Color Atlas of Cardiovascular Disease Glenn N Levine
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1Color Atlas of Cardiovascular Disease2

BOOK COVER IMAGE CREDITS

Left image: 4D velocity mapping MRI pathline visualization of cardiac blood flow in the heart and great vessels. Image courtesy of Dr Michael Markl. Image from Markl M, et al. Comprehensive 4D velocity (3 dimensional, 3 directionally encoded, time resolved velocity acquisition) mapping of the heart and great vessels by cardiovascular magnetic resonance. Journal of Cardiovascular Magnetic Resonance 2011;(13):7.
Top right image: Gross pathological features of constrictive pericarditis. Image courtesy of Dr William D Edwards, Mayo Clinic. Image and legend text from Khandaker MH and Nishimura RA. Pericardial disease. In Chatterjee K, et al. (ed). Cardiology—an illustrated textbook. Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India.
Middle right image: Gross pathology specimen of calcific aortic stenosis. Image adapted from Armed Forces Institute of Pathology.
Bottom right image: Volume rendered CT angiogram demonstrating separate origins from the left coronary sinus of the left anterior descending and left circumflex coronary arteries. Image from Oyama-Manae N, et al. Noncoronary cardiac findings and pitfalls in coronary computed tomography angiography. J Clin Imaging Sci 2011;1:51. http://www.clinicalimagingscience.org.
3Color Atlas of Cardiovascular Disease
Editor Glenn N Levine MD FAHA FACC Professor of Medicine Baylor College of Medicine Director, Cardiac Care Unit Michael E DeBakey VA Medical Center Houston, Texas, USA
4
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© 2015, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book. This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Color Atlas of Cardiovascular Disease
First Edition: 2015
9789351522447
Printed at
5Dedicated to
All those who devote their lives to the diagnosis and treatment of cardiovascular disease, and hence to the betterment of one's fellow man and woman.
“Cure sometimes, treat often, comfort always”
—Hippocrates
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7Contributors 13Preface
Color Atlas of Cardiovascular Disease is a novel twenty-first century print and electronic media endeavor which integrates traditional and cutting-edge multimedia images and videos, gross and microscopic pathology digital photographs, scores of specially created schematic figures, dozens of summary tables and flow diagrams, and comprehensive yet concise text, in order to educate the reader, both visually and through the written word, on normal and abnormal cardiovascular anatomy, function, and pathology.
The book contains over 3,000 multimedia images and dozens of videos, including all standard cardiovascular tests and imaging results such as 12-lead electrocardiography, electrophysiological studies and mapping, treadmill testing, 2D and Doppler echocardiography, peripheral ultrasound, cardiac SPECT, coronary angiography and IVUS, cardiac CT, coronary CT angiography, cardiovascular MRI and MRA, and PET CT, as well as novel and cutting-edge images such as strain and 3D echocardiography, 4D MRI, electroanatomic imaging, optical coherence tomography, and ECG isochrones mapping.
Over one hundred and fifty national and international cardiovascular experts, representing almost every continent and part of the world, have contributed to the 8 sections and 58 chapters in the book. Hundreds of other investigators, academicians, and practitioners shared images that were used in this book.
Color Atlas of Cardiovascular Disease covers the gamut of cardiovascular disease, including coronary artery disease and acute coronary syndromes, coronary revascularization, valvular and structural heart disease, heart failure and cardiomyopathies, pericardial disease, conduction abnormalities and arrhythmias, congenital heart disease, cardiac tumors, hyperlipidemia, peripheral vascular disease, stroke and cerebrovascular disease, renovascular disease, diseases of the aorta, and venous thromboembolism. Dozens of well established and emerging device-based therapies are illustrated and discussed, including PCI, CABG, ablation therapy, stent grafts, peripheral bypass, endarterectomy, arrhythmia ablation, septal closure devices, atrial appendage occluders, and TAVR. Both American and European practice guidelines for the management of specific cardiovascular diseases are summarized and discussed.
My hope is that this book will prove interesting, educational, and clinically relevant and useful to healthcare professionals of all levels of training and expertise, including medical students, medical, neurology and surgical residents, medical and surgical nurses, pathologists, allied health care professionals, and established and experienced cardiologists, surgeons, and others who already have expertise in the diagnosis and treatment of cardiovascular disease. The ultimate goal we all share, of course, is to improve the care of patients with cardiovascular disease in the area where we live, in our country, and worldwide, and if this book contributes to this goal in even the smallest of ways, then it has been an endeavor well worth pursuing.
Glenn N Levine
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15Acknowledgments
This Color Atlas of Cardiovascular Disease would not be possible without the efforts of all the national and international experts who were willing to contribute chapters to the book. A special thanks also goes out to the hundreds of persons who were willing to allow us to use their images and videos in this book, and to all those who published their manuscripts under Creative Commons licenses, which allows the sharing of published images for educational purposes, as long as the image creators are fully acknowledged (which we have so done in this book).
I would also like to thank Marco Ulloa (Development Editor), Joe Rusko (Publisher), and Sh Jitendar P Vij, Group Chairman of Jaypee Brothers Medical Publishers (P) Ltd., as well as the entire publishing team at Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India.
A heartfelt acknowledge must also go out to my 3 dogs, all adopted from animal rescue organizations, who were at my feet (or on my lap) giving me moral support during the many late weeknights and long weekends I spent working on this book.
21Video Legends  
SECTION 1: Coronary Artery Disease
  1. Normal Coronary and Venous Anatomy
    Video 1.1: CT 3D volume-rendered image showing the course of the coronary arteries.
    Video 1.2: Right anterior oblique cranial angiogram showing the left anterior descending (LAD). The LAD gives off septal branches which supply the superior interventricular septum and gives off diagonal branches which supply a portion of the anterior and anterolateral walls.
    Video 1.3: Right anterior oblique caudal angiogram showing the left circumflex artery and several obtuse marginal branches of the left circumflex artery.
    Video 1.4: AP angiogram of the right coronary artery.
  2. Coronary Artery Anomalies
    Video 2.1: Angiogram of a mid left anterior descending (LAD) myocardial bridge. (Video courtesy of Glenn N Levine).
  1. Stable Ischemic Heart Disease
    Video 5.1A: Right anterior oblique projection angiogram showing a discrete tight stenosis in the mid to distal segment of a large “wrap around” left anterior descending artery.
    Video 5.1B: Angiogram showing diffuse coronary artery disease of the left anterior descending (LAD) artery in a diabetic patient with stable ischemic heart disease. The catheter is subselectively engaged in the LAD so the left circumflex artery is not well visualized.
    Video 5.2: Angiogram showing discrete stenosis in a segment of a large branching obtuse marginal artery in a patient with stable ischemic heart disease.
    Video 5.3: Angiogram showing a discrete moderate stenosis of the right coronary artery (RCA) before the take-off of the PDA in a patient with stable ischemic heart disease. Several posterolateral branches of the RCA are also visualized.
  2. Acute Coronary Syndromes
    Video 6.1: Angiogram obtained in a patient undergoing primary percutaneous coronary intervention of the right coronary artery for an inferior wall myocardial infarction. After the guidewire is passed, the shown angiogram demonstrates a large, complex, filling defect, which is due to thrombus formation that has resulted from plaque rupture.
    Videos 6.2A to E: Primary percutaneous coronary intervention of an occluded mid left anterior descending (LAD) artery in a patient with acute anterior wall myocardial infarction. (A) Initial angiogram showing complete occlusion at the level of the mid LAD. (B) Guidewire passed across occlusion, resulting in some restoration of blood flow. A residual stenotic lesion is visible. (C) A coronary stent being positioned at the site of residual stenosis. (D) Inflation of the balloon and deployment of the coronary stent. (E) Post-stent deployment angiogram showing the treated stenosis and TIMI 3 flow throughout the coronary artery.
    Videos 6.3 to 6.7: Examples of apical thrombi that developed in patients with transmural infarctions and apical akinesis.
  3. Percutaneous Coronary Intervention
    Videos 7.1A to D: Example of primary stenting in a patient with chronic stable angina. (A) Initial angiogram shows a moderate mid left anterior descending (LAD) stenosis. (B) Guide wire across the mid-LAD stenosis and a coronary stent positioned at the site of the stenosis. (C) Balloon inflation and stent deployment. (D) Post-stent deployment angiogram showing 0% residual stenosis.
    Videos 7.2A to E: Primary percutaneous coronary interventions of an occluded mid left anterior descending (LAD) artery in a patient with acute anterior wall myocardial infarction. (A) Initial angiogram showing complete occlusion at the level of the mid LAD. (B) Guide wire passed across occlusion, resulting in some restoration of blood flow. A residual stenotic lesion is visible. (C) A coronary stent being positioned at the site of residual stenosis. (D) Inflation of the balloon and deployment of the coronary stent. (E) Post-stent deployment angiogram showing the treated stenosis and TIMI 3 flow throughout the coronary artery.
    Videos 7.3A to G: Primary percutaneous coronary interventions of an occluded left circumflex artery. (A) Angiogram showing a subtotally occluded left circumflex artery with TIMI grade 1 flow. Contrast is visible just distal to the culprit lesion from a previous contrast injection. A late-filing large obtuse marginal (OM) branch is visible. (B) Guide wire passed across the lesion and balloon positioned at the site of subtotal occlusion. (C) Balloon inflation. (D) Post-balloon inflation angiogram showing some improvement in blood flow to TIMI grade 2 and a residual stenosis. (E) Positioning of a long coronary stent. (F) Deployment of the coronary stent. (G) Final coronary angiogram showing the treated culprit lesion and restoration of TIMI grade 3 blood flow.
  4. Coronary Artery Bypass Graft Surgery
    Video 8.1: Left internal mammary artery (LIMA) to left anterior descending (LAD).
    Video 8.2: Saphenous vein graft (SVG) to obtuse marginal (OM) branch.
    Video 8.3: Saphenous vein graft (SVG) to posterior descending artery (PDA).
    Video 8.4: Saphenous vein graft (SVG) occluded.
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SECTION 2: Valvular Heart Disease
  1. Normal Valve Anatomy and Function
    Video 9.1: Apical four chamber TTE showing a mitral valve with good coaptation.
    Video 9.2: Parasternal short-axis showing a trileaflet aortic valve (center of image). The tricuspid valve is visible at the 9 O'clock position in the image. The pulmonic valve, which is usually not well visualized, is imaged at the 2 O'clock position.
    Video 9.3: Parasternal long-axis TTE showing a normal aortic valve.
  2. Aortic Stenosis
    Videos 10.1 to 10.3: Parasternal long-axis transthoracic echocardiography (TTE) of heavily calcified and stenotic aortic valves. Note the markedly decreased excursion of the aortic valve leaflets during systole. Videos (Video courtesy of Glenn N Levine, MD).
    Video 10.4: MRI of a stenotic bicuspid aortic valve. (Video courtesy of Scott D Flamm, MD).
  3. Aortic Regurgitation
    Video 11.1: Parasternal long axis echocardiographic image demonstrating severe AI (Video courtesy of Glenn N. Levine, MD).
    Video 11.2: Color Doppler imaging in the parasternal long axis view showing mild AI due to a dilated aortic annulus (Video courtesy of Glenn N. Levine, MD).
    Videos 11.3A and B: Severe aortic regurgitation due to a flail right aortic leaflet. (A) 2D video and (B) Corresponding color. Doppler video (Video courtesy of Glenn N. Levine, MD).
    Video 11.4: Five-chamber view showing AI in a patient with heavily calcified aortic leaflets (Video courtesy of Glenn N. Levine, MD).
    Video 11.5: MRI demonstrating aortic regurgitation in a patient with a dilated aortic annulus and proximal ascending aorta (Video courtesy of Scott D. Flamm, MD).
  4. Mitral Stenosis and Percutaneous Mitral Valvotomy
    Video 12.1: Parasternal long axis transthoracic echocardiography (TTE) showing mitral stenosis (MS) in a patient with rheumatic heart disease. The anterior mitral leaflet (AML) forms a “hockey stick” as it tries to open during ventricular diastole. Note also aortic stenosis is present in this patient. (Video courtesy of Levine GN, MD).
    Video 12.2: Parasternal short axis transthoracic echocardiography (TTE) of a patient with mitral stenosis (MS). A “fish mouth” appearance of the stenotic mitral valve (MV) is present.
    Video 12.3: Transesophageal echocardiography (TEE) of a patient showing mitral stenosis (MS).
  5. Mitral Regurgitation
    Video 13.1: Parasternal long axis transthoracic echocardiography (TTE) showing mild mitral regurgitation (MR) in a patient with myxomatous mitral leaflets.
    Videos 13.2A and B: Transesophageal echocardiography (TEE) study showing (A) endocarditis of mitral valve and (B) resulting mitral regurgitation.
    Video 13.3: Transesophageal echocardiography (TEE) showing endocarditis of the mitral valve and resulting regurgitation.
    Video 13.4: Apical 4 chamber transthoracic echocardiography (TTE) showing severe, somewhat eccentric, mitral regurgitation (MR). Tethering of the posterior mitral leaflet is contributing to the MR.
    Videos 13.5A and B: Transesophageal echocardiography (TEE) study showing (A) a restricted posterior mitral leaflet with (B) resulting mitral regurgitation.
    Video 13.6: Mitral regurgitation due to mitral valve prolapse.
    Video 13.7: Transesophageal echocardiography (TEE) showing mitral regurgitation due to a flail mitral leaflet.
    Video 13.8: Transesophageal echocardiography (TEE) showing a flail A1 scallop with resulting mitral regurgitation (MR).
    Video 13.9: Functional mitral regurgitation (MR) in a patient with dilated cardiomyopathy and a dilated mitral annulus.
  6. Mitral Valve Prolapse
    Video 14.1: Parasternal long-axis TTE showing mitral valve prolapse. During systole both the anterior and posterior mitral leaflets are seen prolapsing into the left atrium. Video courtesy of Glenn N. Levine, MD. (TTE: Transthoracic echocardiogram).
    Video 14.2: Zoomed parasternal long-axis TTE demonstrating mitral valve prolapse (MVP). (TTE: Transthoracic echocardiogram).
    Video 14.3: TEE showing mitral regurgitation in a patient with mitral valve prolapse. (TEE: Transesophageal echocardiography).
    Video 14.4: Left ventriculography performed in the right anterior oblique projection with a straight pigtail catheter (end-systole) demonstrating prolapse of a posteromedial scallop (arrow).
    Video 14.5: 2-Dimensional transesophageal echocardiography (TEE) of mitral valve prolapse demonstrating Barlow's disease with thickened leaflets and bileaflet prolapse
    Video 14.6: 2-Dimensional transesophageal echocardiography (TEE) of mitral valve prolapse. Fibroelastic deficiency with thin leaflets and focal scallop prolapse (arrow).
    Video 14.7: Real-time full volume (wide-angle) 3-dimensional transesophageal echocardiography of MVP.
    Video 14.8: Real-time 3D zoom/live 3D (narrow-angle) 3-dimensional transesophageal echocardiography demonstrating a flail P2 leaflet with a ruptured chordae, typical of fibroelastic deficiency.
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    Video 14.9: Real-time full volume (wide-angle) 3-dimensional transesophageal echocardiography utilizing a simultaneous display of a multiplanar reformat in orthogonal planes and a 3D volume rendering of the region of interest (flail P2 scallop).
    Video 14.10: Real-time 3D zoom/live 3D (narrow-angle) 3-dimensional transesophageal echocardiography demonstrating multi-scallop prolapse A1, P1 and P2 shown in from a left atrial view.
    Video 14.11: Intraoperative video. Totally endoscopic robotic repair of the mitral valve. Following resection of the prolapsing P2 leaflet, the mitral valve has been sutured. Suturing of the annuloplasty ring prosthesis with the robotic arms is underway.
  7. Right-Sided Valvular Heart Disease
    Video 15.1: Non-standard RV inflow view demonstrating severe tricuspid regurgitation in the patient pictured in Fig. 15.7.
    Video 15.2: Additional non-standard RV inflow view demonstrating severe tricuspid regurgitation.
    Video 15.3: 4-chamber view similar to Fig 15.7B demonstrating severe tricuspid regurgitation. In severe tricuspid regurgitation, the rapid normalization of pressures between the right atrium and right ventricle results in a dense, triangular jet as seen in Fig. 15.14 (red arrows).
  8. Endocarditis
    Video 1: Parasternal long axis TTE showing small vegetations on the aortic valve. Video courtesy of Glenn N. Levine, MD.
    Video 2: Transesophageal echocardiography (TEE) videoclip showing complex vegetation on the posterior mitral leaflet. Video courtesy of Alvin Blaustein, MD.
    Video 3: Transesophageal echocardiography (TEE) videoclip showing complex vegetation on the mitral valve in a patient with endocarditis. Video courtesy of Alvin Blaustein, MD.
    Video 4: TEE videoclip of large, highly mobile vegetation on a prosthetic mitral valve.
    Video 5: TEE showing a mobile vegetation on a prosthetic mitral valve in a patient with endocarditis. Video courtesy of Alvin Blaustein, MD.
    Video 6: TEE showing a complex and highly mobile vegetation on a prosthetic mitral valve in a patient with endocarditis. Video courtesy of Alvin Blaustein, MD.
    Video 7: Large, complex vegetation on a prosthetic mitral valve in a patient with blood-culture documented endocarditis.
    Video 8: Color Doppler TEE showing mitral regurgitation as a result of mitral valve endocarditis and valve destruction. Video courtesy of Alvin Blaustein, MD.
  9. Transcatheter Aortic Valve Replacement
    Video 17.1: Animation of transfemoral transcatheter aortic valve replacement with the Edwards Sapian valve. (Video courtesy of Edwards Lifesciences).
    Video 17.2: Fluoroscopy of deployment of a Edwards Sapien valve. (Video courtesy of Edwards Lifesciences).
    Video 17.3: Animation of apical transcatheter aortic valve replacement with the Edwards Sapian valve. (Video courtesy of Edwards Lifesciences).
  10. Valve Surgery and Prosthetic Heart Valves
    Video 18.1: TEE video of a prosthetic aortic valve showing valve dehiscence, visible most prominently from 1 o'clock to 3 o'clock. The sutures are visualized.
    Video 18.2: Color Doppler TEE video corresponding to Video 18.1, showing that the valve dehiscence has led to significant paravalvular leak.
 
SECTION 3: Heart Failure and Cardiomyopathy
  1. Systolic Heart Failure and Dilated Cardiomyopathy
    Videos 20.1 to 20.3: Representative magnetic resonance imaging (MRI) video clips of left ventricular (LV) noncompaction. (Videos courtesy of Flamm SD, MD).
    Video 20.4: Example of noncompaction demonstrated on four chamber magnetic resonance imaging (MRI).
    Video 20.5: Example of noncompaction demonstrated on shortaxis magnetic resonance imaging (MRI).
  2. Heart Failure with Preserved Ejection Fraction
    Video 21.1: Apical 4-chamber transthoracic echocardiography (TTE) showing moderate tricuspid regurgitation.
    Video 21.2: Apical 4-chamber transthoracic echocardiography (TTE) showing moderate mitral regurgitation.
    Video 21.3: 3-chamber transthoracic echocardiography (TTE) showing moderate aortic insufficiency.
    Video 21.4: Short-axis transthoracic echocardiography (TTE) showing prominent “septal bounce” in constrictive pericarditis.
    Video 21.5: Apical 4-chamber transthoracic echocardiography (TTE) showing prominent “septal bounce” in constrictive pericarditis.
    Video 21.6: MRI of a patient with systemic sclerosis with pericardial effusion and constriction causing heart failure with preserved ejection fraction. The video shows a smallto- moderate sized pericardial effusion, which is resulting in decreased cardiac chamber compliance and ventricular interdependence. There is interventricular septal flattening with inversion of the septum into the left ventricle (LV) during peak inspiration.
    Video 21.7: Apical 4-chamber transthoracic echocardiography (TTE) showing small, thickened left ventricle (LV) and right ventricle (RV) with biatrial enlargement in a patient with restrictive cardiomyopathy.
    Videos 21.8 to 21.10: Parasternal long-axis (Fig. 21.8), shortaxis (Fig. 21.9) and apical 4-chamber (Fig. 21.10) transthoracic echocardiography (TTE) images of a patient with infiltrative cardiomyopathy. The findings of abnormal myocardia texture and thickened left 24ventricle (LV) and right ventricle (RV) with biatrial enlargement raise the possibility of infiltrative cardiomyopathy from amyloidosis.
  3. Hypertrophic Cardiomyopathy
    Video 22.1: Parasternal long-axis TTE showing septal hypertrophy in a patient with HCM. (Video courtesy of Glenn N. Levine, MD).
    Video 22.2: Apical 4-chamber TTE of a patient with marked septal hypertrophy and HCM.
    Video 22.3: Parasternal long axis transthoracic echocardiography video clip of a patient with HCM showing thickening of the interventricular septum.
    Video 22.4: MRI displayed in the 4-chamber view showing apical hypertrophic cardiomyopathy. (Video courtesy of Scott D. Flamm, MD).
    Video 22.5: MRI displayed in the 2-chamber view showing apical hypertrophic cardiomyopathy. (Video courtesy of Scott D. Flamm, MD).
    Video 22.6: Apical 4-chamber TTE from a patient with apical HCM. (Video courtesy of Glenn N. Levine, MD).
    Video 22.7: Apical 2-chamber TTE from a patient with apical HCM. (Video courtesy of Glenn N. Levine, MD).
    Videos 22.8A and B: Apical 4-chamber TTE images of a patient with septal hypertrophy and HCM. (A) 2D video shows systolic anterior motion (SAM) of the anterior mitral leaflet during systole. (B) Corresponding color Doppler video clip shows the resulting mitral regurgitation.
    Videos 22.9A and B: Parasternal long-axis TTE images showing modest SAM and resulting mitral regurgitation in a patient with HCM and dynamic outflow obstruction. Note also the turbulent blood flow in the left ventricular outflow tract.
    Video 22.10: Three-chamber TTE in a patient with HCM demonstrating SAM and resulting severe eccentric MR during Valsalva maneuver. (Video courtesy of Glenn N. Levine, MD).
  1. Arrhythmogenic Right Ventricular Cardiomyopathy
    Video 24.1: MRI of a patient with arrhythmogenic right ventricular dysplasia demonstrating a dilated right ventricle with markedly depressed systolic function. (Video courtesy of Scott D Flamm, MD).
 
SECTION 4: Arrhythmias
  1. Atrial Fibrillation
    Video 29.1: Transesophageal echocardiography (TEE) video clip showing thrombus in the left atrial appendage.
 
SECTION 5: Pericardial Disease
  1. Pericarditis
    Video 36.1: Parasternal long-axis transthoracic echocardiography (TTE) demonstrating a circumferential pericardial effusion in a patient with pericarditis.
    Video 36.2: Pericardial effusion imaged in the parasternal long axis view in a patient with suspected pericarditis.
    Video 36.3: Apical 4-chamber transthoracic echocardiography (TTE) in a patient with pericarditis demonstrating a circumferential pericardial effusion.
  1. Pericardial Effusion
    Video 37.1: Parasternal long-axis TTE demonstrating a large circumferential pericardial effusion.
    Video 37.2: Circumferential effusion imaged in the parasternal long-axis view.
    Video 37.3: Parasternal long-axis transthoracic echocardiogram videoclip showing pericardial effusion with RV collapse.
    Video 37.4: Apical 4-chamber TTE showing pericardial effusion with some inversion and compression of the right atrium.
 
SECTION 6: Congenital Heart Disease
  1. Patent Foramen Ovale
    Video 39.1: Transesophageal echocardiogram (TEE) showing a patent foramen ovale (PFO) with intermittent right to left flow during an agitated saline (“bubble”) study. (Video clip courtesy of Glenn N Levine, MD).
    Video 39.2: Color Doppler transesophageal echocardiogram (TEE) demonstrating a patent foramen ovale (PFO).
    Video 39.3: Color Doppler transesophageal echocardiogram (TEE) showing a patent foramen ovale (PFO) with intermittent left-right flow (intermittent thin blue jet). (Video clip courtesy of Glenn N Levine, MD).
  2. Atrial Septal Defects
    Video 40.1: Apical four-chamber TTE showing a large secundum ASD. Note that the right atrium and right ventricle are both dilated. Video courtesy of Glenn N. Levine, MD.
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    Video 40.2: Color Doppler apical four-chamber TTE corresponding to video 40.1, showing left to right flow across a large secundum ASD. Note that the right atrium and right ventricle are dilated, and some tricuspid regurgitation is also present. Video courtesy of Glenn N. Levine, MD.
    Video 40.3: Zoomed video of videos 40.1 and 40.2, showing a large secundum ASD with left to right flow. Video courtesy of Glenn N. Levine, MD.
    Video 40.4: Subcostal view TTE showing a small restrictive ASD with relatively high velocity left to right flow. Video courtesy of Glenn N. Levine, MD.
  3. Ventricular Septal Defect
    Videos 41.1 and 41.2: Magnetic resonance imaging (MRI) video clips demonstrating a ventricular septal defect (VSD) with flow from the left ventricle (LV) to the right ventricle (RV). (Videoclips courtesy of Scott D Flamm, MD).
    Video 41.3: Five-chamber transthoracic echocardiography (TTE) demonstrating a perimembranous ventricular septal defect (VSD) with flow from the left ventricle (LV) to the right ventricle (RV). (Video courtesy of Glenn N Levine, MD).
    Video 41.4: Short-axis transthoracic echocardiography (TTE) demonstrating a perimembranous ventricular septal defect (VSD). (Video courtesy of Glenn N Levine, MD).
  4. Ebstein Anomaly
    Video 42.1: MRI in the 4-chamber projection demonstrating Ebstein anomoly.
  5. Tetralogy of Fallot
    Video 43.1: Severe pulmonary regurgitation in a patient with repaired Tetralogy of Fallot (TOF). Blue coloration demonstrates forward flow toward the branch pulmonary arteries and red flow demonstrates regurgitation toward the right ventricle (RV).
  1. Aortic Coarctation
    Video 46.1: CT demonstrating aortic coarctation. (Video courtesy of Scott D Flamm).
 
SECTION 7: Peripheral Vascular Disease
  1. Carotid Artery Disease
    Video 49.1: Three-dimensional (3D) computed tomography (CT) reconstruction of the carotid arteries.
  1. Aortic Dissection
    Video 51.1: Echocardiography videoclip illustrating a dissection flap in a patient with aortic dissection. Color Doppler shows flow only in what in this case is the true lumen.
    Video 51.2: Transthoracic echocardiogram demonstrating a dilated aortic root and ascending aorta and acute type A aortic dissection. There is malcoaptation of the aortic valve leaflets due to aortic root and annular dilatation. The intimal flap prolapses across the aortic valve.
    Video 51.3: Transthoracic echocardiogram of acute type A aortic dissection with severe aortic regurgitation. Multiple mechanisms are present contributing to aortic regurgitation including dilatation of the aortic root; loss of commissural support of the valve leaflets and intimal flap prolapse across the aortic valve.
    Video 51.4: Transesophageal echocardiogram of an acute type B aortic dissection. The mobile intimal flap separates the true lumen (at the top of the image) from the larger false lumen (at the bottom on the image).
 
SECTION 8: Miscellaneous Cardiovascular Disease
  1. Cardiac Tumors
    Video 54.1: Magnetic resonance imaging (MRI) demonstrating a left atrial myxoma. (Video courtesy of Scott D Flamm, MD).
  1. Stroke
    Video 57.1: Transesophageal echocardiogram showing thrombus in the left atrial appendage of a patient with atrial fibrillation and recent stroke. (Videos courtesy of Glenn N Levine).
    Videos 57.2 to 57.7: Transthoracic echocardiography videos demonstrating left ventricular apical thrombi in patients with an akinetic apex. (Videos courtesy of Glenn N Levine).
    Video 57.8: Transthoracic echocardiography showing vegetations on the posterior mitral leaflet.
    Video 57.9: Transthoracic echocardiography showing vegetations on a prosthetic mitral valve.
    Video 57.10: Transthoracic echocardiography showing mobile vegetations on a prosthetic mitral valve. (Video courtesy of Glenn N Levine).
    Video 57.11: Cardiac MRI showing a left atrial myxoma. (Video courtesy of Scott D Flamm).
    Video 57.12: Transthoracic echocardiography showing a patent foramen ovale with intermittent right to left flow during an agitated saline (“bubble”) study.
    Video 57.13: Color Doppler transthoracic echocardiography demonstrating a patent foramen ovale.
    Video 57.14: Transthoracic echocardiography study showing mobile atheroma in the aortic arch. (Video courtesy of Glenn N Levine).
  2. Venous Thromboembolism
    Videos 58.1 and 58.2: Parasternal short-axis TTE imaging showing a thrombus present in the distal main and proximal right pulmonary artery. (Videos courtesy of Glenn N Levine, MD).