Textbook of Clinical Echocardiography, 7e (Nov 14, 2023)_(0323882080)_(Elsevier).pdf

Today's echocardiography continues to be a widely available, minimal-risk procedure with the potential to yield a vast amount of detailed, precise anatomic and physiologic information. Dr. Catherine Otto's Textbook of Clinical Echocardiography, 7th Edition, clearly outlines how to master the core principles of echocardiographic imaging in order to make an initial diagnosis and integrate this data in clinical decision making for patients with a wide range of cardiovascular diseases. Ideal for cardiology fellows, medicine residents, and cardiac sonography students, this bestselling text teaches all the essential elements of ultrasound physics, tomographic and 3D anatomy, image acquisition, advanced imaging modalities, and application in specific disease categories-all with a practical, problem-based approach. Concentrates on the foundational concepts you need to know to perform and interpret echocardiographic studies and to pass your board exams. Incorporates new clinical knowledge, new guidelines, and recent innovations in echocardiographic imaging, including advances in handheld devices, specialized echo applications, and technical aspects of image collection. Covers all advanced echo techniques, including contrast echo, 3D echo, and myocardial mechanics, as well as intraoperative and intra-procedural transesophageal echocardiography (TEE). Provides an updated understanding of the clinical applications of specific echocardiographic findings, and discusses what alternative diagnostic approaches to initiate when echocardiography does not provide a definitive answer. Offers a thorough, must-know explanation of the physics behind echocardiography and its applications in the clinical setting; Echo Math boxes in each chapter for quick review and greater comprehension; updated evidence tables validating echo parameters; and an Echo Exam summary at the end of each chapter. Matches full-color anatomic drawings of heart structures with the 2D and 3D echocardiographic views, and includes dozens of new illustrations throughout the text. Pairs state-of-the-art echo images with more than 360 videos that illustrate the full range of cardiac disease diagnosed with this powerful imaging approach. An eBook version is included with purchase. The eBook allows you to access all of the text, figures and references, with the ability to search, customize your content, make notes and highlights, and have content read aloud. TEXTBOOK OF CLINICAL ECHOCARDIOGRAPHY COVER FRONTMATTER PREFACE ACKNOWLEDGMENTS GLOSSARY KEY EQUATIONS 1. Principles of Echocardiographic Image Acquisition and Doppler Analysis ULTRASOUND WAVES TRANSDUCERS Piezoelectric Crystal Types of Transducers Beam Shape and Focusing Resolution ULTRASOUND IMAGING MODALITIES Two- Dimensional Echocardiography Image Production Instrument Settings Imaging Artifacts Three- Dimensional Echocardiography Echocardiographic Imaging Measurements DOPPLER ECHOCARDIOGRAPHY Doppler Velocity Data Doppler Equation Spectral Analysis Continuous- Wave Doppler Ultrasound Pulsed- Wave Doppler Ultrasound Doppler Velocity Instrument Controls Doppler Velocity Data Artifacts Color Doppler Flow Imaging Principles Color Doppler Instrument Controls Color Doppler Imaging Artifacts Tissue Doppler BIOEFFECTS AND SAFETY Bioeffects Safety THE ECHO EXAM SUGGESTED READING 2. Normal Anatomy and Flow Patterns on Transthoracic Echocardiography BASIC IMAGING PRINCIPLES Tomographic Imaging Nomenclature of Standard Views Image Orientation Examination Technique Technical Quality Echocardiographic Image Interpretation TRANSTHORACIC TOMOGRAPHIC VIEWS Parasternal Window Long- Axis Views Right Ventricular Inflow and Outflow Views Short- Axis Views Apical Window Four- Chamber View Two- Chamber View Long- Axis View Other Apical Views Subcostal Window Suprasternal Notch Window Other Acoustic Windows M- MODE RECORDINGS Aortic Valve and Left Atrium Mitral Valve Left Ventricle Other M- Mode Recordings NORMAL INTRACARDIAC FLOW PATTERNS Basic Principles Laminar Versus Disturbed Flow Flow- Velocity Profiles Clinical Quantitative Doppler Methods Measurement of Volume Flow Velocity- Pressure Relationships Spatial Pattern of Flow Normal Antegrade Intracardiac Flows Left Ventricular Outflow Right Ventricular Outflow Left Ventricular Inflow Right Ventricular Inflow Left Atrial Filling Right Atrial Filling Descending Aorta Normal Color Doppler Flow Patterns Impact of Color Doppler Physics Normal Ventricular Outflow Patterns Normal Ventricular Inflow Patterns Normal Atrial Inflow Patterns Physiologic Valvular Regurgitation AGING CHANGES ON ECHOCARDIOGRAPHY THE DIAGNOSTIC ECHOCARDIOGRAM Core Elements Additional Components THE ECHO EXAM SUGGESTED READING 3. Transesophageal Echocardiography PROTOCOLS AND RISKS TOMOGRAPHIC VIEWS Esophageal Position Four-Chamber Plane Two-Chamber Plane Long-Axis Plane Short-Axis Plane Transgastric Position Short-Axis Plane Two- Chamber Plane Four- Chamber Plane Long- Axis Plane Descending Thoracic Aorta VALVE ANATOMY AND FUNCTION Aortic Valve Mitral Valve Pulmonic Valve Tricuspid Valve CHAMBER ANATOMY AND FILLING PATTERNS Left Ventricle Left Atrium Right Ventricle Right Atrium IMAGING SEQUENCE THE ECHO EXAM SUGGESTED READING 4. Specialized Echocardiography Applications THREE- DIMENSIONAL ECHOCARDIOGRAPHY Image Acquisition Image Display Examination Protocol Quantitation From 3D Images Clinical Utility Limitations MYOCARDIAL MECHANICS Tissue Doppler Strain and Strain Rate Speckle Tracking Strain Imaging Clinical Utility Dyssynchrony, Twist, and Torsion CONTRAST ECHOCARDIOGRAPHY Contrast Agents Contrast Image Acquisition Applications Limitations and Safety INTRACARDIAC ECHOCARDIOGRAPHY Instrumentation Technique Applications Limitations and Safety THE ECHO EXAM SUGGESTED READING 5. Clinical Indications and Quality Assurance TYPES OF ECHOCARDIOGRAPHIC STUDIES BASIC PRINCIPLES OF DIAGNOSTIC TESTING Reliability of a Diagnostic Test Accuracy Precision Expertise Integration of Clinical Data and Test Results Predictive Value Likelihood Ratio Pretest and Posttest Probability Cost- Effectiveness Clinical Outcomes INDICATIONS AND APPROPRIATENESS CRITERIA INDICATIONS FOR DIAGNOSTIC ECHOCARDIOGRAPHY Transthoracic Echocardiography Transesophageal Echocardiography Stress Echocardiography POINT OF CARE CARDIAC ULTRASOUND STUDIES Instrumentation Applications Safety and Limitations QUALITY ASSURANCE IN ECHOCARDIOGRAPHY Sonographer Education and Training Physician Education and Training Echocardiography Reporting Echocardiography Laboratory Structure THE ECHO EXAM SUGGESTED READING 6. Left and Right Ventricular Systolic Function BASIC PRINCIPLES Cardiac Cycle Physiology of Systolic Function Ventricular Volumes and Geometry Cardiac Output Response to Exercise IMAGING THE LEFT VENTRICLE Qualitative Evaluation of Systolic Function Quantitative Evaluation of Systolic Function Linear Dimensions 2D and 3D Ventricular Volumes Left Ventricular Wall Stress Strain Imaging Left Ventricular Geometry and Mass Limitations and Alternate Approaches Endocardial Definition Geometric Assumptions Accuracy and Reproducibility Alternate Approaches DOPPLER EVALUATION OF LEFT VENTRICULAR SYSTOLIC FUNCTION Stroke Volume Calculation Sites for Stroke Volume Measurement Left Ventricular Outflow Mitral Valve Right Heart Differences in Transvalvular Volume Flow Rates Other Doppler Measures of Systolic Function Ejection Acceleration Times Rate of Ventricular Pressure Rise (dP/dt) Limitations and Alternate Approaches ECHO APPROACH TO RIGHT VENTRICULAR SYSTOLIC FUNCTION Right Ventricle Size Right Ventricular Systolic Function Right Ventricular Strain Patterns of Ventricular Septal Motion Limitations and Alternate Approaches PULMONARY VASCULATURE Pulmonary Systolic Pressure Estimates Tricuspid Regurgitant Velocity Pulmonic Regurgitant Velocity Estimation of Right Atrial Pressure Pulmonary Vascular Resistance Pulmonary Artery Velocity Curve Pulmonary Vascular Resistance Calculations Limitations and Alternate Approaches THE ECHO EXAM SUGGESTED READING 7. Ventricular Diastolic Filling and Function BASIC PRINCIPLES Causes of Diastolic Dysfunction Phases of Diastole Parameters of Diastolic Function Ventricular Relaxation Ventricular Compliance Ventricular Diastolic Pressures Ventricular Diastolic Filling (Volume) Curves Atrial Pressures and Filling Curves Normal Respiratory Changes DOPPLER EVALUATION OF LV FILLING Nomenclature and Measurements Volumetric Flow Rates Doppler Data Recording TISSUE DOPPLER MYOCARDIAL IMAGING LEFT ATRIAL PARAMETERS Left Atrial Doppler Filling Curves Left Atrial Volumes LEFT VENTRICULAR CHANGES ESTIMATED PULMONARY SYSTOLIC PRESSURE OTHER APPROACHES LV and LA Myocardial Mechanics Isovolumic Relaxation Time Propagation Velocity ÿþR CONFOUNDING FACTORS Physiologic Factors Respiration, Heart Rate, and PR Interval Age Preload Pathophysiology LV Systolic Function Mitral Valve Disease Cardiac Rhythm and Atrial Contractile Function CLINICAL CLASSIFICATION OF LV DIASTOLIC DYSFUNCTION Estimates of Diastolic Filling Pressures Mild Diastolic Dysfunction Moderate Diastolic Dysfunction Severe Diastolic Dysfunction RIGHT VENTRICULAR DIASTOLIC FUNCTION Right Ventricular Filling Doppler Data Recording Physiologic Factors That Affect Right Ventricular Filling Right Atrial Filling ALTERNATE APPROACHES DIASTOLIC FUNCTION REPORTING THE ECHO EXAM SUGGESTED READING 8. Coronary Artery Disease BASIC PRINCIPLES Coronary Artery Anatomy Evaluation of Left Ventricular Wall Motion Transthoracic Imaging Transesophageal Imaging Sequence of Events in Ischemia Evaluation of Global and Regional Ventricular Function MYOCARDIAL ISCHEMIA Basic Principles of Stress Echocardiography Exercise Echocardiography Dobutamine Stress Echocardiography Evaluation for Ischemia Evaluation for Myocardial Viability Other Stress Modalities Limitations and Technical Aspects Alternate Approaches Clinical Utility Diagnosis of Coronary Artery Disease Extent and Location of Ischemic Areas Prognostic Implications ACUTE CORONARY SYNDROMES Basic Principles Echocardiographic Imaging Limitations and Alternate Approaches Clinical Utility Initial Diagnosis Evaluation of Interventional Therapy Myocardial Viability Mechanical Complications of Myocardial Infarction END- STAGE ISCHEMIC CARDIAC DISEASE Differentiation From Other Causes of Left Ventricular Systolic Dysfunction Echocardiographic Approach Limitations and Alternate Approaches THE ECHO EXAM SUGGESTED READING 9. Cardiomyopathies, Hypertensive and Pulmonary Heart Disease DILATED CARDIOMYOPATHY Basic Principles Echocardiographic Approach LV Size and Systolic Function LV Diastolic Function and Filling Pressures Secondary Mitral Regurgitation Pulmonary Pressures Right Heart Size and Function Limitations and Technical Considerations Clinical Utility Diagnostic Approach Heart Failure With Normal LV Systolic Function Monitoring Medical Therapy Indications for Biventricular Pacing or Implantable Defibrillator Cardio- Oncology Alternate Approaches HYPERTROPHIC CARDIOMYOPATHY Basic Principles Echocardiographic Approach Asymmetric Left Ventricular Hypertrophy Left Ventricular Diastolic Function Dynamic Subaortic LV Outflow Tract Obstruction Mitral Valve Abnormalities Limitations and Technical Considerations Clinical Utility Diagnosis and Screening Evaluation of Medical Therapy Selection of Patients for Implantable Cardiac Defibrillators Monitoring of Septal Reduction Therapy Alternate Approaches RESTRICTIVE CARDIOMYOPATHY Basic Principles Echocardiographic Approach Anatomic Features Diastolic Function Limitations and Technical Considerations Clinical Utility Alternate Approaches OTHER CARDIOMYOPATHIES Arrhythmogenic Right Ventricular Dysplasia Left Ventricular Noncompaction ADVANCED HEART FAILURE THERAPIES Cardiac Resynchronization Therapy Left Ventricular Assist Devices Total Artificial Heart Cardiac Transplantation Cardiac Allograft Structure and Function Acute Transplant Rejection Post- Transplant Monitoring Limitations, Technical Considerations, and Alternate Approaches HYPERTENSIVE HEART DISEASE Basic Principles Echocardiographic Approach Ventricular Hypertrophy Diastolic Function Systolic Function Other Echocardiographic Findings Limitations and Technical Considerations Clinical Utility Diagnosis and Prognosis Evaluation of Heart Failure Symptoms in a Patient With Hypertension Alternate Approaches PULMONARY HEART DISEASE Chronic Versus Acute Pulmonary Disease Echocardiographic Approach Pulmonary Pressures Right Ventricular Pressure Overload Secondary Tricuspid Regurgitation Limitations and Technical Considerations Clinical Utility Alternate Approaches THE ECHO EXAM SUGGESTED READING 10. Pericardial Disease PERICARDIAL ANATOMY AND PHYSIOLOGY PERICARDITIS Basic Principles Echocardiographic Approach Clinical Utility PERICARDIAL EFFUSION Basic Principles Diagnosis of Pericardial Effusion Diffuse Effusion Loculated Effusion Distinguishing From Pleural Fluid Clinical Utility PERICARDIAL TAMPONADE Echocardiographic Approach Right Atrial Systolic Collapse Right Ventricular Diastolic Collapse Reciprocal Changes in Ventricular Volumes Respiratory Variation in Diastolic Filling Tissue Doppler Early Diastolic Velocity Inferior Vena Cava Dilation Clinical Utility Diagnosis of Pericardial Tamponade Echo- Guided Pericardiocentesis PERICARDIAL CONSTRICTION Basic Principles Echocardiographic Approach Imaging Doppler Examination Constrictive Pericarditis Versus Restrictive Cardiomyopathy Clinical Utility THE ECHO EXAM SUGGESTED READING 11. Valvular Stenosis BASIC PRINCIPLES Approach to the Evaluation of Valvular Stenosis Fluid Dynamics of Valvular Stenosis High- Velocity Jet Relationship Between Pressure Gradient and Velocity Distal Flow Disturbance Proximal Flow Patterns AORTIC STENOSIS Diagnostic Imaging of the Aortic Valve Calcific Aortic Stenosis Congenital Bicuspid or Unicuspid Valve Rheumatic Aortic Stenosis Differential Diagnosis Quantitation of Aortic Stenosis Severity Maximum Aortic Jet Velocity Pressure Gradients Continuity Equation Valve Area Doppler Velocity Ratio Coexisting Valvular Disease Response of the Left Ventricle Clinical Applications Decisions About Timing of Intervention Disease Progression and Prognosis in Asymptomatic Aortic Stenosis Evaluation of Low- Flow Aortic Stenosis Aortic Stenosis With Left Ventricular Systolic Dysfunction Low- Flow Aortic Stenosis With a Normal LV Ejection Fraction MITRAL STENOSIS Diagnostic Imaging of the Mitral Valve Rheumatic Disease Mitral Annular Calcification Differential Diagnosis Quantitation of Mitral Stenosis Severity Pressure Gradients Mitral Valve Area Technical Considerations and Potential Pitfalls Consequences of Mitral Stenosis Left Ventricular Response Left Atrial Enlargement and Thrombus Pulmonary Hypertension Mitral Regurgitation Other Coexisting Valvular Disease Clinical Applications in Specific Patient Populations Disease Stages, Hemodynamic Progression, and Timing of Intervention Patients Undergoing Balloon Mitral Commissurotomy Quantitation of Calcific Mitral Stenosis Severity TRICUSPID STENOSIS PULMONIC STENOSIS THE ECHO EXAM SUGGESTED READING 12. Valvular Regurgitation BASIC PRINCIPLES Etiology of Valvular Regurgitation Fluid Dynamics of Valvular Regurgitation Pathophysiologic Consequences Detection of Valvular Regurgitation Valvular Regurgitation in Normal Individuals APPROACHES TO QUANTITATION OF REGURGITANT SEVERITY Color Doppler Imaging Jet Size and Shape Vena Contracta Proximal Flow Convergence Continuous- Wave Doppler Approach Distal Flow Reversals Volume Flow at Two Intracardiac Sites Limitations and Alternate Approaches AORTIC REGURGITATION Diagnostic Imaging of the Valve Apparatus Left Ventricular Response Indirect Signs of Aortic Regurgitation Evaluation of Aortic Regurgitant Severity Screening Examination Vena Contracta Aortic Flow Reversal Continuous- Wave Doppler Regurgitant Volume and Fraction Clinical Utility Diagnostic Utility for Aortic Regurgitation Timing of Surgical Intervention for Chronic Asymptomatic Aortic Regurgitation Decisions About Type of Intervention MITRAL REGURGITATION Diagnostic Imaging of the Mitral Valve Apparatus Primary Mitral Regurgitation Secondary Mitral Regurgitation Response of the Left Ventricle, Left Atrium, and Pulmonary Vasculature Evaluation of Mitral Regurgitant Severity Screening Examination Vena Contracta Regurgitation Volume and Orifice Area Pulmonary Vein Flow Reversal Clinical Utility Diagnosis and Severity of Mitral Regurgitation Clinical Follow- Up and Timing of Intervention Decisions About Type of Intervention TRICUSPID REGURGITATION Diagnostic Imaging of the Tricuspid Valve Apparatus Right Ventricular and Right Atrial Dilation Evaluation of Tricuspid Regurgitation Severity Clinical Utility PULMONIC REGURGITATION THE ECHO EXAM SUGGESTED READING 13. Prosthetic Valves BASIC PRINCIPLES Types of Prosthetic Valves Surgical Bioprosthetic Valves Transcatheter Bioprosthetic Valves Homograft Valves Mechanical Valves Mechanisms of Prosthetic Valve Dysfunction Nonstructural Valve Dysfunction Structural Valve Deterioration Thromboembolic Complications Endocarditis ECHOCARDIOGRAPHIC APPROACH Imaging Bioprosthetic Valves Mechanical Valves Valved Conduits Normal Doppler Findings ÿþP Antegrade Flow Patterns and Velocities Normal Regurgitation Technical Aspects of Echo Evaluation Integrated Approach PROSTHETIC VALVE STENOSIS Pressure Gradients Valve Areas PROSTHETIC VALVE REGURGITATION Detection Valvular Versus Paravalvular Severity LIMITATIONS AND ALTERNATE APPROACHES CLINICAL UTILITY Baseline Prosthetic Valve Function After Implantation Periodic Monitoring Prosthetic Valve Stenosis Patient- Prosthesis Mismatch Prosthetic Valve Regurgitation Prosthetic Valve Endocarditis Prosthetic Valve Thrombosis THE ECHO EXAM SUGGESTED READING 14. Endocarditis BASIC PRINCIPLES ECHOCARDIOGRAPHIC APPROACH Valvular Vegetations Transthoracic Echocardiography Transesophageal Imaging Diagnostic Accuracy Valve Dysfunction Paravalvular Abscess and Intracardiac Fistula Other Echocardiographic Findings LIMITATIONS AND TECHNICAL CONSIDERATIONS Active Versus Healed Vegetations Nonbacterial Thrombotic Endocarditis Diagnosis With Underlying Valve Disease Prosthetic Valves and Intracardiac Devices CLINICAL UTILITY Suspected Endocarditis Known Endocarditis Alternate Approaches THE ECHO EXAM SUGGESTED READING 15. Cardiac Masses and Potential Cardiac Source of Embolus BASIC PRINCIPLES VALVE VEGETATIONS CARDIAC TUMORS Nonprimary Primary Benign Primary Cardiac Tumors Malignant Primary Cardiac Tumors Technical Considerations and Alternate Approaches LEFT VENTRICULAR THROMBUS Predisposing Conditions Identification of Left Ventricular Thrombi Clinical Implications Alternate Approaches LEFT ATRIAL THROMBUS Predisposing Factors Identification of Left Atrial Thrombi Prognosis and Clinical Implications Alternate Approaches RIGHT HEART THROMBI CARDIAC SOURCE OF EMBOLUS Basic Principles Identifiable Cardiac Sources of Emboli Predisposing Conditions Indications for Echocardiography in Patients With Systemic Embolic Events THE ECHO EXAM SUGGESTED READING 16. Diseases of the Great Arteries BASIC PRINCIPLES ECHOCARDIOGRAPHIC APPROACH Transthoracic Approach Echocardiographic Imaging Doppler Flows Limitations Transesophageal Approach Echocardiographic Imaging Doppler Flows Limitations AORTIC DILATION AND ANEURYSM AORTIC DISSECTION Diagnosis Transthoracic Imaging Transesophageal Imaging Complications of Aortic Dissection Postoperative Evaluation After Surgery on the Ascending Aorta AORTIC INTRAMURAL HEMATOMA AORTIC PSEUDOANEURYSM TRAUMATIC AORTIC DISEASE SINUS OF VALSALVA ANEURYSM ATHEROSCLEROTIC AORTIC DISEASE Aortic Atherosclerosis as a Potential Source of Embolus Aortic Atherosclerosis as a Marker of Coronary Artery Disease PULMONARY ARTERY ABNORMALITIES ALTERNATE APPROACHES THE ECHO EXAM SUGGESTED READING 17. The Adult With Congenital Heart Disease BASIC PRINCIPLES Stenosis Regurgitation Shunts Cardiac Chamber and Great Vessel Identification CONGENITAL STENOTIC LESIONS Congenital Aortic Valve Stenosis Subaortic Stenosis Congenital Obstructions to Right Ventricular Outflow Location and Severity Pulmonary Artery Pressure Estimation CONGENITAL ABNORMALITIES OF THE AO RTA Aortic Coarctation Sinus of Valsalva Aneurysm CORONARY ARTERY ANOMALIES Coronary Arteriovenous Fistula Anomalous Origins of the Coronary Arteries CONGENITAL REGURGITANT LESIONS Ebstein Anomaly of the Tricuspid Valve Cleft Mitral Valve INTRACARDIAC SHUNTS Atrial Septal Defects Anatomy Transthoracic Imaging Contrast Echocardiography Transesophageal Imaging Ventricular Septal Defects Anatomy Imaging Doppler Findings Patent Ductus Arteriosus OTHER CONDITIONS Corrected Transposition of the Great Arteries ÿþ ̋ I PALLIATED ADULT CONGENITAL HEART DISEASE Classification of Types of Procedures Tetralogy of Fallot Complete Transposition of the Great Arteries Fontan Physiology ALTERNATE APPROACHES Measurement of RV Volumes and Ejection Fraction Calculations of Shunt Ratios Imaging Cardiac Anatomy Intracardiac Hemodynamics INTEGRATING THE DIAGNOSTIC APPROACH ACKNOWLEDGMENT THE ECHO EXAM SUGGESTED READING 18. Intraoperative and Interventional Echocardiography BASIC PRINCIPLES Indications Preoperative Diagnosis Hemodynamics Surgical Manipulation and Instrumentation Time Constraints ECHOCARDIOGRAPHIC APPROACH Views Sequence Reporting and Image Storage LIMITATIONS AND TECHNICAL CONSIDERATIONS Image Plane Orientation Doppler Interrogation Angle Technical Issues in the Operating Room and Interventional Suite Optimization of Instrument Settings CLINICAL UTILITY OF INTRAOPERATIVE TEE Monitoring Ventricular Function Valvular Heart Disease Mitral Valve Repair Valve Stenosis Endocarditis Prosthetic Valve Dysfunction Aortic Disease Aortic Dissection Aortic Atheroma Cardiomyopathies Hypertrophic Cardiomyopathy Ventricular Assist Devices Heart Transplantation Congenital Heart Disease CLINICAL UTILITY IN TRANSCATHETER PROCEDURES Atrial Septal Defect Closure Transcatheter Valve Implantation Mitral Transcatheter Edge- to- Edge Repair Other Transcatheter Interventions THE ECHO EXAM SUGGESTED READING Appendix A. Normal Values for Echocardiographic Measurements Appendix B. Evidence Tables The fourth edition is presents an accessible primer on this complex topic from Dr. Catherine Otto, one of the foremost teachers and writers in the field. You'll find straight forward explanations of the basics of ultrasound physics, image acquisition, and all the major techniques and major disease categories, as well as the latest on advanced echo techniques-such as contrast echo, 3D echo, and myocardial mechanics (strain rate imaging, speckle tracking, and synchrony). Each chapter-including a new one on intraoperative transesophageal echocardiography-features a practical outline called The Echo Exam, ideal for understanding the use of echo and its outcomes. State-of-the-art echo images are complemented by full-color comparative drawings of heart structures.