Editor
V Amuthan MD DM FACC FIAE FCSI
The Emeritus Professor Department of Cardiology The Tamil Nadu Dr MGR Medical University
Chennai, Tamil Nadu
Formerly Professor and Head Department of Cardiology Madurai Medical College and Government Rajaji Hospital
Madurai, Tamil Nadu
Consultant Cardiologist Vadamalayan Hospitals
Madurai, Tamil Nadu
Consultant Cardiologist Jeyalakshmi Heart Centre
Madurai, Tamil Nadu, India
ForewordM Srinivasan
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Manual of 3D Echocardiography
First Edition: 2013
9789350255865
Printed at
4Dedicated to
My wife Rajammal and My children RVA Ananth and RVA Arthy Jeya
5Contributors
- A Jegadeeswari MD
- Senior Resident
- Department of Cardiology
- Madurai Medical College
- Madurai, Tamil Nadu, India
- Balu Vaidyanathan MD DM
- Clinical Professor
- Department of Cardiology
- Amrita Insititute of Medical Sciences
- Ernakulam, Kerala, India
- C Balachandran MD DM
- Assistant Professor
- Department of Cardiology
- Thirunelveli Medical College
- Thirunelveli, Tamil Nadu, India
- Girish S Shirali MD
- Department of Pediatric Cardiology
- Medical University of South Carolina USA
- GS Siva Kumar MD DM
- Assistant Professor
- Department of Cardiology
- Madurai Medical College
- Madurai, Tamil Nadu, India
- John M Simpson MD
- Professor
- Department of Imaging Sciences
- Evelina Children Hospital
- St Thomas Hospital, London, UK
- N Ganesan MD DM
- Assistant Professor
- Department of Cardiology
- Madurai Medical College
- Madurai, Tamil Nadu, India
- P Ashok Kumar MD DM
- Assistant Professor
- Department of Cardiology
- Thanjavur Medical College
- Thanjavur, Tamil Nadu, India
- RA Janarthanan MD DM
- Professor and Head
- Department of Cardiology
- Madurai Medical College
- Madurai, Tamil Nadu, India
- R Alagesan MD DM
- Professor and Head
- Department of Cardiology (Retd)
- Madras Medical College
- Chennai, Tamil Nadu, India
- Raman Krishna Kumar MD DM Professor
- Department of Cardiology
- Amirtha Institute of Medical Sciences
- Ernakulam, Kerala, India
- R Aravazhi MD
- Senior Resident
- Department of Cardiology
- Madurai Medical College
- Madurai, Tamil Nadu, India
- S Balasubramanian MD DM
- Professor and Head
- Department of Cardiology
- Government Mohan Kumaramangalam
- Medical College, Salem, Tamil Nadu, India
- S Naina Mohamed MD DM
- Assistant Professor
- Department of Cardiology
- Madurai Medical College
- SR Veeramani MD DM
- Assistant Professor
- Department of Cardiology
- Madurai Medical College
- Madurai, Tamil Nadu, India
- V Amuthan MD DM FACC FIAE FCSI
- The Emeritus Professor Department of Cardiology
- The Tamil Nadu Dr MGR Medical University
- Chennai, Tamil Nadu
- Formerly Professor and Head
- Department of Cardiology
- Madurai Medical College and Government Rajaji Hospital
- Madurai, Tamil Nadu
- Consultant Cardiologist
- Vadamalayan Hospitals
- Madurai, Tamil Nadu
- Consultant Cardiologist
- Jeyalakshmi Heart Centre
- Madurai, Tamil Nadu, India
The twentieth century witnessed great leaps in diagnostic imaging, Echocardiography, CT imaging and MRI to name a few. Though introduced by Elder in 1953, Echocardiography was a curiosity like Apex Cardiography and Balisto Cardiogram in the formative years.
When M-mode echocardiogram was refined in the early seventies and with the widespread cooperation of industry, it came to clinical arena. Its usefulness in early stages was restricted to the diagnosis of pericardial effusion and valvular heart diseases.
Then, two major breakthroughs came in the early eighties—Real-time 2D imaging and integration of Doppler echo, and later real-time color flow too was added to the armamentarium. With this, we had a tool with high diagnostic accuracy both in terms of specificity and sensitivity. For a brief period, invasive hemodynamics was surpassed—only to re-emerge after development of transcatheter therapeutics. The next major advance is real-time 3D echocardiography with integration of color flow mapping.
The diagnostic accuracy with 3D echo equals surgical exploration and autopsy studies. It is also emerging as an important, useful tool in the assessment of percutaneous cardiovascular interventions, especially in the treatment of septal defects and valvular heart disease.
Dr Amuthan has taken great efforts to put together the advances in 3D echo in a beautiful comprehensive monograph with the help of pioneers in the field. It is a commendable effort by him. Dr Amuthan always looks forward. I hope the monograph and the symposium will enlighten the postgraduates, consultants and novice in this field like me. It gives me pleasure to share a few thoughts as foreword. It is easy to write foreword than to contribute scientific material. Hence, I have chosen this job.
I wish all success to Dr Amuthan's endeavors.
M Srinivasan MD DM
Senior Interventional Cardiologist
Vadamalayan Hospital,
Madurai, Tamil Nadu, India
8Preface
It gives me immense pleasure to bring out this Manual of 3D Echocardiography. This book is aimed at students of echocardiography, cardiologists and physicians performing basic two-dimensional and color Doppler echocardiography. The book has been made possible with enormous grants from Dr Pugazhagiri Vadamalayan, Managing Director, Vadamalayan Heart Foundation and Philips India Limited.
There is an initial chapter on 3D echocardiogram by Professor Dr R Alagesan. This is followed by a chapter fully dedicated on “How to perform 3D echocardiography” by the uninitiated. Tips and tricks of the trade have been given as a separate table. This is followed by 3 chapters on valvular heart disease. There is a dedicated chapter on Coronary Artery Disease emphasizing the need for calculation of 3D regional wall motion abnormalities and ejection fraction. There has been a dedicated chapter on congenital heart disease by Professor Girish S Shirali, with permission from Annals of Pediatric Cardiology. Professor Dr Raman Krishna Kumar has written a chapter on Interventional Device Closure in Atrial Septal Defects which has been reproduced with permission from JACC imaging. There is a separate chapter on 3D Transthoracic ecocardiography (TTE) and Transesophageal ecocardiography (TEE) in interventions. Finally, we have taken great efforts to reproduce some of the interesting 3D echo clippings as an atlas.
I take this opportunity to thank our medical superintendent Professor Dr SM Siva Kumar, who has helped our department in all our endeavors.
My solid work in cardiology would not have been possible without encouragement and inspiration from my teachers, Professor Dr T Sakthivel and Profesor Dr N Kasirajan. I have the esteemed pleasure of support from my Associate Professor Dr RA Janarthanan, Assistant Professors Dr S Balasubramanian, Dr S Naina Mohamed, Dr N Ganesan, Dr GS Siva Kumar and my postgraduates Dr SR Veeramani, Dr P Ashok Kumar, Dr R Aravazhi, Dr R Sampath Kumar, Dr RR Saravanan and Dr A Jegadeeswari.
My great inspiration for my higher studies in cardiology would not have been possible without my parents Professor R Vivekanandan, and Mrs Jeyalakshmi, and my brother Dr RV Asokan, MD.
I dedicate my work to my beloved wife and my children.
V Amuthan