Veterinary Echocardiography

Table of Contents:
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 (Inflow—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 Shortening—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

About the Author :
June A. Boon, MS, is an Echocardiographer at Colorado State University, Fort Collins, CO.

Review :
“This is a welcome update. To my knowledge, there is no other book dedicated solely to veterinary echocardiography.”  (Doody’s, 29 June 2012) “June A. Boon’s Veterinary Echocardiography (978081382850, $149.99) appears in a fully revised second updated edition to provide an in-depth reference to the ultrasound of the heart.”  (The Midwest Book Review, 1 January 2012)