Preface xvii
Acknowledgments xix
Chapter 1 the Physics of Ultrasound 3
Basic Physics 3
Cycles and Wavelengths 3
Frequency 5
Speed of Sound 5
Acoustic Impedance 6
Reflection, Refraction, and Scattering 7
Attenuation 8
Tissue Harmonic Imaging 9
Transducers and Resolution 9
Pulse Repetition Frequency 9
Sound Beams 11
Axial Resolution 12
Lateral Resolution 12
Temporal Resolution 14
Doppler Physics 14
The Doppler Shift 15
The Doppler Tracing 15
Pulsed-Wave Doppler 16
Continuous-Wave Doppler 17
The Doppler Equation 18
Angle of Interrogation 19
Effect of Transducer Frequency 20
Effect of Sampling (Gate) Depth 21
Blood Flow 22
Color-Flow Doppler 23
Tissue Doppler Imaging 26
Artifacts 29
Patient Movement and Breathing Artifacts 30
Side Lobe Artifact 30
Reverberation Artifact/Mirror Image Artifact 31
Summary 33
Recommended Reading 35
Chapter 2 the Two-dimensional Echocardiographic Exam 37
Introduction 37
Patient Preparation 37
Patient Positioning 37
Small Animal Positioning 37
Large Animal Positioning 39
Transducer Selection 40
Two-dimensional Images 40
Introduction 40
Right Parasternal Long-Axis Images 46
Left Ventricular Outflow View (Inflowâ"Outflow View) 46
The Image 46
Scanning Technique: Small Animal 49
Scanning Technique: Horse 54
Four-Chamber View 58
The Image 58
Scanning Technique: Small Animal 58
Scanning Technique: Equine 58
Right Parasternal Short-Axis Images 58
Introduction 58
Left Ventricle with Papillary Muscles and Chordae Tendinae View 63
The Image 63
Scanning Technique: Small Animal 65
Scanning Technique: Equine 66
Mitral Valve View 66
The Image 66
Scanning Technique: Small Animal 66
Scanning Technique: Equine 67
Heart Base: Aorta and Left Atrium View 67
The Image 67
Scanning Technique: Small Animal 69
Scanning Technique: Equine 69
Heart Base: Pulmonary Artery View 69
The Image 69
Scanning Technique: Small Animal 69
Scanning Technique: Equine 71
Left Ventricle with Pulmonary Artery View 71
The Image 71
Scanning Technique: Small Animal 71
Left Parasternal Apical Images 72
Introduction 72
Apical Five-Chamber View 72
The Image 72
Scanning Technique: Small Animal 75
Scanning Technique: Equine 75
Apical Four-Chamber View 75
The Image 75
Scanning Technique: Small Animal 75
Left Parasternal Cranial Long-Axis Images 80
Introduction 80
Left Cranial Left Ventricular Outflow View 80
The Image 80
Scanning Technique: Small Animal 80
Left Cranial Right Atrium and Auricle View 80
The Image 80
Scanning Technique: Small Animal 81
Left Cranial Right Ventricular Outflow View 82
The Image 82
Scanning Technique: Small Animal 83
Left Cranial Four-Chamber View: Equine 85
The Image 85
Scanning Technique: Equine 86
Left Cranial Five-Chamber View (Large Animal) 87
The Image 87
Scanning Technique: Equine 87
Left Parasternal Short-Axis Images 87
Introduction 87
Left Cranial Transverse Heart Base View 87
The Image 87
Scanning Technique: Small Animal 89
Scanning Technique: Equine 90
Left Cranial Left Auricle View: Small Animal 90
The Image 90
Scanning Technique: Small Animal 90
Left Cranial Transverse Left Ventricle View: Equine 91
The Image 91
Scanning Technique: Equine 92
Subcostal Image 92
Subcostal Five-Chamber View: Small Animal 92
The Image 92
Scanning Technique: Small Animal 92
Two-dimensional Imaging Controls 93
Introduction 93
Depth 93
Gain 93
Time Gain Compensation 93
Compress/Dynamic Range 96
Persistence/Frame Averaging 96
Sector Width 96
Focus 97
Harmonics 97
Gray Map 98
References 98
Chapter 3 the M-mode and Doppler Examination 101
Introduction 101
M-mode Echocardiography 101
Introduction 101
Controls 101
Cursor 105
Sweep Speed 105
M-Mode Images and Technique 105
Left Ventricle 105
Mitral Valve 108
Aortic Root 110
Mitral Annular Motion 112
Color-flow Doppler 112
Introduction 112
Controls 112
Gain 113
Color Sector Width and Height 113
Color Map 113
Threshold or Tissue Priority 114
Color-Flow Processing 114
Baseline 115
Persistence or Frame Averaging 115
Normal Color-Flow Images 116
Introduction 116
Mitral Valve and Tricuspid Valve Flow 118
Aortic Flow 118
Pulmonary Artery Flow 118
Spectral Doppler 118
Introduction 118
Controls 120
Cursor 120
Gate 120
Gate Size 120
Angle Correction 120
Baseline 120
Scale 124
Doppler Gain 124
Wall Filters 128
Sweep Speed 128
Normal Doppler Flow Profiles and Technique 128
Introduction 128
Aortic Flow 130
Imaging Plane Used 130
Flow Appearance 132
Left Ventricular Outflow Tract Flow 132
Imaging Plane Used 132
Flow Appearance 132
Pulmonary Artery Flow 132
Imaging Plane Used 132
Flow Appearance 135
Right Ventricular Outflow Tract Flow 135
Imaging Plane Used 135
Flow Appearance 135
Transmitral Flow 135
Imaging Plane Used 135
Flow Appearance 138
Trans Tricuspid Flow 139
Imaging Plane Used 139
Flow Appearance 142
Pulmonary Vein Flow 142
Imaging Plane Used 142
Flow Appearance 144
Isovolumic Relaxation Time 144
Imaging Plane Used 144
Flow Appearance 144
Left Auricular Flow 145
Imaging Plane Used 145
Flow Appearance 145
Tissue Doppler Imaging 146
Introduction 146
Imaging Plane Used 148
Spectral Appearance 149
References 149
Chapter 4 Evaluation of Size, Function, and Hemodynamics 153
Measurement and Assessment of Two-dimensional Images 153
Subjective Impression of Size 153
Right Parasternal Long-Axis Left Ventricular Outflow View 153
Right Parasternal Long-Axis Four-Chamber View 158
Right Parasternal Transverse Left Ventricle 159
Right Parasternal Transverse Heart Base 160
Quantitative Measurement of Size 162
Left Ventricular Chamber, Wall, and Septum 163
Left Ventricular Mass 164
Aorta and Left Atrium 168
Right Ventricular Chamber 170
Evaluation of Quantitative Measurements 171
Dogs 171
Cats 171
Horses 172
Measurement and Assessment of M-mode Images 172
Measurement Guidelines for M-Mode Images 172
Left Ventricle 173
Measurement 173
Measuring Pitfalls 177
Assessment 181
Mitral Valve 182
Measurement 182
Assessment 182
Left Atrium and Aorta 183
Measurement 183
Assessment 184
Ratio Indices 185
Measurement and Assessment of Spectral Doppler Flow 186
Measurement 186
Peak and Mean Velocity 186
Flow Velocity Integral 186
Systolic Time Intervals 186
Diastolic Time Intervals 187
Evaluation 187
Aortic Flow 188
Pulmonary Artery Flow 188
Systolic Time Intervals 190
Mitral Valve Flow 190
Tricuspid Valve Flow 192
Pulmonary Vein Flow 192
Left Auricle Flow 193
Measurement and Assessment of Tissue Doppler Imaging 193
Measurement 193
Assessment 193
Evaluation of Color-flow Doppler 196
Normal Regurgitant Flows 196
Evaluation of Ventricular Function 198
Systolic Function 198
Left Ventricular Function 198
Right Ventricular Function 201
M-mode Evaluation of Systolic Function 201
Fractional Shorteningâ"Left Ventricle 201
Volume, Ejection Fraction, and Cardiac Output 202
Left Ventricle 202
Right Ventricle 204
Systolic Time Intervals 204
Mitral and Tricuspid Annular Motion 205
Two-Dimensional Measurement of Systolic Function 206
Volume, Ejection Fraction, and Cardiac Output 206
Spectral Doppler Evaluation of Systolic Function 210
Volumetric Flow 210
Systolic Time Intervals 213
Myocardial Performance Index 213
Tissue Doppler Evaluation of Systolic Function 216
Left Ventricle 216
Right Ventricle 217
Evaluation of Diastolic Function 217
Impaired Relaxation 219
Decreased Compliance 220
Elevated Left Atrial Pressure 220
Pseudonormalization 223
Grading of Diastolic Function 224
Hemodynamic Information Obtained From Echocardiographic Exams 225
Doppler Hemodynamic Information 225
Pressure Gradients 226
Systolic Left Ventricular and Systemic Pressures 229
Systolic Right Ventricular and Pulmonary Pressures 230
Diastolic Systemic Pressure 231
Diastolic Pulmonary Pressure 232
Regurgitant Fraction 232
Shunt Ratios 234
Pressure Half-Time 234
Aortic Regurgitation 234
Mitral and Tricuspid Stenosis 236
M-Mode Hemodynamic Information 236
Aortic Valve Motion 236
Mitral Valve Motion 237
Left Ventricular Wall 239
Interventricular Septum 239
References 247
Exercises 256
Chapter 5 Acquired Valvular Disease 267
Mitral Regurgitation 267
Two-Dimensional and M-mode Evaluation 269
Valvular Appearance and Motion 269
Degenerative Lesions 269
Ruptured Chordae Tendineae 271
Mitral Valve Prolapse 274
Left Ventricular Size 276
Left Ventricular Function 281
Color-Flow Doppler Evaluation 284
Jet Size 284
Proximal Isovelocity Surface Area 290
Vena Contracta 293
Spectral Doppler Evaluation 294
Jet Area 294
Regurgitant Volume and Fraction 294
Transmitral Valve Flow 295
Regurgitant Jet Appearance 296
Pulmonary Vein Flow 297
Presence of Pulmonary Hypertension 298
Acute Mitral Regurgitation 302
Diastolic Mitral Insufficiency 302
Overall Assessment of Mitral Regurgitation 302
Aortic Regurgitation 303
Two-Dimensional and M-Mode Evaluation 303
Valve Appearance and Motion 303
Left Ventricular Size and Function 308
Color-Flow Doppler Evaluation 309
Jet Size 309
Vena Contracta 312
Proximal Isovelocity Surface Area 313
Spectral Doppler 314
Pressure Half-Time and Slope 314
Regurgitant Volume and Fraction 316
Diastolic Flow Reversal 317
Regurgitant Jet Appearance 317
Overall Assessment of Aortic Regurgitation 318
Tricuspid Regurgitation 319
Two-Dimensional and M-mode Evaluation 319
Color-Flow Doppler Imaging 322
Spectral Doppler Imaging 322
Overall Assessment of Tricuspid Regurgitation 322
Pulmonary Regurgitation 324
Two-Dimensional Evaluation 324
Color-Flow Doppler Imaging 324
Spectral Doppler Imaging 325
Overall Assessment of Pulmonary Regurgitation 325
Endocarditis 325
References 327
Chapter 6 Hypertensive Heart Disease 335
Pulmonary Hypertension 335
Two-Dimensional and M-mode Findings 335
Doppler Evaluation 343
Tissue Doppler 349
Heartworms 350
Systemic Hypertension 351
Two-Dimensional and M-mode Features 351
Spectral Doppler 354
Tissue Doppler Imaging 355
References 356
Chapter 7 Myocardial Diseases 359
Hypertrophic Cardiomyopathy 359
Two-Dimensional and M-mode Evaluation 359
Left Ventricular Chamber 359
Left Atrium 360
Left Ventricular Outflow Obstruction 360
Systolic Function 367
Doppler Evaluation of HCM 367
Evaluation of Outflow Obstruction 367
Evaluation of Diastolic Function 369
Tissue Doppler Evaluation of Diastolic Function 373
Complications 376
Thrombus 376
Ischemia and Effusion 377
Other Causes of Hypertrophy 379
Dynamic Right Ventricular Outflow Obstruction 380
Moderator Bands 381
Dilated Cardiomyopathy 381
Two-Dimensional and M-Mode Evaluation 381
Early Diagnosis 388
Predictors of Outcome 390
Other Causes of Poor Systolic Function 392
Color Doppler Evaluation 393
Right Ventricular Cardiomyopathy 396
Differentiation from Other Disease 399
Myocardial Infarction 400
Myocardial Contusions 403
References 404
Chapter 8 Pericardial Disease, Effusions, and Masses 411
Pericardial Effusion 411
Cardiac Tamponade 414
Neoplasia as a Cause of Pericardial Effusion 416
Introduction 416
Aortic Body Tumors 416
Other Heart Base Masses 418
Hemangiosarcoma 420
Lymphosarcoma 422
Lipomas 424
Rhabdomyosarcoma 425
Pericardial Disease 425
Introduction 425
Idiopathic Effusion 425
Pericardial Neoplasia 426
Infectious Pericarditis 427
Constrictive Pericarditis 428
Spectral Doppler Findings 429
Pericardial Cysts 431
Thrombus 431
References 431
Chapter 9 Congenital Shunts and Av Valve Dysplasia 437
Ventricular Septal Defect 437
Introduction 437
Spectral and Color-Flow Doppler Evaluation 446
Patent Ductus Arteriosus 450
Introduction 450
Structural Changes 450
Left Ventricular Function 452
Spectral and Color-Flow Doppler Evaluation 453
Aorticopulmonary Window 458
Atrial Septal Defects 459
Introduction 459
Two-Dimensional and M-mode Evaluation 459
Spectral and Color-Flow Doppler Evaluation 464
Endocardial Cushion Defects 465
Bubble Studies 467
Tricuspid Dysplasia 468
References 472
Chapter 10 Stenotic Lesions 477
Outflow Obstructions 477
Two-Dimensional Evaluation 479
M-Mode Evaluation 486
Color-Flow Doppler Evaluation 488
Spectral Doppler Evaluation 491
Pulmonary Stenosis 495
Spectral Doppler Evaluation 501
Color-Flow Doppler Evaluation 503
Double-Chamber Right Ventricle and Infundibular Stenosis 504
Two-Dimensional and Doppler Evaluation 505
Mitral Stenosis 507
M-Mode Evaluation 509
Color-Flow Doppler Evaluation 510
Tricuspid Stenosis 513
Cor Triatriatum 515
Cor Triatriatum Dexter 516
Tetralogy of Fallot 517
References 522
Appendices
Appendix 1: Bovine 527
Appendix 2: Canine 531
Appendix 3: Equine 559
Appendix 4: Feline 569
Appendix 5: Miscellaneous Species 581
Index 589
