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Overview of the Process, Exclusions and Risks, and Preparation

Overview of the Process Pre-Scanning Issues Study Issues □ Review the case history. □ Establish: The primary indication for the study Other indications for the study Contraindications to the study The appropriateness of CT versus other alternative modalities for the indication and for the patient □ Select: The optimal scanning protocol The optimal radiation-lowering features The optimal contrast injection technique Patient Issues □ Appropriate patient exclusion…

Single Ventricles

Single-ventricle anomalies are a diverse group of congenital heart defects with one common feature: a single dominant ventricle supports the systemic and pulmonary circulations. Most patients born with single-ventricle anomalies undergo the Fontan operation. The Fontan operation has several variations, but the common result is passive systemic venous return to the pulmonary circulation without reliance on an interposing subpulmonary ventricle. This chapter reviews single-ventricle anomalies, the…

Transposition of the Great Arteries

Complete Transposition of the Great Arteries Background Complete transposition of the great arteries (TGA, also called d -loop TGA [ d -TGA]) is a relatively common cyanotic congenital heart defect that accounts for 5% to 7% of congenital heart disease and affects 3 in 10,000 live births. It affects males more commonly than females. In TGA, there are two parallel circulations that transport oxygenated blood through…

Complex Conotruncal Anomalies

Abnormal conotruncal development results in defects involving the ventricular outflow tracts and great arteries. Developmental abnormalities in the conotruncus may result in (1) abnormal ventriculoarterial alignments and connections; (2) outlet septation defects; or (3) outlet hypoplasia, stenosis, or atresia. The category of conotruncal anomalies includes many defects, some of which, including transposition of the great arteries (TGA) (see Chapter 45 ), interrupted aortic arch (see Chapter…

Right Heart Anomalies

Pulmonic Valve, Subpulmonic, And Supravalvular Pulmonary Stenosis Pulmonic Valve Stenosis Pulmonic valve stenosis is usually an isolated lesion. It occurs in 8% to 10% of individuals with congenital heart disease (CHD) and is the most common form of right-sided obstruction. The pulmonic valve is often dome shaped, with a narrow central opening and leaflet fusion. It can be calcified in older adults. Pulmonic valve dysplasia is…

Left Heart Anomalies

Left-sided anomalies are prevalent among adults with congenital heart disease. They can occur in isolation or with associated defects ( Fig. 42.1 ). Patients usually require lifelong monitoring because native lesions may progress and postintervention complications may develop. Echocardiography is essential for diagnosis, management, and long-term follow-up, and it increasingly plays a role in understanding the physiologic changes of left-sided anomalies and the timing for intervention.…

Congenital Shunts

Approximately 1 in 100 adults have congenital heart disease. Congenital heart defects (CHDs) can be characterized as simple, moderate, or severe in complexity, based on the morbidity and mortality associated with each of these lesions. Echocardiography plays a central role in the screening and diagnosis of congenital shunts, and all pediatric and adult echocardiography laboratories should be accustomed to evaluating CHDs. Evaluation and management of adult…

Heart Disease in Pregnancy

Echocardiography is safe for use during pregnancy and is an important tool in evaluation of pregnant women with heart disease. It is used for risk stratification, follow-up during pregnancy, and diagnosis of women who develop complications during pregnancy. The signs and symptoms of pregnancy can mimic those of heart disease, and transthoracic echocardiography (TTE) is an important tool for differentiating normal pregnancy changes from pathologic cardiac…

Echocardiography in Patients With Atrial Fibrillation and Flutter

Prevalence and Impact of Atrial Fibrillation Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an estimated prevalence of more than 3 million Americans in 2012. Although the true prevalence of atrial flutter (AFL) is not known, it is suspected that a large proportion of patients with cavotricuspid isthmus–dependent AFL, also known as typical flutter, have AF. Other forms of AFL, referred to as atypical,…

Echocardiographic Evaluation of Patients With a Systemic Embolic Event

Background Cardiac Embolism The heart and the aorta are a potential source of embolism to the systemic circulation. Because the brain is the most frequent target, investigation of cardiac embolic sources is especially aggressive after a cerebral embolic event. Most data on outcome and prevention of recurrences come from the stroke literature. The same embolic sources and principles for investigating them also apply to peripheral embolic…

Systemic Diseases Characterized by Immune-Mediated Injury

Rheumatologic diseases are chronic inflammatory states caused by autoimmunity. They are more common in women than in men (with the exception of ankylosing spondylitis and Behçet disease), and they usually manifest between the second and fifth decade. Cardiovascular involvement is common in rheumatologic diseases and causes significant morbidity and mortality. Estimates of the prevalence of cardiovascular involvement vary widely because of differences in study design, study…

Pulmonary Hypertension

General Principles Breathlessness is usually the first presenting symptom of pulmonary hypertension (PHT). Because breathlessness has a wide variety of causes, PHT is often not suspected initially by the patient or the physician. However, identification of PHT has important implications for the diagnosis and for morbidity, and mortality. , The diagnostic workup for breathlessness should include comprehensive echocardiography, which may provide the first objective evidence of…

The Athletic Heart on Echocardiography

Regular athletic training causes changes in cardiac structure and function, commonly referred to as athlete’s heart . The character and magnitude of these changes vary with the type and volume of training but may result in parameters of cardiac structure and function that fall outside the normal range for the general population. The echocardiographer should understand the characteristics of athlete’s heart and the normal limits of…

Hypertensive Heart Disease and Nutritional and Metabolic Disorders

Hypertensive, nutritional, and metabolic disorders have diverse presentations and adversely affect multiple organ systems. Heart disease is common, but it is often subclinical and detected only when noninvasive studies such as echocardiography are performed. Cardiovascular disease is a major source of morbidity and mortality in many metabolic disorders, and the ability to detect early cardiac changes is important. Early treatment of the underlying disorder can reverse…

Inherited Connective Tissue Disorders

Forms of Connective Tissue Disorders Connective tissue disorders can affect multiple organs, but the most feared sequelae are complications associated with the cardiovascular system. Although there is potential for left and right heart involvement, clinically important pathology is typically confined to the mitral valve, the aortic valve, and the aorta itself. In contrast to other forms of cardiovascular disease, many patients first come to medical attention…

Acute Aortic Syndromes

Basic Principles Incidence and Predisposing Factors Among patients with acute chest pain, a cardiac cause (most often acute myocardial infarction) is responsible for less than 20% of cases ( Fig. 32.1 ). Aortic disease accounts for less than 1% of patients with acute chest pain and is 20 times less common than acute myocardial infarction, with an estimated prevalence of only 3 to 4 cases per…

Echocardiographic Recognition and Quantitation of Prosthetic Valve Dysfunction

Prosthetic Valve Complications and Dysfunction Doppler echocardiography remains the cornerstone for evaluation and follow-up of prosthetic valve function and detection of valve complications after aortic, mitral, tricuspid, or pulmonary valve replacement ( Fig. 31.1 ). Evaluation follows the same principles used for evaluation of native valves, although with some important particularities and caveats specific to the prosthetic valves, which are discussed in this chapter. Patient-Prosthesis Mismatch…

Fluid Dynamics of Prosthetic Valves

Acknowledgments The work on prosthetic heart valves was performed in our Cardiovascular Fluid Mechanics Laboratory at Georgia Tech University and was supported by grants from the US Food and Drug Administration, the American Heart Association, the heart valve industry, and generous gifts from Tom and Shirley Gurley and the Lilla Boz Foundation. Doppler echocardiography has made noninvasive examination of prosthetic heart valve function a clinical reality.…

Endocarditis

Infective endocarditis (IE), a noncontagious infection of the endocardium and heart valves, has an incidence of 2.6 to 11.6 cases per 1 million people. The high in-hospital mortality rate remains approximately 20% despite medical and surgical advances. The contemporary epidemiology of IE, particularly host and microbiologic characteristics, has changed compared with earlier eras, and these changes have an important influence on the evaluation and outcome of…

Right-Sided Valve Disease in Adults

The importance of right-sided valve disease was underappreciated for decades, largely because tricuspid and pulmonary valve diseases have a prolonged latency phase before the onset of overt symptoms. Tricuspid regurgitation (TR) is frequently caused by another predisposing disease process that may dominate the clinical presentation. There is a growing recognition that tricuspid valve (TV) and pulmonary valve (PV) diseases are independently associated with increased morbidity and…