Thomas Buck, Andreas Franke, Mark J. Monaghan (Editors) Three-dimensional Echocardiography

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1 Thomas Buck, Andreas Franke, Mark J. Monaghan (Editors) Three-dimensional Echocardiography

2 Thomas Buck, Andreas Franke, Mark J. Monaghan (Editors) Three-dimensional Echocardiography With 248 figures including 825 single illustrations and 5 tables 1 23

3 Thomas Buck, MD, FACC, FESC Associate Professor of Medicine Assistant Director, Department of Cardiology Director, Echocardiography West German Heart Center Essen University Hospital Essen Essen, Germany Mark J. Monaghan, PhD, FRCP(Hon), FACC, FESC Professor of Echocardiography Director, Noninvasive Cardiology King s College Hospital London, UK Andreas Franke, MD, FESC Associate Professor of Medicine Head, Department of Cardiology, Angiology and Intensive Care Medicine Klinikum Region Hannover Klinikum Siloah Hannover, Germany ISBN Springer-Verlag Berlin Heidelberg New York Bibliographic information Deutsche Bibliothek The Deutsche Bibliothek lists this publication in Deutsche Nationalbibliographie; detailed bibliographic data is available in the internet at < This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable to prosecution under the German Copyright Law. SpringerMedizin Springer-Verlag GmbH ein Unternehmen von Springer Science+Business springer.de Springer-Verlag Berlin Heidelberg 2011 The use of general descriptive names, registered names, trademarks, etc. in this publications does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Planning: Hinrich Kuester, Heidelberg Project management: Barbara Karg, Heidelberg Copy-Editing: Dr. Mary Gossen, Dietzenbach Cover design: deblik Berlin Typesetting: TypoStudio Tobias Schaedla, Heidelberg, Germany SPIN

4 About the editors Thomas Buck, MD, FACC, FESC Thomas Buck is an Associate Professor of Medicine and Cardiology at the University Hospital of Essen, Germany. There he holds the position of Director of Echocardiography Laboratories as well as the appointments of Chief Consultant and Assistant Medical Director of the Department of Cardiology at the West German Heart Center. Since the beginning of his academic career in 1992, three-dimensional echocardiography has been a major field of his scientific interest. One of his primary clinical areas of expertise is the management of heart valve disease patients, where his early scientific work was stimulated while working as a Research Fellow at Massachusetts General Hospital. As one of his official assignments, he is currently acting as the Chair of the German Working Group of Echocardiography. In addition to a considerable number of scientific articles, his work includes several teaching book contributions and international patents in the field of echocardiography. Since the introduction of real-time 3D echocardiography into clinical practice, he has regularly organized national and international training courses as an expert trainer. Andreas Franke, MD, FESC Andreas Franke is Associate Professor of Medicine and Cardiology and Director of the Department of Cardiology, Angiology and Intensive Care Medicine of the Klinikum Siloah in Hannover, Germany. During his clinical and academic career starting in 1988 at the RWTH Technical University Aachen, echocardiography and congenital heart disease in adults have been his main fields of scientific interest and work. His primary clinical areas of expertise besides non-invasive cardiac imaging are the interventional therapy of coronary artery disease and the management of valvular disease. Since the early 90 s he was involved in further development of three-dimensional echocardiography and published numerous clinical studies on 3D echo. Between 1998 and 2001 he was nucleus member of the Working Group on Echocardiography of the ESC as organizer of the subgroup 3D echocardiography. Over the last ten years he also contributed to several textbooks and atlases on echocardiography. Moreover, since 2003 he regularly organizes national real-time 3D echocardiographic training courses as an expert trainer. Mark J. Monaghan PhD, FRCP(Hon), FACC, FESC Mark J. Monaghan is a Professor of Echocardiography and Director of Non- Invasive Cardiology at King s College Hospital, London UK. He has worked in the field of Echocardiography for over 25 years and has published extensively on the subject, especially on the use of 3D. In addition he holds two International patents on Echo technology and lectures widely at International meetings and Cardiology Conferences throughout the world. He runs several teaching Courses and Workshops on 3D Echocardiography every year and has contributed to and co-edited several textbooks. Professor Monaghan has been a Board member of the European Association of Echocardiography and is a past President of the British Society of Echocardiography.

5 Table of contents 1 Introduction Thomas Buck, Andreas Franke, and Mark J. Monaghan 2 Three-dimensional echocardiography: lessons in overcoming time and space Jos R.T.C. Roelandt and Joseph Kisslo 2.1 Reconstruction techniques The linear scanning approach The fan-like scanning approach The rotational scanning approach Volumetric real-time (high-speed) scanning The future is based on the past References Basic principles and practical application Thomas Buck (with contribution by Karl E. Thiele, Philips Medical Systems, Andover, MA, USA) 3.1 How real-time 3D ultrasound works It s all about the transmit beams The need for bigger, better, faster Fully sampled matrix array transducers Parallel receive beam processing Three-dimensional color flow The probes Live 3D echocardiographic examination First steps and learning curve Three-dimensional acquisition (modes and image settings) Standard 3D views Basic 3D analysis: cropping and slicing First steps of 3D dataset cropping Basic 3D measurements Artifacts Stitching artifacts Dropout artifacts Blurring and blooming artifacts Gain artifacts References Left ventricular function Harald P. Kühl 4.1 Assessment of left ventricular volumes and ejection fraction Evaluation of left ventricular mass Assessment of regional left ventricular function Determination of left ventricular dyssynchrony Parametric imaging Transesophageal real-time 3D echocardiography Three-dimensional assessment of left atrial volume and function References Three-dimensional stress echocardiography Andreas Franke 5.1 Method Clinical studies on 3D stress echocardiography Limitations New approaches and future perspectives...80 References Cardiac dyssynchrony Mark J. Monaghan and Shaumik Adhya 6.1 Technique Acquisition of 3D volumes Measures of intraventricular dyssynchrony Performing 3D analyses Measurement variability Normal values Dyssynchrony in heart failure and left bundle branch block Relationship between left ventricular function and dyssynchrony Patterns of dyssynchrony SDI as a predictor of outcome of cardiac resynchronisation therapy Dyssynchrony due to right ventricular pacing Dyssynchrony in other situations

6 VIII Table of contents In children In congenital right heart disease After acute myocardial infarction In amyloidosis Assessment of dyssynchrony after CRT Conclusion References The right ventricle Stephan von Bardeleben, Thomas Buck, and Andreas Franke 7.1 Assessment of right ventricular volumes and function New aspects of 3D right ventricular analysis References Valvular heart disease insufficiencies Thomas Buck 8.1 Mitral regurgitation Evaluation of mitral valve insufficiency Classification of mitral valve insufficiency Mitral valve prolapse, flail and Barlow s disease Mitral valve quantification Papillary muscle rupture Functional mitral regurgitation Endocarditis Mitral valve prosthesis Mitral valve repair Rare etiologies Assessment of severity of mitral regurgitation Aortic regurgitation Right-sided heart valves References Valvular heart disease stenoses Jose L. Zamorano and Jose Alberto de Agustín 9.1 Evaluation of mitral valve stenosis Morphological assessment of the mitral valve Functional assessment of mitral stenosis Evaluation of aortic valve stenosis Morphological assessment of aortic stenosis Functional assessment of aortic stenosis Evaluation of tricuspid and pulmonary valve stenosis Evaluation of prosthetic and reconstructed valves References Three-dimensional echocardiography in adult congenital heart disease Folkert J. Meijboom, Heleen van der Zwaan, and Jackie McGhie 10.1 Patent foramen ovale Atrial septal defect Ventricular septal defect Atrioventricular septal defects Ebstein s anomaly Transposition of the great arteries Congenitally corrected transposition of the great arteries Tetralogy of Fallot RT3DE in other congenital cardiac malformations The role of RT3DE in the analysis of right ventricular function Acquisition Analysis Conclusion References Congenital heart disease in children John M. Simpson 11.1 Technical and patient-specific factors Selection of imaging probes in children Presentation of 3D echocardiographic images Types of cardiac lesions which can be assessed using 3D echocardiography Abnormalities of venous drainage Atrial septal defects Ventricular septal defects Atrioventricular valves Atrioventricular septal defects Mitral valve abnormalities Ebstein s anomaly of the tricuspid valve Atrioventricular junction Complex anatomy Three-dimensional echocardiography during catheter intervention and surgery Imaging during catheter intervention Three-dimensional imaging during surgery Role of RT3DE in the assessment of cardiac function in children

7 Table of contents IX The left ventricle The right ventricle Conclusions References Cardiac tumors and sources of embolism Björn Plicht 12.1 Sources of embolism Cardiac and vascular thrombi, spontaneous echo contrast Patent foramen ovale Infective endocarditis Primary cardiac tumors Primary benign cardiac tumors Primary malignant tumors Secondary cardiac tumors and metastases References Monitoring and guiding cardiac interventions and surgery Harald P. Kühl, Andreas Franke, and Thomas Buck 13.1 Method Intraoperative monitoring and guiding Periinterventional monitoring and guiding Transcatheter closure of PFO and ASD Transcatheter closure of VSD Percutaneous aortic valve implantation Percutaneous mitral repair Left atrial appendage occluder implantation Percutaneous occluder implantation for paravalvular leaks Percutaneous mitral valvuloplasty Electrophysiological procedures Conclusion References Subject index

8 List of authors Adhya, Shaumik, BSc MBBS MRCP CCDS Clinical Research Fellow King s College Hospital London, UK de Agustín, Jose Alberto Senior Staff Universidad Complutense de Madrid University Clinic San Carlos Madrid, Spain von Bardeleben, Stephan, MD Director, Echocardiography Department of Cardiology University Hospital Mainz Mainz, Germany Buck, Thomas, MD, FACC, FESC Associate Professor of Medicine Assistant Director, Department of Cardiology Director, Echocardiography West German Heart Center Essen University Hospital Essen Essen, Germany Franke, Andreas, MD, FESC Associate Professor of Medicine Head, Department of Cardiology, Angiology and Intensive Care Medicine Klinikum Region Hannover Klinikum Siloah Hannover, Germany Kisslo, Joseph, MD Professor of Medicine Duke University Medical Center Durham, NC, USA Kühl, Harald P., MD Associate Professor of Medicine Head, Department of Cardiology Städtisches Klinikum München Klinikum Harlaching Munich, Germany McGhie, Jackie Chief sonographer Department of Cardiology The Thoraxcenter Erasmus University Medical Center Rotterdam, the Netherlands Meijboom, Folkert J., MD, PhD, FESC GUCH & pediatric cardiologist Dept of Pediatrics and Cardiology University Medical Centre Utrecht, Utrecht, the Netherlands Monaghan, Mark J., PhD, FRCP(Hon), FACC, FESC Professor of Echocardiography Director, Noninvasive Cardiology King s College Hospital London, UK Plicht, Björn, MD Senior Cardiologist Department of Cardiology West German Heart Center Essen University Hospital Essen Essen, Germany Roelandt, Jos R.T.C., MD, PhD, FESC Professor of Cardiology Emeritus Chairman Thoraxcenter Erasmus University Medical Center Rotterdam, the Netherlands Simpson, John M., MD, FRCP, FESC Consultant in Paediatric and Fetal Cardiology Director of Paediatric Echocardiography Evelina Children s Hospital Guy s and St Thomas NHS Foundation Trust London, UK Thiele, Karl E., ME Principal Scientist Philips Healthcare Andover, MA, USA

9 XII List of authors van der Zwaan, Heleen Senior Staff Department of Cardiology The Thoraxcenter Erasmus University Medical Center Rotterdam, the Netherlands Zamorano, Jose L., MD, FESC Professor of Medicine Universidad Complutense de Madrid Director, Cardiovascular Institute University Clinic San Carlos Madrid, Spain

10 List of figures and videos Chapter 1 Introduction Thomas Buck, Andreas Franke, and Mark Monaghan No Figures No videos Chapter 2 Three-dimensional echocardiography: lessons in overcoming time and space Jos R.T.C. Roelandt and Joseph Kisslo Fig. 2.1 page 4 No video Fig. 2.2 page 5 No video Fig. 2.3 page 5 No video Fig. 2.4 page 6 No video Fig. 2.5 page 7 No video Fig. 2.6 page 8 No video Fig. 2.7 page 8 No video Fig. 2.8 page 8 No video Fig. 2.9 page 9 No video Fig page 9 No video Fig page 11 No video Fig page 11 No video Fig page 12 No video Fig page 12 No video Fig page 13 No video Fig page 13 No video Fig page 14 No video Fig page 14 No video Fig page 15 No video Fig page 15 No video Fig page 16 No video Fig page 17 No video Fig page 17 No video Fig. 3.4 page 23 No video Fig. 3.5 page 23 No video Fig. 3.6 page 24 No video Fig. 3.7 page 25 No video Fig. 3.8 page 26 No video Fig. 3.9 page 26 No video Fig page 28 No video Fig page 28 No video Fig page 30 No video Fig page 31 Videos 3.13A-H Fig page 32 Videos 3.14A-D Fig page 33 Videos 3.15A-D Fig page 34 No Video Fig page 36 Videos 3.17A-H Fig page Videos 3.18A-L Fig page 41 Video 3.19 Fig page 42 Video 3.20 Fig page 42 Video 3.21 Fig page 43 Video 3.22 Fig page 43 Video 3.23 Fig page 44 Video 3.24 Fig page 44 Video 3.25 Fig page 45 Video 3.26 Fig page 45 Video 3.27 Fig page 46 Video 3.28 Fig page 46 Video 3.29 Fig page 47 Videos 3.30A, B Fig page 48 No video Fig page 49 Videos 3.32A-F Fig page 50 Videos 3.33 Fig page 50 Videos 3.34A-C Fig page 51 Videos 3.35A, B Fig page 52 Videos 3.36A-F Chapter 4 Left ventricular function Chapter 3 Basic principles and practical application Thomas Buck (with contribution by Karl E. Thiele) Fig. 3.1 page 21 No video Fig. 3.2 page 22 No video Fig. 3.3 page 22 No video Harald P. Kühl Fig. 4.1 page 56 Video 4.1 Fig. 4.2 page 57 No video Fig. 4.3 page 58 Video 4.3 Fig. 4.4 page 59 Videos 4.4A, B Fig. 4.5 page 60 No video Fig. 4.6 page 60 No video

11 XIV List of figures and videos Fig. 4.7 page 61 Videos 4.7A, B Fig. 4.8 page 62 Video 4.8 Fig. 4.9 page Videos 4.9A, C Fig page 66 No video Fig page 67 No video Fig page 68 Video 4.12 Fig page 69 Videos 4.13A, B Chapter 5 Three-dimensional stress echocardiography Andreas Franke Fig. 5.1 page 74 No video Fig. 5.2 page 74 Videos 5.2A, B Fig. 5.3 page 75 Videos 5.3A-F Fig. 5.4 page 76 Videos 5.4A-D Fig. 5.5 page 77 No video Fig. 5.6 page 78 No video Chapter 6 Cardiac dyssynchrony Mark J. Monaghan and Shaumik Adhya Fig. 6.1 page 87 Videos 6.1A, B Fig. 6.2 page 88 Video 6.2 Fig. 6.3 page 88 Video 6.3 Fig. 6.4 page 89 No video Fig. 6.5 page 89 Video 6.5 Fig. 6.6 page 90 Video 6.6 Fig. 6.7 page 90 Video 6.7 Fig. 6.8 page 91 No video Fig. 6.9 page 93 No video Fig page 94 No video Fig page 94 No video Chapter 7 The right ventricle Stephan von Bardeleben, Thomas Buck, and Andreas Franke Fig. 7.1 page 102 Videos 7.1A-D Fig. 7.2 page 102 Videos 7.2A, B Fig. 7.3 page 103 Videos 7.3A-D Fig. 7.4 page 105 No video Fig. 7.5 page 105 No video Fig. 7.6 page 106 Videos 7.6A-D Fig. 7.7 page 106 Videos 7.7A, B Fig. 7.8 page 107 No video Chapter 8 Valvular heart disease insufficiencies Thomas Buck Fig. 8.1 page 110 Videos 8.1A-D Fig. 8.2 page 110 Videos 8.2A-D Fig. 8.3 page 111 Videos 8.3A, B Fig. 8.4 page 113 Videos 8.4A-D Fig. 8.5 page 113 Video 8.5 Fig. 8.6 page 114 Videos 8.6A-F Fig. 8.7 page 115 Videos 8.7A-H Fig. 8.8 page 115 Videos 8.8A-C Fig. 8.9 page Videos 8.9A-9F Fig page 118 Video 8.10 Fig page 119 No video Fig page 120 No video Fig page 121 Videos 8.13A-C Fig page 122 Videos 8.14A, B Fig page 123 No video Fig page 124 Videos 8.16A, B Fig page 125 Videos 8.17A-F Fig page 126 Videos 8.18A-D Fig page 127 Videos 8.19A-F Fig page 127 Video 8.20 Fig page 128 Videos 8.21A, B Fig page 129 Videos 8.22A-F Fig page 130 Videos 8.23A, B Fig page 131 Videos 8.24A-E Fig page 132 Videos 8.25A-G Fig page 133 Videos 8.26A-E Fig page 134 No video Fig page Videos 8.28A(a, b) Fig page 138 No video Fig page 139 No video Fig page 140 Videos 8.31A-E Fig page 140 No video Fig page 141 No video Fig page 141 No video Fig page 142 No video Fig page 143 Videos 8.36A-C Fig page 143 No video Fig page 144 Videos 8.38A-E Fig page 145 Videos 8.39A-F Fig page 146 Videos 8.40A-F Fig page 147 Videos 8.41A-F Fig page 148 Videos 8.42B(a-e) Fig page 149 Videos 8.43A-F Fig page 150 No video

12 List of figures and videos XV Chapter 9 Valvular heart disease stenoses Jose L. Zamorano and Jose Alberto de Agustín Fig. 9.1 page 156 Videos 9.1A(a-d) Fig. 9.2 page 157 Videos 9.2A-C Fig. 9.3 page 157 Videos 9.3A-D Fig. 9.4 page 158 Videos 9.4A-D Fig. 9.5 page 159 Videos 9.5A, B Fig. 9.6 page 160 Videos 9.6A, B Fig. 9.7 page 161 No video Fig. 9.8 page 161 No video Fig. 9.9 page 162 Videos 9.9A, B Fig page 163 Videos 9.10A-D Fig page 163 Videos 9.11A-C Fig page 164 Videos 9.12A-C Fig page 166 Videos 9.13A(a, b), B Fig page 168 Video 9.14 Fig page 169 No video Fig page 170 Videos 9.16A-D Fig page 171 Videos 9.17A-D Chapter 10 Three-dimensional echocardiography in adult congenital heart disease Folkert J. Meijboom, Heleen van der Zwaan, and Jackie McGhie Fig page 176 Video 10.1 Fig page 176 No video Fig page 178 Video 10.3 Fig page 178 Video 10.4 Fig page 179 Video 10.5 Fig page 179 Videos 10.6A-D Fig page 180 No video Fig page 180 Videos 10.8A-E Fig page 181 No video Fig page 182 Video Fig page 183 No video Fig page 183 Videos 10.12A-D Fig page 184 No video Fig page 185 Videos 10.14A-D Fig page 185 Videos 10.15A, B Fig page 186 Videos 10.16A(a-e), B(a) Fig page 188 Videos 10.17A-D Fig page 189 Videos 10.18A, B Fig page 190 No video Fig page 190 Video Fig page 191 Video Fig page 191 Video Fig page 192 Video Fig page 192 Videos 10.24A, B Fig page 194 Videos 10.25A-C Fig page 195 Video Fig page 195 Video Fig page 196 No video Fig page 197 Video Chapter 11 Congenital heart disease in children John M. Simpson Fig page 202 Videos 11.1A-C Fig page 203 Video 11.2 Fig page 204 Videos 11.3A, B Fig page Videos 11.4A-E Fig page 207 Videos 11.5A-F Fig page 209 Videos 11.6A-C Fig page 210 Videos 11.7A, B Fig page 210 Videos 11.8A, B Fig page 211 Videos 11.9A-D Fig page 213 Videos 11.10A-C Fig page 215 Videos 11.11A-D Fig page 216 Videos 11.12A-D Fig page Videos 11.13A-C Chapter 12 Cardiac tumors and sources of embolism Björn Plicht Fig page 224 Video 12.1 Fig page 224 Videos 12.2A-C Fig page 225 Videos 12.3A, B Fig page 225 Videos 12.4A-D Fig page 226 Videos 12.5A, B Fig page 227 Videos 12.6A-C, E-G Fig page 228 Videos 12.7A-C Fig page 228 Videos 12.8A, B Fig page 229 Videos 12.9A, B Fig page 230 Videos 12.10A-D Fig page 231 Videos 12.11A-C Fig page 231 Videos 12.12A, B Fig page 232 Videos 12.13A-F Fig page 234 Videos 12.14A-D Fig page 235 Videos 12.15A-C, E Fig page 237 Videos 12.16A, B, D, F Fig page 237 No video Fig page 238 Videos 12.18A-F Fig page 239 Videos 12.19

13 XVI List of figures and videos Chapter 13 Monitoring and guiding cardiac interventions and surgery Harald P. Kühl, Andreas Franke, and Thomas Buck Fig page 242 No video Fig page 243 Videos 13.2A-D Fig page 243 Videos 13.3A-F Fig page 245 Videos 13.4A-D Fig page 245 Videos 13.5A, B Fig page 246 Videos 13.6A, B Fig page 246 No video Fig page 247 Videos 13.8A-D Fig page 247 Videos 13.9A-D Fig page Videos 13.10A(a, b), B(a, b), C(a-l) Fig page 252 Videos 13.11A-F Fig page 252 No video Fig page 253 Videos 13.13A-D Fig page 253 Videos 13.14A, B Fig page 254 Videos 13.15A(a-g) Fig page 255 Videos 13.16A-C Fig page 255 No video Fig page 256 No video Fig page 257 Videos 13.19A-K Fig page 258 Video Fig page 259 Video Fig page 260 Videos 13.22A-D Fig page 260 Videos 13.23A-C Fig page 261 Videos 13.24A-H Fig page 262 Videos 13.25A-H Fig page 263 Video 13.26