Veterinary Echocardiography

June A. Boon, MS, is an Echocardiographer at Colorado State University, Fort Collins, CO.

• Preface xviiAcknowledgments xixChapter 1 the Physics of Ultrasound 3Basic Physics 3Cycles and Wavelengths 3Frequency 5Speed of Sound 5Acoustic Impedance 6Reflection, Refraction, and Scattering 7Attenuation 8Tissue Harmonic Imaging 9Transducers and Resolution 9Pulse Repetition Frequency 9Sound Beams 11Axial Resolution 12Lateral Resolution 12Temporal Resolution 14Doppler Physics 14The Doppler Shift 15The Doppler Tracing 15Pulsed-Wave Doppler 16Continuous-Wave Doppler 17The Doppler Equation 18Angle of Interrogation 19Effect of Transducer Frequency 20Effect of Sampling (Gate) Depth 21Blood Flow 22Color-Flow Doppler 23Tissue Doppler Imaging 26Artifacts 29Patient Movement and Breathing Artifacts 30Side Lobe Artifact 30Reverberation Artifact/Mirror Image Artifact 31Summary 33Recommended Reading 35Chapter 2 the Two-dimensional Echocardiographic Exam 37Introduction 37Patient Preparation 37Patient Positioning 37Small Animal Positioning 37Large Animal Positioning 39Transducer Selection 40Two-dimensional Images 40Introduction 40Right Parasternal Long-Axis Images 46Left Ventricular Outflow View (Inflow—Outflow View) 46The Image 46Scanning Technique: Small Animal 49Scanning Technique: Horse 54Four-Chamber View 58The Image 58Scanning Technique: Small Animal 58Scanning Technique: Equine 58Right Parasternal Short-Axis Images 58Introduction 58Left Ventricle with Papillary Muscles and Chordae Tendinae View 63The Image 63Scanning Technique: Small Animal 65Scanning Technique: Equine 66Mitral Valve View 66The Image 66Scanning Technique: Small Animal 66Scanning Technique: Equine 67Heart Base: Aorta and Left Atrium View 67The Image 67Scanning Technique: Small Animal 69Scanning Technique: Equine 69Heart Base: Pulmonary Artery View 69The Image 69Scanning Technique: Small Animal 69Scanning Technique: Equine 71Left Ventricle with Pulmonary Artery View 71The Image 71Scanning Technique: Small Animal 71Left Parasternal Apical Images 72Introduction 72Apical Five-Chamber View 72The Image 72Scanning Technique: Small Animal 75Scanning Technique: Equine 75Apical Four-Chamber View 75The Image 75Scanning Technique: Small Animal 75Left Parasternal Cranial Long-Axis Images 80Introduction 80Left Cranial Left Ventricular Outflow View 80The Image 80Scanning Technique: Small Animal 80Left Cranial Right Atrium and Auricle View 80The Image 80Scanning Technique: Small Animal 81Left Cranial Right Ventricular Outflow View 82The Image 82Scanning Technique: Small Animal 83Left Cranial Four-Chamber View: Equine 85The Image 85Scanning Technique: Equine 86Left Cranial Five-Chamber View (Large Animal) 87The Image 87Scanning Technique: Equine 87Left Parasternal Short-Axis Images 87Introduction 87Left Cranial Transverse Heart Base View 87The Image 87Scanning Technique: Small Animal 89Scanning Technique: Equine 90Left Cranial Left Auricle View: Small Animal 90The Image 90Scanning Technique: Small Animal 90Left Cranial Transverse Left Ventricle View: Equine 91The Image 91Scanning Technique: Equine 92Subcostal Image 92Subcostal Five-Chamber View: Small Animal 92The Image 92Scanning Technique: Small Animal 92Two-dimensional Imaging Controls 93Introduction 93Depth 93Gain 93Time Gain Compensation 93Compress/Dynamic Range 96Persistence/Frame Averaging 96Sector Width 96Focus 97Harmonics 97Gray Map 98References 98Chapter 3 the M-mode and Doppler Examination 101Introduction 101M-mode Echocardiography 101Introduction 101Controls 101Cursor 105Sweep Speed 105M-Mode Images and Technique 105Left Ventricle 105Mitral Valve 108Aortic Root 110Mitral Annular Motion 112Color-flow Doppler 112Introduction 112Controls 112Gain 113Color Sector Width and Height 113Color Map 113Threshold or Tissue Priority 114Color-Flow Processing 114Baseline 115Persistence or Frame Averaging 115Normal Color-Flow Images 116Introduction 116Mitral Valve and Tricuspid Valve Flow 118Aortic Flow 118Pulmonary Artery Flow 118Spectral Doppler 118Introduction 118Controls 120Cursor 120Gate 120Gate Size 120Angle Correction 120Baseline 120Scale 124Doppler Gain 124Wall Filters 128Sweep Speed 128Normal Doppler Flow Profiles and Technique 128Introduction 128Aortic Flow 130Imaging Plane Used 130Flow Appearance 132Left Ventricular Outflow Tract Flow 132Imaging Plane Used 132Flow Appearance 132Pulmonary Artery Flow 132Imaging Plane Used 132Flow Appearance 135Right Ventricular Outflow Tract Flow 135Imaging Plane Used 135Flow Appearance 135Transmitral Flow 135Imaging Plane Used 135Flow Appearance 138Trans Tricuspid Flow 139Imaging Plane Used 139Flow Appearance 142Pulmonary Vein Flow 142Imaging Plane Used 142Flow Appearance 144Isovolumic Relaxation Time 144Imaging Plane Used 144Flow Appearance 144Left Auricular Flow 145Imaging Plane Used 145Flow Appearance 145Tissue Doppler Imaging 146Introduction 146Imaging Plane Used 148Spectral Appearance 149References 149Chapter 4 Evaluation of Size, Function, and Hemodynamics 153Measurement and Assessment of Two-dimensional Images 153Subjective Impression of Size 153Right Parasternal Long-Axis Left Ventricular Outflow View 153Right Parasternal Long-Axis Four-Chamber View 158Right Parasternal Transverse Left Ventricle 159Right Parasternal Transverse Heart Base 160Quantitative Measurement of Size 162Left Ventricular Chamber, Wall, and Septum 163Left Ventricular Mass 164Aorta and Left Atrium 168Right Ventricular Chamber 170Evaluation of Quantitative Measurements 171Dogs 171Cats 171Horses 172Measurement and Assessment of M-mode Images 172Measurement Guidelines for M-Mode Images 172Left Ventricle 173Measurement 173Measuring Pitfalls 177Assessment 181Mitral Valve 182Measurement 182Assessment 182Left Atrium and Aorta 183Measurement 183Assessment 184Ratio Indices 185Measurement and Assessment of Spectral Doppler Flow 186Measurement 186Peak and Mean Velocity 186Flow Velocity Integral 186Systolic Time Intervals 186Diastolic Time Intervals 187Evaluation 187Aortic Flow 188Pulmonary Artery Flow 188Systolic Time Intervals 190Mitral Valve Flow 190Tricuspid Valve Flow 192Pulmonary Vein Flow 192Left Auricle Flow 193Measurement and Assessment of Tissue Doppler Imaging 193Measurement 193Assessment 193Evaluation of Color-flow Doppler 196Normal Regurgitant Flows 196Evaluation of Ventricular Function 198Systolic Function 198Left Ventricular Function 198Right Ventricular Function 201M-mode Evaluation of Systolic Function 201Fractional Shortening—Left Ventricle 201Volume, Ejection Fraction, and Cardiac Output 202Left Ventricle 202Right Ventricle 204Systolic Time Intervals 204Mitral and Tricuspid Annular Motion 205Two-Dimensional Measurement of Systolic Function 206Volume, Ejection Fraction, and Cardiac Output 206Spectral Doppler Evaluation of Systolic Function 210Volumetric Flow 210Systolic Time Intervals 213Myocardial Performance Index 213Tissue Doppler Evaluation of Systolic Function 216Left Ventricle 216Right Ventricle 217Evaluation of Diastolic Function 217Impaired Relaxation 219Decreased Compliance 220Elevated Left Atrial Pressure 220Pseudonormalization 223Grading of Diastolic Function 224Hemodynamic Information Obtained From Echocardiographic Exams 225Doppler Hemodynamic Information 225Pressure Gradients 226Systolic Left Ventricular and Systemic Pressures 229Systolic Right Ventricular and Pulmonary Pressures 230Diastolic Systemic Pressure 231Diastolic Pulmonary Pressure 232Regurgitant Fraction 232Shunt Ratios 234Pressure Half-Time 234Aortic Regurgitation 234Mitral and Tricuspid Stenosis 236M-Mode Hemodynamic Information 236Aortic Valve Motion 236Mitral Valve Motion 237Left Ventricular Wall 239Interventricular Septum 239References 247Exercises 256Chapter 5 Acquired Valvular Disease 267Mitral Regurgitation 267Two-Dimensional and M-mode Evaluation 269Valvular Appearance and Motion 269Degenerative Lesions 269Ruptured Chordae Tendineae 271Mitral Valve Prolapse 274Left Ventricular Size 276Left Ventricular Function 281Color-Flow Doppler Evaluation 284Jet Size 284Proximal Isovelocity Surface Area 290Vena Contracta 293Spectral Doppler Evaluation 294Jet Area 294Regurgitant Volume and Fraction 294Transmitral Valve Flow 295Regurgitant Jet Appearance 296Pulmonary Vein Flow 297Presence of Pulmonary Hypertension 298Acute Mitral Regurgitation 302Diastolic Mitral Insufficiency 302Overall Assessment of Mitral Regurgitation 302Aortic Regurgitation 303Two-Dimensional and M-Mode Evaluation 303Valve Appearance and Motion 303Left Ventricular Size and Function 308Color-Flow Doppler Evaluation 309Jet Size 309Vena Contracta 312Proximal Isovelocity Surface Area 313Spectral Doppler 314Pressure Half-Time and Slope 314Regurgitant Volume and Fraction 316Diastolic Flow Reversal 317Regurgitant Jet Appearance 317Overall Assessment of Aortic Regurgitation 318Tricuspid Regurgitation 319Two-Dimensional and M-mode Evaluation 319Color-Flow Doppler Imaging 322Spectral Doppler Imaging 322Overall Assessment of Tricuspid Regurgitation 322Pulmonary Regurgitation 324Two-Dimensional Evaluation 324Color-Flow Doppler Imaging 324Spectral Doppler Imaging 325Overall Assessment of Pulmonary Regurgitation 325Endocarditis 325References 327Chapter 6 Hypertensive Heart Disease 335Pulmonary Hypertension 335Two-Dimensional and M-mode Findings 335Doppler Evaluation 343Tissue Doppler 349Heartworms 350Systemic Hypertension 351Two-Dimensional and M-mode Features 351Spectral Doppler 354Tissue Doppler Imaging 355References 356Chapter 7 Myocardial Diseases 359Hypertrophic Cardiomyopathy 359Two-Dimensional and M-mode Evaluation 359Left Ventricular Chamber 359Left Atrium 360Left Ventricular Outflow Obstruction 360Systolic Function 367Doppler Evaluation of HCM 367Evaluation of Outflow Obstruction 367Evaluation of Diastolic Function 369Tissue Doppler Evaluation of Diastolic Function 373Complications 376Thrombus 376Ischemia and Effusion 377Other Causes of Hypertrophy 379Dynamic Right Ventricular Outflow Obstruction 380Moderator Bands 381Dilated Cardiomyopathy 381Two-Dimensional and M-Mode Evaluation 381Early Diagnosis 388Predictors of Outcome 390Other Causes of Poor Systolic Function 392Color Doppler Evaluation 393Right Ventricular Cardiomyopathy 396Differentiation from Other Disease 399Myocardial Infarction 400Myocardial Contusions 403References 404Chapter 8 Pericardial Disease, Effusions, and Masses 411Pericardial Effusion 411Cardiac Tamponade 414Neoplasia as a Cause of Pericardial Effusion 416Introduction 416Aortic Body Tumors 416Other Heart Base Masses 418Hemangiosarcoma 420Lymphosarcoma 422Lipomas 424Rhabdomyosarcoma 425Pericardial Disease 425Introduction 425Idiopathic Effusion 425Pericardial Neoplasia 426Infectious Pericarditis 427Constrictive Pericarditis 428Spectral Doppler Findings 429Pericardial Cysts 431Thrombus 431References 431Chapter 9 Congenital Shunts and Av Valve Dysplasia 437Ventricular Septal Defect 437Introduction 437Spectral and Color-Flow Doppler Evaluation 446Patent Ductus Arteriosus 450Introduction 450Structural Changes 450Left Ventricular Function 452Spectral and Color-Flow Doppler Evaluation 453Aorticopulmonary Window 458Atrial Septal Defects 459Introduction 459Two-Dimensional and M-mode Evaluation 459Spectral and Color-Flow Doppler Evaluation 464Endocardial Cushion Defects 465Bubble Studies 467Tricuspid Dysplasia 468References 472Chapter 10 Stenotic Lesions 477Outflow Obstructions 477Two-Dimensional Evaluation 479M-Mode Evaluation 486Color-Flow Doppler Evaluation 488Spectral Doppler Evaluation 491Pulmonary Stenosis 495Spectral Doppler Evaluation 501Color-Flow Doppler Evaluation 503Double-Chamber Right Ventricle and Infundibular Stenosis 504Two-Dimensional and Doppler Evaluation 505Mitral Stenosis 507M-Mode Evaluation 509Color-Flow Doppler Evaluation 510Tricuspid Stenosis 513Cor Triatriatum 515Cor Triatriatum Dexter 516Tetralogy of Fallot 517References 522AppendicesAppendix 1: Bovine 527Appendix 2: Canine 531Appendix 3: Equine 559Appendix 4: Feline 569Appendix 5: Miscellaneous Species 581Index 589

“This is a welcome update. To my knowledge, there is no other book dedicated solely to veterinary echocardiography.”  (Doody’s, 29 June 2012)“June A. Boon’s Veterinary Echocardiography (978081382850, $149.99) appears in a fully revised second updated edition to provide an in-depth reference to the ultrasound of the heart.”  (The Midwest Book Review, 1 January 2012)