By Christophe Klimczak MD PhD, Petros Nihoyannopoulos MD FRCP FACC FESC
This booklet deals either skilled cardiologists and trainees alike the chance to spot and tackle the most typical pitfalls encountered with echocardiology in regimen scientific perform. The publication covers a sequence of demanding situations starting from technical problems to issues of echocardiographic interpretation with each one part featuring a sequence of simulations to check the reader's realizing of the matter. The textual content is written in a hugely functional and didactic kind as a way to support the busy health practitioner through featuring the data in a succinct, 'essentials merely' demeanour. The heavy use of top of the range illustrations serves to make sure that the techniques defined are supported through real-life examples and therefore effortlessly acceptable to the medical setting.Edited by means of a global expert.Abundant use of full-colour permits exact illustration of pictures to have enough money particular dialogue of the concepts involved.Didactic procedure guarantees supply of key info in practicable parts hence saving time for the busy cardiologist.Includes the main widespread pitfalls linked to a number of recommendations therefore making sure applicability to quite a few scientific settings and gear availability.
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Extra resources for 100 Challenges in Echocardiography
Each echo Doppler method has preferential indications and its own limitations. 1. 1) Absence of mean pressure gradient measurement The mean pressure gradient better reflects the severity of the valvular stenosis than does the maximuml gradient. 1 Pitfalls when measuring the trans-stenotic gradient using echo Doppler • • Failure to measure the mean gradient • • Failure to interpret the gradient as a function of the output and the cardiac frequency Incomplete recording of stenotic jet Particular cases: – inappropriate use of Bernoulli’s equation – neglect of the phenomenon of restoration of pressure of the instantaneous gradient over the entire duration of the diastole (MS) or systole (AS).
The TEE planes that can be used to study the different mitral segments are: 0°, A1 and P1; 45°, AC and PC; 90°, A3 and P3; 140°, A2 and P2. AO, aorta; LAR, left auricle. 3 Two-dimensional cross-sections centred on the aortic orifice: (a) longitudinal and (b) transverse, parasternal TTE cross-sections; (c) major axis, multiplanar (110–130°) TEE crosssection; (d) minor axis multiplanar (60–80°) TEE cross-section. LA, left atrium; LCC, left coronary cusp; LV, left ventricle; NCC, non-coronary cusp; Pa, pulmonary artery; Pulm, pulmonary valve; RA, right atrium; RCC, right coronary cusp; RV, right ventricle; Tric, tricuspid valve.
Stress echocardiography under low doses of Dobutamine is very useful in this differential diagnosis. In fact, it makes it possible to identify the presence of a myocardial contractile reserve and to study the evolution of the gradients as well as the functional aortic surface area under stimulation. The presence of the contractile reserve is defined by an increase of 20% in the subaortic VTI or of 10% in the left ventricular ejection fraction. 2 The three types of haemodynamic response observed under Dobutamine in cases of low output AS Response type Output Gradient Surface area Contractile reserve Stenosis I ≠ ≠ Stable Present Tight II ≠ Stable ≠ Present Moderate III Stable Stable Stable Absent Undefined ≠, increased.