Table of Contents

Cover

Table of Contents

Half title page

Title page

Copyright page

Dedication

Preface

Acknowledgments

CHAPTER ONE The Physics of Ultrasound

Basic Physics

Transducers and Resolution

Doppler Physics

Artifacts

Summary

CHAPTER TWO The Two-Dimensional Echocardiographic Exam

Introduction

Patient Preparation

Patient Positioning

Transducer Selection

Two-Dimensional Images

Two-Dimensional Imaging Controls

CHAPTER THREE The M-Mode and Doppler Examination

Introduction

M-Mode Echocardiography

Color-Flow Doppler

Spectral Doppler

Tissue Doppler Imaging

CHAPTER FOUR Evaluation of Size, Function, and Hemodynamics Measurement and Assessment of Two-Dimensional Images Measurement and Assessment of M-Mode Images

Measurement and Assessment of Spectral Doppler Flow Measurement and Assessment of Tissue Doppler Imaging Evaluation of Color-Flow Doppler

Evaluation of Ventricular Function

Hemodynamic Information Obtained From Echocardiographic Exams

CHAPTER FIVE Acquired Valvular Disease

Mitral Regurgitation

Aortic Regurgitation

Tricuspid Regurgitation

Pulmonary Regurgitation

Endocarditis

CHAPTER SIX Hypertensive Heart Disease

Pulmonary Hypertension

Systemic Hypertension

CHAPTER SEVEN Myocardial Diseases

Hypertrophic Cardiomyopathy

Dynamic Right Ventricular Outflow Obstruction

Moderator Bands

Dilated Cardiomyopathy

Right Ventricular Cardiomyopathy

Restrictive Cardiomyopathy

Endocardial Fibroelastosis

Arrhythmogenic Right Ventricular Cardiomyopathy

Myocardial Infarction

Myocardial Contusions

CHAPTER EIGHT Pericardial Disease, Effusions, and Masses

Pericardial Effusion

Neoplasia as a Cause of Pericardial Effusion

Pericardial Disease

Abscesses

Pericardial Cysts

Thrombus

CHAPTER NINE Congenital Shunts and AV Valve Dysplasia Ventricular Septal Defect

Patent Ductus Arteriosus

Aorticopulmonary Window Right to Left Shunting PDA Atrial Septal Defects Endocardial Cushion Defects Bubble Studies

Atrioventricular Valve Dysplasia

CHAPTER TEN Stenotic Lesions

Outflow Obstructions

Inflow Obstructions

Tetralogy of Fallot

APPENDIX ONE Bovine

APPENDIX TWO Canine

APPENDIX THREE Equine

APPENDIX FOUR Feline

APPENDIX FIVE Miscellaneous Species

Index

VETERINARY ECHOCARDIOGRAPHY

SECOND EDITION

This edition first published 2011 © 2011 by June A. Boon

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Library of Congress Cataloging-in-Publication Data

Boon, June A.

Veterinary echocardiography / June A. Boon. – 2nd ed. p. ; cm.

Rev. ed. of: Manual of veterinary echocardiography / June A. Boon. ©1998. Includes bibliographical references and index.

ISBN 978-0-8138-2385-0 (hardcover : alk. paper)

1. Veterinary echocardiography. I. Boon, June A. Manual of veterinary echocardiography. II. Title. [DNLM: 1. Echocardiography–veterinary. SF 811]

SF811.B66 2011 636.089´61207543–dc22 2010028092

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF 9780470958841; ePub 9780470958919

For the people who make my life rich and bring joy to my days:

Dave—my best friend and soul mate for 23+ years—thank you for all you do—I love you Denali and Logan—you have both become such exceptional individuals

Reuben—I am so glad you are part of our family Mike and Stephan—I could not be prouder of you guys

Preface

When I started this project, I thought it would be easy. The first 20 years of veterinary echocardiography were done; I simply had to write about new developments over the past ten years. It was not so easy. The past ten years have brought with it significant advances in technology including better transducers, tissue harmonic imaging, better color flow mapping, and color and spectral tissue Doppler imaging. The echocardiographic examination now provides so much more information than it did 10 years ago. The amount of information continues to grow exponentially – because of and thanks to the many cardiologists who have been trained, certified and working to expand our knowledge over this past decade.

The format of this edition is different from the previous one in the hope that it makes this book easier to use. Chapter 1, a necessary evil, still covers the pertinent physical principles of sound that allow us to use ultrasound as a diagnostic tool. Chapters 2 and 3 describe the two dimensional, m- mode and Doppler examinations. All imaging planes are described with instructions and pictures for obtaining these images. I have included images of common mistakes and directions for fixing them. After all these years, I still find myself discovering little pearls of wisdom about obtaining and evaluating certain imaging planes. This is a skill that continuously develops, so don’t give up. With this in mind, I would like to acknowledge Dr. Jim Woods – creator of Woods’ Criteria - for reminding me that a study does not need to be perfect in order to obtain valuable information. Assessment of the echocardiographic examination is covered in Chapter 4. This chapter describes how to measure, and interpret the ultrasound examination. It describes the application of each parameter in a general way. It also tells of the factors that influence their interpretation, factors like heart rates, age, blood pressure, preload and afterload. The chapters following this cover the echocardiographic features of the most common cardiac diseases seen in veterinary medicine. Chapter 5 discusses acquired valvular diseases. Chapter 6 describes the features of systemic and pulmonary hypertension. Chapter 7 deals with all of the myopathies seen in animals. Pericardial effusion and cardiac masses are described in Chapter 8. Congenital shunts and stenotic lesions are covered in Chapters 9 and 10.

I have as usual probably overdone the references that are included in each chapter. Many offer viewpoints form the human side of echocardiography. I hope that this comprehensive reference list provides insight into the how and why of echocardiographic parameters and interpretation. I also hope that they spark some new ideas. I continue to learn every day, and this is what keeps me interested and loving what I do.

As with the first edition, it is my sincere wish that this book provides a comprehensive reference and instruction manual for echocardiographers at all levels of experience.

Acknowledgments

My sincere gratitude goes to Dr. Chris Orton and Dr. Jan Bright for their support in my endeavors. I couldn’t ask for better people to work with and have as mentors.

I would also like to acknowledge all of the cardiology residents that I have had the pleasure of working with over the past 10 years: Julie Martin, Sarah Zimmerman, TJ Morrison, Leigh Griffiths, Sarah Scruggs, Cassidy Sedacca, and Holly MacLea. I have become a better teacher because of you, and you have kept me on my toes. Many images in this book are from studies you have obtained, and I am thankful for your dedication to creating excellent echocardiographic studies.

June A. Boon

CHAPTER ONE

The Physics of Ultrasound

Cardiac ultrasound, echocardiography, permits noninvasive and nonionizing visualization of the inside of the heart including the aorta, the ventricles and atria, the auricular appendages, and all of the cardiac valves. Dynamic images of the contracting heart are created with two-dimensional and motion mode (M-mode) images while blood flow through the heart can be seen and measured with Doppler ultrasound. Tissue Doppler imaging allows analysis of myocardial motion. Defects including valvular lesions, cardiac shunts, cardiac and thoracic masses, pleural and pericardial effusions, myocardial diseases, and stenotic lesions can be seen. More importantly it allows assessment of cardiac chamber sizes, cardiac function, blood flow, and myocardial motion, which provides information on hemodynamic status and extent of the disease process.

Uses of Echocardiography

See internal cardiac structures.

Evaluate function.

Evaluate size.

See defects.

Valvular lesions

Shunts

Myocardial abnormalities

Masses

Effusions

Stenotic lesions

Evaluate blood flow.

Assess myocardial motion and function.

All of this is possible because of sound. Sound is sent into the body and reflected from soft tissue structures. The reflected sound waves are analyzed, and an image is generated on a monitor. Sending out many sound waves side by side will produce an image with depth and width. The result is a twodimensional image (Figure 1.1). When the sound waves are continuously and rapidly sent out in sequence, many two-dimensional images can be generated per minute, and a moving image of the heart is made called real-time or B-mode ultrasound. By sending out only one sound beam instead of many, only the structures associated with that one beam are seen, producing an M-mode image (Figure 1.2). The structures associated with that one line through the heart keep scrolling on the screen as the heart continues to contract and relax. The M-mode image displays depth on the vertical axis and time along the horizontal axis.

Figure 1.1 Many sound waves sent into the body side by side will create an image with depth and width. The result is a two-dimensional echocardiographic image. This is a right parasternal long-axis four-chamber view of the heart. RV = right ventricle, TV = tricuspid valve, RA = right atrium, IVS = interventricular septum, LV = left ventricle, LVW = left ventricular wall, LA = left atrium, MV = mitral valve, CT = chordae tendineae.

Figure 1.2 When one of the sound beams used to create the two-dimensional image is selected to generate an M-mode image, only the structures associated with that one beam are seen. The twodimensional image at the left side of this figure shows a cursor representing the one beam. A onedimensional M-mode image is created from the structures the cursor crosses. The vertical axis represents depth while the horizontal axis represents time. Here the structures of the left ventricle are seen on the M-mode to the right as they change throughout a cardiac cycle. RV = right ventricle, IVS = interventricular septum, LV = left ventricle, LVW = left ventricular wall, AO = aorta, LA = left atrium.

Doppler is used in diagnostic ultrasound to provide information on blood flow (spectral and colorflow Doppler) or myocardial motion (tissue Doppler imaging [TDI]) of the heart and its vessels. Specific locations within the heart can be selected and a spectral display of blood flow or muscle motion is created. As in M-mode the horizontal axis represents time while the vertical axis represents velocity (Figure 1.3).