Final Feigenbaum’s Echocardiography DIGITAL

Feigenbaum’s Echocardiography

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Feigenbaum’s Echocardiography

FIGURE 5.53. Example of posterior wall pseudodyskinesis related to ascites. In the central image note that the ascites has compressed the posterior wall of the left ventricle ( arrows ) and that in diastole it has a “D-shaped” configuration. In early systole (upper left inset, note the ventricle has resumed normal circular geometry). In the real-time image note the appar- ent dyskinesis of the posterior wall in early systole followed by normal and traction. Posterior Compression Nonischemic abnormalities also include those occurring when there is extracardiac compression of the le ventricle. is can be seen when a structure such as an aneurysmal thoracic aorta or hia- tial hernia compresses the heart or when there is compression from a subdiaphragmatic process such as ascites, abdominal masses, and pregnancy. In these instances, the inferior wall will be compressed superiorly resulting in a D-shaped distortion of le ventricular geometry when viewed in a short-axis view. e distortion is most prominent during diastole. With mechanical systole and myocardial contraction, the le ventricle reassumes normal circular geometry and the previously distorted wall appears to move paradoxically. Figure 5.53 illustrates this phenomenon. Close attention to underly- ing coexisting pathology likely to result in this phenomenon, and to myocardial thickening, allows accurate identi cation of this artifac- tual wall motion abnormality. is phenomenon is quite similar to the “paradoxical” septal motion seen in a right ventricular volume overload in which there is diastolic deformation of the le ventricle with resumption of normal circular geometry in early systole. Suggested Readings G ENERAL Aurich M, Andre F, Keller M, et al. Assessment of le ventricular volumes with echocardiography and cardiac magnetic resonance imaging: real-life evalua- tion of standard versus new semiautomatic methods. J Am Soc Echocardiogr 2014;27(10):1017–1024. Claus P, Omar AMS, Pedrizzeti G, Sengupta PP, Nagel E. Tissue tracking technol- ogy for assessing cardiac mechanics: principles, normal values, and clinical applications. JACC Cardiovasc Imaging 2015;8(12):1444–1460. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quanti cation by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28(1):1–39. Muraru D, Cecchetto A, Cucchini U, et al. Intervendor consistency and accuracy of le ventricular volume measurements using three-dimensional echocardi- ography. J Am Soc Echocardiogr 2018;31(2):158–168. Potter E, Marwick TH. Assessment of le ventricular function by echocardiogra- phy: e Case for Routinely Adding Global Longitudinal Strain to Ejection Fraction. JACC Cardiovasc Imaging 2018;11(2 Pt 1):260–274. avendiranathan P, Grant AD, Negishi T, Plana JC, Popović ZB, Marwick TH. Reproducibility of echocardiographic techniques for sequential assessment of le ventricular ejection fraction and volumes: application to patients under- going cancer chemotherapy. J Am Coll Cardiol 2013;61(1):77–84. Voigt JU, Pedrizzetti G, Lysyansky P, et al. De nitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ ASE/Industry task force to standardize deformation imaging. J Am Soc Echo- cardiogr 2015;28(2):183–193.

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FIGURE 5.52. Apical four-chamber view recorded in a patient after cardiac surgery demon- strates postoperative motion of the entire heart. A: Image was recorded in end-diastole. The vertical line marks the position of the right side of the ventricular septum. B: Image was recorded in end-systole. Note that, compared with the vertical reference line, there has been overall anterior ( leftward ) motion of the heart. Note the thickness of the ventricular septum ( double-headed arrow ). motion. It is also important to have a rm understanding of the anticipated pathophysiology of underlying coronary artery disease. Many of the abnormalities discussed above result in an “anatom- ically incorrect” distribution of wall motion abnormalities, and a skilled clinician-echocardiographer should be in a position to rec- ognize that a wall motion abnormality is a result of a nonischemic process based on its location, timing, and other characteristics. It should also be recognized that a er successful coronary bypass sur- gery, the distribution of regional wall motion abnormalities might also be atypical.

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