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Postoperative Echocardiography of the Aorta

Postsurgical Imaging of the Aortic Root and Aorta Advances in imaging have raised expectations of improved outcomes for both emergency and elective surgery of the aorta. These advances have allowed early diagnosis and more prompt surgical intervention. Simultaneous with improvements in imaging, improved surgical techniques and postoperative care have enhanced outcomes. As a consequence, more patients are presenting for follow-up care. For both aortic aneurysms and…

Blunt Aortic Trauma

Blunt aortic trauma (BAT) is a life-threatening injury because most patients die at the scene, and delayed adventitial rupture may occur during hospitalization. Multiplane transesophageal echocardiography (TEE) and contrast-enhanced helical computed tomography (CT) have similar diagnostic accuracy for the identification of BAT that requires repair. , Historically, BAT constituted a surgical emergency to avoid lethal adventitial rupture. Progressively, delayed repair was proposed in specific patients, and…

Penetrating Atherosclerotic Ulcer and Intramural Hematoma

Acknowledgment The authors acknowledge the contributions of Dr. Raimund Erbel, Dr. Sofia Churzidse, Dr. Riccardo Gorla, and Dr. Alexander Janosi, who were the authors of this chapter in the previous edition. Intramural hematoma (IMH) and penetrating atherosclerotic ulcers (PAU), along with acute aortic dissection (AD), are part of the spectrum of acute aortic syndromes, which involve disruption of the medial layer of the aortic wall (…

Aortic Dissection

Aortic dissection (AD) is a form of acute aortic syndrome (AAS). This syndrome encompasses several life-threatening clinical entities with overlapping features, including acute onset of chest pain, disruption of the aortic wall media, and a need for urgent medical care ( Fig. 133.1 ). The term acute aortic syndrome was first proposed in 2001 by the Spanish physicians Vilacosta and San Román. Originally, the spectrum of…

Sinus of Valsalva Aneurysm

The sinuses of Valsalva are cuplike dilatations in the aortic wall just above the three cusps of the aortic valve (AV). These sinuses function in part to suspend the AV between the valve annulus and the sinotubular ridge. In addition, the left and right sinuses house the ostia of the left and right coronary arteries ( Fig. 132.1 ). Aneurysm of the sinus of Valsalva was…

Aortic Aneurysm

Imaging techniques play a pivotal role in the diagnosis, follow-up and management of aortic aneurysms. Ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI)have strengths and limitations in the assessment of this disease depending on the aortic segment involved and reasons for the study. Ultrasonography is useful in the diagnosis and follow-up of proximal ascending aorta and abdominal aorta aneurysms, respectively. However, other imaging modalities are…

Aortic Atherosclerosis and Embolic Events

Acknowledgment The authors would like to acknowledge the contribution of Dr. Paul A. Tunick, who was one of the authors for this chapter in the previous edition. Nearly 150 years ago, P.L. Panum suggested that atherosclerotic material within the aorta can embolize to peripheral arteries. In a 1945 paper based on an autopsy, Flory showed that arterial occlusion was the result of aortic atherosclerotic plaque. However,…

Normal Anatomic Variants and Artifacts

Echocardiography has greatly enhanced the field of cardiology. However, optimal use of echocardiography requires the ability to recognize and differentiate pathological conditions from normal cardiac structures and their variants that may simulate serious pathology. Although errors can occur with both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), they are especially common with TEE. Despite its superior image resolution—in fact, partly because of it—TEE is particularly prone…

Right Heart Thrombi

Acknowledgment The authors acknowledge the contributions of Dr. Vrinda Sardana, who was the author of this chapter in the previous edition. Right heart thrombi (RHT) are relatively common but can often be missed on routine echocardiography without careful image acquisition and high suspicion. Because of increased use of right heart catheters, pacemakers, and other devices coupled with a growing population of adults with congenital heart diseases…

Left Atrial Appendage Thrombus

Pathogenesis of Left Atrial Appendage Thrombus Formation The left atrial appendage (LAA) is by far the most common location for an atrial thrombus with extra-appendage thrombi being very rare in nonvalvular atrial fibrillation (AF). Thrombus forms within the LAA primarily as a result of stasis within the cavity, although additional components of the Virchow triad, such as hypercoagulable state and endothelial dysfunction, likely also contribute. The…

Left Ventricular Thrombus

Acknowledgments The authors acknowledge the contributions of Drs. Amr E. Abbas, MD, and Steven J. Lester, MD, who were the authors of this chapter in the previous edition. Left Ventricular Thrombus With Impaired Left Ventricular Function Thrombus formation within the left ventricle can be noted 24 hours after an acute myocardial infarction (AMI); 90% of the time they are formed within 2 weeks following the event,…

Primary Benign, Malignant, and Metastatic Tumors of the Heart

Acknowledgments The authors acknowledge the contribution of Jason Kim, who provided Fig. 125.1 , and the contributions of Drs. Zoe Yu and Gillian Murtagh, who were authors of this chapter in the previous edition. Cardiac masses are often the subject of case reports because of their rarity. However, because they are so infrequent, they often challenge the diagnostic skills of even the most experienced physician. Improvements…

Pericardial Cysts and Congenital Absence of the Pericardium

Acknowledgement The authors thank Dr. Sonia Jain for her contribution to this chapter in the previous edition. Pericardial Cysts Pericardial cysts are benign intrathoracic lesions accounting for 6% of all mediastinal masses. They are typically unilocular, contain serous fluid, and range from 1 to 5 cm in diameter, although giant cysts have been reported. Inflammatory cysts and pseudocysts are caused by pericardial inflammation or loculated effusion…

Effusive Constrictive Pericarditis

Effusive constrictive pericarditis is the least common of the pericardial constraint syndromes. It is defined as the persistence of elevated intracardiac pressure after pericardiocentesis for pericardial tamponade. It was first recognized in the 1920s and 1930s when surgical pericardiectomy became an established therapy for constrictive pericarditis. The syndrome combines elements of pericardial effusion or tamponade with a visceral constrictive pericarditis. , Epidemiology The prevalence of effusive…

Constrictive Pericarditis

Acknowledgment The authors acknowledge the American Society of Echocardiography for allowing us to reproduce Figs. 122.1 to 122.3 . Constrictive pericarditis (CP) is a relatively rare disorder in which the stiff, poorly compliant pericardium interferes with ventricular filling, causing elevation of ventricular diastolic pressure and, as a result, increased atrial pressures. This condition is responsible for a unique form of diastolic dysfunction and diastolic heart failure…

Pericardial Effusion and Cardiac Tamponade

Acknowledgments The authors acknowledge the coauthors of the preceding editions of the chapter on pericardial tamponade—Drs. Richard Kutnick, R. Parker Ward, and Roberto M. Lang—for providing the structure for the current update and the included echocardiography and Doppler illustrations. Normal Anatomy of The Pericardium The pericardium is a two-layered fibroelastic membrane or sac that surrounds the heart and proximal segments of the aorta, pulmonary artery, pulmonary…

Pericarditis

Acknowledgment The authors thank Dr. Sonia Jain for her contribution to this chapter in the previous edition. Definition Pericarditis refers to a symptomatic inflammation of the pericardium and can be categorized as acute, incessant (episode lasting 4–12 weeks without remission), recurrent, or chronic (episodes lasting >3 months). Myopericarditis implies associated inflammation, often with coinciding tissue necrosis of the myocardium. Acute pericarditis is the most common manifestation…

Normal Pericardial Anatomy

The pericardium is a membranous sac that envelops almost the entire heart (with the exception of the region of the left atrium around the pulmonary venous ostia) as well as the origins of the great cardiac vessels (the ascending aorta, the main pulmonary artery, and the venae cavae). The term “pericardium” is a Latinized version of the Greek word πɛρικάρδιον, which literally means “that which is…