli, 330 congenital heart disease, 397 infective endocarditis, 295, 296 instrumentation , 417, 418

left atrial appendage in atrial fibrillation, facilitated early cardioversion, 313–316 hemodynamics, 308, 312

internal morphology, 307, 308 thrombi detection, 312, 313

topographical relationships and external anatomy, 307 mitral valve analysis, 279

spatial relationships, 419, 420 stages of examination,

stage 1, 421, 442 stage 2, 421, 442 stage 3, 421, 442, 443 stage 4, 421, 443, 444 views, 418, 419, 420

Transposition of the great arteries, anatomy, 407

surgical correction, 407

Tricuspid regurgitation velocity, pulmonary hypertension, 343, 344

Tumors, see Cardiac masses

Two-dimensional echocardiography, aortic stenosis, 210, 211

applications, 72

examination protocol, 38–45 imaging planes, 38

left ventricle size, 98

left ventricle systolic function, 94–96 mitral regurgitation,

left atrium size, 267

left ventricular performance, 266, 267 overview, 19

Ultrasound,

fundamental versus harmonic imaging, 7 image generation, 3, 5

propagation velocity, 3 resolution versus penetration, 7 tissue interactions, 5, 6 wave characteristics, 3

Valvular heart disease, see also specific conditions, echocardiography indications, 82

Vena contracta, width measurement, 270

Ventricular septal defect (VSD), myocardial infarction association and echocardiography, 140–143 anatomy, 398

echocardiographic findings, 398, 399 Views,

apical position,

five-chamber view, 30 four-chamber view, 28–30 long-axis view, 31, 32 two-chamber view, 30, 31 overview, 22, 24, 25, 37 parasternal position,

long-axis view, 25

right ventricle inflow view, 27, 28 short-axis view, 28

subcostal position views, 32 suprasternal position views, 32, 33

transesophageal echocardiography, 418–420 VSD, see Ventricular septal defect

Warfarin, cardioversion use guidelines, 307, 313, 314