Essential Echocardiography: A Review of Basic Perioperative TEE and Critical Care Echocardiography

Description

Building on the success of the previous edition, this review book includes all of the original content plus several new chapters dedicated to the education and implementation of transthoracic echocardiography and point-of-care ultrasonography. Chapters feature board review-style questions and answers to assist readers with board exam preparation. This book also includes the most up-to-date echocardiography content and practice guidelines.  This book fills an educational gap in the perioperative and critical care echocardiography landscape. It addresses essential perioperative and critical care echocardiography topics in an accessible manner for those who provide acute care and resuscitation in any environment, including the operating room, intensive care unit, and the emergency department.  Essential Echocardiography, 2nd edition, is expertly written for the practitioner with limited knowledge of echocardiography preparing for either the Examination of Special Competence in Basic Perioperative TEE (Basic PTEeXAM) or the Examination of Special Competence in Critical Care Echocardiography (CCEeXAM). Preface Contents Contributors Part I: Basic Perioperative and Critical Care Echocardiography 1: Introduction to Basic Perioperative and Critical Care Echocardiography: Examination, Certification, Indications, and Contraindications Introduction Transesophageal Echocardiography in Noncardiac Surgery and Intensive Care Certification in Basic Perioperative Transesophageal Echocardiography Basic TEE Examination Contraindications Complications Using the TEE Probe Insertion Manipulation Orientation Point-of-Care Transthoracic Echocardiography and Ultrasound Certification in Critical Care Echocardiography Basic TTE Examination Patient Positioning and Optimization Contraindications and Complications Using the TTE Probe Manipulation Orientation Point-of-Care Echocardiography Reporting and Image Storage Conclusion Questions References 2: Transesophageal Echocardiography: Probe Manipulation and Essential Views Introduction Basic PTE Examination Transgastric (TG) Midpapillary Short-Axis (SAX) View Midesophageal (ME) Four-Chamber View ME Two-Chamber View ME Long-Axis (LAX) View ME AV SAX View ME RV Inflow-Outflow View ME Bicaval View ME Ascending Aortic SAX and LAX Views Descending Aortic SAX and LAX Views Additional Views Deep TG Five-Chamber View TG Basal SAX View TG Apical SAX View TG Two-Chamber View TG LAX View TG RV Basal View TG RV Inflow-Outflow View TG RV Inflow View ME Five-Chamber View ME Mitral Commissural View ME Left Atrial Appendage View ME AV LAX View ME Modified Bicaval TV View UE Right and Left Pulmonary Veins View ME Right Pulmonary Vein View Upper Esophageal (UE) Aortic Arch LAX and SAX Views Conclusion Questions References 3: Point-of-Care Transthoracic Echocardiography: Probe Manipulation, Positioning, and Essential Views Introduction Probe Manipulation Positioning Essential TTE Views (Table 3.1) Parasternal Long-Axis (LAX) View Parasternal Short-Axis (SAX) View Apical Four-Chamber View Subcostal Views Suprasternal View Conclusion Questions References 4: Basic Ultrasound Physics, Doppler Ultrasound, and Hemodynamic Assessment Introduction Physics of Ultrasound Ultrasound Probes Doppler Ultrasound Hemodynamic Assessment Flow Valvular Area Pressure Gradient Estimation 3D Echocardiography Bioeffects Conclusion Questions References 5: Knobology and Image Optimization Introduction Resolution 2D Controls Preprocessing Versus Postprocessing Transmit Power Gain Time Gain Compensation and Lateral Gain Compensation Autoscan/iScan Depth Focus Sector Width/Sector Steer Freeze M-Mode Doppler Controls Doppler Effect Pulsed-Wave Doppler Continuous-Wave Doppler Color Flow Doppler Conclusion Questions Part II: Echocardiographic Assessment 6: Left Ventricular Systolic Function Introduction Visual Estimation of Ejection Fraction Fractional Shortening Fractional Area Change Left Ventricular Volumes Modified Simpson’s Method Rate of Rise of Ventricular Pressure (dP/dt) Tissue Doppler Imaging Advanced Methods Three-Dimensional (3D) EF Calculation Global Longitudinal Strain (GLS) Measurements of Left Ventricular Geometry Left Ventricular Wall Thickness LV Mass Calculation Conclusion Questions References 7: Regional Ventricular Function Introduction Coronary Anatomy Application of Coronary Topography to Echocardiography Transesophageal Echocardiography Correlation Transthoracic Echocardiography Correlation Grading of Regional Wall Motion Abnormalities (Highlight Box 7.1) Complications from Myocardial Ischemia Conclusion Questions References 8: Mitral Valve Introduction Anatomy and Function 2D Imaging of the Mitral Valve TEE: Midesophageal Four-Chamber View (ME Four-Chamber View) TEE: ME Mitral Commissural View TEE: ME Two-Chamber View TEE: ME Long-Axis View (ME LAX View) TEE: Transgastric Basal Short-Axis View (TG Basal SAX) TEE: Transgastric Two-Chamber View (TG Two-Chamber View) TTE: Parasternal Long-Axis View (PLAX) TTE: Parasternal Short-Axis (PSAX) TTE: Apical Four-Chamber View (A4C) TTE: Apical Two-Chamber (A2C) Mitral Regurgitation (Highlight Box 8.1) Grading Severity 2D Echocardiography Color Flow Doppler Vena Contracta Pulmonary Venous Flow Profile Proximal Isovelocity Surface Area (PISA) Hemodynamics Mitral Stenosis (Highlight Box 8.2) 2D Echocardiography Quantitative Assessment of Mitral Stenosis Pressure Gradients Mitral Valve Area Calculations Pressure Half-Time (PHT) Proximal Isovelocity Surface Area (PISA) Planimetry Conclusion Questions References 9: Aortic Valve Introduction Aortic Stenosis Echocardiographic Evaluation (Highlight Box 9.1) Two-Dimensional Assessment Color Flow Doppler Spectral Doppler Aortic Regurgitation (Insufficiency) Echocardiographic Evaluation (Highlight Box 9.2) Two-Dimensional Assessment Color Flow Doppler Quantification of Aortic Regurgitation Vena Contracta Jet Width to LVOT Diameter Spectral Doppler Aortic Valve Pressure Half Time Descending Aorta Reversal of Flow Conclusion Questions References 10: The Right Heart Introduction Right Ventricle Structure and Function Echocardiographic Views for Evaluation of the Right Ventricle TEE Views Midesophageal (ME) Four-Chamber View ME RV Inflow-Outflow View ME Bicaval View ME Ascending Aortic Short-Axis View Transgastric (TG) Midpapillary Short-Axis View TG RV Inflow View TTE Views Parasternal Long-Axis View Parasternal RV Inflow View Parasternal Short-Axis View (RVOT Level) Parasternal Short-Axis View (Midpapillary Level) Apical Four-Chamber View Three-Dimensional Echocardiography Physiology of the Right Heart: Adaptations to Pulmonary Hypertension Right Ventricular Enlargement Right Ventricular Hypertrophy Quantitative Assessment of Right Ventricular Function (Highlight Box 10.1) Tricuspid Annular Plane Systolic Excursion Right Ventricular Fractional Area Change Tissue Doppler Imaging Right Ventricular Myocardial Performance Index Evaluation of the IVS to Assess RV Function Adaptation to Chronic Right Ventricular Overload Tricuspid Regurgitation Pulmonary Artery Interatrial Septum Acute Pulmonary Embolism Assessment of the Right Ventricle with Left Ventricular Assist Devices Conclusion Questions References 11: Atria Introduction The Right Atrium Anatomy Size Linear Dimension Area Volume The Left Atrium Anatomy Size Linear Dimension Area Volume Left Atrial Appendage The Interatrial Septum Anatomy Position Conclusion Questions References 12: Diastology Introduction Phases of Diastole Assessment of Chamber Filling: Pulsed-Wave Doppler Echocardiography Transmitral Inflow: Measuring Flow into the Left Ventricle Pulmonary Venous Flow: Measuring Flow into the Left Atrium Tissue Doppler Imaging: Measuring the Velocity of Myocardial Tissue Stages of Diastolic Dysfunction: From Mild to Severe Dysfunction (Table 12.1) (Highlight Box 12.1) Impaired Relaxation Pseudonormalization: Impaired Relaxation with Elevated LA Pressure Restrictive: Impaired Relaxation, Poor LV Compliance, and Elevated LA and LV Pressures Clinical Implications of Diastolic Dysfunction: Real-Time Measurements Conclusion Questions References 13: Thoracic Aorta Introduction Echocardiographic Views of the Thoracic Aorta TEE Views TTE Views Aortic Dissection (Highlight Box 13.1) Dissection Flap Identification Differentiating True from False Lumens Identifying Complicating Pathologies Aortic Aneurysm (Highlight Box 13.2) Aortic Atheroma Thoracic Aortic Trauma Conclusion Questions References 14: Pericardium Introduction Anatomy and Physiology of the Pericardium Anatomy Transverse Sinus Oblique Sinus Epicardial Fat Pad Function Respirophasic Variation Echocardiographic Views of the Pericardium TEE and TTE Views Indications for Echocardiography Pericardial Effusions (Highlight Box 14.1) Pericardial Hematoma Cardiac Tamponade Constrictive Pericarditis (Highlight Box 14.2) Differentiating Constrictive Pericarditis and Restrictive Cardiomyopathy Conclusion Questions References 15: Perioperative Rescue Echocardiography Introduction Acute Valvular and Aortic Pathology Cardiac Tamponade (Highlight Box 15.1) Right Ventricular Dysfunction (Highlight Box 15.2) Pulmonary Embolism (Highlight Box 15.3) Left Ventricular Dysfunction (Highlight Box 15.4) Hypovolemia (Highlight Box 15.5) Low Afterload (Highlight Box 15.6) Conclusion Questions References 16: Imaging Artifacts, Normal Anatomic Variants, and Common Misdiagnoses Introduction Normal Anatomic Variants/Misdiagnoses Epicardial and Extracardiac Fat Eustachian Valve Moderator Band Crista Terminalis Lipomatous Hypertrophy of the Interatrial Septum Lambl’s Excrescences Fibroelastoma Nodules of Arantius Coumadin Ridge Chiari Network Artifacts Dropout “Railroad” Artifact Acoustic Shadowing Acoustic Enhancement Side Lobe Reverberation Ring-Down and Comet-Tail Artifacts Mirroring Spectral Doppler Mirroring Beam Width Aliasing Artifact Conclusion Questions References 17: Intracardiac Masses, Devices, and Foreign Bodies Introduction Thrombi (Highlight Box 17.1) Endocarditis (Highlight Box 17.2) Tumors: Benign (Highlight Box 17.3) Tumors: Malignant Tumors with Systemic Cardiac Manifestations Carcinoid Renal Cell Carcinoma Foreign Bodies (Highlight Box 17.4) Intravascular Catheters Prosthetic Valves Cardiovascular Implantable Electronic Devices MitraClip™ Atrial Appendage Occlusion Devices PFO Closure Devices Mechanical Circulatory Support Conclusion Questions References 18: Adult Congenital Heart Disease Introduction Atrial Septal Defect (ASD) (Highlight Box 18.1) Ostium Secundum ASD Ostium Primum ASD Sinus Venosus ASD Coronary Sinus ASD (Unroofed Coronary Sinus) Transesophageal Echocardiographic Examination for ASDs Transthoracic Echocardiographic Examination for ASDs Ventricular Septal Defect (VSD) (Highlight Box 18.2) Transesophageal Echocardiographic Examination of VSDs Transthoracic Echocardiographic Examination for VSDs Persistent Left Superior Vena Cava (SVC) Patent Ductus Arteriosus/Aorticopulmonary Window Transesophageal Echocardiographic Evaluation of Tetralogy of Fallot (Highlight Box 18.3) Transthoracic Echocardiographic Examination of Tetralogy of Fallot Conclusion Questions References Part III: Critical Care Ultrasonography 19: Abdominal and Vascular Ultrasound Introduction Focused Assessment with Sonography for Trauma (Highlight Box 19.1) Background Anatomy Epidemiology and Pathophysiology Ultrasound Technique Right Upper Quadrant Left Upper Quadrant Pelvis Subcostal (Subxiphoid) View Image Interpretation Deep Venous Thrombosis (Highlight Box 19.2) Background Anatomy Lower Extremity Veins Upper Extremity Veins Pathophysiology and Epidemiology Ultrasound Technique Differentiation Between Acute and Chronic Deep Vein Thromboses Abdominal Aorta (Highlight Box 19.3) Background Anatomy Epidemiology and Pathophysiology Ultrasound Technique Conclusion Questions References 20: Volume Assessment and Fluid Responsiveness Introduction Physiology Predicting Preload Responsiveness (Highlight Box 20.1) Assessment of Ventricular Volumes Assessment of Left Ventricular Outflow Tract Assessment of Mitral Inflow Velocity Assessment of the Inferior Vena Cava Assessment of Arterial Velocity Assessing Response to Volume Challenge Conclusion Questions References 21: Lung Ultrasonography Introduction Equipment Performing the Examination Artifacts and Findings (Highlight Box 21.1) Shadowing Lung Sliding T-Lines and Lung Pulse Lung Point A-Lines (Reverberation Artifact) B-Lines (Comet Tails) Consolidation Profiles Diagnoses Pneumothorax Pulmonary Edema Pleural Effusion Pneumonia Lung Contusion Pulmonary Embolism Diaphragmatic Weakness Asthma/COPD Thromboembolic Disease Protocols BLUE Protocol Extended BLUE Protocol PINK Protocol CLOT Protocol FALLS Protocol Conclusion Questions References 22: Shock and Cardiac Arrest Introduction Using Point-of-Care Echocardiography Cardiogenic Shock (Table 22.2) Rate and Rhythm Abnormalities Global Systolic Function Regional Wall Motion Abnormalities Valvular Abnormalities Right Ventricular Dysfunction Obstructive Shock (Table 22.3) Pulmonary Embolism Cardiac Tamponade Tension Pneumothorax Great Vessel Compression Hypovolemic Shock (Table 22.4) Left Ventricular Chamber Size IVC Evaluation Stroke Volume Variation Distributive Shock Point-of-Care Ultrasound During Cardiac Arrest Systematic Evaluation Conclusion Questions References 23: Ultrasound for Vascular Access Introduction Probe Orientation Vessel Selection Vessel Identification Static Versus Dynamic Imaging Performing the Procedure Internal Jugular Vein Cannulation Subclavian/Axillary Vein Cannulation Femoral Vein Cannulation Ultrasound for Arterial Access Ultrasound for Peripheral Venous Access Ultrasound for Guidewire Confirmation and Pulmonary Arterial Catheter Placement Guidewire Placement and Catheter Patency Pulmonary Arterial Catheter Placement with Ultrasound Conclusion Questions References Appendix – Answers Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 Index