Real-Time Three-Dimensional Transesophageal Echocardiography
Annette Vegas Massimiliano Meineri Angela Jerath Real-Time Three-Dimensional Transesophageal Echocardiography A Step-by-Step Guide
Annette Vegas, MD, FRCPC, FASE Associate Professor of Anesthesiology Director of Perioperative TEE Massimiliano Meineri, MD Assistant Professor of Anesthesiology Angela Jerath, FRCPC, FANZCA, BSc, MBBS Assistant Professor of Anesthesiology Department of Anesthesia Toronto General Hospital University of Toronto Toronto, Ontario M5G 2C4 Canada ISBN 978-1-4614-0664-8 e-isbn 978-1-4614-0665-5 DOI 10.1007/978-1-4614-0665-5 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2011933838 Springer Science+Business Media, LLC 2012 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)
Dedications Annette Vegas To my mentors, Dr DCH Cheng, Dr Andre Denault, Dr Harry Rakowski, and Dr Susan Lenkei, for their unwavering support and believing in my dreams Massimilliano Meineri To Rosa Maria for her continuous unconditioned support and constant inspiration Angela Jerath To the pure continuum and Words of Zohra and Santosh v
Preface Three-dimensional (3D) transesophageal echocardiography (TEE) is a potent visual medium which can be used by the novice or experienced echocardiographer, cardiologist, and cardiac surgeon. It can achieve a better understanding and assessment of normal and pathological cardiac function and anatomy. This new technology complements traditional 2D imaging and permits visualization of any cardiac structure of interest from multiple perspectives. 3D technology challenges the echocardiographer to acquire a different skill set for image acquisition and manipulation. This handbook is created in response to a need for a succinct illustrative synopsis on 3D technology and image acquisition. We have aimed to provide a simple step-by-step guide to the practical fundamentals of this technology, altered knobology, and how to acquire and manipulate image datasets. The chapters encompass normal and common cardiac pathology. As with all written echocardiography texts, still 3D images do not do justice to the cardiac activity seen in a live video clip. Hence, we advise readers to refer to other video sources including the TEE Perioperative Interactive Education (PIE) Web site, http://pie.med.utoronto.ca/tee, which provides a wealth of free on-line video material. This handbook is a compilation of echocardiography information and perioperative TEE images performed at Toronto General Hospital (TGH), Toronto, Ontario, Canada. The images are unaltered except for cropping to fit the size of the book. All 3D TEE images were acquired using an le33 machine and X7-2t 3D TEE probe (Philips Medical System, Andover, Massachusetts, USA). None of the authors have received any financial support from the industry during this project. At the time of writing, this monograph represents the current technology in this field based predominantly on this single vendor. Growth in this field continues as evidenced by technological advances and an increasing number of publications. vii Dr. Annette Vegas Dr. Massimilliano Meineri Dr. Angela Jerath April 2011
Acknowledgments To members of the current TGH Anesthesiology Perioperative TEE group: Drs. L. Bahrey, G. Djaiani, J. Heggie, M. Jariani, J. Karski, R. Katznelson, P. McNama, P. Murphy, P. Slinger, A. Van Rensburg, and M. Wasowicz, who perform, train, and educate others about TEE. To our colleagues from the Division of Cardiac Surgery, under the leadership of Dr. Tirone E. David, who attract a varied practice that keeps TGH cardiac anesthesiologists challenged to provide exemplary patient care. To members of the TGH cardiology echocardiography lab, under the direction of Dr. Anna Woo and former directors Dr. Sam Siu and Dr. Harry Rakowski, who generously share their knowledge with the perioperative TEE group at TGH. To medical student Mr. Gian-Marco Busato, MSc, for his extraordinary artistic talent he used to draw the illustrations for this handbook. Finally to Ms. Willa Bradshaw, BSc, MScBMC, and Ms. Frances Yeung, BSc, MScBMC, medical illustrators, who precisely assembled all the detailed figures. ix
Contents 1 Technology and 3D Imaging... 1 2 TEE Basic Views 3D Imaging... 25 3 Native Cardiac Valves... 53 4 Cardiac Prosthetic Valves... 113 5 Left and Right Ventricles... 131 6 Cardiomyopathy... 157 7 Aorta... 171 8 Cardiac Masses 3D Imaging... 183 9 Congenital Heart 3D Imaging... 199 10 Miscellaneous 3D Imaging... 217 Illustration Credits... 229 Index... 231 xi
Abbreviations A AC ACB AHA AI AL AMVL AS ASD ASE AV AVA AVR BAV BPM C CAD CE CO CPB CS CSA CVP CW ECG ED EDA EDD EDV EF Anterior Anterior commissure Aortocoronary bypass American Heart Association Aortic insufficiency Anterolateral Anterior mitral valve leaflet Aortic stenosis Atrial septal defect American Society of Echocardiography Aortic valve Aortic valve area Aortic valve replacement Bicuspid aortic valve Beats per minute Chamber Coronary artery disease Carpentier-Edwards Cardiac output Cardiopulmonary bypass Coronary sinus Cross-sectional area Central venous pressure Continuous wave Electrocardiogram End-diastole End-diastolic area End-diastolic diameter End-diastolic volume Ejection fraction xiii
Abbreviations EI ERO ES ESA ESD ESV FAC FL FR FS FV GE HBP HOCM HR HV HVR I IABP IAS IHSS ITD IVC IVV IVS JA JH L LAA LA LAE LAP LAX LCA LCC LMA LLPV LSA LUPV Eccentricity index Effective regurgitant orifice End-systole End-systolic area End-systolic diameter End-systolic volume Fractional area change False lumen Frame rate Fractional shortening Full volume Gastroesophageal High blood pressure Hypertrophic obstructive cardiomyopathy Heart rate Hepatic vein High volume rate Inferior Intra-aortic balloon pump Inter-atrial septum Idiopathic hypertrophic subaortic stenosis Intertrigonal distance Inferior vena cava Isovolumetric contraction Interventricular septum Jet area Jet height Left or lateral or length Left atrial appendage Left atrium Left atrial enlargement Left atrial pressure Long axis Left coronary artery Left coronary cusp Left main coronary artery Left lower pulmonary vein Left subclavian artery Left upper pulmonary vein xiv
Abbreviations LV LVAD LVH LVID LVOT MAC MC ME MI MPR MR MS MV MVA MVP MVQ MVR N NCC NSR P PA PAP PAPVD PASP PC PDA PFO PG PHT PI PISA PM PMVL PS PV PVC Left ventricle Left ventricular assist device Left ventricular hypertrophy Left ventricle internal diameter Left ventricular outflow tract Mitral annular calcification Mitral commissural Midesophageal Myocardial infarction Multiplanar reconstruction Mitral regurgitation Mitral stenosis Mitral valve Mitral valve area Mitral valve prolapse Mitral valve quantification Mitral valve replacement Non Noncoronary cusp Normal sinus rhythm Pressure or posterior Pulmonary artery Pulmonary artery pressure Partial anomalous pulmonary venous drainage Pulmonary artery systolic pressure Posterior commissure Patent ductus arteriosus Patent foramen ovale Pressure gradient Pressure half-time Pulmonic insufficiency Proximal isovelocity surface area Papillary muscles or posteromedial Posterior mitral valve leaflet Pulmonic stenosis Pulmonic valve Premature ventricular contraction xv
Abbreviations PW PWT R RA RAP RCA RCC RF RLPV ROI RPA RT RUPV RV RVAD RegV RVH RVOT RVSP SAM SAX SBP SCA SDI STJ SV SVC SVR SWMA SWT TAPSE TAV TDI TEE TG TL TOF TGA TMSV Pulsed wave Posterior wall thickness Right Right atrium Right atrial pressure Right coronary artery Right coronary cusp Regurgitant fraction Right lower pulmonary vein Region of interest Right pulmonary artery Real-time Right upper pulmonary vein Right ventricle Right ventricular assist device Regurgitant volume Right ventricular hypertrophy Right ventricular outflow tract Right ventricular systolic pressure Systolic anterior motion Short axis Systolic blood pressure Society of Cardiovascular Anesthesiology Systolic dysynchrony index Sinotubular junction Stroke volume Superior vena cava Systemic vascular resistance Segmental wall motion abnormality Septal wall thickness Tricuspid annular plane systolic excursion Tricuspid annulus velocity Tissue Doppler imaging Transesophageal echocardiography Transgastric True lumen Tetralogy of Fallot Transposition of the great arteries Time to minimum systolic volume xvi
Abbreviations TR TS TTE TV TVA UE US VC VSD VTI 2D 3D Tricuspid regurgitation Tricuspid stenosis Transthoracic echocardiography Tricuspid valve Tricuspid valve area Upper esophageal Ultrasound Vena contracta Ventricular septal defect Velocity time integral Two-dimensional Three-dimensional xvii