xixContents

Contents

Section 1: History and Basics

1. HistoryofEchocardiography 3Fadi G Hage, Anant Kharod, David Daly, Navin C Nanda• HistoryofUltrasound 4• TheDevelopmentofClinicalCardiacUltrasound:A-ModeandM-ModeEchocardiography 4• Two-DimensionalEchocardiography 8• ConventionalDopplerUltrasound 9• ColorDopplerUltrasound 11• ContrastEchocardiography 11• TransesophagealEchocardiography 13• TissueDopplerandSpeckleTrackingImaging 14• Three-DimensionalEchocardiography 14• Perspective 19

2. EarlyCardiacFlowDopplerEra:AKeyforaNewClinicalUnderstandingofCardiology 24Colette Veyrat• ThePreflowDopplerEra:PaucityofExistingNoninvasiveTools 25• ExplosiveEmergenceofthe“FlowConcept”,anIndispensableMutationfrom

PressureMeasurements,whichPreparedtheDopplerFlowEra 27• ReturntotheDopplerTechniqueinSearchofaNoninvasiveTool

Documentingthe“FlowConcept” 28

3. BasicsofUltrasound 55Caroline Morbach, Kamran Haleem, Lissa Sugeng• GeneralPhysics 55• ImagingbyUltrasound 57• ImageOptimizationandEquipment 60• Artifacts 61• DopplerUltrasound 63

4. DopplerEchocardiography—Methodology,ApplicationandPitfalls 65George Thomas• DopplerinCardiology 65• DopplerInstrumentation 66• ContinuousWaveDoppler 68• PulsedWaveDoppler 69• ColorDoppler 71

Volume1

xx Comprehensive Textbook of Echocardiography

• PowerDoppler 71• TissueDoppler 72• TheDopplerMethodology 72• InformationDerivedfromDoppler 73

5. Basicsof3DUltrasound 74Ivan S Salgo, Wendy Tsang, Nicole Bhave, Roberto M Lang• Evolutionof3DEchocardiography 74• TransducerTechnology 76• BeamForming 77• Rendering 78• Limitationsin3DImageQuality 80• 3DEchocardiographyQuantification 81

6. SpeckleTrackingAcquisition:BasicsandPracticalTips 87Willem Gorissen, Navin C Nanda• M-Mode(1DSpeckleTracking) 87• Two-DimensionalSpeckleTracking 88• R-RInterval 91• StandardViews 91• Standardization 91• Two-DimensionalSpeckleTrackingLimitation 92• SpeckleTrackingVersusTissueDopplerImaging 92• TissueDopplerImagingVersusSpeckleTracking 92• Three-DimensionalAcquisition 92• MultiviewMonitoringDuringLiveAcquisition 97• MultiviewOrientation 97• GainSetting 97• PatientBreath-Hold 98• Arrhythmias 98

7. InstrumentationforTransesophagealEchocardiographyIncludingNewTechnology 99Ryozo Omoto, Kiyoshi Tamura• KindsofTransesophagealEcho(TEE) 99• WhatMakesImageQuality 104• Artifacts 107• SafetyConsiderations 110• CurrentandFutureTechnologies 112• IntheFuture 116

Section 2: Echocardiography/Ultrasound Examination and Training

8. M-ModeExamination 119Kamran Haleem, Caroline Morbach, Lissa Sugeng• HistoricalPerspective 119• UnderlyingConcept 119

xxiContents

• ColorM-Mode 120• AdvantagesandDisadvantagesofM-Mode 120• UseofM-Mode 121

9. TheCompleteTransthoracicEchocardiography 132Rachel Hughes-Doichev, Anita Radhakrishnan, Abid Ali Fakhri Teena Tulaba, Rachel Myers• GettingStarted 132• EchocardiographicImagingWindowsandPlanes 135• ImagingModalities 135• ParasternalWindow 137• ApicalWindow 146• SubcostalWindow 155• SuprasternalNotchWindow 159• Three-DimensionalEchocardiography 159• LeftVentricleChamberQuantificationandRegionalWallMotionDetermination 161

10. TheStandardTransthoracicExamination:ADifferentPerspective 164Atif N Qasim, Nelson B Schiller • Set-UpandPatientPositioning 164• ImagedPlanes 166

11. NonstandardEchocardiographicExamination 188Navin C Nanda, Aylin Sungur, Kunal Bhagatwala, Nidhi M Karia, Tuğba Kemaloğlu Öz • RightParasternalExaminationPlanes 188• RightandLeftSupraclavicularExamination 189• LeftParasternalandApicalPlanesforExaminationofCoronaryArteries 190• ExaminationofLeftAtrialAppendage 212• ExaminationfromtheBack 216• AbdominalExamination 220

12. TechniqueandApplicationsofContinuousTransthoracicCardiacImaging 224Premindra AN Chandraratna, Dilbahar S Mohar, Peter Sidarous• FeasibilityofContinuousCardiacImaging 224• Limitations 237

13. TheBasicsofPerformingThree-DimensionalEchocardiography 240Steven Bleich, Navin C Nanda, Satish K Parashar, HK Chopra, Rakesh Gupta• 3DTechnology 240• 3DExaminationProtocol 241• LeftParasternalApproach 244• ApicalApproach 244• SubcostalApproach 244• SuprasternalApproach 244• SupraclavicularApproach 244• RightParasternalApproach 246• ColorDopplerImaging 248• Advantages/Disadvantagesof3DEchocardiography 262

xxii Comprehensive Textbook of Echocardiography

14. HowtodoThree-DimensionalTransthoracicEchocardiographyExamination 268Fabrice Larrazet, Colette Veyrat• History 268• MethodsforDataAcquisition 268• LeftVentricularAssessment 270• Reproducibility 272• RegionalLVFunction 276• AorticRegurgitation 280• AorticAnnulus 280• MitralStenosis 280• MitralRegurgitation 282• TricuspidValveDisease 283• PulmonicValveDisease 284• AdvancesinPediatricandFetalCardiacPathologies 285

15. Point-of-CareDiagnosiswithUltrasoundStethoscopy 291JRTC Roelandt• Battery-PoweredUltrasoundImagers 291• TheTraditionalPhysicalExamination 292• TheNewPhysicalExamination 293• AcuteCareEnvironment 294• Screening 294• PreparticipationScreeningofAthletes 295• ImaginginRemoteAreasandDevelopingCountries 295• TrainingRequirements 295• FutureDirections 296

16. SpectralDoppleroftheHepaticVeins 299Bahaa M Fadel, Bader Almahdi, Mohammad Al-Admawi, Giovanni Di Salvo• ImagingoftheHepaticVeins 299• PhysiologicalandOtherFactorsthatAffectHepaticVenousFlow 302• DopplerPatternoftheHepaticVeinsVersustheSuperiorVenaCava 304• TransthoracicEchocardiography 304• TransesophagealEchocardiography 305• TechnicalConsiderations 305• HepaticVenousFlowinDiseaseStates 305• Limitations,TechnicalPitfallsandArtifacts 319

17. SpectralDopplerofthePulmonaryVeins 325Bahaa M Fadel, Bader Almahdi, Mohammad Al-Admawi, Giovanni Di Salvo• HistoricalPerspective 325• ImagingofthePulmonaryVeins 325• PhysiologicalFactorsthatAffectPulmonaryVenousFlow 329• PulmonaryVenousFlowinDiseaseStates 331• LimitationsandTechnicalPitfalls 342• Artifacts 343

xxiiiContents

18. TissueDopplerImaging 349Hisham Dokainish• TechnicalConsiderations 349• DevelopmentofTissueDopplerImaging 350• CurrentClinicalUsesofTDImaging 350

19. SpeckleTrackingEchocardiography:ClinicalUsefulness 360Shyam Padmanabhan, Siddharth Singh, Navin C Nanda• CardiacMuscularAnatomy,CardiacMechanics 360• WhatisStrain? 362• Two-DimensionalSpeckleTrackingEchocardiography(2DSTE) 365• ImageAcquisitionandProcessing 367• ClinicalApplicationof2DSTE 367• Three-DimensionalSpeckleTrackingEchocardiography(3DSTE) 372• ClinicalApplicationsof3DSTE 373• LimitationsofSpeckleTrackingEchocardiography 374

20. EchocardiographicAssessmentofGlobalandSegmentalFunctionUsingVelocityVectorImagingTM 380Michael J Campbell, David A Parra, Daniel Forsha, Piers Barker, Jonathan H Soslow• ApplicationofVelocityVectorImagingbyAgeandDiseaseGroup 390• DyssynchronyVelocityVectorImagingAnalysis 400• ReproducibilityandCorrelationBetweenVendors 401• FutureDirections 404

21. ContrastEchocardiography 416Jatinder Singh Pabla, Benoy Nalin Shah, Roxy Senior• WhatisUltrasoundContrast? 416• HowdoesUltrasoundContrastWork? 417• IndicationsfortheUseofUltrasoundContrast 426• WhyShouldIUseUltrasoundContrastAgents? 428• PracticalTips 431• SafetyofUltrasoundContrastAgents 434• SalineContrastEchocardiography 435

22. MyocardialPerfusionEchocardiography 441Angele A A Mattoso, Jeane M Tsutsui, Wilson Mathias Jr• AcuteCoronarySyndromes 443• AssessmentofMyocardialViability 443• ChronicCoronaryArteryDisease 443

23. EndothelialDysfunction 449Naveen Garg, Kanwal K Kapur• History 450• EndothelialFunctions 450• EndothelialDysfunctions 451

xxiv Comprehensive Textbook of Echocardiography

• RoleofAcetylcholine 451• ShearStressandFlow-MediatedDilatation 452• VasoactiveMoleculesInvolvedinVasoregulation 454• NORelease 455• MethodologyforAssessingEndothelialFunction 455• AnalysisofShearStressandFlow-MediatedDilatationResponse 457• Limitations 458• FactorsAffectingtheFlow-MediatedDilatation 463• ClinicalUtility 465• OtherNoninvasiveMethodstoAssessEndothelialFunction 465• AssessmentofEndothelialFunctionandFutureDirections 471

24. HowtodoaTwo-DimensionalTransesophagealExamination 480Andrew P Miller, Navin C Nanda• PatientSelectionandConsent 480• Preparation,ConsciousSedationandEsophagealIntubation 480• TheTEEExamination 481

25. UpperTransesophagealandTranspharyngealExamination 487Stephanie El-Hajj, Navin C Nanda, Kunal Bhagatwala, Nidhi M Karia, Fadi G Hage• TechniqueandRecognitionofVessels 487• Application 495

26. HowtoPerformaThree-DimensionalTransesophagealEchocardiogram 507Elisa Zaragoza-Macias, Michael Chen, Edward Gill• Three-DimensionalTransesophagealTechnology 507• Performing3DTEEEvaluation 508• Specificusesof3DTEE 512• GuidelinesandFinalRecommendations 514

27. Three-DimensionalExaminationtoEvaluateValvularHeartDisease:TheValueofanAddedDimension 515Nina Ghosh, Judy R Mangion• DataAcquisition 515• 3DEchoImageOptimization 516• 3DEchooftheMitralValve 516• 3DEchooftheAorticValve 520• 3DEchoofthePulmonicValve 522• 3DEchooftheTricuspidValve 523

CaseExamplesof3DEchoinValvularHeartDisease 525• CaseStudy1:ParavalvularLeakMechanicalMV 525• CaseStudy2:MVRepairandAorticValveReplacement 526• CaseStudy3:S/PCardiacTransplantwithRightHeartFailure,TricuspidValveReplacement 526• CaseStudy4:FlailMiddle-Scallop,PosteriorLeaflet,MV 526• CaseStudy5:BileafletMVProlapse,ModeratetoSevereMitralInsufficiency 527• CaseStudy6:SevereAorticStenosis,EvaluateforPossibleTAVR 527• CaseStudy7:RheumaticMitralStenosis 527

xxvContents

• CaseStudy8:S/PBalloonAorticValvuloplasty 527• CaseStudy9:MechanismandSeverityofEccentricMitralInsufficiency 528• CaseStudy10:QuestionofCarcinoidInvolvementofthePulmonicValve 528

28. Three-DimensionalEchocardiographicGuidanceofPercutaneousProcedures 531Muhamed Saric, Ricardo Benenstein• FluoroscopyVersusEchocardiographyinGuidingPercutaneousInterventions 532• TransseptalPuncture:ACommonElementofManyInterventionalProcedures 532• ValvularDisease 533• DeviceClosureofCardiacShunts 548• OcclusionoftheLeftAtrialAppendage 559• GuidanceofElectrophysiologyProcedures 566• MiscellaneousProcedures 569

29. Three-DimensionalEchocardiographyintheOperatingRoom 577Ahmad S Omran• MitralValveDisease 577• AorticValveDisease 582• TricuspidValveDisease 589• NativeValveEndocarditis 597• ProstheticValveDysfunction 605• CardiacMasses 617• Limitationsof3DTEE,FutureDirections 628

30. EpiaorticUltrasonography 638Dheeraj Arora, Yatin Mehta• BackgroundforEpiaorticUltrasonographyExamination 638• Indications 638• EpiaorticProbeandPreparation 638• ImagingViews/Planes 639• RoleofEpiaorticUltrasonographyinAorticPathology 640• AdvantagesofThree-DimensionaloverTwo-DimensionalinEpiaorticUltrasonography 641

31. IntracardiacEchocardiography 643Krishnaswamy Chandrasekaran, Donald Hagler, James Seward• EquipmentandtheCatheters 643• ImagingSpecifications 644• IntracardiacEchocardiography:ClinicalApplications 644• IntracardiacEchocardiographyduringElectrophysiology(EP)Intervention 644• IntracardiacEchocardiographyduringStructuralIntervention 648

32. IntravascularUltrasoundImaging 655Sachin Logani, Charles E Beale, Luis Gruberg, Smadar Kort• PrinciplesofUltrasoundTechnology 655• ImageAcquisition 655• IntravascularUltrasoundExamination 656• ImageInterpretation 657• UtilityofIntravascularUltrasoundinClinicalPractice 659• SafetyConsiderations 661• FuturePerspectives 661

xxvi Comprehensive Textbook of Echocardiography

33. PeripheralVascularUltrasound 663Ricardo Benenstein, Muhamed Saric• UltrasoundDiagnosisofCarotidArteryDiseases 663• UltrasoundDiagnosisofFemoralAccessComplications 694

34. AdvancedNoninvasiveQuantificationTechniquesinEchocardiography 705Bernhard Mumm, Navin C Nanda• TechnologicalBackgroundoftheDifferentAdvancedQuantificationTools 706• ClinicalApplicationsofAdvancedThree-DimensionalEchoQuantificationTools 721• RightVentricularQuantification 723• MitralValveAssessment 725• AorticValveAssessment 727• ConclusionandFutureOutlook 728

35. ArtifactsinEchocardiography 732Shyam Padmanabhan, Navin C Nanda, Aylin Sungur, Tuğba Kemaloğlu Öz, Kunal Bhagatwala, Nidhi M Karia, Kruti Jayesh Mehta, Rohit Tandon• AcousticShadowingandAcousticEnhancement 733• ReverberationArtifacts 734• MirrorImageArtifacts 735• DoubleImageArtifacts 736• SideLobeArtifact 736• ArtifactsSecondarytoUseofElectronicEquipment 736• Aliasing 736• RangeAmbiguity 736• ArtifactsinThree-DimensionalEchocardiography 736• TechniquestoIdentifyandEliminateArtifacts 737

36. EchocardiographyTraining 750Monodeep Biswas, Steven Bleich, Navin C Nanda• TrainingofNoncardiologists 752• TrainingforCardiacSonographers 753• TraininginComputedTomographyandMagneticResonanceImaging 755• CertificationandMaintenanceofProficiency 758• AppropriateUseCriteria 758

Section 3: Valvular Heart Disease

37. EchocardiographyinAcuteRheumaticFeverandChronicRheumaticHeartDisease 765IB Vijayalakshmi• EchocardiographyintheDiagnosisofCarditisinARF 765• ChronicRheumaticHeartDisease 775• MitralValveDiseases 775• MitralStenosis 776• MitralRegurgitation 791• AorticValveDiseases 802

xxviiContents

• AorticStenosis 802• AorticRegurgitation 806• TricuspidValveDiseases 812• TricuspidStenosis 812• TricuspidRegurgitation 813

38. EchocardiographicAssessmentofMitralValveDisease 826C N Manjunath, Nagaraja Moorthy, Luis Bowen, Navin C Nanda• Overview 826• EchocardiographicAssessmentofMitralStenosis 826• EchocardiographicAssessmentofMitralRegurgitation 847• AssessmentofSeverityofMitralRegurgitation 863

39. MitralRegurgitation 880Luc A Pierard, Christine Henri, Julien Magne• Etiology 880• Mechanisms 884• SeverityofMitralRegurgitation 885• MitralRegurgitationConsequences 889• SequentialEvaluationofChronicAsymptomaticMitralRegurgitation 890• FeasibilityofMitralValveRepair 892• RoleofExerciseEchocardiography 892

40. AorticStenosis 896Timothy D Woods, Ashvin K Patel, Sharath Subramanian• NormalAorticValveAnatomy 896• EtiologyofAorticStenosis 897• EchocardiographyinAorticStenosis 898• AorticValveDopplerExamination 904• UseofStressEchoandStraininEvaluationofAorticStenosis 912• IndicationsandAppropriatenessforEchocardiographyinAorticValveStenosis 913

41. Low-Gradient,SevereAorticStenosiswithDepressedandPreservedEjectionFraction 919Eleonora Gashi, Neil L Coplan, Itzhak Kronzon • MyocardialResponsetoChronicAorticStenosis 920• High-Flow,High-GradientAorticStenosisinSettingofNormalEjectionFraction 920• Low-Flow,Low-GradientAorticStenosisinSettingofLowEjectionFraction 920• Low-Flow,Low-GradientAorticStenosisinSettingofNormalEjectionFraction 921• MechanismsBehindPLFLG-AS 924• RoleofSurgicalAorticValveReplacement(SAVR)inAorticStenosis 926• SAVRinLow-Flow,Low-GradientAorticStenosiswithLowEjectionFraction 927• SAVRinParadoxicalLow-Flow,Low-GradientAorticStenosiswithNormalEjectionFraction 927

42. AorticRegurgitation 930Arzu Ilercil, Arthur J Labovitz • AREtiologies 930• QuantificationofARSeverity 936• TimingofAorticValveSurgery 941

xxviii Comprehensive Textbook of Echocardiography

43. EchocardiographicEvaluationofAorticDisease 945Martin G Keane• EchocardiographicEvaluationoftheAorta 945• AorticAneurysms 951• AorticDissection 954• CommonGeneticSyndromesAffectingtheAorta 958• AorticAtheroma 959• AorticTraumaandFreeRupture 961• CoarctationoftheAorta 963

44. TransesophagealEchocardiographyintheDiagnosisofAorticDisease 967Leon J Frazin• TheAnatomicalRelationshipoftheAortaandEsophagus 967• ImagingtheAortawithTransesophagealEchocardiography 967

45. EchocardiographicExaminationoftheTricuspidValve 984Poonam Malhotra Kapoor, Kunal Bhagatwala, Nidhi M Karia, Navin C Nanda• TheAnatomyofTricuspidValve(TV) 984• M-ModeEchocardiography 984• Two-Dimensional(2D)TransthoracicExamination 986• Two-DimensionalTransesophagealExamination 988• Three-DimensionalExamination 988• TricuspidRegurgitation 990• TricuspidStenosis 1004• TricuspidValveProlapse:FlailTricuspidValve 1007

46. EchocardiographicAssessmentofPulmonaryValve 1031Hoda Mojazi-Amiri, Padmini Varadarajan, Ramdas G Pai• Epidemiology 1031• PulmonaryStenosis 1032• PulmonaryRegurgitation 1036• EchocardiographicEvaluation 1037• RossProcedure 1038• PostpulmonaryValveSurgery:MonitoringSequelae 1039• OtherComplementaryTechniquesforEvaluationofPulmonaryValves 1040

47. EchocardiographyinInfectiveEndocarditis 1042Javier López, Teresa Sevilla, José Alberto San Román, Isidre Vilacosta, Maximiliano German Amado Escanuela, Kunal Bhagatwala, Nidhi M Karia, Navin C Nanda• EchocardiographicFindingsinInfectiveEndocarditis 1043• SpecialConsiderationsinPatientswithInfectiveEndocarditis 1047• RoleofEchocardiographyinthePrognosticStratificationofInfectiveEndocarditis 1050• IndicationsofEchocardiographyinInfectiveEndocarditis 1058

48. TheRoleofEchocardiographyinPulmonaryHypertension 1063Michele D' Alto, Francesco Ferrara, Emanuele Romeo, Anna Agnese Stanziola, Eduardo Bossone • ConventionalEchocardiography 1063• NonconventionalEchocardiography 1070• DiagnosticAlgorithminPulmonaryHypertension 1073

xxixContents

49. EchocardiographicAssessmentofProstheticValves 1080Aditya Bharadwaj, Pooja Swamy, Gary P Foster, Padmini Varadarajan, Ramdas G Pai• TypesofProstheticValves 1080• AssessmentofProstheticValves 1082• ProstheticValveDysfunction 1087• OtherComplementaryImagingModalities 1092

50. Three-DimensionalTransthoracicandTransesophagealEchocardiographicEvaluationofProstheticValves 1094Steven Bleich, Navin C Nanda• Three-DimensionalVisualizationofProstheticValve 1094• Three-DimensionalTransthoracicEchocardiographicAssessmentofProstheticValves 1095• Three-DimensionalTransesophagealEchocardiographicAssessmentofProstheticValves 1100

Volume2

Section 4: Left & Right Ventricle and Left Atrium Hemodynamics

51. M-ModeandTwo-DimensionalEchocardiographicAssessmentofLeftVentricularSystolicFunction 1115Anjlee M Mehta, Navin C Nanda• VisualEstimationofLeftVentricularSystolicFunction 1115• M-ModeandTwo-DimensionalTransthoracicEchocardiographicMethodsfor

AssessmentofLeftVentricularSystolicFunction 1116• DopplerEchocardiographicMethodsofAssessmentofLeftVentricularFunction 1119• Two-DimensionalSpeckleTrackingEchocardiographyandVelocityVectorImaging 1120• MyocardialPerformanceIndex 1120• ContrastEchocardiographyintheAssessmentofLeftVentricularSystolicFunction 1121• Arterial–VentricularCoupling 1121• Three-DimensionalTransthoracicEchocardiography 1122

52. HowtoAssessDiastolicFunction 1124Hisham Dokainish• IntegratingEchocardiographicVariablesforAccurateDiagnosisofDiastolicFunction 1130• NovelImagingTechniquesandFutureDirections 1131

53. EvaluationoftheRightVentricle 1134Vincent L Sorrell, Steve W Leung, Brandon Fornwalt• GeneralOverview 1134• RightVentricleMorphology 1135• Echocardiography 1136• M-ModeEchocardiography 1136• Two-DimensionalEchocardiography 1138• DopplerEchocardiography 1139• Two-DimensionalStrain(SpeckleTracking) 1141• Three-DimensionalEchocardiography 1142

xxx Comprehensive Textbook of Echocardiography

• TransesophagealEchocardiography 1143• Hemodynamics 1143• OtherImagingModalities 1144

54. Three-DimensionalEchocardiographicAssessmentofLVandRVFunction 1149Aasha S Gopal• 3DQuantitationoftheLeftVentricle 1149• 3DQuantitationoftheRightVentricle 1165

55. NewerAspectsofStructure/FunctiontoAssessCardiacMotion 1176Gerald Buckberg, Navin C Nanda, Julien IE Hoffman, Cecil Coghlan• BasicHeartFunction 1177• State-of-the-Art 1180• CompositeofState-of-the-ArtReports 1181• NovelMechanicalandTimingInterdependencebetweenTorsionandUntwisting 1184• TheNormalHeart 1185• TheSeptum 1194• TheRightVentricle 1198• OtherConsiderations 1198

56. EchocardiographyinAssessmentofComplicationsRelatedtoPermanentPacemakersandIntracardiacDefibrillators 1210Ahmed Almomani, Khadija Siddiqui, Masood Ahmad• NormalEchocardiographicFindingsinPermanentPacemakers/Implantable

Cardioverter-Defibrillators 1210• PacemakerandImplantableCardioverter-Defibrillator-RelatedComplications 1212• TricuspidRegurgitation 1212• Masses:LeadInfectionandThrombus 1214• MyocardialPerforation 1215• DeleteriousEffectsofRightVentricularApicalPacingonLeftVentricularFunction 1217

57. EchocardiographicEvaluationofVentricularAssistDevices 1222 Peter S Rahko • ClinicalUsesofVentricularAssistDevices 1224• ReverseRemodeling 1226• TypesofDevices 1226• PreoperativeEchocardiographicEvaluation 1229• ImmediatePostsurgicalEvaluation 1234• SerialChangesinCardiacStructureandFunction 1234• ComplicationsofLeftVentricularAssistDevices 1240• EvidenceofUnderfillingoftheLeftVentricle 1246• OptimizingLeftVentricularAssistDeviceSettings 1248• Explantation 1249• PercutaneousContinuousFlowDevices 1250

58. EchocardiographicAssessmentofLeftAtrialFunction 1255Utpal N Sagar, Hirohiko Motoki, Allan L Klein• Anatomy 1255• Physiology 1256

xxxiContents

• FunctionalAssessment 1257• LeftAtrialPathophysiology 1259

59. TheUseofEchocardiographytoAssessCardiacHemodynamicsandGuideTherapy 1264Roy Beigel, Robert J Siegel• RightAtrialPressure/CentralVenousPressure 1264• PulmonaryArteryHemodynamics 1269• Left-SidedFillingPressures 1273• AdditionalParametersforEstimationofLeftAtrialPressure 1279• StrokeVolume,StrokeDistance,CardiacOutput,andSystemicPulmonaryShunts(QP/QS) 1280

Section 5: Ischemic Heart Disease, Cardiomyopathies, Pericardial Disorders, Tumors and Masses

60. EchocardiographyinIschemicHeartDisease 1289Chetan Shenoy, Hamid Reza Salehi, Francesco F Faletra, Natesa G Pandian • DetectionofIschemia 1289• RoleinAcuteCoronarySyndromes 1292• MechanicalComplicationsofMyocardialInfarction 1294• RoleofEchocardiographyinChronicIschemicCardiomyopathy 1298• NovelEchocardiographyTechniquesinIschemicHeartDisease 1301

61. StressEchocardiography 1306Azhar Supariwala, Siu-Sun Yao, Farooq A Chaudhry• FundamentalsofStressEchocardiography 1306• TypesofStressEchocardiography 1307• InterpretationofStressEchocardiography 1309• StressEchocardiography:FutureDirections 1319

62. SquattingStressEchocardiography 1323Premindra AN Chandraratna, Dilbahar S Mohar, Peter Sidarous• SquattingEchocardiography 1324

63. Three-DimensionalStressEchocardiography 1328Rajesh Ramineni, Masood Ahmad • Two-DimensionalStressEchocardiography 1328• Three-DimensionalTransducers 1329• AdvantagesofThree-DimensionalinStressImaging 1329• Three-DimensionalImageAcquisition 1330• Three-DimensionalStressProtocol 1331• PostacquisitionAnalysis 1331• ReviewofStudiesComparingThree-DimensionalStress

EchocardiographytoCurrentStandards 1331• Differencesbetween2DSEand3DSEinWallVisualization 1334• ParametricImaginginThree-DimensionalStressEchocardiography 1334• RoleofContractionFrontMappinginRT3DSE 1334• ContrastinThree-DimensionalStressTesting 1335

xxxii Comprehensive Textbook of Echocardiography

64. EchocardiographicAssessmentofCoronaryArteries—MorphologyandCoronaryFlowReserve 1337Karina Wierzbowska-Drabik, Jarosław D Kasprzak• TheAssessmentofCoronaryMorphologyandFlowin

TransthoracicandTransesophagealStudies 1337• VisualizationofCoronaryArteries 1337• DistalCoronaryFlowandCoronaryFlowReserve 1340• CongenitalAbnormalitiesoftheCoronaryArteries 1343

65. EchocardiographyinHypertrophicCardiomyopathy 1348Dan G Halpern, Mark V Sherrid• DefinitionsandTypesofHypertrophy 1349• Mid-LeftVentricularHypertrophicCardiomyopathy 1356• DifferentialDiagnosis 1359• TreatmentStrategiesinHypertrophicCardiomyopathy 1361• AlcoholSeptalAblation 1362• EndocarditisProphylaxis 1363

66. EchocardiographicAssessmentofNonobstructiveCardiomyopathies 1369Rohit Gokhale, Manreet Basra, Victor Vacanti, Steven J Horn, Aylin Sungur, Robert P Gatewood Jr, Navin C Nanda• Cardiomyopathies 1369• DilatedCardiomyopathy(DCM) 1370• SecondaryFindingsinDilatedCardiomyopathy 1372• TheRoleofEchocardiographyinOptimizingHeartFailure 1376• EchocardiographyinAssessingVentricularRemodeling 1379• FindingsinDilatedCardiomyopathyBasedonEtiology 1379• RestrictiveCardiomyopathy 1397• OtherInfiltrativeCardiomyopathies 1405• InfectiousandMetabolicCardiomyopathies 1405• CarcinoidHeartDisease 1407

67. EchocardiographicDifferentiationofIschemicandNonischemicCardiomyopathy:ComparisonwithOtherNoninvasiveModalities 1418Sula Mazimba, Arshad Kamel, Navin C Nanda, Maximiliano German Amado Escanuela, Kunal Bhagatwala, Nidhi M Karia• EchocardiographicAssessmentofIschemicandNonischemicCardiomyopathy 1419• M-ModeEchocardiography 1419• Two-Dimensional/Three-Dimensional/DopplerEchocardiography 1421• EchocardiographicDistinctionbetweenIschemicCardiomyopathyand

NonischemicDilatedCardiomyopathy 1425• OtherNoninvasiveImagingModalities 1425

68. PericardialDisease 1435Trevor Jenkins, Brian D Hoit• AcutePericarditis 1436• PericardialEffusion 1436

xxxiiiContents

• M-ModeandTwo-DimensionalEchocardiography 1437• PericardialTamponade 1438• ConstrictivePericarditis 1444• Effusive-ConstrictivePericarditis 1448• CongenitalAnomalies 1448• MultimodalityImagingofthePericardium 1450

69. Three-DimensionalEchocardiographicAssessmentinPericardialDisorders 1452O Julian Booker, Navin C Nanda• Two-DimensionalTransthoracicEchocardiographyVersusThree-Dimensional

TransthoracicEchocardiographyinPericardialEffusion 1453• Two-DimensionalTransthoracicEchocardiographyVersusThree-Dimensional

TransthoracicEchocardiographyinConstriction 1456• Two-DimensionalTransthoracicEchocardiographyVersusThree-Dimensional

TransthoracicEchocardiographyinPericardialMasses 1458

70. EchocardiographicAssessmentofCardiacTumorsandMasses 1462Leon Varjabedian, Jennifer K Lang, Abdallah Kamouh, Steven J Horn, Tuğba Kemaloğlu Öz Aylin Sungur, Kruti Jayesh Mehta, Kunal Bhagatwala, Nidhi M Karia Maximiliano German Amado Escañuela, Robert P Gatewood Jr, Navin C Nanda • EchocardiographicAssessmentofCardiacTumorsandMasses 1462• PrimaryBenignCardiacTumors 1464• MalignantPrimaryCardiacTumors 1484• MICE 1511

Section 6: Congenital Heart Disease

71. FetalCardiacImaging 1527Aarti H Bhat• ScopeofFetalCardiology 1527• IndicationsforFetalCardiacEvaluation 1528• FetalPhysiology 1528• IndicationsforFetalEchocardiography 1529• ExtracardiacReasonsandAssociationsforFetalHeartDisease 1529• FundamentalsofFetalCardiacImaging 1530• CaseStudies 1542

72. M-modeandTwo-DimensionalEchocardiographyinCongenitalHeartDisease 1561Neeraj Awasthy, Savitri Shrivastava

Part1:BasicsofImagingandSequentialSegmentalAnalysis 1562

• PatientPreparation 1562• Imaging 1563• Dextrocardia 1570• PrinciplesofSequentialChamberAnalysis 1575

xxxiv Comprehensive Textbook of Echocardiography

Part2:Left-to-RightShunts:AtrialSeptalDefect,VentricularSeptalDefect,PatentDuctusArteriosus,and AortopulmonaryWindow 1582

• GeneralFeatures:ShuntLesions 1582• AtrialSeptalDefects 1585• VentricularSeptalDefect 1591• PatentDuctusArteriosus 1599• AortopulmonaryWindow 1602• GerbodeDefect 1603

Part3:AtrioventricularSeptalDefects 1604

• TypesofAtrioventricularSeptalDefect 1604• HemodynamicAssessmentofAtrioventricularSeptalDefect 1610• MechanismofAtrioventricularValveRegurgitation 1610

Part4:CongenitalLeftVentricularandRightVentricularInflowAnomalies 1610

• CongenitalAnomaliesofMitralValve 1610• CongenitalAbnormalitiesofTricuspidValve 1616

Part5:LeftVentricularOutflowTractObstruction 1618

• ValvularAorticStenosis 1618• SubvalvularAorticStenosis 1624• SupravalvularAorticStenosis 1626• AorticRegurgitation 1628• SinusofValsalvaAneurysm 1630• AortocameralCommunications 1632

Part6:EchocardiographicAnatomyofTetralogyofFallotwithPulmonaryStenosis 1633

• AorticOverride 1633• VentricularSeptalDefect 1633• PulmonaryStenosis 1634• TetralogyofFallotwithAbsentPulmonaryValve 1637• ThePulmonaryArteries 1637• AorticArch 1638• PatentArterialDuctandAortopulmonaryCollaterals 1639• CoronaryArteryAnomalies 1640• EchocardiographicMeasurementsinTetralogyofFallot 1640• PostoperativeEvaluationofTetralogyofFallot 1641• SubaorticVentricularSeptalDefect 1646• SubpulmonaryVentricularSeptalDefect(Taussig–BingAnomaly) 1647• StenosisofthePulmonaryOutflow 1647• RoleofEchocardiographyinPlanningSurgicalStrategy 1648• TruncusArteriosus 1650

Part7:CompleteTranspositionofGreatArteries 1653

• TranspositionofGreatVessels 1653

Part8:AtrioventricularandVentricoarterialDiscordance 1664

• AssociatedDefects 1664• CoronaryArteryAnatomy 1664• AssociatedMalformations 1667

xxxvContents

Part9:PulmonaryVeins 1670

• NormalFlowPatternofPulmonaryVeins 1670• AnomaliesofPulmonaryVeins 1672• TotalAnomalousPulmonaryVenousConnection 1673• AnomaliesofSystemicVeins 1678

Part10:ImagingofCoronaryAnomaliesandPulmonaryArteries 1684

• AnomalousPulmonaryOriginofCoronaryArtery 1685• AnomalousOriginofRightCoronaryArteryfromPulmonaryArtery 1687• TangentialOriginofCoronaryArtery 1687• CoronaryArteriovenousFistula 1688• CoronaryAneurysms 1688

Part11:EchocardiographicEvaluationofAorticArchandItsAnomalies 1690

• AbnormalFormationofArch 1690• CoarctationofAorta 1692• InterruptionofAorticArch 1694• AorticAneurysm 1695

Part12:UniventricularHeartandHeterotomySyndrome 1696

• UniventricularAtrioventricularConnections 1697• TricuspidAtresia 1700• MitralAtresiaandHypoplasticLeftHeartSyndrome 1701• HeterotaxySyndrome 1704• PostoperativeEvaluation 1709

73. RealTime3DEchocardiographyforQuantificationofVentricularVolumes,MassandFunctioninChildrenwithCongenitalandAcquiredHeartDiseases 1721Shuping Ge, Jie Sun, Lindsay Rogers, Rula Balluz• LeftVentricularVolumes,EjectionFraction,andMass 1722• RightVentricularVolumes,EjectionFraction,andMass 1723• SingleVentricularVolumes,EjectionFraction,andMass 1725• Three-DimensionalAnalysisofRegionalWallMotion,Synchrony,andStrain 1726

74. Three-DimensionalEchocardiographyinCongenitalHeartDisease 1733Steven Bleich, Gerald R Marx, Navin C Nanda, Fadi G Hage• ShuntLesions/SeptalDefects 1733• CommonAtrium 1747• AortopulmonaryWindow 1751• PatentDuctusArteriosus(PDA) 1751• ConotruncalAnomalies 1754• OutflowTractObstruction 1766• AorticArchAnomalies 1770• AtrialandAtrioventricularValveAbnormalities 1773• OtherAbnormalities 1776• DoubleOutletRightVentricle 1779• SinusofValsalvaAneurysm 1784

xxxvi Comprehensive Textbook of Echocardiography

75. EchocardiographyintheEvaluationofAdultswithCongenitalHeartDisease 1791Reema Chugh• KeyConceptsofEchocardiographyinAdultswithCongenitalHeartDisease 1793• SimpleCongenitalHeartDefectsinAdults 1798• ValvularDisease 1813• ComplexCongenitalHeartDefects 1826

76. EchocardiographicEvaluationforAcquiredHeartDiseasesinChildhood 1856Jie Sun, Rula Balluz, Lindsay Rogers, Shuping Ge• InfectiveEndocarditis 1856• ModifiedDukeCriteriafortheDiagnosisofInfectiveEndocarditis 1857• EchocardiographicFindings 1857• ComplicationsofInfectiveEndocarditis 1859• RheumaticHeartDisease 1859• JonesCriteria,Updated1992 1859• KawasakiDisease 1861• CoronaryEctasiaandAneurysmsbyEchocardiography 1861

Section 7: Miscellaneous and Other Noninvasive Techniques

77. EchocardiographyinSystemicDiseases 1867Mahdi Veillet-Chowdhury, Smadar Kort• SystemicLupusErythematosus 1867• RheumatoidArthritis 1868• HypereosinophilicSyndrome 1868• SystemicSclerosis 1869• RenalDisease 1871• Amyloidosis 1872• Carcinoid 1874• ChagasDisease 1875• Sarcoidosis 1876• ThyroidDisorders 1879• NutritionalDeficiency 1880

78. EchocardiographyinWomen 1886Jennifer Kiessling, Navin C Nanda, Tuğba Kemaloğlu Öz, Aylin Sungur, Kunal Bhagatwala, Nidhi M Karia• DifferencesinEchocardiographicMeasurementsandTechnicalConsiderations 1886• StructuralHeartDisease:MVP,MitralStenosis,andMitralAnnularCalcification 1888• IschemicHeartDisease/StressEchocardiography/PolycysticOvarianSyndrome 1889• TakotsuboCardiomyopathy 1899• CongenitalHeartDisease 1900• EchocardiographyinPregnancy,PeripartumCardiomyopathy,FetalEchocardiography 1902

xxxviiContents

79. EchocardiographyintheElderly 1921Gopal Ghimire, Navin C Nanda, Kunal Bhagatwala, Nidhi M Karia• AorticAtherosclerosisandPenetratingAorticUlcer 1921• AorticValveSclerosis 1923• AorticStenosis 1924• AorticAneurysm 1934• AorticDissection 1937• LeftVentricularMass,Dimensions,andFunction 1942• EchocardiographyinStrokePatients:AssessmentofCoronaryStenosis 1943• MitralAnnularCalcification 1946• ProstheticValves 1948

80. HowtodoEchofortheElectrophysiologist 1957Chittur A Sivaram• EchocardiographyinSupraventricularTachycardia 1957• LeftAtrium 1960• AtrialSeptum 1962• PulmonaryVeins 1963• InferiorVenaCava 1964• EchocardiographyinVentricularTachycardia 1966• EchocardiographyinCardiacImplantableElectronicDevices 1967

81. EchocardiographyinLife-ThreateningConditions 1969Rachel Harris, Elizabeth Ofili • ChestTrauma 1969• BluntChestTrauma 1969• PenetratingChestTrauma 1972• AcuteMitralRegurgitation 1972• AcuteSevereAorticRegurgitation 1972• AorticDissection 1974• DebakeyClassification 1974• TheStanfordClassification 1974• PulmonaryThromboembolicDisease 1976• AirEmbolism 1977• Hypovolemia 1977• LargeIntracardiacThrombus 1978

82. LungUltrasoundinCardiology 1982Luna Gargani, Eugenio Picano• PhysicalandPhysiologicalBasisofLungUltrasound 1982• Methodology 1983• PulmonaryInterstitialEdema 1984• PleuralEffusion 1985• PulmonaryEmbolism 1985• AcuteRespiratoryDistressSyndrome 1986• Pneumothorax 1986• CardiopulmonaryUltrasound:AnIntegratedApproach 1987• Limitations 1987

xxxviii Comprehensive Textbook of Echocardiography

83. TheFutureofEchocardiographyandUltrasound 1990David Cosgrove• PlaneWaveUltrafastImaging 1990• TrendsinScanners 1991• Doppler 1993• Microbubbles 1993• Elastography 1994• LightandSound 1995• TherapeuticApplicationsofUltrasound 1996

84. APrimeronCardiacMRIfortheEchocardiographer 1998Madhavi Kadiyala, Aasha S Gopal• QuantitativeLeftandRightVentricularAssessment 1998• StrainAssessment 1999• LeftVentricularStructure 2000• MyocarditisandSarcoidosis 2004• CardiacHypertrophy 2006• Cardiomyopathies 2008• VelocityMapping,FlowandShuntAssessment 2008• ValvularHeartDiseaseandProstheticValves 2009• PericardialDisease 2014• NormalVariantsandMasses 2016• LimitationsofCardiacMRIandCT 2017• GlossaryofCardiacMRISequences 2020

85. CardiacCTImaging 2023Satinder P Singh, Sushilkumar K Sonavane• ChallengesforCardiacComputedTomography 2024• RadiationDose 2025• PatientSelection 2027• Technique 2027• ImagePostprocessing 2028• ImageAnalysis 2032• PitfallsandArtifacts 2034• DiagnosticAccuracyofCoronaryComputedTomographyAngiogram 2040• CoronaryPlaque 2041• PrognosticInformationfromCoronaryComputedTomographyAngiogram 2042• CardiacFunction 2042• MyocardialPerfusion 2042• HowtoImproveAccuracyofComputedTomographyAngiograminDetermining

FlowLimitingDisease 2044• ClinicalIndications 2044

Movie Clip Legends i

Additional Movie Clip Legends xxi

Index I-i

xxxixDVD Contents

DVD Contents

CHAPTER 9 Movie Clip 9.1: Parasternallong-axisview.Movie Clip 9.6:Parasternallong-axisview.Aorticvalveandleftventricularoutflowtract.

Movie Clip 9.11: Parasternal long-axisview.Mitral regur-gitation.

Movie Clip 9.14A: Rightventricularinflowview.Movie Clip 9.14B: Rightventricularinflowviewwithcolor.Movie Clip 9.17A: Parasternal long-axis viewof the rightventricularoutflowtract.

Movie Clip 9.21: Parasternalshort-axisviewatthelevelofthe aortic valve.

Movie Clip 9.22: Parasternalshort-axisviewatthelevelofthe mitral valve.

Movie Clip 9.26: Parasternalshort-axisviewatthelevelofthe mitral valve. Mitral regurgitation.

Movie Clip 9.30: Apical four-chamber view.Movie Clip 9.31: Apical four-chamber view. Left ventricular

walls.Movie Clip 9.32A: Apical four-chamberview.Normalflow

across mitral valve.Movie Clip 9.32B: Apical four-chamberview.Normalflow

across tricuspid valve.Movie Clip 9.32C: Apical four-chamber view. Mitral and

tricuspid valves.Movie Clip 9.40: Apical four-chamber view. Interatrial

septum.Movie Clip 9.41: Apical four-chamber view with agitated

saline contrast injection.Movie Clip 9.42A: Apicalfive-chamberviewwithoutcolor.Movie Clip 9.42B: Apicalfive-chamberviewwithcolor.Movie Clip 9.43: Apical two-chamber view.Movie Clip 9.44: Apical two-chamber view.Movie Clip 9.45A: Apical two-chamber view. Left atrial

appendage.Movie Clip 9.45B: Apical two-chamber view (zoomed). Left

atrial appendage.Movie Clip 9.47:Apical long-axis(three-chamber)viewof

the left ventricle without color.Movie Clip 9.48: Apical long-axis(three-chamber)viewof

the left ventricle with color.

Movie Clip 9.50A: Subcostal four-chamber view withoutcolor.

Movie Clip 9.50B: Subcostalfour-chamberviewwithcolor.Movie Clip 9.51A: Short-axisplaneattheaorticvalvelevel.Movie Clip 9.51B: Short-axisplaneatthepapillarymuscle

level.Movie Clip 9.56A: Suprasternalnotchwindowwithoutcolor.Movie Clip 9.56B: Suprasternalnotchwindowwithcolor.Movie Clip 9.58B: Three-dimensional echocardiogram of

left ventricular volumes.Movie Clip 9.59B: Real time 3D acquired from an apical

window showing on-face reconstruction of the mitral valveorifice.

CHAPTER 10 Movie Clip 10.1: Parasternallongaxisoftheleftventricle,

with the depth settings of 20 cm.Movie Clip 10.2A: Parasternallongaxisoftheleftventricle

at normal depth.Movie Clip 10.2B: Parasternallongaxiszoomedinviewof

the aortic and mitral valves.Movie Clip 10.6: Parasternal longaxis, inflowof the right

ventricle, with color Doppler study.Movie Clip 10.7: Parasternal long axis of the pulmonary arteryandrightventricularoutflowtract.

Movie Clip 10.8A: Parasternalshortaxisattheleveloftheaortic valve.

Movie Clip 10.8B: Parasternalshortaxisattheleveloftheaortic valve (zoomed in).

Movie Clip 10.9: Parasternal short axis main pulmonary artery.

Movie Clip 10.12: Parasternalshortaxisoftheleftventricleat the level of mitral valve.

Movie Clip 10.13: Parasternalshortaxisoftheleftventricleat the level of the papillary muscles.

Movie Clip 10.14: Apical four-chamber view.Movie Clip 10.18A: Apical four-chamber view. Flow in

pulmonary veins.Movie Clip 10.21: Apicalfive-chamberview.Movie Clip 10.23: Apical two-chamber view.Movie Clip 10.27: Apicallong-axisviewoftheleftventricle.

* Refer to Movie Legends Refer to Movie Clips

xl Comprehensive Textbook of Echocardiography

Movie Clip 10.28A: Subcostal four-chamber viewwithoutcolor.

Movie Clip 10.28B:Subcostalfour-chamberview(zoomedin) with color.

Movie Clip 10.29A: Short-axissubcostalview.Movie Clip 10.29B: Short-axissubcostalview.Movie Clip 10.30:Subcostal long-axisviewof the inferior

vena cavaMovie Clip 10.32: Subcostal long axis of the abdominal

aorta with color Doppler study.Movie Clip 10.33A: Suprasternal viewof the longaxisof

aortic arch.Movie Clip 10.33B: Suprasternal viewof the longaxisof

aortic arch.Movie Clip 10.35A: Color Doppler interrogation of superior

vena cava.Movie Clip 10.35B: Pulsed wave Doppler interrogation of

superior vena cava.

CHAPTER 11 Movie Clip 11.1A: Two-dimensional transthoracic echo-cardiography. Right parasternal approach. Eustachianvalve and the right arrowhead points to crista terminalis.

Movie Clip 11.1B: Two-dimensional transthoracic echo-cardiography. Right parasternal approach. Eustachianvalve and the right arrowhead points to crista terminalis.

Movie Clip 11.2: Two-dimensional transthoracic echocardio-graphy. Right parasternal approach. Right marginal vein and Thebesian valve.

Movie Clip 11.3: Two-dimensional transthoracic echocardio-graphy. Right parasternal approach. Right marginal vein and interventricular vein draining into coronary sinus.

Movie Clip 11.4: Two-dimensional transthoracic echocardio-graphy.Rightparasternalapproach.Superiorvenacavaand inferior vena cava.

Movie Clip 11.5: Two-dimensional transthoracic echo-cardio graphy. Right parasternal approach. Right coro-nary artery.

Movie Clip 11.6: Two-dimensional transthoracic echocardio-graphy. Right parasternal approach. Flow from right lower pulmonary vein to left atrium.

Movie Clip 11.7A: Two-dimensional transthoracic echocar-diography. Right parasternal approach. Ascending aorta, superior vena cava and coronary sinus.

Movie Clip 11.8: Two-dimensional transthoracic echocardio-graphy. Right parasternal approach. Ascending aorta, arch of aorta, descending aorta and left main coronary artery.

Movie Clip 11.9: Two-dimensional transthoracic echo-cardio graphy. Right parasternal approach. Main pulmo-nary artery and left pulmonary artery.

Movie Clip 11.10A: Two-dimensional transthoracic echo-cardiography. Right parasternal approach. Pulmonary artery and descending thoracic aorta.

Movie Clip 11.10D: Two-dimensional transthoracic echo-cardiography.Suprasternalapproach.Aorticarchanditsbranches.

Movie Clip 11.10E: Two-dimensional transthoracic echo-cardiography.Suprasternalapproach.Aorticarchanditsbranches.

Movie Clip 11.10F: Two-dimensional transthoracic echo-cardiography.Suprasternalapproach.Flow indescend-ing thoracic aorta.

Movie Clip 11.11: Two-dimensional transthoracic echo-cardio graphy. Right parasternal approach. Main pulmo-nary artery bifurcation.

Movie Clip 11.12A: Two-dimensional transthoracic echo-cardiography. Parasternal long-axis view. Ventricularseptal aneurysm.

Movie Clip 11.12B: Two-dimensional transthoracic echo-cardiography. Parasternal long-axis view. Ventricularseptal aneurysm.

Movie Clip 11.12C: Two-dimensional transthoracic echo-cardiography. Parasternal long-axis view. Ventricularseptal aneurysm.

Movie Clip 11.13: Two-dimensional transthoracic echo-cardiography. Right ventricular inflow view. Tricuspid regurgitation.

Movie Clip 11.14A: Two-dimensional transthoracic echo-cardio graphy. Apical four-chamber view. Ventricular septal aneurysm.

Movie Clip 11.14B: Two-dimensional transthoracic echo-cardio graphy. Apical four-chamber view. Ventricular septal aneurysm.

Movie Clip 11.15A: Two-dimensional transthoracic echo-cardiography. Right parasternal approach. Secundumatrial septal defect.

Movie Clip 11.15B: Two-dimensional transthoracic echo-cardiography.Subcostalexamination.

Movie Clip 11.16: Two-dimensional transthoracic echo-cardiography. Right parasternal approach. Secundumatrial septal defect.

Movie Clip 11.17: Two-dimensional transthoracic echo-cardiography. Right parasternal approach. Normal flowfrom the inferior vena cava and superior vena cava into the right atrium.

Movie Clip 11.18A: Two-dimensional transthoracic echo-cardio graphy. Right parasternal approach. Ascending aortic aneurysm.

Movie Clip 11.18B: Two-dimensional transthoracic echo-cardio graphy. Right parasternal approach. Ascending aortic aneurysm.

xliDVD Contents

Movie Clip 11.19 (Part 1): Live/real time three-dimensional rightparasternaltransthoracicechocardiographicexami-nation of atrial septum and superior and inferior vena cava.

Movie Clip 11.19 (Part 2): Live/real time three-dimensional rightparasternaltransthoracicechocardiographicexami-nation of atrial septum and superior and inferior vena cava.

Movie Clip 11.20 (Part 1): Live/real time three-dimensional rightparasternaltransthoracicechocardiographicexami-nation of ascending aorta and right atrial appendage.

Movie Clip 11.20 (Part 2): Live/real time three-dimensional rightparasternaltransthoracicechocardiographicexami-nation of ascending aorta and right atrial appendage.

Movie Clip 11.21: Live/real time three-dimensional right parasternaltransthoracicechocardiographicexaminationof pulmonary valve, main pulmonary artery, pulmonary artery branches and left atrium.

Movie Clip 11.22A: Two-dimensional transthoracic echo-cardio graphy. Right parasternal approach. Coronary sinus.

Movie Clip 11.22B: Live/real time three-dimensional echo-cardio graphy. Right parasternal approach. Coronary sinus and Thebesian valve.

Movie Clip 11.22C: Live/real time three-dimensional echo-cardiography. Right parasternal approach. Short-axisview.Allthreeleafletsofthetricuspidvalveandbothleaf-lets of the mitral valve.

Movie Clip 11.23A: Live/real time three-dimensional trans-thoracic echocardiography. Thrombus in superior vena cava.

Movie Clip 11.23B (From RA): Live/real time three-dimen-sional transthoracic echocardiography. Thrombus in superior vena cava.

Movie Clip 11.23B: Live/real time three-dimensional trans-thoracic echocardiography. Thrombus in and superior vena cava.

Movie Clip 11.24: Live/real time three-dimensional trans-thoracic echocardiography. Right parasternal approach. Valve of foramen ovale.

Movie Clip 11.25: Two-dimensional transthoracic echo-cardio graphy. Right supraclavicular approach. Left inno-minate vein draining into superior vena cava.

Movie Clip 11.26: Two-dimensional transthoracic echo-cardio graphy. Left supraclavicular approach. Flow through left common carotid artery.

Movie Clip 11.27A: Two-dimensional transthoracic echo-cardio graphy. Left supraclavicular approach. Venous valve in the left innominate vein.

Movie Clip 11.27B: Two-dimensional transthoracic echo-cardiography. Left supraclavicular approach. Venous valve in the left innominate vein.

Movie Clip 11.28A: Two-dimensional transthoracic echo-cardio graphy. Right supraclavicular approach. Left inno-minate vein draining into the superior vena cava.

Movie Clip 11.28B: Two-dimensional transthoracic echo-cardio graphy. Right supraclavicular approach. Left inno-minate vein draining into the superior vena cava.

Movie Clip 11.30A: Two-dimensional transthoracic echo-cardio graphy. Right supraclavicular approach. Flow in superior vena cava and the pulmonary artery

Movie Clip 11.30B: Two-dimensional transthoracic echo-cardio graphy. Right supraclavicular approach. Flow in ascending aorta and the innominate artery

Movie Clip 11.31A: Two-dimensional transthoracic echo-cardio graphy. Parasternal long-axis view. Left-sidedsuperior vena cava.

Movie Clip 11.31B: Two-dimensional transthoracic echo-cardio graphy. Leftsupraclavicularexamination.Left-sided superior vena cava.

Movie Clip 11.31C: Two-dimensional transthoracic echo-cardiography.Leftsupraclavicularexamination.Left-sided superior vena cava.

Movie Clip 11.31D: Two-dimensional transthoracic echo-cardio graphy. Leftsupraclavicularexamination.Left-sided superior vena cava.

Movie Clip 11.31F: Two-dimensional transthoracic echo-cardio graphy. Right supraclavicular examination. Rightsuperior vena cava.

Movie Clip 11.32: Live/real time three-dimensional supra-clavicular transthoracic echocardiographic examination.Venous valve at the junction of left innominate vein with superior vena cava.

Movie Clip 11.33A (Part 1): Live/real time three-dimen-sional transthoracic echocardiography. Supraclavicularapproaches. Thrombus in innominate veins and superior vena cava.

Movie Clip 11.33A (Part 2): Live/real time three-dimen-sional transthoracic echocardiography. Supraclavicularapproaches. Thrombus in innominate veins and superior vena cava.

Movie Clip 11.33E: Live/real time three-dimensional trans-thoracicechocardiography.Supraclavicularapproaches. Thrombus in innominate veins and superior vena cava.

Movie Clip 11.33F: Live/real time three-dimensional trans-thoracicechocardiography.Supraclavicularapproaches. Thrombus in innominate veins and superior vena cava.

Movie Clip 11.33G: Live/real time three-dimensional trans-thoracicechocardiography.Supraclavicularapproaches. Thrombus in innominate veins and superior vena cava.

Movie Clip 11.33H: Live/real time three-dimensional trans-thoracicechocardiography.Supraclavicularapproaches. Thrombus in innominate veins and superior vena cava.

xlii Comprehensive Textbook of Echocardiography

Movie Clip 11.33I: Live/real time three-dimensional trans-thoracicechocardiography.Supraclavicularapproaches.Thrombus in innominate veins and superior vena cava.

Movie Clip 11.34: Two-dimensional transthoracic echo-cardiography.Parasternalshort-axisviewatthelevelofthe aorta. Left main coronary artery.

Movie Clip 11.39: Two-dimensional transthoracic echo-cardio graphy. Apical four-chamber view. Left atrial appe-ndage.

Movie Clip 11.40: Live/real time three-dimensional trans-thoracic study. Clot in left atrial appendage.

Movie Clip 11.41A: Live/real time three-dimensional trans-thoracic echocardiography. Left atrial appendage.

Movie Clip 11.41B (Part 1): Live/real time three-dimensional trans thoracic echocardiography. Left atrial appendage.

Movie Clip 11.41B (Part 2): Live/real time three-dimensional trans thoracic echocardiography. Left atrial appendage.

Movie Clip 11.42: Live/real time three-dimensional trans-thoracic echocardiography. Left atrial appendage in aortic short-axisview.

Movie Clip 11.43: Live/real time three-dimensional trans-thoracic study. Mass in left atrial appendage.

Movie Clip 11.44A: Two-dimensional transthoracic echo-cardiographicexaminationfromthebacklymphomaandbilateral pleural effusion.

Movie Clip 11.44B: Two-dimensional transthoracic echo-cardiographicexaminationfromthebacklymphomaandbilateral pleural effusion.

Movie Clip 11.44C: Two-dimensional transthoracic echo-cardiographicexaminationfromthebacklymphomaandbilateral pleural effusion.

Movie Clip 11.44D: Two-dimensional transthoracic echo-cardiographicexaminationfromthebacklymphomaandbilateral pleural effusion.

Movie Clip 11.44F: Two-dimensional transthoracic echo-cardiographicexaminationfromthebacklymphomaandbilateral pleural effusion.

Movie Clip 11.45A: Two-dimensional transthoracic echo-cardiography.Examinationfromtheleftback.Largeleftpleural effusion.

Movie Clip 11.45B: Two-dimensional transthoracic echo-cardiography.Examinationfromtheleftback.Largeleftpleural effusion.

Movie Clip 11.46A: Two-dimensional subcostal echocardio-graphy. Aortic dissection.

Movie Clip 11.46B: Two-dimensional subcostal echocardio-graphy. Aortic dissection.

Movie Clip 11.46C: Two-dimensional subcostal echocardio-graphy. Aortic dissection.

Movie Clip 11.47A: Two-dimensional subcostal echocardio-graphy: Abdominal aortic atherosclerosis.

Movie Clip 11.47B: Two-dimensional subcostal echocardio-graphy. Abdominal aortic atherosclerosis.

CHAPTER 12* Movie Clip 12.1: Short axis of the left ventricle obtainedwiththeCONTISCANtransducer.Imageswereobtainedduring lateral rotation of the patient from 0° to 90° in 20° increments.

Movie Clips 12.2A and B:(A)LVshort-axisviewdepictingnormal wall motion during a chest free pain period; (B) Depicts akinesis of the anterolateral wall during an epi-sode of chest pain.

Movie Clip 12.3: Baseline echocardiogram.Movie Clip 12.4: Echocardiogramat peakexercise (slow

playback) illustrating lung interference.Movie Clip 12.5:Echocardiogramatpeakexercisewithout

lung interference (slow playback and real time motion).Movie Clip 12.6: LV short-axis view in a normal patient.

Increased heart rate on walking.Movie Clip 12.7: LV short-axis view depicting normal LV

wall motion at rest in a patient with CAD.

CHAPTER 13 Movie Clip 13.1:ScanningbeamalongY-andZ-axes.Movie Clip 13.2:Parasternalexamination.Movie Clips 13.13A to C: Two-dimensional bubble study. Parasternallong-axisview.

Movie Clips 13.13D to H: Three-dimensional bubble study. Parasternallong-axisview.

Movie Clip 13.14:Echo-freespaceinparasternallong-axisview.

Movie Clip 13.15A:Superior vena cavaand right pulmo-naryarterybehindtheaortainparasternallong-axisview.

Movie Clip 13.15B:Superior vena cavaand right pulmo-naryarterybehindtheaortainparasternallong-axisview.

Movie Clip 13.15C:Superior venacavaand rightpulmo-naryarterybehindtheaortainparasternallong-axisview.

Movie Clips 13.16A to C: Superior vena cava and rightpulmonary artery behind the aorta in parasternal long-axisview.

Movie Clips 13.16D to E:Superiorvenacavaandrightpul-monaryarterybehind theaorta inparasternal long-axisview.

Movie Clip 13.17:Superiorvenacavaandrightpulmonaryarterybehindtheaortainparasternallong-axisview.

Movie Clip 13.22 (Parts 1 and 2):Apicalexamination.Movie Clip 13.23 (Part 1): Cropping of apical view from

ventricular and atrial aspects.Movie Clip 13.23 (Part 2): Apical view of the attachment of

the anterolateral papillary muscle in the left ventricle.Movie Clip 13.23 (Part 3): Cropping of the right heart

showing entrance of coronary sinus into the right atrium.Movie Clip 13.26: Supraclavicular transthoracic exami-

nation.

xliiiDVD Contents

Movie Clips 13.27A and B:Rightparasternalexamination.Movie Clips 13.27P and Q: Large thrombus in right atrium. Rightparasternalexamination.

Movie Clip 13.28 (Part 1): Right parasternal view of ascending aorta and right atrial appendage.

Movie Clip 13.28 (Part 2): Right parasternal view of ascending aorta and right atrial appendage.

Movie Clip 13.29: Right parasternal view of pulmonary valve, main pulmonary artery, pulmonary artery branches, and left atrium.

Movie Clip 13.30: Tricuspid valve regurgitation.

CHAPTER 14 Movie Clip 14.1: Tomographic views of the left ventricle

(LV) in diastole during a bicycle stress test.Movie Clip 14.2: Tomographic views of the left ventricle

(LV) in diastole during a bicycle stress test.Movie Clip 14.3: Apical view of the aortic valve/annulus in

systole.Movie Clip 14.4: Mitral and tricuspid valves from ventricular

aspect.Movie Clip 14.5: Mitral valve from left ventricle.Movie Clip 14.6: Mitral valve from left atrium.Movie Clip 14.7: Mitral valve prolapse (P3 scallop) from left

atrium.Movie Clip 14.8: Mitral valve prolapse (P2) from left atrium.Movie Clip 14.9: Tricuspid valve from right ventricle.

CHAPTER 19* Movie Clip 19.1B: Heart specimen.Movie Clip 19.2: Radial strain.Movie Clip 19.4: Longitudinal strain.Movie Clip 19.5: Circumferential strain.Movie Clip 19.7 (Part 1): Rotation and twist.Movie Clip 19.7 (Part 2): Rotation and twist.Movie Clip 19.9 (Part 1): Velocity vector imaging.Movie Clip 19.9 (Part 2): Velocity vector imaging.Movie Clip 19.9 (Part 3): Velocity vector imaging.Movie Clip 19.12: Graphic display of longitudinal strain.Movie Clip 19.18: Area strain.Movie Clip 19.19: Two-dimensional intraventricular flow

analysis.Movie Clip 19.20: Three-dimensional LV simulated flow

assessment.

CHAPTER 20* Movie Clip 20.1: Normal velocity vector imaging of the left ventricular(LV)endocardiumintheshortaxis.

Movie Clip 20.2: Normal velocity vector imaging of the LV endocardium in the apical four-chamber. (LA: Left atrium).

Movie Clip 20.3: Normal velocity vector imaging of the LV endocardiuminthelongaxis.

Movie Clip 20.4: Velocity vector imaging of the LV endo-cardium of a normal mid-trimester fetus.

Movie Clip 20.5: Velocity vector imaging of the RV endo-cardium of a normal mid-trimester fetus.

Movie Clip 20.6: Left ventricular torsion calculated from velocity vector imaging data.

Movie Clip 20.7: Three-dimensional strain in a heart with chronic rejection.

CHAPTER 21* Movie Clip 21.1: Linear oscillation of microbubble.Movie Clip 21.2: Non-linear oscillation of microbubble.Movie Clip 21.3: Normal myocardial contrast imaging.Movie Clip 21.4: Normal myocardial contrast imaging.Movie Clip 21.5: Abnormal myocardial contrast imaging.Movie Clip 21.6: Abnormal myocardial contrast imaging.Movie Clip 21.7: Poor visualization of endocardium without

contrast.Movie Clip 21.8: Clear delineation of LV endocardium

following contrast administration.Movie Clip 21.9: Apical four-chamber view. No apical

abnormality seen without contrast.Movie Clip 21.10: Apical four-chamber view. Apical throm-

bus seen following contrast administration.Movie Clip 21.11: Left ventricular noncompaction. Unen-hancedparasternalshort-axisview.

Movie Clip 21.12: Left ventricular noncompaction. Para-sternalshort-axisviewfollowingcontrastadministration.

Movie Clip 21.13: Left ventricular noncompaction. Unen-hanced apical four-chamber view.

Movie Clip 21.14: Left ventricular noncompaction. Apical four-chamber view following contrast administration.

Movie Clip 21.15: Cardiac rupture. Unenhanced para-sternalshort-axisview.

Movie Clip 21.16: Cardiac rupture. Contrast enhanced parasternalshort-axisview.

Movie Clip 21.17: Apical 4-chamber view in another patient with ischemic cardiomyopathy being considered for cardiac resynchronization therapy.

Movie Clip 21.18: Apical 4-chamber view in another patient with ischemic cardiomyopathy being considered for cardiac resynchronization therapy.

Movie Clip 21.19: Attenuation artifact preventing perfusion assess ment.

Movie Clip 21.20: Well opacified left ventricle with theimaging settings optimized.

Movie Clip 21.21:Swirlingartifact.Movie Clip 21.22: Blooming artifact.

xliv Comprehensive Textbook of Echocardiography

Movie Clip 23: Bubble study. Patent foramen ovale.Movie Clip 21.24: Patent foramen ovale. Bicaval view on

two-dimensional transesophageal echocardiogram.Movie Clip 21.25: Patent foramen ovale. Three-dimensional

trans esophageal echocardiogram.

CHAPTER 23 Movie Clip 23.10C:EffectofreleasedNOonconduitartery.Movie Clip 23.13 CS-2g: Shear rate and brachial artery

diameter after reactive hyperemic stress.Movie Clip 23.13 CS-3c: Shear rate and brachial artery

diameter after reactive hyperemia.Movie Clip 23.26 CS-4b:ColorflowsignalsandPIC.Movie Clip 23.26 CS-4d: Doppler velocity wave forms.Movie Clip 23.26 CS-4e: Decline in peak velocity during inflation(occlusion).

Movie Clip 23.26 CS-4h: Reactive hyperemia following deflation(occlusion-release).

Movie Clip 23.26 CS-4k:Changeinluminaldiameterinfirst30secofdeflation.

CHAPTER 24* (Movie clips prepared by Drs Navin C Nanda and Andrew P Miller with the help of Drs Kunal Bhagatwala and Nidhi M Karia)

Movie Clip 24.1: Two-dimensional transesophageal echo-cardiographic procedure.

Movie Clip 24.2: Normal two-dimensional transesophageal echocardiographicexamination.

Movie Clip 24.3: Two-dimensional transesophageal echo-cardio graphy.

Movie Clip 24.4: Pulmonary veins. Movie Clip 24.5: Five-chamber view. Movie Clip 24.6: Left atrial appendage. Movie Clip 24.7: Hypertrophed pectinate muscles mimick-

ing a clot in the left atrial appendage. Movie Clip 24.8: Velocity vector imaging. Movie Clip 24.9: Rheumatic mitral and tricuspid valve dis-

ease. Movie Clip 24.10: Mitral regurgitation. Movie Clip 24.11:Severemitralregurgitation.Movie Clip 24.12: Mitral valve prolapse. Movie Clip 24.13: Redundancy of the middle (A2) segment

of the mitral valve with regurgitation. Movie Clip 24.14:Myxomatousmitral valvewith chordae

rupture. Movie Clip 24.15: Mitral valve prolapse and vegetation with

chordae rupture. Movie Clip 24.16: Mitral valve vegetation. Movie Clip 24.17: Mitral valve vegetation with chordae rup-

ture.

Movie Clip 24.18: Mitral and aortic valve vegetations. Movie Clip 24.19: Mitral, aortic and tricuspid valve vegeta-

tions. Movie Clip 24.20: Mitral valve perforation. Movie Clip 24.21: Aortic valve prolapse with severe aortic

regur gitation. Movie Clip 24.22: Flail aortic valve with leaflet nonco-

aptation. Movie Clip 24.23: Flail aortic valve. Movie Clip 24.24: Perforation of the right coronary cusp of

the aortic valve. Movie Clip 24.25: Aortic dissection. Movie Clip 24.26: Aortic dissection. Movie Clip 24.27: Postoperative development of aortic dis-

section. Movie Clip 24.28: Aortic dissection with rupture into the

media stinum. Movie Clip 24.29: Aortic dissection with rupture into the

media stinum. Movie Clip 24.30: Intraluminal aortic tube graft dehiscence. Movie Clip 24.31: Mitral prosthetic valve dysfunction. Movie Clip 24.32: Thrombus following mitral valvular

replace ment. Movie Clip 24.33: Mitral prosthesis valvular regurgitation. Movie Clip 24.34: Paravalvular mitral prosthetic regur-

gitation. Movie Clip 24.35: Paravalvular mitral prosthetic regur-

gitation. Movie Clip 24.36: Degenerated tissue mitral prosthesis

with cusp prolapse. Movie Clip 24.37: Degenerated tissue mitral prosthesis

with cusp rupture. Movie Clip 24.38: Prosthetic aortic valve abscess. Movie Clip 24.39: Ventricular septal defect following aortic

valve replacement. Movie Clip 24.40: Homograft aortic valve prosthesis degen-

eration. Movie Clip 24.41: Tricuspid valve prosthesis. Movie Clip 24.42:Leftatrialmyxoma.Movie Clip 24.43:Rightatrialmyxoma.Movie Clip 24.44:Extracardiactumor.Movie Clip 24.45: Patent foramen ovale. Movie Clip 24.46: Iatrogenic atrial septal defect. Movie Clip 24.47: Partial atrioventricular septal defect

(ostium primum atrial septal defect).

CHAPTER 25 Movie Clip 25.1:Examinationofaorticarchandbranches.Movie Clip 25.2:Transpharyngealexaminationofleftsided

carotid arteries.

xlvDVD Contents

Movie Clip 25.6A: Transesophageal echocardiographic detection of left subclavian artery branches.

Movie Clip 25.6B: Transesophageal echocardiographic detection of left subclavian artery branches.

Movie Clip 25.6C: Transesophageal echocardiographic detection of left subclavian artery branches.

Movie Clip 25.7A: Left internal mammary artery to left anterior descending coronary artery graft.

Movie Clip 25.7B: Left internal mammary artery to left anterior descending coronary artery graft.

Movie Clip 25.7C: Left internal mammary artery to left anterior descending coronary artery graft.

Movie Clip 25.7D: Left internal mammary artery to left anterior descending coronary artery in another patient with stenosis in the junctional region.

Movie Clip 25.7E: Left internal mammary artery to left anterior descending coronary artery in another patient with stenosis in the junctional region.

Movie Clip 25.7F: Left internal mammary artery to left anterior descending coronary artery in another patient with stenosis in the junctional region.

Movie Clip 25.10: Transpharyngeal examination of right-sided carotid arteries.

Movie Clip 25.12: Transpharyngeal echocardiographic diagnosis of left carotid bulb and internal carotid artery stenosis.

Movie Clip 25.14: Transpharyngeal ultrasound evaluation of internal carotid stent in an octogenarian.

Movie Clip 25.17: Transesophageal echocardiographic identificationofbilateralvertebralostialstenosis.

Movie Clip 25.18: Transesophageal echocardiographic identificationofleftsubclavianarterystenosiswithstealphenomenon.

CHAPTER 27* Movie Clip 27.1: Full volume transthoracic zoomed view of

the mitral valve from the left atrium.Movie Clip 27.2: Live 3D zoomed transesophageal view of

the mitral valve from the left atrium. Movie Clip 27.3A: Live 3D transesophageal zoomed view

of the mitral valve from the left atrium.Movie Clip 27.3B: Live 3D transesophageal zoomed view

of the mitral valve from the left ventricle.Movie Clip 27.4A: Live 3D transthoracic parasternal view of

the aortic valve. Movie Clip 27.4B: Live 3D apical Five-chamber view of the

aortic valve.Movie Clip 27.5A: Live 3D transesophageal basal short axis view of a bicuspid aortic valve from the aortic perspective.

Movie Clip 27.5B:Live3Dtransesophagealshort-axisviewof a prosthetic aortic valve from the aortic perspective.

Movie Clip 27.6A: Live 3D transthoracic acquisition of thepulmonicvalve fromrightventricularoutflow tractview.

Movie Clip 27.6B: Live 3D transthoracic acquisition of the pulmonicvalvefromparasternalshort-axisview.

Movie Clips 27.7A and B: (A) Live 3D transesophageal acquisition of the pulmonic valve from a 90 degree high esophageal view; (B) Live 3D transesophageal acquisition of the pulmonic valve also from a 90 degree high esophageal view.

Movie Clips 27.8A and B: (A) Live 3D transthoracic echo of the tricuspid valve from the apical four-chamber view; (B) Live 3D transthoracic en face view of the tricuspid valve from the right atrium.

Movie Clip 27.9: 3D transesophageal image of the tricus-pid valve obtained from a mid-esophageal four-chamber view.

Movie Clips 27.10A to C: (A) 2D mid esophageal four-chamber transesophageal view of the mitral prosthesis. Paraval vular leak; (B) 2D mid esophageal four-chamber transesophageal view of the mitral prosthesis. Paravalvular leak; (C) Live 3D. Mitral prosthesis from the left atrium. Large paravalvular defect.

Movie Clips 27.11A to G: (A) 2D mid esophageal view. Partially dehised mitral ring; (B) Mitral insufficiency.Color Doppler examination; (C) 2D mid esophagealtwo chamber view. Partially dehisced mitral ring; (D) Live3Dexamination.Extentofpartiallydehiscedmitralring;(E)2Dlongitudinalviewof theaorticprosthesis;(F) 2D longitudinal view of the aortic prosthesis. Para-valvular leak; (G) 3D transesophageal imaging. Aortic prosthesis and mitral ring. Dehisced mitral ring and paravalvular aortic leak.

Movie Clips 27.12A to D: (A) 2D mid esophageal view. Tricuspid prosthesis gradients; (B) 2D mid esophageal view. Tricuspid prosthesis with regurgitation; (C) Live 3D transesophageal view of the tricuspid prosthesis from the right atrium; (D) Full volume 3D reconstruction of the tri-cuspid prosthesis. Prosthesis diameter.

Movie Clips 27.13A to D:(A)#26EdwardsSapienvalveina#31CarpentierEdwardsbioprostheticvalve; (B)Mildvalvular TR; (C) 3D transthoracic view. Tricuspid prosthe-sisfromRVinflowview;(D)Enfaceviewofthetricuspidvalve from the right atrium.

Movie Clips 27.14A to C:(A)2DTEEmidesophagealview.Partialflailposteriorsegmentwithtornchords;(B)ColorDoppler examination. Mitral insufficiency; (C) Live 3Dview of the mitral valve from the left atrium. Isolated P2 flailscallop.

Movie Clips 27.15A to C: (A) 2D mid esophageal four-chamber view.Mitralvalveprolapse;(B)ColorDopplerexamina-tion.Mitralregurgitation;(C)Live3Dexamination.Mitralvalve prolapse.

xlvi Comprehensive Textbook of Echocardiography

Movie Clips 27.16A to C: (A) 2D transesophageal ba-sal view. Aortic stenosis; (B) 2D transesophageal basal view.Aorticstenosis.ColorDopplerexamination;(C)2Dtransesophageal basal view. Aortic annulus measure-ment.

Movie Clips 27.17A and B: Live 3D transthoracic views. Mitral stenosis.

Movie Clips 27.18A and B: (A) Live 3D transthoracic echo. Mitral valve from the left atrium; (B) Planimetered mitral valve area.

Movie Clips 27.19A to C: (A)2DColorDopplerexamina-tion.Moderateaorticinsufficiencypost-valvuloplasty;(B)Live3Dwithcolor.Moderateaorticinsufficiency;(C)Live3D transthoracic examination. Disruption of the nativeaortic valve.

Movie Clips 27.20A and B:(A)2Dtransesophagealexami-nation. Mitral insufficiency; (B) 2D transesophageal examination.Mitralinsufficiency;(C)3Dtransesophagealexamination.Mitralvalveprolapse;(D)Planimetryofthemitral valve.

Movie Clips 27.21A and B: (A) Live 3D transesophageal examination.Pulmonaryvalveincarcinoidheartdisease;(B) Live 3D transesophageal examination. Tricuspidvalve in carcinoid heart disease.

CHAPTER 28 Movie Clips 28.1A and B: 3D transesophageal guidance of

transseptal puncture.Movie Clip 28.1D: 3D transesophageal guidance of trans-

septal puncture.Movie Clip 28.2: Anatomy of fossa ovalis.Movie Clip 28.3: Lipomatous hypertrophy of the interatrial

septum.Movie Clip 28.4: 3D transesophageal diagnosis of mitral

stenosis.Movie Clip 28.5A: Guidance of percutaneous mitral balloon

valvuloplasty.Movie Clips 28.5B and C: Guidance of percutaneous mitral

balloon valvuloplasty.Movie Clip 28.5D: Guidance of percutaneous mitral balloon

valvuloplasty.Movie Clip 28.6: Outcomes of percutaneous mitral balloon

valvulo plasty.Movie Clip 28.7: Guidance of mitral valve clipping.Movie Clip 28.8: Delivery of mitral clip.Movie Clip 28.21A: TUPLE maneuver for orienting the

interatrial septum.Movie Clip 28.21B: TUPLE maneuver for orienting the

interatrial setum.Movie Clip 28.43B: 3D appearance of left ventricular

pseudo aneurysm.

CHAPTER 32 Movie Clip 31.1: Intravascular ultrasound with virtual histol-

ogy of coronary artery.

CHAPTER 34* Movie Clip 34.1: Automatic segmentation algorithms.

Delineation of LV endocardial border.Movie Clip 34.2: Automatic segmentation of the LV through-

out the entire cardiac cycle.Movie Clip 34.3:3DEbasedLVendocardialsegmentation.Movie Clip 34.4: 3DE based LV wireframe (Beutel) with automaticderivedlongaxisoftheLV.

Movie Clip 34.5: Parametric display of regional wall motion timingontheLVBeuteland16segmentbulls-eyeview.

Movie Clip 34.6: Comparable parametric display of abnor-mal wall motion.

Movie Clip 34.7: Contraction front maps (CFM). Movie Clip 34.8: Velocity vectors throughout the cardiac

cycle. Movie Clip 34.9: Longitudinal velocity is displayed in a

dynamic parametric way.Movie Clip 34.10: 3D speckle tracking of the entire left

ventricular endocardial wall.Movie Clip 34.11:ExtractionofMPR“cutplanes”together

with the 3D speckle tracking based endocardial contours.Movie Clip 34.12: Functional parameter displayed in regional“timetopeak”displacement.

Movie Clip 34.13: Twist of left ventricle.Movie Clip 34.14: Tracking of ultrasound contrast bubbles

through LV.Movie Clip 34.15:TypicalflowpatterninLVbasedontrack-

ing contrast bubbles. Movie Clip 34.16:SegmentedRVinadynamicway.Movie Clip 34.17: Dynamic cast of the RV (Beutel) with RV volume-timecurveandmeasuredRVvolumesandEF.

Movie Clip 34.18: RV with its 3 compartments in a dynamic.Movie Clip 34.19: 4D MV-Assessment software (TomTec)

based on 3D speckle tracking.Movie Clip 34.20: Fusion of cardiac CT data with LV Beutel

generated by 3D echo.

CHAPTER 35 Movie Clip 35.8: Reverberations from the mitral valve

region.Movie Clip 35.9: Reverberatory artifact from a pacemaker.Movie Clip 35.10: Color artifact mimicking mitral regurgita-

tion.Movie Clip 35.11:Shadowingproducedbymitralprosthe-

sis.

xlviiDVD Contents

Movie Clip 35.12A: Shadowing and reverberations frommetallic mitral prosthesis.

Movie Clip 35.12B: Shadowing and reverberations frommetallic mitral prosthesis.

Movie Clip 35.13:Suture fromametallicprostheticmitralvalve and normal prosthetic motion.

Movie Clip 35.14: Acoustic shadowing from the metallic components of aortic prosthesis.

Movie Clip 35.16: Reverberations from the descending thoracic aorta.

Movie Clip 35.17: Artifactual flow signals behind thedescending thoracic aorta.

Movie Clip 35.18:Echogenicartifactsfromairbubbles.Movie Clip 35.19A: Artifact in descending aorta mimicking

dissection.Movie Clip 35.19B: Artifact in descending aorta mimicking

dissection.Movie Clip 35.20: Artifacts resulting from the use of cautery

during surgery.Movie Clip 35.24: Artifactual discontinuity of the atrial

septum resulting from transducer or patient motion.Movie Clip 35.25A: Stitch artifact from patient and/or

transducer movement.Movie Clip 35.25B: Stitch artifact from patient and/or

transducer movement.Movie Clip 35.26: Artifacts from fibrinous material in

superior vena cava.Movie Clip 35.27A:Effectofinstrumentgainontheimage.Movie Clip 35.27B:Effectofinstrumentgainontheimage.Movie Clip 35.27C:Effectofinstrumentgainontheimage.Movie Clip 35.28A: Effect of color gain on colorDoppler

signals.Movie Clip 35.28B: Effect of color gain on colorDoppler

signals.Movie Clip 35.29: Effect of color gain on color Doppler

signals.Movie Clip 35.30: Artifact produced by a normal cusp of the

aortic valve.Movie Clip 35.31: Coumadin ridge.Movie Clip 35.32: Transesophageal echocardiography of

spinal cord and intervertebral disc.Movie Clip 35.33: Pectinate muscles in the left atrial

appendage mimicking a mass.Movie Clip 35.34:Lambl’sexcrescenceontheaorticvalve.Movie Clip 35.35A: Plaque in the descending thoracic aorta

mimicking tumor.Movie Clip 35.35B: Plaque in the descending thoracic aorta

mimicking tumor.Movie Clip 35.36A:EffectofNyquistlimitandcolorgainon

color Doppler signals.Movie Clip 35.36B:EffectofNyquistlimitandcolorgainon

color Doppler signals.

Movie Clip 35.36C:EffectofNyquistlimitandcolorgainoncolor Doppler signals.

Movie Clip 35.36D:EffectofNyquistlimitandcolorgainoncolor Doppler signals.

Movie Clip 35.36E:EffectofNyquistlimitandcolorgainoncolor Doppler signals.

CHAPTER 38 Movie Clip 38.1: Mitral stenosis.Movie Clip 38.2: Mitral stenosis.Movie Clip 38.3: Mitral stenosis.Movie Clip 38.4A: Mitral stenosis.Movie Clip 38.4B: Mitral stenosis.Movie Clip 38.5: Mitralstenosis.Subvalvularthickening.Movie Clip 38.6: Mitralstenosis.Subvalvularthickening.Movie Clip 38.7: Mitralstenosis.Subvalvularthickening.Movie Clip 38.8: Mitralstenosis.Subvalvularthickening.Movie Clip 38.9: Calcificmitralstenosis.Movie Clip 38.10: Calcificmitralstenosis.Movie Clip 38.12: Mitral valve gradient.Movie Clip 38.14A: Mitralvalveorificearea.Movie Clip 38.14B: Mitralvalveorificearea.Movie Clip 38.16A: Spontaneouscontrastinleftatrium.Movie Clip 38.16B: Left atrial appendage clot.Movie Clip 38.16C: Left atrial clot.Movie Clip 38.16D: Left atrial clots.Movie Clip 38.16E: Left atrial clot.Movie Clip 38.16F: Left atrial clot.Movie Clip 38.18: Severemitralregurgitation.Movie Clip 38.19: Severetricuspidregurgitation.Movie Clip 38.20: Mitral stenosis with left atrial thrombus.Movie Clip 38.21: Mitral stenosis with giant left atrium.Movie Clip 38.22A: Balloon mitral valvotomy.Movie Clip 38.22B: Balloon mitral valvotomy.Movie Clip 38.23: Mitral regurgitation secondary to chordal

tear.Movie Clip 38.24: Mitral regurgitation secondary to chordal

tear.Movie Clip 38.25: Balloon mitral valvotomy.Movie Clip 38.26: Balloon mitral valvotomy.Movie Clip 38.27A: Balloon mitral valvotomy.Movie Clip 38.27B: Balloon mitral valvotomy.Movie Clip 38.28A: Balloon mitral valvotomy.Movie Clip 38.28B: Balloon mitral valvotomy.Movie Clip 38.29A: Balloon mitral valvotomy.Movie Clip 38.29B: Balloon mitral valvotomy.Movie Clip 38.30: Pericardial effusion secondary to left

atrial per foration.

xlviii Comprehensive Textbook of Echocardiography

Movie Clip 38.31: Balloon mitral valvotomy with residual atrial septal defect.

Movie Clip 38.32: Doubleorificemitralvalve.Movie Clips 38.33A to C: Stenoticdoubleorificeparachute

mitral valve with single papillary muscle.Movie Clips 38.33D to G:Stenoticdoubleorificeparachute

mitral valve with single papillary muscle.Movie Clip 38.34A: Left atrial myxoma causing mitral

valvular obstruction.Movie Clip 38.34B: Left atrial myxoma causing mitral

valvular obstruction.Movie Clip 38.35: Severemitralstenosiswithaballvalve

thrombus.Movie Clip 38.38A: Mitral valve prolapse.Movie Clip 38.38B: Mitral valve prolapse.Movie Clip 38.38C: Mitral valve prolapse.Movie Clip 38.38D: Mitral valve prolapse.Movie Clip 38.38E: Mitral valve prolapse.Movie Clip 38.38F: Mitral valve prolapse.Movie Clip 38.39: Mitral valve prolapse.Movie Clip 38.40A: Flailmitralvalveleaflet.Movie Clip 38.40B: Flailmitralvalveleaflet.Movie Clip 38.40C: Flailmitralvalveleaflet.Movie Clip 38.40D: Flailmitralvalveleaflet.Movie Clip 38.41: Flailmitralvalveleaflet.Movie Clip 38.42A: Flailposteriormitralvalve leafletwith

aortic root aneurysm.Movie Clip 38.42B: Flailposteriormitralvalve leafletwith

aortic root aneurysm.Movie Clip 38.42C: Flailposteriormitralvalve leafletwith

aortic root aneurysm.Movie Clip 38.43A: Tricuspid valve prolapse associated

with mitral valve prolapse.Movie Clip 38.43B: Pulmonary valve prolapse associated

with mitral valve prolapse.Movie Clip 38.44: Mitral valve prolapse.Movie Clip 38.48: Mitral valve prolapse.Movie Clip 38.49A: Mitral valve prolapse.Movie Clip 38.49 (Cropping): Mitral valve prolapse.Movie Clip 38.50A (Left): Mitral valve prolapse.Movie Clip 38.50A (Right): Mitral valve prolapse.Movie Clip 38.50B (Left): Mitral valve prolapse.Movie Clip 38.50B (Right): Mitral valve prolapse.Movie Clip 38.51: Mitral valve prolapse.Movie Clip 38.52A: Mitral valve prolapse with chordae

rupture.Movie Clip 38.53A: Mitral valve prolapse with chordae

rupture.Movie Clip 38.53B: Mitral valve prolapse with chordae

rupture.

Movie Clip 38.54A: Mitral valve prolapse with chordae rupture.

Movie Clip 38.54B: Mitral valve prolapse with chordae rupture.

Movie Clip 38.55A: Mitral valve prolapse with chordae rupture.

Movie Clip 38.56: Dilated left ventricle with severe systolic dys function and severe mitral regurgitation.

Movie Clip 38.57: Papillary muscle rupture following acute myocardial infarction.

Movie Clip 38.58: Severemitral regurgitation in ischemiccardiomyopathy.

Movie Clip 38.59: Severemitral regurgitation in ischemiccardiomyopathy.

Movie Clip 38.60A: Mitralannularcalcificationresultinginmitral regurgitation.

Movie Clip 38.60B: Mitralannularcalcificationresultinginmitral regurgitation.

Movie Clip 38.60C: Mitralannularcalcificationresultinginmitral regurgitation.

Movie Clip 38.60D: Mitralannularcalcificationresultinginmitral regurgitation.

Movie Clip 38.61: Rheumatic mitral valve with severe mitral regurgitation.

Movie Clip 38.62: Rheumatic mitral valve with severe mitral regurgitation.

Movie Clip 38.63: Mitral valve vegetations.Movie Clip 38.64: Mitral valve abscess and rupture into left

atrium.Movie Clip 38.65: Mitral valve perforation due to endocar-

ditis.Movie Clip 38.66: Mitral valve perforation due to endocar-

ditis.Movie Clip 38.67: Mitral aortic intervalvular fibrosa

aneurysm rupturing into left atrium.Movie Clip 38.68: Submitral aneurysm with endocarditis

and perforation.Movie Clip 38.69: Mitral prosthesis. Paravalvular regurgita-

tion.Movie Clip 38.70: Mitral prosthesis. Paravalvular regurgita-

tion.Movie Clip 38.71A: Central mitral regurgitation.Movie Clip 38.71B: Eccentricmitralregurgitation.Movie Clip 38.72: Severemitral regurgitation. Vena con-

tracta.Movie Clip 38.77: Vena contracta measurement in mitral

regurgi tation.Movie Clip 38.78: Vena contracta measurement in tricuspid

regurgitation.Movie Clip 38.79: Vena contracta measurement in aortic

regurgitation.Movie Clip 38.80: Vena contracta measurement in pulmo-

nary regur gitation.

xlixDVD Contents

CHAPTER 39* Movie Clip 39.1: Degenerative disease: Billowing mitral

valve.Movie Clip 39.2: Degenerative disease: Billowing mitral

valve.Movie Clip 39.3: Degenerative disease: Billowing mitral

valve.Movie Clip 39.4: Degenerative disease: Billowing mitral

valve.Movie Clip 39.5: Rheumatic mitral stenosis. Movie Clip 39.6: Mitral valve vegetation. Movie Clip 39.7: Mitral valve vegetation.Movie Clip 39.8: Mitral regurgitation.Movie Clip 39.9: Mitral regurgitation.Movie Clip 39.10:Bi-leafletmitralvalverestriction.Movie Clip 39.11:Bi-leafletmitralvalverestriction.Movie Clip 39.12: Mitral regurgitation.Movie Clip 39.13: Assessment of mitral regurgitation. Vena

contracta width.Movie Clip 39.14: Ischemic mitral regurgitation.Movie Clip 39.15: Ischemic mitral regurgitation.

CHAPTER 40* Movie Clip 40.1:TEEshort-axisviewoftheaorticvalve.Movie Clip 40.2:3DTEEimageofabicuspidaorticvalve.Movie Clip 40.3: Quadricuspid aortic valve.Movie Clip 40.4: Bicuspid aortic valve.Movie Clip 40.5: Bicuspid aortic valve with perforation and

vegetation.Movie Clip 40.6: Bicuspid aortic valve.

CHAPTER 42 Movie Clip 42.1:Degenerativefibrocalcificaorticvalvedis-

ease.Movie Clip 42.2:Degenerativefibrocalcificaorticvalvedis-

ease.Movie Clip 42.3: Quadricuspid aortic valve.Movie Clip 42.4: Aortic regurgitation resulting from obstruc-

tive subaortic membranes.Movie Clip 42.5: Aortic regurgitation resulting from obstruc-

tive subaortic membranes.Movie Clip 42.6: Aortic regurgitation resulting from obstruc-

tive subaortic membranes.Movie Clip 42.7: Aortic regurgitation resulting from aortic

valve endocarditis.Movie Clip 42.8: Aortic regurgitation resulting from aortic

valve endocarditis.Movie Clip 42.9: Aortic regurgitation in a patient with LV

assist device.

Movie Clip 42.10: Ascending aortic dissection causing aortic regurgitation.

Movie Clip 42.11: Ascending aortic dissection causing aortic regurgitation.

Movie Clip 42.12: Ascending aortic dissection causing aortic regurgitation.

Movie Clip 42.13: Aortic regurgitation. Vena contracta width.Movie Clip 42.14: Aortic regurgitation. Vena contracta width.Movie Clip 42.15: Aortic regurgitation. Vena contracta width.

CHAPTER 43 Movie Clip 43.3A:SinusofValsalvaaneurysmofthenon-

coronary cusp of aortic valve.Movie Clip 43.3B: Paravalvular abscess of the aortic root withparavalvularflow.

Movie Clip 43.6:Subcostalview.Abdominalaorta in longaxis.

Movie Clip 43.8: Patent ductus arteriosus.Movie Clip 43.11:Aorticarchexamination.Movie Clip 43.16: Aneurysm of the distal ascending aorta andproximalaorticarch.

Movie Clip 43.18A: Ascending aortic aneurysm.Movie Clip 43.18B: Ascending aortic aneurysm with aortic

regurgitation.Movie Clip 43.22A: Aortic dissection.Movie Clip 43.22B: Aortic dissection.Movie Clip 43.23A: Aortic dissection.Movie Clip 43.23B: Aortic dissection.Movie Clip 43.29: Traumatic rupture of aortic arch.

CHAPTER 45 Movie Clip 45.15:Threeleafletsofthetricuspidvalve.Movie Clip 45.16: Tricuspid regurgitation.Movie Clip 45.17A: Tricuspid regurgitation.Movie Clip 45.17B: Tricuspid regurgitation.Movie Clip 45.18A:Systemiclevelpulmonaryhypertension.Movie Clip 45.18B:Systemiclevelpulmonaryhypertension.Movie Clip 45.18C: Systemic level pulmonary hyperten-

sion.Movie Clip 45.18G: Systemic level pulmonary hyperten-

sion.Movie Clip 45.19B: Tricuspid regurgitation.Movie Clip 45.21:EffectofNyquistlimitandcolorgainon

color Doppler regurgitant jet area.Movie Clip 45.27B: Tricuspid regurgitation.Movie Clip 45.28A: Tricuspid regurgitation before annulo-

plasty.Movie Clip 45.28B: Tricuspid regurgitation after annulo-

plasty.Movie Clip 45.30A: Rheumatic tricuspid valve regurgitation.

l Comprehensive Textbook of Echocardiography

Movie Clip 45.30C: Rheumatic tricuspid valve regurgitation.Movie Clip 45.31B: Tricuspid regurgitation.Movie Clip 45.32A: Tricuspid valve stenosis.Movie Clip 45.32B: Tricuspid valve stenosis.Movie Clip 45.32C: Tricuspid valve stenosis.Movie Clip 45.32H: Tricuspid valve stenosis.Movie Clip 45.33A (Part 1): Carcinoid heart disease.Movie Clip 45.33A (Part 2): Carcinoid heart disease.Movie Clip 45.33A (Part 3): Carcinoid heart disease.Movie Clip 45.33B: Carcinoid heart disease.Movie Clip 45.33C: Carcinoid heart disease.Movie Clip 45.34A:Loeffler’sendocarditis.Beforetherapy.Movie Clip 45.34B:Loeffler’sendocarditis.Beforetherapy.Movie Clip 45.34C:Loeffler’sendocarditis.Beforetherapy.Movie Clip 45.35A:Loeffler’sendocarditis.Aftertherapy.Movie Clip 45.35B:Loeffler’sendocarditis.Aftertherapy.Movie Clip 45.35C:Loeffler’sendocarditis.Aftertherapy.Movie Clip 45.36A: Tricuspid valve prolapse.Movie Clip 45.36C: Tricuspid valve prolapse.Movie Clip 45.37A: Tricuspid valve prolapse.Movie Clip 45.37B: Tricuspid valve prolapse.Movie Clip 45.37C: Tricuspid valve prolapse.Movie Clip 45.39A: Tricuspid valve prolapse.Movie Clip 45.40A (Part 1): Flail tricuspid valve.Movie Clip 45.40A (Part 2): Flail tricuspid valve.Movie Clip 45.41A: Tricuspid papillary muscle and chordae

rupture.Movie Clip 45.42A (Part 1): Tricuspid papillary muscle and

chordae rupture.Movie Clip 45.42A (Part 2): Tricuspid papillary muscle and

chordae rupture.Movie Clip 45.42C: Tricuspid papillary muscle and chordae

rupture.Movie Clip 45.44: Right ventricular papillary muscle

rupture.Movie Clip 45.45A: Tricuspid valve vegetation.Movie Clip 45.45B: Tricuspid valve vegetation.Movie Clip 45.45C: Tricuspid valve vegetation.Movie Clip 45.45D: Tricuspid valve vegetation.Movie Clip 45.45E: Tricuspid valve vegetation.Movie Clips 45.47A and B: Tricuspid valve vegetations.Movie Clip 45.47C: Tricuspid valve vegetations.Movie Clip 45.47D: Tricuspid valve vegetations.Movie Clip 45.47E: Tricuspid valve vegetations.Movie Clip 45.47F: Tricuspid valve vegetations.Movie Clip 45.48A: Tricuspid valve vegetation.Movie Clip 45.48B: Tricuspid valve vegetation.Movie Clip 45.48C: Tricuspid valve vegetation.Movie Clip 45.48E: Tricuspid valve vegetation.

Movie Clip 45.48F: Tricuspid valve vegetation.Movie Clip 45.48G: Tricuspid valve vegetation.Movie Clip 45.49: Tricuspid valve vegetation.Movie Clip 45.50A: Tricuspid valve vegetation.Movie Clip 45.50B: Tricuspid valve vegetation.Movie Clip 45.53A: Normal tricuspid valve prosthesis.Movie Clip 45.53B: Normal tricuspid valve prosthesis.Movie Clip 45.54: Normal tricuspid valve prosthesis.Movie Clip 45.55A:Tricuspidvalvefibroelastoma.Movie Clip 45.55B:Tricuspidvalvefibroelastoma.Movie Clip 45.55C:Tricuspidvalvefibroelastoma.Movie Clip 45.55D:Tricuspidvalvefibroelastoma.Movie Clip 45.57A:Ebstein’sanomaly.Movie Clip 45.57B:Ebstein’sanomaly.Movie Clip 45.57C:Ebstein’sanomaly.Movie Clip 45.57D:Ebstein’sanomaly.Movie Clip 45.62A:Ebstein’sanomaly.Movie Clip 45.62B:Ebstein’sanomaly.

CHAPTER 46 (Movie clips prepared by Drs Navin C Nanda, Ming C Hsiung, Kunal Bhagatwala and Nidhi M Karia)

Movie Clip 46.1A: Pulmonary valve stenosis.Movie Clip 46.2: Mild pulmonary valve regurgitation.Movie Clip 46.3:Severepulmonaryregurgitation.Movie Clip 46.4:Severepulmonaryregurgitation.

CHAPTER 47 Movie Clip 47.12A: Mitral valve vegetation.Movie Clip 47.13A: Mitral valve vegetation.Movie Clip 47.14: Mitral valve vegetation progression.Movie Clip 47.15A: Aortic valve vegetation.Movie Clip 47.16: Aortic valve vegetation.Movie Clip 47.17: Prosthetic aortic valve vegetation and

abscess.Movie Clip 47.18: Tricuspid valve vegetation.Movie Clip 47.19: Pulmonary valve vegetation.Movie Clip 47.20: Mitral valve vegetations.Movie Clip 47.21: Mitral valve vegetations.Movie Clip 47.22: Mitral valve vegetations.Movie Clip 47.23A: Mitral valve vegetation.Movie Clip 47.23B: Mitral valve vegetation with perforation.Movie Clip 47.23C: Mitral valve vegetation with perforation

and mitral regurgitation.Movie Clip 47.23D: Mitral valve vegetation with perforation

and mitral regurgitation.Movie Clip 47.24: Mitral valve vegetation.Movie Clip 47.25A: Large mitral valve vegetation with a

central perforation.

liDVD Contents

Movie Clip 47.25B: Large mitral valve vegetation with annular abscess.

Movie Clip 47.26A: Mitral valve perforation.Movie Clip 47.26B: Mitral valve perforation.Movie Clip 47.27: Aortic valve vegetation with perforation.Movie Clip 47.28: Bicuspid aortic valve vegetation with

perforation.Movie Clip 47.29A: Prosthetic aortic valve vegetation.Movie Clip 47.29B: Prosthetic aortic valve dehiscence.Movie Clip 47.29C: Echodensity in left main coronary

artery.Mo