The Noninvasive Evaluation of Hemodynamics in Congenital Heart Disease

I The Technical Aspects of Doppler Ultrasound.- Review of the Physical Principles of Ultrasound.- Principles of Doppler Ultrasound.- Pulsed Doppler.- The Sample Volume.- Aliasing.- Range Ambiguity.- Continuous Wave Doppler.- The Color TM Mode.- Bidimensional Color Flow Mapping (CFM) Mode.- Low Velocity Reject in the Color Flow Mapping Mode.- Methods of Implementing a Color Flow Mapping System.- Frame Rate in a Color Flow Mapping System.- Summary.- II Clinically Relevant Topics in Signal Analysis.- Frequency Analysis.- Quadrature Demodulation.- The Fourier Transform.- The Spectral Display.- Filtering.- Spectral Broadening.- Signal Analysis in Color Flow Imaging.- The Mean Frequency and Variance.- Color Flow Mapping Display Algorithms.- Methods of Quantifying Color Flow Signals.- III Blood Flow Measurement by Doppler Ultrasound.- Laminar Blood Flow.- The Flow Profile.- Turbulent Flow.- Volumetric Flow Measurements.- The Clinical Measurement of Blood Flow.- The Aortic Site.- The Pulmonic Site.- The Mitral Site.- Measurement of the Qp/Qs Ratio.- IV The Normal Examination Technique.- The Characterization of Blood Flow by Doppler Ultrasound.- The Normal Doppler Examination.- The Acoustic Windows and Transducer Positions.- Evaluation of Left Ventricular Outflow and Transaortic Blood Flow.- Evaluation of Pulmonary Artery Blood Flow.- Evaluation of Mitral Blood Flow.- Evaluation of Tricuspid Blood Flow.- Evaluation of Pulmonary Veinous Flow.- Evaluation of the Superior and Inferior Vena Caval Flow.- Evaluation of Blood Flow in the Hepatic Veins.- Measurement of Normal Blood Flows.- Regurgitation in Normal Valves.- V Obstructive Lesions in Congenital Heart Disease.- Determination of the Pressure Gradient.- Limitations of the Modified Bernoulli Equation.- Estimation of the Valve Area.- Valvular Aortic Stenosis.- Subvalvular Aortic Stenosis.- Coarctation of the Aorta.- Obstructive Cardiomyopathy.- Pulmonic Stenosis.- Infundibular Pulmonic Stenosis.- Pulmonary Branch Narrowing.- Mitral Stenosis.- Valvuloplasty.- Summary.- VI Regurgitant Lesions in Congenital Heart Disease.- Aortic Insufficiency.- Bidimensional and TM Imaging in Aortic Regurgitation.- Pulsed Doppler Techniques in Aortic Insufficiency.- Continuous Wave Applications in Aortic Insufficiency.- Color Flow Mapping in Aortic Insufficiency.- The Multi-modality Approach.- Mitral Insufficiency.- Pulsed Doppler in Mitral Insufficiency.- Continuous Wave Applications in Mitral Regurgitation.- Color Flow Mapping in Mitral Regurgitation.- Pulmonary Regurgitation.- Pulsed Doppler Applications in Pulmonic Valve Regurgitation.- Color Flow Mapping in Pulmonic Valve Regurgitation.- Tricuspid Regurgitation.- Pulsed Doppler Applications.- Color Flow Mapping Applications.- VII Estimation of Pulmonary Artery Pressure.- The Measurement of Pulmonary Artery Pressure.- The Pulmonary Artery Acceleration Time.- The Bernoulli Equation in Determination of Right Ventricular Pressure.- Tricuspid Regurgitation.- Pulmonary Regurgitation.- Ventricular Septal Defect.- Patent Ductus Arteriosus.- Conclusion.- VIII Atrial Septal Defects.- Normal Development of the Atrial Septum.- Patent Foramen Ovale.- Types of Atrial Septal Defects.- Secundum Defects.- Sinus Venosus Defects.- Coronary Sinus Defects.- Assessment of Pulmonary and Systemic Blood Flow.- Cross-sectional Imaging and M-mode Echocardiography.- Doppler Analysis of Complications of Atrial Septal Defects.- Eisenmenger Syndrome.- Atrial Septal Aneurysm.- Monitoring of Therapeutic Interventions.- IX Doppler Echocardiography in Ventricular Septal Defects.- Morphology and Classification of Ventricular Septal Defects.- The Use of Cross Sectional Imaging to Define Ventricular Septal Defect Morphology.- Pulsed Doppler Echocardiography.- Volume Flow Considerations.- Continuous Wave Doppler.- Doppler Color Flow Mapping.- Intraoperative Color Flow Mapping.- Post Operative Follow-up.- X Combined Cross-Sectional Imaging and Doppler Echocardiography in Atrioventricular Septal Defects.- Morphological Considerations — What We Need to Know.- Hemodynamic Considerations.- Cross-Sectional Imaging.- Doppler Echocardiography.- Pulsed Wave Doppler.- Continuous Wave Doppler.- Doppler Color Flow Mapping.- Intraoperative Echocardiography.- Post Operative Follow-up.- Summary.- XI The Doppler Evaluation of Patent Ductus Arteriosus.- Patent Ductus Arteriosus.- Imaging in Patent Ductus Arteriosus.- Pulsed Doppler Applications.- Continuous Wave Applications.- Color Flow Mapping.- Post-operative Follow-up.- Conclusion.- XII Doppler Findings in Hypoplastic Left Heart Syndrome.- Pulsed Doppler Echocardiography.- Mitral Valve, Aortic Valve and Atrial Septum.- Tricuspid and Pulmonary Valves.- Ascending Aorta, Aortic Arch and Duct.- Continuous Wave Doppler.- Color Flow Mapping Left Ventricle, Mitral Valve and Aortic Valve.- Tricuspid Valve and Pulmonary Valve.- Ascending Aorta, Aortic Arch and Duct.- Conclusion.- XIII Doppler Echocardiography Evaluation of Total Anomalous Pulmonary Venous Drainage.- Pulsed Doppler Echocardiography.- Supracardiac TAPVD.- TAPVD with Drainage to the Coronary Sinus or Right Atrium.- Infradiaphragmatic TAPVD.- Flow Characteristics within Individual Pulmonary Veins.- Doppler Color Flow Mapping.- Distinction of TAPVD from Cor Triatriatum.- Infradiaphragmatic TAPVD.- Conclusion.- XIV The Evaluation of Complex Shunt Lesions.- Ruptured Sinus of Valsalva.- Coronary Artery Lesions.- Connections Between the Aorta and Pulmonary Artery.- Endocarditis Related Shunts.- Conclusion.- XV Tetralogy Of Fallot, Pulmonary Atresia and Truncus Arteriosus.- Tetralogy of Fallot.- Cross-sectional Imaging.- The Role of Doppler in the Evaluation of Tetralogy of Fallot.- The Ventricular Septal Defect.- The Definition of the Pulmonary Arteries.- Ultrasound in the Evaluation of the Repair of Tetralogy of Fallot.- Ultrasound Evaluation of Pulmonary Atresia with VSD.- Truncus Arteriosus.- XVI The Use of Intraoperative Ultrasound in Congenital Heart Disease.- Clinical Practice of Intraoperative Ultrasound.- Epicardial Studies.- Transesophageal Studies.- Post-Operative Studies.- Assessment of Cardiac Surgery by Epicardial Doppler Ultrasound.- Atrial Level.- Atrioventricular Valves.- Ventricular Level.- Interventricular Septum.- Ventricular Outflow Tracts.- Arterial Valves and Great Arteries.- Doppler Ultrasound During Special Surgical Procedures and Fontan Procedures.- Senning, Mustard Procedure.- Rastelli Procedure.- Arterial Switch Procedure.- XVII Transesophageal Echocardiography in Congenital Heart Disease.- Technique.- Scanning Equipment.- Advantages and Limitations.- Assessment of Congenital Heart Disease.- Cardiac Position.- Atrial Appendage Anatomy — Atria.- Systemic Venous Drainage.- Pulmonary Venous Drainage.- The Atrial Septum.- Atrioventricular Valves and Connections.- The Interventricular Septum.- Ventricular Outflow Tracts.- Arterial Valves and Great Vessels.- Where To Use It.- Summary.