ATLAS OF NONINVASIVE CARDIAC IMAGING
Rick A Nishimura 
Panithya Chareonthaitawee 
Matthew Martinez
ECHOCARDIOGRAPHIC IMAGES
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Video 42-1 Real-time two-dimensional echocardiographic images of a patient with a normal heart. A. Parasternal long-axis view. B. Parasternal short-axis view. There is symmetric contraction of the ventricles, evidenced by a decrease in cavity size and increase in wall thickness during systole. Echocardiographic imaging is performed in multiple acoustic windows with different transducer rotations so that the entire heart and great vessels can be displayed in various planes. Most information from a study is obtained from visual analysis of the two-dimensional images, although objective measurements of cardiac dimensions can be made.
Video 42-2 Real-time two-dimensional echocardiographic images of a patient with a severe decrease in left ventricular systolic function. The estimated ejection fraction is 20%. A. Parasternal long-axis view. B. Parasternal short-axis view.
Video 42-3 Real-time two-dimensional echocardiographic images of a patient with hypertrophic cardiomyopathy. There is a marked increase in left ventricular wall thickness with hyperdynamic systolic function. A. Parasternal long-axis view. B. Parasternal short-axis view.
Video 42-4 Real-time two-dimensional parasternal long-axis images from a patient with aortic stenosis. There is normal left ventricular cavity size with normal systolic function. The aortic valve is thickened and calcified, with restricted opening.
Video 42-5 Real-time two-dimensional echocardiographic images of a patient with mitral stenosis. There is diastolic doming and restricted leaflet opening secondary to fusion of the commissures. A. Parasternal long-axis view. B. Parasternal short-axis view.
Video 42-6 Real-time two-dimensional echocardiographic images from the parasternal long-axis view of a patient with mitral valve prolapse. During systole, both anterior and posterior leaflet of the mitral valve prolapse into the left atrium. A. Gray-scale images demonstrate a leaflet morphology and motion. B. Color flow imaging demonstrating late systolic blue-colored jet of mitral regurgitation. Abnormalities of the valve apparatus such as annular dilatation, prolapse, flail leaflets, vegetation, and rheumatic involvement can be diagnosed by two-dimensional echocardiography. The left ventricular response to volume overload can be assessed by two-dimensional echocardiography.
Video 42-7 Real-time two-dimensional images with color flow Doppler imaging of a patient with mitral regurgitation due to ruptured chordae tendineae. A. Gray-scale image showing a thickened redundant posterior leaflet of the mitral valve with loss of coaptation during systole. B. Color flow imaging showing severe mitral regurgitation as high velocity turbulence (mosaic pattern) extending into the left atrium during systole.
Video 42-8 Real-time transesophageal echocardiographic images of a patient with severe mitral regurgitation due to a flail posterior leaflet. The posterior mitral valve leaflet is completely unsupported and moves into the left atrium during systole. Transesophageal echocardiography provides high-resolution images of posterior structure such as the left atrium, mitral valve, and aorta.
Video 42-9 Real-time two-dimensional echocardiographic images of a patient with a vegetation on the mitral valve. There is a mobile echo density attached directly to the mitral valve apparatus that intermittently appears in the left atrium.
Video 42-10 Real-time transesophageal echocardiographic images of a patient with a left atrial myxoma. There is a large echo-dense mass in the left atrium that is attached to the atrial septum. The mass moves across the mitral valve during diastole. Although an echocardiographic image cannot provide pathologic confirmation of the etiology of a mass, the diagnosis of atrial myxoma can be suspected from the appearance, mobility, and attachment to the atrial septum.
Video 42-11 Real-time two-dimensional echocardiographic images from the parasternal long-axis view of a patient with a large aneurysm of the ascending aorta.
Video 42-12 Real-time two-dimensional echocardiographic images of a patient with pericardial effusion. The effusion is shown as a black echo-free space surrounding the heart.
Video 42-13 Real-time two-dimensional echocardiographic images from a subcostal view showing a large secundum atrial septal defect. There is a “drop out” in the region of the mid atrial septum. The right ventricle is enlarged from right ventricular volume overload.
Video 42-14 Real-time two-dimensional echocardiographic images showing a close-up view of the atrial septum in a patient with the question of an atrial septal defect. A. Gray-scale image showing a questionable “drop out” in the atrial septum. B. Color flow imaging confirms left to right flow across the atrial septum.
Video 42-15 Real-time two-dimensional stress echocardiogram in a normal subject. The studies at rest are shown on the left and the studies during peak exercise are shown on the right. A. Parasternal long-axis (top) and short-axis (bottom) views. B. Apical four-chamber (top) and two-chamber (bottom) views. At rest, there is contraction of all segments of the myocardium. During exercise, there is an increase in contractility and in the thickening of all segments of the myocardium with a decrease in end-systolic volume.
Video 42-16 Real-time two-dimensional stress echo-cardiogram of a patient with coronary artery disease. The studies at rest are shown on the left and studies during peak exercise are shown on the right. A. Parasternal long-axis (top) and short-axis (bottom) views. B. Apical four-chamber (top) and two-chamber (bottom) views. The images during peak exercise show regional wall motion abnormalities in the anteroseptal distribution indicative of myocardial ischemia. This was subsequently found to be associated with a high-grade lesion on the left anterior descending artery.
NUCLEAR IMAGES
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