To our knowledge, this is the first book dealing exclusively with myocardial contrast two-dimensional echocardiography (MC-2DE), a new and exciting diagnostic methodology for assessment of myocardial perfusion, which has seen rapid development and has now entered the clinical stage. The experi mental research and human applications have been described in technical papers published in a variety of journals, but our objective is to provide the reader with a comprehensive and concentrated overview of the field and of the current state of the art. To facilitate appreciation of the significant ad vances made and issues yet to be resolved, we are pleased to have several well known specialists contribute their own assessment of specific aspects of MC- 20E and illustrate the method's principles as well as applications. We were faced with inevitable overlaps and some repetitions in the discussion of quan titative potentials or limilations of the methodology. Rather than strictly 'streamlining' the text, we decided to accept some redundancy in the interest of presenting a diversity of points of views, reflecting the current evolutionary state of MC-20E. Following a brief reference to the established clinical contrast echocardiog raphy, recent developments and validations of the specialized MC-2DE tech nique are reviewed, bearing in mind that the field is in a flux and some of the ongoing activities have not as yet been formally reported. Mechanisms of the echo contrast and several new agents are decribed next, and an additional chapter illustrates current thoughts-on optimizing the echo contrast medium.

This monograph represents an attempt to collect the methods developed within the past decade in which echocardiography was being used to guide or to assess the results of some cardiovascular interventions or to overcome the imaging limitations of transthoracic approaches. I have entitled this book Echocardio graphy in Cardiac Interventions, although I am aware that this title is not entirely applicable to all the included methods. In these interventive procedures echocar diography preserves its noninvasive nature, and by combining it with invasive procedures, they become more accurate, safer and less invasive. The book is divided into 8 sections and 42 chapters written by many authorities in the field. When such comprehensive contributions from many authors are used, some overlapping cannot be avoided. I would like to express my appreciation to the individual contributors for their A. 1. Tajik dedication and cooperation in preparing this book. I am indebted to Dr. from the Mayo Clinic, who created a pleasant milieu for preparing the book during my sabbatical year at the Mayo Clinic. It is hoped that the reader will derive from this book a sense of where and how the ultrasound can be used in cardiovascular interventions today and what new approaches might be forthcoming. Iva Cikes List of contributors M. L. Antunes, MD., Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA. J. Areeda, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Effective treatment of acute myocardial infarction remains one of the major issues in cardiology and internal medicine. The present monograph summarizes the relevant experimental data and the results of major clinical trials in the treatment of myocardial infarction. There are contributions of fundamental anatomical and physiological concepts of vascular occlusion and myocardial damage due to ischemia as well as discussions of therapeutic strategies involving thrombolytic agents, adjuvant drug therapy for limitation of myocardial damage, improvement in myocardial tolerance to ischemia and prevention of coronary reocclusion. In this regard, there is an extensive discussion of the role of coronary angioplasty and bypass surgery in the setting of acute myocardial infarction.

Some 25 years ago, the coronary care unit concentrated high technology and the acutely ill patients who might benefit from it in a single, recognizable space. Since then, that space and its technical equipment have changed, as has part of its population. Acute ischemia, silent and manifest, occurs within and outside of the coronary care unit as pain, arrhythmia, or pump failure. Its detection and treatment require the utilization of many diagnostic techniques and skills, not the least of which is two-dimensional Doppler echocardio graphy, which is gaining importance. Future developments, in tandem with computer technology, may add to this importance by enabling tissue identification, spatial representation, and Doppler flow mapping. This book describes the state of the art for the practicing clinician using Doppler echocardi?graphy at the bedside of patients with acute ischemic manifestations of coronary heart disease. The first requirement is to move from the echo laboratory to the coronary care unit, emergency department, operating room, or catheterization laboratory, using equipment suited for that purpose. The second, more trying imperative is to secure good cooper Ition between those treating the acutely ill patient and the investigator who interferes with his probes. If successful ceeding in both, rewarding results can be obtained, since echocardiography is a very sensitive and specific tool for recognizing and quantifying early ischemia.

This Textbook will give the reader a detailed understanding of the use of 3D echo covering a wide range of topics; from the evolution of RT3D echo to the role of RT3D echo in drug trials, including chapters on the Principles of Transthoracic and Transesophageal Real-time 3D echocardiography. Other books in this area are more varied, less specific.

Although the technology required for the successful application of contrast echo cardiography has evolved rapidly over the past few years, the technique has not yet gained widespread clinical acceptance. One important reason for the lack of clinical acceptance is the relative complexity of the technique, particularly in respect to myocardial perfusion imaging. The interaction between micro bubbles and ultrasound is an entire field by itsel£ as is the coronary microvasculature. It is in this regard that practicing echocardiographers, cardiologists in training, radiologists, so no graphers, and students will find 'A Handbook of Contrast Echocardiography' particularly useful. Written by two leaders in the field who have presented illustrative cases not only from their own laboratories but also from others around the world, this volume is a lucid, concise, and practical guide for the day-to-day use of contrast echocardiography. Dr Peter Burns has been involved in almost all the technical advances in the imaging methods that have made it possible to detect opacification of the left ventricular cavity and myocardium from a venous injection of microbubbles. He has been responsible to a large degree for advancing our understanding of the interaction between micro bubbles and ultrasound, which he describes in clear and easy to understand terms in this book. Dr Harald Becher has been active in the clincal application of contrast echocardiography for several years and has gained considerable experience with many imaging techniques and microbubbles, which he describes in this volume in some detail.

Transesophageal echocardiography has become an important diagnostic method for cardiologists. It offers better resolution of images in certain cases (patients with endocarditis, prosthetic valves, central and peripheral embolism) and the distinct advantage of applicability during heart surgery. In the intensive care unit or in high risk patients during general anesthesia, it allows continuous monitoring and earlier detection of irregularities. Well-known international experts discuss the present status of this new technique, from technology and indications, advantages and disadvantages, to use in the operating room.

Cardiac ultrasound has rapidly developed into one of the most important clinical methods for diagnosis and follow-up of patients with heart disease and has changed the practice of cardiology permanently. In addition to improving image quality, most of the progress relies on digital image acquisition, storage, and quantitative analysis equipment. Automatic endocardial detection and three dimensional reconstruction are now being developed. The progress with contrast echocardiography for myocardial perfusion imaging and results with tissue characterization is slow, but ever increasing, illustrating that the full potential of the method has not yet been explored. All of these digital techniques are extensively dealt with in this volume. Computerized tools will help the clinical cardiologists in their daily practice and stimulate further development to gen uinely improve patient care in the coming years. We wish to thank the authors to this volume for their excellent contribution and Mrs. T. van der Kolk for secretarial assistance. IX Contributors F.J. ten Cate Thorax Center, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands R. Erbel II Medical Clinic, Johannes Gutenberg University, Langenbeckstr. 1, P.O. Box 3960, D-6500 Mainz, FRG Co-authors: R. Zotz, B. Henkel, G. Schreiner, C. Steuernagel, R. Zahn, H. Kopp, W. Clas, R. Brennecke, P. Schweizer, J. Meyer S.B. Feinstein Division of Cardiology, Box 44, University of Chicago, 950 East 59th Street, Chicago, IL 60637, USA D.G. Gibson Department of Cardiology, Brompton Hospital, Fulham Road, London SW3 6HP, UK Co-author: R.B. Logan Sinclair E.

Dr. Otto's best-selling text not only explains how to qualitatively and quantitatively interpret echocardiographic images and Doppler flow data, but also outlines how this information affects your clinical decision making. This edition features new chapters on tissue doppler, intracardiac echocardiography, hand-held echocardiography, and echocardiography in inherited connective tissue disorders. A companion DVD offers case-based multiple-choice questions to help you assess your understanding. Whether you are attempting to choose a course of therapy, ascertain the optimal timing for intervention, arrive at a prognosis, or determine the possible need for periodic diagnostic evaluation, this is an essential resource you'll consult time and time again. Delivers clear and concise coverage of the basics of image acquisition that explains the how and why of echocardiography. Reflects the latest technology and standards of practice. Provides a clinically based approach to echocardiography, with an in-depth discussion of the main cardiac events seen in practice, including adult congenital heart disease. Devotes extensive detail to training, education, and quality assurance-making it the most comprehensive text on echocardiography. Includes a practical outline called The Echo Exam at the end of each chapter that presents necessary calculations, diagnoses, and examples along with guidance on how to interpret outcomes. Includes a bonus DVD containing 3 cases and 5 multiple-choice questions for each chapter that test your knowledge of the material. Perfect resource for Residents preparing for the boards. Offers an expanded section on echocardiography techniques that explains the latest applications for all types of practices. Discusses new echocardiography modalities, including contrast and 3-D echocardiography, so you can utilize the most promising new approaches for your patients. Includes new chapters on tissue doppler, intracardiac echocardiography, hand-held echocardiography, and echocardiography in inherited connective tissue disorders. Uses new, full-color line drawings and new color Doppler images to help you easily visualize cardiac problems.