Clinical Echocardiography
Recently, much progress has been made with echocardiography and Doppler techniques and these ultrasound methods have grown in importance and reliability as non-invasive diagnostic procedures for many cardiovascular disorders. The objective of this t~xtboo
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DEVELOPMENTS IN CARDIOVASCULAR MEDICINE
MASATSUGU IWASE and IWAO SOTOBATA 1st Department of Internal Medicine, Nagoya University School of Medicine, Nagoya, Japan
CLINICAL ECHOCARDIOGRAPHY
KLUWER ACADEMIC PUBLISHERS DORDRECHT I BOSTON / LONDON
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!vI-mode traces of the left side heart.
M-mode tracing of the pulmonary valve is recorded with the right ventricular outflow view which is obtained by placing the transducer on the second or the third intercostal space and the sector plane parellel to the sternum . The tricuspid valve is recorded with the right ventricular inflow view that is obtained by placing the transducer lower than the parasternal long axis view, rotating it counterclockwise and then tilting the plane up or down to obtain the best image (Figure 2.7). In normal subjects, it is usually difficult to record the pulmonary or the tricuspid valve motion through the entire cardiac cycle. However, it is often possible to record the valve motion entirely in the case of right ventricular enlargement.
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Figure 3.82. Correlation between CW Doppler and cardiac catheterization in patients with tricuspid regurgitation . In the left panel, a very good correlation (r = 0.987) of right ventricular/atrial pressure gradient obtained by catheterization and the Doppler technique is demonstrated. The right panel also shows a very good correlation (r = 0.979) of right ventricular pressure. We assume a right atrial pressure of 5 mm Hg in patients with normal respiratory changes in the size of inferior vena cava and 10 mm Hg in patients without respiratory changes in the inferior vena cava .
Acquired valvular heart disease
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Parasternal long axis view and apical four chamber views from a patient with a large ventricular septal defect.
Figure 4.16.
M-mode scan illustrating a discontinuity of the IVS in a patient with large ventricular septal defect.
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Figure 4.17. Pulsed and CW Doppler echocardiogram of a patient with a small ventricular septal defect. Pulsed Doppler illustrates the systolic turbulent flow in the right ventricle and CW Dop1Jler demonstrates a high velocity flow (peak velocity = 4 m/sec).
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Figure 4.18. Pulsed and high PRF Doppler echocardiogram of a patient with a large ventricular septal defect and an Eisenmenger complex. In this patient, the pulmonary hypertension is moderate
