The Practice of Clinical Echocardiography, 6e (Aug 5, 2021)_(0323697283)_(Elsevier)

Cover The Practice of Clinical Echocardiography Copyright Section Editors Contributors Table of Contents Preface Acknowledgments Glossary 1 - 3D Echocardiographic Image Acquisition, Display, and Analysis Resolution in 3D Echocardiography Spatial Resolution Temporal Resolution Single-­Beat or Multibeat Acquisition Parallel Beamforming Interpolation of Images or Image Sectors Frame Reordering Virtual Array Multiline Transmission High Pulse Repetition Frequency Relationship Between Spatial and Temporal Resolution Multiview 3D Echocardiography Image Fusion 3D Echocardiography Data Acquisition 2D Image Optimization Simultaneous Multiplane Mode Pyramidal Size Zoom Narrow Sector Wide Sector Color-­Flow Doppler Temporal Versus Spatial Resolution ECG-­Gating and Breath-­Hold 3D Image Optimization Gain Brightness Smoothing Colorization Data Set Cropping Box Crop Plane Crop Quick Cropping Methods Post-­Acquisition Display Volume Rendering Surface Rendering 2D Tomographic Slices 3D Echocardiographic Analysis Multiplanar Reconstruction Modeling Color Doppler True 3D Visualization 3D Echocardiographic Acquisition and Analysis Protocols Acquisition Presentation Analysis Limitations Acquisition Presentation Analysis Limitations Acquisition Presentation Analysis Limitations Acquisition Presentation Analysis Limitations Acquisition Presentation Analysis Limitations Acquisition Presentation Analysis Limitations Acquisition Presentation Analysis Limitations References 2 - Principles of Myocardial Mechanics and Strain Imaging Velocity Imaging Deformation Imaging Limitations of Velocity and Strain Imaging Normal LV Physiology Myocardial Ischemia Cardiac Synchrony 3 - Contrast Echocardiography Investigational Agents Microbubble Ultrasound Signal Generation Contrast-­Specific Imaging Methods Resting Quantitation of LV Volumes and Ejection Fraction Resting LV Regional Wall Motion LV Opacification During Stress LV Opacification for Intracardiac Abnormalities Myocardial Perfusion Imaging Detection of Ischemia Myocardial Viability Other Perfusion Imaging Applications References 4 - Quantitative Analysis of Left Ventricular Anatomy and Systolic Function LV Wall Thickness and Mass LV Shape and Its Implications for Measurements LV Response to Pressure and Volume Overload Pressure Overload Volume Overload LV Mechanics Ejection Fraction Strain dP/dt Myocardial Work and Pressure-­Volume Loops Myocardial Segments Fractional Shortening Mitral Annulus Plane Systolic Excursion Tissue Doppler Imaging References 5 - Left Ventricular Diastolic Function Invasive Evaluation of LV Diastolic Function Basic Principles Mitral Inflow Parameters Mitral Inflow Patterns Pulmonary Venous Flow Parameters Color M-­Mode Echocardiography Tissue Doppler Echocardiography Echocardiographic Findings Supporting the Presence of Diastolic Dysfunction Left Atrial Dilation Pulmonary Hypertension Considerations about the Assessment of Diastolic Function in the Elderly Diastolic Stress Echocardiography Left Ventricular Strain Left Atrial Strain Echocardiographic Assessment of LV ­Filling Pressure Algorithms to Diagnose LV Diastolic Dysfunction and Estimate LV Filling Pressure by Echocardiography Atrial Fibrillation Hypertrophic Cardiomyopathy Constrictive Pericarditis Hemodynamic Validation Prognostic Validation Clinical Implications Limitations Future Perspectives References 6 - Right Ventricular Anatomy and Function RV External Anatomy RV Internal Anatomy Tricuspid Valve Right Atrium and Inferior Vena Cava Pulmonic Valve and Pulmonary Artery RV Blood Supply RV Physiology Basic Principles of Image ACQUISITION Qualitative Evaluation 2D Measurements of RV Size 3D Volumetric Measurements of RV Size Qualitative Evaluation Fractional Area Change Tricuspid Annular Plane Systolic Excursion The dP/dt Function for Assessing ­Myocardial Work Tissue Doppler Tricuspid Annular Systolic Velocity RV Index of Myocardial Performance 3D Volumetric Assessment of RV Function RV Strain and Strain Rate RV Diastolic Function TRANSESOPHAGEAL ECHOCARDIOGRAPHY Intracardiac Echocardiography Cardiac Magnetic Resonance Imaging Cardiac Computed Tomography Angiography Radionucleotide Angiography Disease States and Outcome Data Transcatheter Procedures Mechanical Support Devices Future Directions References 7 - Diagnostic Echocardiography ­Laboratory: Structure, Standards, and Quality Improvement Quality in Context Structure and Standards Laboratory Structure Laboratory Accreditation Laboratory Staff Physician Training Medical Director Medical Staff Technical Director Technical Staff Ancillary Personnel Facility Infection Control Time-­Out Moderate Sedation Radiation Safety Instrument Maintenance Instrument Inventory Quality Improvement Program Appropriate Use Criteria: A Brief History and Guideline Updates Appropriate Indications Rarely Appropriate Indications Appropriate Use In Practice Protocol Consistency Transthoracic Echocardiography Protocol Analysis and Interpretation Quality Echocardiography Core Laboratory Reporting Report Completeness and Consistency Report Timeliness Examination Status and Turnaround Times Summary References 8 - Comprehensive Diagnostic Transthoracic and Transesophageal Echocardiography Patient and Transducer Position Parasternal Long-­Axis View.For the left parasternal window, the patient is placed in a left lateral decubitus position with the...� RV Inflow View.The RV inflow view is obtained by tilting the transducer inferomedially from the PLAX and rotating it slightly cl... Parasternal Short-­Axis Views.The parasternal short-­axis (PSAX) views are obtained by rotating the transducer 90 degrees clockw...� Apical 4-­Chamber View.The apical window is obtained by placing the transducer at the point of maximal impulse, with the patient...� Apical 2-­Chamber and Long-­Axis Views.Rotating the transducer counterclockwise approximately 60 degrees from the apical 4-­cham...� Subcostal Window Suprasternal Notch Window M-­Mode Echocardiography Doppler Echocardiography Principles of Doppler Echocardiography Continuous-­Wave Doppler Echocardiography Pulsed-­Wave Doppler Echocardiography Application of Doppler Echocardiography: LV Outflow Tract Application of Doppler Echocardiography: Pulmonary Pressure Estimation Application of Doppler Echocardiography: Diastolic Function Color Doppler Flow Imaging Proposed Sequence of a Comprehensive TTE Study Indications For TEE Training and Personnel Patient Preparation and Sedation Esophageal Intubation Probe Manipulation and Standard Imaging Views Image Formatting and Display Left and Right Ventricles Atria and Left Atrial Appendage Aortic Valve and Aorta Mitral Valve Tricuspid and Pulmonic Valves 3-­Dimensional Echocardiography Atrial Fibrillation and Cardiac Source of Embolus Native and Prosthetic Valve Evaluation Infective Endocarditis Acute Aortic Syndromes Proposed Sequence of a Comprehensive TEE Study References 9 - Intraoperative Echocardiography Echocardiography Evaluation of Intraoperative Ventricular Function TEE Monitoring of Intraoperative Cardiac Function in Specific Clinical Entities Alternative Techniques Intraoperative TEE: Impact on Postoperative Outcomes and Cost-Effectiveness 10 - Interventional Echocardiography Echocardiographic Imaging Modes 2D TEE 3D TEE Intraprocedural TEE for Transcatheter Aortic Valve Replacement Intraprocedural TEE for PERCUTANEOUS Mitral Valve ­Edge-­To-­Edge Repair Mitral Valve and Regurgitant Jet Evaluation Transseptal Puncture Positioning of Steerable Guide Catheter and Clip Delivery System Advancement of Clip Device into LV and Mitral Leaflet Grasping Assessment of Postprocedural Results and Complications Intraprocedural TEE for Transcatheter Mitral Valve Replacement Evaluation of Mitral Valve Pathology Transseptal Puncture and Advancement of the Transcatheter Heart Valve Positioning and Deployment of the ­Transcatheter Heart Valve Assessment of Postprocedural Results and Complications Intentional Laceration of the Anterior Mitral Valve Leaflet to Prevent LV Outflow Tract Obstruction (Lampoon Procedure) Intraprocedural TEE for Percutaneous Paravalvular Leak Occlusion Para-­Aortic Defect Repair Para-­Mitral Defect Repair Intraprocedural TEE for Left Atrial Appendage Occlusion Periprocedural Multimodality Imaging Intraprocedural TEE Assessment Transseptal Puncture and Advancement of the Left Atrial Appendage Access Sheath Device Deployment and Release Challenges and Hazards Future Directions References 11 - Focused Cardiac Ultrasound at the Bedside Focused Cardiac Ultrasound at the Bedside Echocardiography as an Adjunct to the Physical Examination Diagnostic Targets of FoCUS LV Size and Function RV Size and Function Pericardial Effusion Intravascular Volume Status Limitations of FoCUS Basic Approach to the FoCUS Examination Positioning Standard Views Parasternal Long-­Axis View Parasternal Short-­Axis View at the Mid-­Ventricle Apical 4-­Chamber View Subcostal 4-­Chamber View Subcostal Inferior Vena Cava View Documentation Emergency Diagnoses Undifferentiated Hypotension and Shock Penetrating Chest Trauma Massive Pulmonary Embolus Cardiac Tamponade Cardiac Arrest Patient Outcomes Training and Certification Current Training Practices Training Recommendations 1. Structured Training Should Include Didactic and Hands-­On Learning 2. Training Should Address Image Acquisition, Quality Assessment, and Image Interpretation 3. Ongoing Practice Is Required for Skills Retention Certification, Credentialing, and Competency Quality Assurance References 12 - Dilated Cardiomyopathy Familial Screening Appropriateness Criteria for Echocardiography LV Systolic Function LV Systolic Function and Prognosis LV Size and Shape Tissue Doppler Imaging Strain Imaging LV Torsion LV Diastolic Function Secondary Mitral Regurgitation LV Contractile Reserve Right-­Sided Involvement Myocarditis Chagas Heart Disease LV Noncompaction Stress-­Induced Cardiomyopathy Cardiac Resynchronization Therapy Echocardiography and Cardiac Resynchronization Therapy Intraventricular Dyssynchrony Septal Flash and Apical Rocking Speckle-Tracking Imaging Interventricular Delay Changes in Diastolic Function with Cardiac Resynchronization Therapy Response to Cardiac Resynchronization Therapy Management of Nonresponders Targeted LV Lead Placement Heart Failure Risk Scores References 13 - Hypertrophic Cardiomyopathy Diagnosis Differential Diagnosis Pressure Overload Conditions Genetic Phenocopies and Infiltrative Conditions Athlete’s Heart Severity, Distribution, and Patterns of Hypertrophy Echocardiographic Assessment of Hypertrophy Hypercontractility, Cavity Size, and Adverse Remodeling Mitral Valve Abnormalities Dynamic LV Outflow Tract Obstruction Systolic Anterior Motion of the Mitral Leaflets Loading Conditions and Provocative Maneuvers Doppler Assessment of Obstruction Pitfalls of Doppler Evaluation Myocardial Deformation and Strain Factors Contributing to Impaired Diastolic Function Echocardiographic Assessment of Diastolic Function Assessment of Hypertrophic Cardiomyopathy Subtypes Apical Variant Hypertrophic Cardiomyopathy Mid-­Ventricular Obstruction Thin-­Filament Hypertrophic Cardiomyopathy Nonfamilial Hypertrophic Cardiomyopathy Management of LV Outflow Tract Obstruction Septal Reduction Therapies Surgical Myectomy Alcohol Septal Ablation Clinical Results After Septal Reduction Echocardiography in the Risk Stratification for Sudden Death Family Screening and Preclinical Hypertrophic Cardiomyopathy References 14 - Restrictive Cardiomyopathy Introduction to Imaging in Restrictive Cardiomyopathy 2D Echocardiographic and Doppler Features M-­Mode Imaging 2D Imaging Spectral Doppler Imaging Findings Mitral Inflow Pulsed-­Wave Doppler Imaging Pulmonary Vein Pulsed-­Wave Doppler Imaging Tissue Doppler Imaging of the Mitral Annulus Color M-­Mode Tissue Doppler Imaging and Longitudinal Strain Limitations and Pitfalls of Pulsed-­Wave Doppler and Color M-­Mode 2D Speckle Tracking Strain Imaging Other Imaging Modalities Specific Restrictive Cardiomyopathies Amyloidosis Definition Clinical Features Echocardiography Echo-­Doppler Imaging Magnetic Resonance Imaging Nuclear Imaging Treatment Idiopathic Restrictive Cardiomyopathy Hypereosinophilic Syndrome and Endomyocardial Fibrosis Hemochromatosis Sarcoidosis Glycogen Storage Disorder: Pompe Disease Fabry Disease Drug-­Induced Restrictive Cardiomyopathy Postradiation Cardiomyopathy Other Causes of Restrictive Cardiomyopathy Differentiating Between Restrictive Cardiomyopathy and Constrictive Pericarditis References 15 - Cardiac Transplantation Post-­Transplantation Evaluation Surgical Considerations in Echocardiographic Imaging and Interpretation Perioperative Post-­Transplantation Period Acute Post-­Transplantation Period Primary Graft Dysfunction Acute Rejection RV Failure Pericardial Effusions and Tamponade Infections Complications After Endomyocardial Biopsy Subacute Post-­Transplantation Period Chronic Post-­Transplantation Period Chronic Graft Failure Chronic Rejection Cardiac Masses Challenges to Diagnosing Complications by Echocardiography Prognostic Significance of Echocardiography After Transplantation Future Directions Conclusions References 16 - Cardiac Assist Devices Percutaneous Mechanical Circulatory Support Devices Total Artificial Heart Preimplantation Assessment Periprocedural Guidance Postimplantation Surveillance and Complications Overfilling Underfilling Valvular Dysfunction Effects of Speed Changes Pump Thrombosis Ventricular Recovery Percutaneous Mechanical Circulatory Support Device Position Technical Details, Quantitation, and Data Analysis LV End-­Diastolic Diameter and Septal Orientation Ventricular Function Aortic Valve Opening Pericardial Pathology Cannulas Optimization Studies Ramp Studies Turndown Studies for Ventricular Recovery Clinical Utility and Outcome Data Potential Limitations and Future Directions Alternative Approaches References 17 - Pericardial Disease Pericardial Pressure and Normal Respiratory Effects on Hemodynamics Pathophysiologic Principles in Compressive Pericardial Disease Echocardiographic Evaluation of Pericardial Disease Definition and Etiology Pathology and Pathophysiology Clinical Presentation and Treatment Echocardiographic Diagnosis Abnormal Ventricular Septal Motion: Ventricular Septal Shift and Shudder Ventricular Septal Shift Ventricular Septal Shudder Respiratory Variation in the Hepatic Vein Doppler Profile: Prominent Diastolic Flow Reversals in Expiration Preserved or Elevated e′ Values Annulus Reversus Annulus Paradoxus Respiratory Variation in Mitral Inflow Velocity Other 2D and M-­Mode Findings Other Doppler Findings Strain Imaging Differentiation From Restrictive Cardiomyopathy Effusive-­Constrictive Pericarditis and Transient Constrictive Pericarditis Multimodality Imaging of Constrictive Pericarditis Pericardial Effusion Echocardiographic Diagnosis Definition and Etiology Pathophysiology Echocardiographic Diagnosis Characterization of the Pericardial Effusion Cardiac Chamber Collapse RA Compression, Inversion, or Collapse RV Compression, Inversion, or Collapse Left Heart Chamber Collapse Plethora of the Inferior Vena Cava Respiratory Variation in Right and Left Heart Filling Combining Chamber Collapse With Abnormal Hepatic Venous Flow: Test Performance Characteristics Regional Tamponade Echocardiographically Guided Pericardiocentesis Contraindications Procedural Steps Acute Pericarditis Congenital Absence of the Pericardium Pericardial Cysts References 18 - Cardiac Tumors and Cardio-­oncology Doppler Methods for Detection of Cardiotoxicity Speckle Tracking Characteristics of Cardiac Mechanics in Cardio-­Oncology Chemotherapeutic Impact on the RV Considerations in Radiation-­Induced Heart Disease Cardiac Masses and Tumors Benign Tumors Other Benign Cardiac Tumors: Lipomas and Lipomatous Hypertrophy Echocardiography and Cardiac Tumors Alternative Imaging Modalities Tumor Types, Physiology, and Treatment Considerations Primary Cardiac Malignant Tumors Secondary (Metastatic) Cardiac Malignant Tumors Differential Diagnosis Prognosis Treatment References 19 - Stress Echocardiography for Detecting Coronary Ischemia The Ischemic Cascade Indications and Contraindications for Stress Echocardiography Indications Exercise Stress Echocardiography for Preoperative Risk Assessment in Noncardiac Surgery Contraindications Cost-­Effectiveness of Exercise Stress Echocardiography General Considerations Equipment and Personnel Patient Preparation Exercise Stress Testing Exercise Stress Protocols Treadmill Protocols Bicycle Protocols Handgrip Effects of Medical Therapy Symptoms, Angina, and Perceived Effort Heart Rate Heart Rate Recovery Blood Pressure Functional Capacity Electrocardiographic Changes Echocardiographic Imaging Duke Treadmill Score Other Important Stress Echocardiographic Outcomes Termination of Stress Echocardiography Reporting of Stress Echocardiography Findings Accuracy of Exercise Stress Echocardiography Sensitivity, Specificity, And Prognostic Value of Stress Echocardiography Strain Echocardiography 3D Echocardiography Myocardial Contrast Perfusion Stress Echocardiography References 20 -Nonexercise Stress Echocardiography for Diagnosis of Coronary Disease Dobutamine and Atropine Stress Echocardiography Dipyridamole, Adenosine, And Regadenoson Stress Echocardiography Ergonovine Stress Echocardiography Pacing Stress Echocardiography Assessment of Myocardial Viability Nonexercise Stress Echocardiography in Specific Clinical Scenarios Use of Contrast During Nonexercise Stress Echocardiography Emerging Techniques in Stress Echocardiography Three-­Dimensional Stress Echocardiography Two-Dimensional Tissue Doppler and Speckle Tracking Strain Echocardiography Coronary Flow Velocity Reserve Myocardial Contrast Perfusion and Myocardial Contrast Blood Flow Reserve Nonexercise Stress Echocardiography: Role in Current Clinical Practice Future Directions References 21 - Role of Echocardiography in Patients With Acute Coronary Syndrome Localization of Infarction Detecting Complications of Acute Myocardial Infarction Papillary Muscle Rupture Ventricular Septal Rupture Rupture of the Ventricular Free Wall Postinfarction Pericardial Effusion Pseudoaneurysm Infarct Expansion and True Aneurysm Formation LV Thrombus LV Systolic Function Regional Wall Motion Score LV Diastolic Function LA Volume and Function LV Remodeling Stress Echocardiography Mitral Regurgitation References 22 - Aortic Stenosis (Including Evaluation for Transcatheter Aortic Valve Replacement) Hemodynamic Severity Aortic Velocity And Mean Pressure Gradient Continuity Equation Aortic Valve Area LV Outflow Tract Velocity LV Outflow Tract Diameter Stroke Volume Index Velocity Ratio Tee Planimetry Valve Area Measurement Variability And Errors Effect of Transaortic Flow Adjustment For Body Size Concurrent Hypertension Anatomic Versus Effective Aortic Valve Area And Pressure Recovery Discordance Between Measures Of Aortic Stenosis Severity Lv Remodeling Diastolic Function Ejection Fraction Stroke Volume Index Longitudinal Function Associated Findings Aortic Regurgitation Concomitant Subvalvular Obstruction Mitral Annular Calcification And Mitral Regurgitation Amyloidosis Coronary Artery Disease Pulmonary Hypertension Exercise Stress Testing Aortic Valve Area Planimetry Fusion Approach Calcium Scoring Preparation for Transcatheter Aortic Valve Implantation Cardiac Magnetic Resonance Imaging Cardiac Catheterization Gradients Aortic Valve Area Clinical Approach Timing of Aortic Valve Replacement Progression of Aortic Stenosis (Stage B) Asymptomatic Patients (Stage C) Symptomatic Patients (Stage D1) Low-­Flow, Low-­Gradient Severe Aortic Stenosis With Reduced Ejection Fraction (Stage D2) Low-­Flow, Low-­Gradient Severe Aortic Stenosis With Preserved Ejection Fraction (Stage D3) Patients Undergoing Cardiac Surgery For Other Indications Type of Valve Replacement Risk Assessment Associated Findings Valve Anatomy References 23 - Aortic Regurgitation Aortic Root Abnormalities Color Doppler Echocardiography Semiquantitative Methods Quantitative Methods Pulsed-­Wave Doppler Continuous-­Wave Doppler Integrating Doppler Indexes of Severity TEE 3D Echocardiography Magnetic Resonance Imaging LV Dimensions and Contractile Function Contractile Reserve Evaluation Aortic Root and Ascending Aorta Evaluation Aortic Valve and Root Function Natural History and Serial Testing in Chronic Aortic Regurgitation Medical Treatment Indications for Surgery Symptomatic Patients With LV Dysfunction Symptomatic Patients With Normal LV Systolic Function Asymptomatic Patients With Reduced Ejection Fraction Asymptomatic Patients With Normal Ejection Fraction Concomitant Aortic Root Disease Selecting and Guiding Surgical Treatment Role of Echocardiography Surgical Implications Results of Surgery and Follow-­Up Acute Aortic Regurgitation Acute Type a Aortic Dissection Infective Endocarditis References 24 - Mitral Regurgitation: Valve Anatomy, Regurgitant Severity, and Timing of Intervention Compensatory Leaflet Growth Chordae Tendineae and Papillary Muscles Mechanisms of Mitral Regurgitation Primary Mitral Regurgitation Secondary Mitral Regurgitation Atrial Functional Mitral Regurgitation Carpentier Classification Quantification of Mitral Regurgitation Distal Jet Area Method Vena Contracta Width Method Proximal Isovelocity Surface Area Method Geometric Factors Influencing the PISA Method Technical Factors EROA in Primary and Secondary Mitral Regurgitation 3D-­Guided Vena Contracta Area Pulmonary Venous Inflow Pattern: Systolic Flow Reversal Peak E-­Wave Velocity CW Doppler Pattern Volumetric Methods Using Pulsed-­Wave Doppler Valve Morphology and Left-­Sided Chamber Size Holosystolic Versus Non-­Holosystolic Jets Hemodynamic and Physiologic Factors Grading Mitral Regurgitation With an Integrative Method Pathophysiology Timing of Intervention Therapy for Primary Mitral Regurgitation Therapy for Secondary Mitral Regurgitation References 25 - Transesophageal Echocardiography for Surgical Repair of Mitral Regurgitation Essential Anatomy Mitral Valve Disease Degenerative (Myxomatous) Disease Infective Endocarditis Rheumatic Disease Radiation Necrosis Dystrophic Calcification Papillary Muscle Rupture Secondary REGURGITATION Standard Multiplane Imaging Principles of Axial Imaging 3d Imaging Pre-­Repair Tee Degenerative Disease Endocarditis Rheumatic Disease Papillary Muscle Rupture Secondary REGURGITATION Disease Combinations Surgical Techniques of Image-­Guided Mitral Repair Degenerative Disease Endocarditis Rheumatic Disease Papillary Muscle Rupture Secondary REGURGITATION Post-­Repair Tee Leaflet Structure And Function Residual Mitral Regurgitation New Mitral Stenosis Ventricular Dysfunction Systolic Anterior Motion References 26 - Transcatheter Mitral Valve Repair Edge-­To-­Edge Mitral Valve Repair Use of Echocardiography In Patient Selection Determining the Cause of Mitral Regurgitation Primary Mitral Regurgitation SECONDARY Mitral Regurgitation Mixed Mitral Regurgitation Determining Mitral Regurgitation Severity Moderate To Severe Mitral Regurgitation Severe Mitral Regurgitation Echocardiographic Parameters to Determine Suitability for MITRAL TRANSCATHETER EDGE-TO-EDGE (TEER) Repair Procedural Guidance Transseptal Puncture Device Navigation in The La Guiding Catheter and Clip Delivery System Steering Device Alignment to Mitral Valve Device Advancement into Lv Leaflets Grasping Device Release and Determination of Residual Mitral Regurgitation Consideration for Additional Clips Retrieval of Delivery Catheters Atrial Septal Defect Check Evaluation of Possible Complications Evaluation of Outcomes Alternative Imaging Techniques Recent Advances and Future Directions References 27 - Mitral Stenosis Evaluation of the Severity Assessment of Hemodynamic Consequences Assessment of Consequences on the La Assessment of Valve Anatomy Mitral Regurgitation Associated Lesions Thromboembolic Complications Use of the Different Echocardiographic Techniques Technique, Quantitation, and Data Analysis Valve Function Valve Anatomy Exercise Echocardiography During Balloon Mitral Commissurotomy Early After Balloon Mitral Commissurotomy During Follow-­Up after Balloon Mitral Commissurotomy Assessment of Degenerative Mitral Stenosis Clinical Utility Results of Balloon Mitral Commissurotomy Failure and Complications Immediate Results Late Results Restenosis After Previous Commissurotomy The Elderly Young Patients Pregnant Women Contraindications Choice of Procedure Timing of the Procedure Transcatheter Mitral Valve Replacement for Degenerative Calcific Mitral Stenosis Stress Echocardiography Evaluation of Atrioventricular Compliance Evaluation of Valve Anatomy Potential Limitations and Future Directions Alternative Approaches References 28 - Right-­Sided Valve Disease in Adults Basic Echocardiographic Imaging Principles Assessing the Mechanism and Severity of Tricuspid Regurgitation Quantification of Regurgitant Severity TEE Role of Echocardiography in Clinical Care Tricuspid Stenosis Pulmonary Valve Anatomy Pulmonary Valve Stenosis Quantification of Pulmonary Stenosis Severity Role of Echocardiography in Clinical Care Pulmonary Regurgitation Echocardiographic Evaluation of Pulmonary Regurgitation Role of Echocardiography in Clinical Care References 29 - Endocarditis Technical Details, Quantitation, and Data Analysis Utility in Diagnosis General Considerations Evaluation of the Patient With Bacteremia Evaluation of the Patient With Prosthetic Valves Evaluation of Patients With Cardiac Implantable Electronic Devices Utility in Management Utility in Follow-­Up Research Applications Potential Limitations and Future Directions Alternative Approaches References 30 -Fluid Dynamics of Prosthetic Valves Mechanical Energy Bernoulli’s Equation Control Volume Energy Analysis Mechanisms of Mechanical Energy Loss Viscous Losses Turbulent Losses Valvular Regurgitation Mechanical Energy Conversion and Loss in a Stenosis Pressure Drop Doppler Gradient Effective Orifice Area Regurgitant Volume Mechanical Energy Losses Novel Energy Loss Parameters In Vivo Evaluation of Prosthetic Valves Hemodynamics of Native Valves Hemodynamics of Specific Prosthetic Valve Designs Mechanical Valves Bioprosthetic Valves Transcatheter Valves Antegrade Flow Normal Regurgitant Flow Thrombosis Future Directions References 31 - Echocardiographic Recognition and Quantitation of Prosthetic Valve Dysfunction Structural Valve Deterioration Doppler Echocardiographic Evaluation of Prosthetic Valve Function Timing of Echocardiographic Follow-­Up Clinical Data Recognition and Quantitation of Prosthetic Valve Stenosis Leaflet Morphology and Mobility Quantitative Parameters Transprosthetic Velocity and Gradient Transprosthetic Jet Contour and Flow Ejection Dynamics Effective Orifice Area Doppler Velocity Index Recognition and Quantitation of Prosthetic Valve Regurgitation Prosthetic Aortic Valve Regurgitation Imaging Considerations Parameters of the Severity of Prosthetic Aortic Valve Regurgitation Color Doppler Parameters Spectral Doppler Parameters Quantitative Parameters Integrative, Multiparametric Approach to the Evaluation of Prosthetic Aortic Valve Regurgitation Prosthetic Mitral Valve Regurgitation Imaging Considerations Parameters of the Severity of Prosthetic Mitral Valve Regurgitation Indirect Signs and Consequences of Prosthetic Valve Regurgitation Prosthetic Tricuspid Valves Prosthetic Pulmonary Valves Interpretation of High Transprosthetic Gradients Prosthetic Aortic Valves Prosthetic Mitral Valves Low-­Flow States Prosthetic Valve Thrombosis Prosthetic Valve Endocarditis Conclusions References 32 - Acute Aortic Syndromes Complications Clinical Presentation and Diagnostic Approach Echocardiographic Views of the Aorta Acute Aortic Dissection Aortic Intramural Hematoma Penetrating Aortic Ulcer Traumatic Aortic Injury Diagnosis of Complications by Echocardiography Aortic Regurgitation Coronary Artery Dissection Pericardial Effusion Distal Vessel Involvement Echocardiographic Procedural Guidance Imaging Follow-­Up After an Acute Aortic Syndrome References 33 - Inherited Connective Tissue Disorders Other Fibrillinopathies Loeys-­Dietz Syndrome Ehlers-­Danlos Syndrome Familial Thoracic Aortic Aneurysm And Dissection Bicuspid Aortic Valve Turner Syndrome Histopathology Normal Aortic Measurements Aortic Dilation Aortic Dissection Aortic Arch and Descending Thoracic Aortic Complications Mitral Valve Prolapse Lv Function Diastolic Function Systolic Function Pulmonary Artery Natural History Pharmacologic Approaches Surgical Approaches Methods Of Assessment Limitations of Assessment Alternative Diagnostic Approaches References 34 - Hypertensive Heart Disease and ­Nutritional and Metabolic Disorders Clinical Interventions Background Technical Considerations Structural Changes Diastolic Function Systolic Function Epicardial Fat Clinical Interventions Background Echocardiographic Findings Clinical Interventions Background Echocardiographic Findings Clinical Interventions Endocrinopathies Hyperthyroidism Hypothyroidism Acromegaly Growth Hormone Deficiency Cushing Syndrome Hyperparathyroidism Pheochromocytoma Liver Diseases Cirrhotic Cardiomyopathy Liver Transplantation Alcohol Nonalcoholic Fatty Liver Disease References 35 - The Athletic Heart on Echocardiography Structure Systolic Function Diastolic Function Structure Function Atria Aorta Electrical Remodeling Detraining Effects Screening Echocardiography in Athletes Technical Considerations and Physiologic Differences Acute Effects of Exercise Alternative Imaging Modalities Common Clinical Dilemmas Valve Disease in Athletes Endurance Athlete or Dilated Cardiomyopathy Strength-­Trained Athlete or Hypertrophic Cardiomyopathy Endurance Athlete or Rv Cardiomyopathy Can This Athlete Continue To Compete Safely References 36 - Pulmonary Hypertension Clinical Classification of Pulmonary