Hemodynamics in the Echocardiography Laboratory

Description

The book provides a practically focused review of the latest techniques used for hemodynamic assessment in the echocardiography laboratory. It features a methodical case-based approach covering how to measure hemodynamic parameters successfully, including stroke volume, valve area and regurgitation severity, in a range of scenarios of varying complexity. Step-by-step guidance on how to apply the techniques described are provided. Each chapter also contains didactic features to assist the reader in assimilating the key points in every case, assisting them to develop their knowledge of how to treat patients with both routine and complex hemodynamic issues in the echocardiograply laboratory.  Hemodynamics in the Echocardiography Laboratory therefore represents a concise resource on how to carry out hemodynamic assessments and is a valuable resource for trainees and fellows in cardiology and echocardiography seeking a concise review of the topic. Contents 1: General Principles 1.1 Doppler Principle 1.2 Bernoulli Principle 1.2.1 Bernoulli Equation (Fig. 1.2) 1.3 Wiggers Diagram 1.4 Summary and Final Points 2: Math in the Echo Lab 2.1 Volume Calculations 2.1.1 VTI-Based Technique 2.1.2 Border Tracing-Based Technique 2.2 Resistance Calculations 2.3 Continuity Principle 2.4 PISA (Proximal Isovelocity Surface Area) Calculation 2.5 Volumetirc Calculations 2.6 Summary and Final Points 3: Pulmonary Pressure: Beginner 3.1 Pulmonary Artery Systolic Pressure 3.2 Analyzing TR Spectral Doppler Envelope 3.3 Measuring Peak TR Velocity 3.4 Assessing Right Atrial Pressure 3.5 Interpreting the Data 3.6 Summary and Final Points 4: Pulmonary Pressure: Advanced 4.1 Pulmonary Artery Diastolic Pressure 4.2 Mean Pulmonary Artery Pressure 4.2.1 Calculating Mean PAP Based on Sys/Dias PAP 4.2.2 PI Early Diastolic Velocity 4.2.3 TR VTI 4.2.4 PA Acceleration Time 4.3 Pulmonary Vascular Resistance 4.3.1 Comparing TR ΔP and RVOT Flow 4.3.2 Calculating Pressure Drop and Flow across Pulmonary Circulation 4.4 Summary and Final Points 5: How Severe Is This MR 5.1 General Principles 5.2 Anatomic/Color Assessment for EROA 5.2.1 3D-Based Direct Measurement of EROA 5.2.2 Vena Contracta Measurement 5.3 PISA Method 5.3.1 Pointers and Potential Pitfalls for the PISA Method 5.4 Color Doppler Assessment 5.5 Volumetric Calculations 5.6 Summary and Final Points 6: What Is Wrong with This MR: Part I 6.1 Case Presentation 6.2 Approach to an Unusual MR Tracing 6.3 Summary and Final Points 7: What’s Wrong with This MR: Part II 7.1 Case Presentation 7.2 Approach to an Unusual MR Tracing 7.2.1 Low Peak Velocity 7.2.2 Abnormal MR Envelope Shape 7.3 Summary and Final Points 8: Why Is This Happening Now 8.1 First-Degree Heart Block 8.1.1 Approach to Abnormal MR Timing 8.2 High Degree Heart Block 8.2.1 Approach to Abnormal MR Timing 8.3 The Missing Atrial Contraction 8.3.1 Approach to Abnormal MR Timing 8.4 Summary and Final Points 9: Extreme Pulsus Alternans 9.1 Case Presentation 9.2 Summary and Final Points 10: Is This AI an Emergency 10.1 AI Quantification 10.2 AI Hemodynamics 10.3 Summary and Final Points 11: There’s a Hole in the Heart: Part I 11.1 Approach to ASD Evaluation 11.2 Case Presentation 11.2.1 Anatomic Type of ASD 11.2.2 Shunt Direction 11.2.3 Magnitude of the Interatrial Shunt 11.2.4 Effect of the Shunt on Chamber Size and Function 11.2.5 Presence of Pulmonary Hypertension 11.2.6 Estimation of Pulmonary Vascular Resistance 11.3 Case Presentation 11.3.1 Shunt Direction 11.3.2 Magnitude of the Interatrial Shunt 11.3.3 Effect of the Shunt on Chamber Size and Function 11.3.4 Presence of Pulmonary Hypertension 11.3.5 Estimation of Pulmonary Vascular Resistance 11.4 Summary and Final Points 12: There’s a Hole in the Heart: Part II 12.1 Approach to VSD Evaluation 12.2 Case Presentation 12.2.1 Anatomic Type of VSD 12.2.2 Quantifying the Degree of Shunt 12.2.3 VSD Flow and Intracardiac Pressures 12.2.4 Summary of Post MI VSD Case 12.3 Case Presentation 12.3.1 Anatomic Type of VSD 12.3.2 Quantifying the Degree of Shunt 12.3.3 VSD Flow and Intracardiac Pressures 12.3.4 Summary of VSD with Cardiomyopathy Case 12.4 Case Presentation 12.4.1 Anatomic Type of VSD 12.4.2 Quantifying the Degree of Shunt 12.4.3 VSD Flow and Intracardiac Pressures 12.4.4 Summary of VSD with RVOT Obstruction Case 12.5 Summary and Final Points 13: The Machinery Confusion 13.1 Case Presentation 13.1.1 Approach to PDA Evaluation 13.2 Summary and Final Points 14: All Those AS Gradients 14.1 Technical Considerations 14.2 Maximal Instantaneous Gradient 14.3 Mean Gradient 14.4 Peak-to-Peak Gradient 14.5 Summary and Final Points 15: Dynamic LVOT 15.1 Anatomic Imaging 15.2 Doppler Imaging 15.2.1 Color Doppler Imaging 15.2.2 Spectral Doppler Imaging 15.3 Summary and Final Points 16: The Futile Heart 16.1 Case Presentation 16.1.1 Unusual Flow into RA 16.1.2 Quantifying the Shunt 16.2 Summary and Final Points Index