(BQ) Part 1 book Board stiff tee - Transesophageal echocardiography presents the following contents: The yellow brick road, principles of ultrasound, principles of ultrasound, principles of doppler ultrasound, quantitative doppler, doppler profiles and assessment of diastolic function, cardiac anatomy,...
Board Stiff TEE Content Strategist: William Schmitt Content Development Specialist: Rachael Harrison/Nani Clansey Content Coordinator: Lee Hood Project Manager: Sukanthi Sukumar Designer: Steven Stave Illustration Manager: Lesley Frazier Illustrator: Dartmouth Publishing Marketing Manager (UK/USA): Abby Swartz Board Stiff TEE Transesophageal Echocardiography Second Edition Christopher J Gallagher, MD Professor and Residency Director Stony Brook Department of Anesthesia Stony Brook University Stony Brook, NY, USA John C Sciarra, MD Assistant Professor Cardiovascular and Thoracic Anesthesiology Fellowship Program Director University of Miami Miami, FL, USA Steven Ginsberg, MD Associate Professor of Anesthesiology Program Director of Cardiothoracic Anesthesia Fellowship UMDNJ-Robert Wood Johnson Medical School New Brunswick, NJ, USA For additional online content visit www.expertconsult.com London, New York, Oxford, St Louis, Sydney, Toronto 2013 SAUNDERS an imprint of Elsevier Inc © 2013 Elsevier Inc All rights reserved First edition 2004 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein) Notices Knowledge and best practice in this field are constantly changing As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein ISBN: 978-1-4557-3805-2 ebook ISBN: 978-1-4557-3759-8 Printed in United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 Contents Preface to the First Edition vii Preface to the Second Edition ix List of Contributors xi Introduction: Neither Rain nor Snow xv CHAPTER The Yellow Brick Road CHAPTER CHAPTER CHAPTER CHAPTER CHAPTER 2 Christopher J Gallagher Principles of Ultrasound Christopher J Gallagher and John C Sciarra 3 Transducers and Instrumentation 4 Equipment, Infection Control, and Safety 19 5 Principles of Doppler Ultrasound 25 6 Christopher J Gallagher and John C Sciarra Steven Ginsberg and Jonathan Kraidin Jonathan Kraidin, Steven Ginsberg, William Jian and Kevin A Jian Quantitative M-mode and Two-dimensional Echocardiography 39 Varun Dixit, John C Sciarra and Christopher J Gallagher CHAPTER 7 Quantitative Doppler 47 Christopher J Gallagher, Christina Matadial and Jadelis Giquel CHAPTER CHAPTER 8 Doppler Profiles and Assessment of Diastolic Function 55 Christopher J Gallagher and John C Sciarra 9 Cardiac Anatomy 67 Christopher J Gallagher and John C Sciarra CHAPTER 10 Pericardium and Extra-Cardiac Structures: Anatomy and Pathology 77 Enrique Pantin and F Luke Aldo CHAPTER 11 Pathology of the Cardiac Valves 97 F Luke Aldo and Enrique Pantin CHAPTER 12 Intra-cardiac Masses and Devices 115 13 Left Ventricular Systolic Function 123 Al Solina, F Luke Aldo and Salvatore Zisa CHAPTER Eric W Nelson CHAPTER 14 Segmental Left Ventricular Systolic Function John C Sciarra and Christopher J Gallagher 131 vi Contents CHAPTER 15 The 17 Segment Model 139 John C Sciarra CHAPTER 16 Assessment of Perioperative Events and Problems Ricardo Martinez-Ruiz and Christopher J Gallagher CHAPTER 17 Congenital Heart Disease 163 Liliana Cohen and Daniel M Shindler CHAPTER 18 Artifacts and Pitfalls 173 Christopher J Gallagher and Gian Paparcuri CHAPTER 19 Related Diagnostic Modalities 191 Steven Gill, John C Sciarra and Christopher J Gallagher CHAPTER 20 Intraoperative 3-D Echocardiography Gian Paparcuri CHAPTER 21 The Structured TEE Examination John C Sciarra CHAPTER 22 Sonographic Formulas 209 John C Sciarra CHAPTER 23 Hemo-dynamo Doc 211 Christopher J Gallagher CHAPTER 24 Test Questions 249 William R Grubb and Andrew T Burr Epilogue: Smooth Sailing 273 Index 275 203 195 147 Preface to the First Edition If you are doing cardiac anesthesia, cardiac surgery, or intensive care work, and you don’t know Transesophageal Echocardiography, you are yesterday’s newspaper You are a repairman for 8-track cassette players You are selling slide rules You need to know TEE Board Stiff TEE is just the ticket I wrote this book to give you a complete introduction to the subject, from the physics of ultrasound to the images you need to recognize to the hemodynamic calculations you can make with TEE The whole nine yards Plus, I direct you to those places where you can deepen your understanding of TEE Board Stiff TEE is the perfect launch pad Board Stiff TEE is for the medical student, the anesthesiologist, the surgeon, the intensivist, who asks, “Just where I start?” The book details n Why you need to know TEE n Which books and meetings will help the most n Everything you need to know if you take the PTEeXAM n How to work through the quantitative aspects of TEE Board Stiff TEE is jam-packed with simplified drawings to illustrate all the points you need to know No need to decipher a small photograph of a TEE image; everything here is laid out with the student in mind Especially when you start out, it’s hard to tell what’s what in a photograph of a TEE image These drawings will lay it out for you Best of all, learning TEE does not have to be a replay of your root canal Board Stiff TEE has a dollop of humor here and there to keep your eyes open and your airway from obstructing Several people helped in this affair Alicia Borus gave expert secretarial help; my editor Natasha Andjelkovic reined in my more outlandish prose; Elsevier’s illustrators redid all the drawings, improving on my “magic marker in a Crayola pad” work; and J.C Duffy did the cover and the cartoons Through it all, my wife endured my manic ravings And final thanks to my daughter Rachel, who is a blast Christopher J Gallagher, MD This page intentionally left blank Preface to the Second Edition A long time ago in a galaxy far, far away…AND SO FORTH John C Sciarra, MD University of Miami 108 Board Stiff TEE (bottom arrow) All of this is typical of senile calcific aortic stenosis To the right, color Doppler demonstrates a mosaic flow pattern after the valve This is typical of turbulent flow, and flow speed above the flow scale limit aka the Nyquist limit In our next set of two images, aortic valve insufficiency is seen after placing the CFD interrogation box over the aortic valve In the image on the left, obtained during ventricular diastole, trace insufficiency is seen The image at the right demonstrates a large color pattern (we know there is no color in this book, but imagine it!) starting immediately from the subvalvular area and extending into the left ventricle occupying the entire CFD box Look closely and you will also notice that the anterior leaflet of the mitral valve has been pushed into the semi-closed position by the regurgitant jet We can see this more so on the right image in severe cases of AI Wider and longer color usually correlates with a more severe problem If the ventricular function is poor, systolic flow will be decreased as well Now that we are done with 2-D and CFD, it’s time to CWD across the valve The transgastric views are the best views to shoot a CWD across the aortic valve, as they allow parallel alignment of the Doppler beam with the valve The Deep Transgastric LAX view, obtained at ZERO degrees, is shown below with the Doppler cursor in ideal position across the aortic valve; RV = right ventricle, LV = left ventricle, LA = left atrium, and A = aorta Chapter 11 Pathology of the Cardiac Valves CWD cursor is seen across the LV, aortic valve, and proximal ascending aorta CWD systolic envelope with a peak velocity greater than 1.5 m/s is seen in stenosis Aortic stenosis can be classified depending on the degree of peak velocity by CWD as: Mild >1.5 m/s, but4 m/s These velocities correlate with aortic valve areas of: >1.5 cm² = Mild AS 1.5–1 cm² = Moderate AS 50% is indicative of mild stenosis; 50–25%, moderate, and 3 m/s² A pressure half-time of >500 ms = mild, 500–200 ms = moderate, and 50% An index