Echocardiography in Pediatric and Adult Congenital Heart Disease
Benjamin W. Eidem, MD, FACC, FASE; Frank Cetta, MD, FACC, FASE; and Patrick W. O’Leary, MD, FACC, FASE, eds.
500 pages. Philadelphia, USA: Lippincott Williams and Wilkins, 2010. $229.00 ISBN 0-7817-8136-1
It has been nearly 8 years since a textbook on echocardiography specifically for pediatric congenital heart disease (CHD) has been published. A specific work on both pediatric and adult CHD emphasizing imaging is a new endeavor. Three expert senior clinicians from the Mayo Clinic are the editors and primary authors of this multiauthor textbook, which includes young investigators, midcareer investigators, and senior experts in pediatric and congenital heart echocardiography and imaging from around the United States and Canada.
In their Introduction, the editors, citing the evolution of echocardiography, remind us of the major contributions of Drs James Seward and Jamil Tajik and Drs William Edwards and Donald Hagler to the field of 2-dimensional echocardiography and CHD in 1987, after the original investigations of M-mode echocardiography and 2-dimensional echocardiography by this reviewer (D.J.S.). Richard Meyer and Nils Lundstrom, the editors of this new text, also, in their Introduction, give special attention to Dr. Edwards, the renowned cardiac pathologist and a major resource.
This textbook is well organized. The first chapter relates to principles of cardiovascular ultrasound, followed by practical issues, anatomic orientation, and segmental cardiovascular analysis; quantitative methods for echocardiography, basic and advanced; and then lesion-oriented chapters, including pulmonary venous abnormalities and abnormalities of the atrial septum, atrial ventricular septal defects, Ebstein malformation, mitral valve abnormalities, congenitally corrected transposition, ventricular septal defects, univentricular connections, abnormalities of right and left ventricular outflow, tetralogy of Fallot, transposition, double-outlet ventricles, truncus arteriosus, patent ductus arteriosus, abnormalities of the aortic arch, Marfan syndrome, hypertrophic and other cardiomyopathies, vascular abnormalities, cardiac tumors, evaluation of the transplanted heart, pulmonary hypertension, and echocardiography for endocarditis and prosthetic valves. There are specific chapters on 3-dimensional echocardiography and CHD, stress echocardiography, intraoperative cardiac, magnetic resonance imaging (MRI) in CHD, and aging and CHD. Three other sections on adult CHD follow, presenting problems related to adult CHD: tetralogy of Fallot, difficulties after the Fontan, and Eisenmenger syndrome. The final chapter focuses on fetal echocardiography.
Like many multiauthor textbooks, unfortunately, this book varies in the quality and comprehensiveness of chapters, including, surprisingly, variations in the quality of some of the images. Organizationally, for instance, there is a brief discussion of 3-dimensional echocardiography early on—just a brief mention in the instrumentation chapter. There is nothing at all in detail about how 3-dimensional imaging is obtained and space-time resolution or processing, which is important for a new text. Likewise, in the chapter by Salgo and Shirali, there is some information on array construction but very little detailed discussion about actual spatial and temporal resolution, although the illustrations in the Salgo/Shirali chapter are of very high quality.
Chapter 2, on anatomic orientation, techniques, image acquisition, and display, is very well organized, systematically written, and beautifully enhanced by anatomic illustrations from Dr Edwards’ collection (eg, Figure 2.15 detailing atrial anatomy). This chapter represents a well-organized resource.
Chapter 3, the quantitative chapter, lists the basic methods both for 2-dimensional imaging and for Doppler echocardiography techniques (ie, measures of diastolic and systolic function and gradients). Tissue Doppler is mentioned, and there is a speckle tracking image, although little is discussed until a comprehensive table of pulsed-wave tissue Doppler normal data is presented later in the chapter. There are only brief discussions of echocardiographic assessment of single-ventricle function and 3-dimensional echocardiography for right ventricular function. This redundancy, with mentions of techniques and needs in various places, is characteristic; for example, right ventricular function is again mentioned in the chapter by Shirali and Salgo, and issues related to left ventricular function are mentioned again in Chapter 37 on tetralogy of Fallot and pulmonary regurgitation and in Chapter 39 on Eisenmenger syndrome.
The advanced quantitative methods chapter, Chapter 4, goes back to some technical aspects of 3-dimensional echocardiography but does not list the newest full-aperture real-time technologies that have recently come to the market. The illustrations, however, are of good quality and show segmental wall and volume analysis for synchrony. There is another explanation of tissue Doppler, principles of strain rate based on tissue Doppler, and finally another brief mention of speckle tracking that states its advantages and presents it as a very new area, which in fact it is not.
Chapter 34, by Mark Fogel, presents a review of MRI in CHD, including MRI of ventricular function cine phase mapping and myocardial tagging, as well as a demonstration of ventricular volumes and mass. A blanket statement is made that MRI cannot be performed in patients with pacemakers, which is not correct. There is some mention of the potential importance of interventional cardiac MRI, a new and exciting field.
Other examples of variation in image quality include Chapter 13, on abnormalities of the right ventricular outflow tract. Some of the illustrations are too dark and some of the color maps are overly averaged, making them unclear. The chapter is, however, very well written and quite informative.
The chapter on left ventricular outflow tract disease, Chapter 14, has high-quality anatomic and echocardiographic illustrations and is extremely well written, especially for a chapter covering such a broad area, including postinterventions.
The coronary abnormalities, while illustrated diagrammatically in the tetralogy chapter, are better shown in the illustrations in Chapter 38 on transpositions where, in fact, they are more important. Very similar diagrams are repeated.
Chapter 20, on aortic arch abnormalities, has no MRI angiograms or computed tomography angiograms, although it has some gradient cine illustrations. Chapter 25, on vascular and coronary abnormalities, has high-quality illustrations.
Chapter 24, on pericardial abnormalities, is comprehensive and well organized; Chapter 27, on posttransplantation surveillance, is very short and quite incomplete. It lacks detail about coronary and myocardial surveillance. Likewise, Chapter 30, on prosthetic valve evaluation, is short and incomplete. It also has an extremely brief statement about transplant and contrast agents.
Chapter 33, on intracardiac and transesophageal echocardiography, is a good, well-illustrated chapter, especially the discussion of transesophageal echocardiography. The short comments about intracardiac echocardiography are illustrative, but there is no real review of how it is being used in CHD other than a single case on atrial septal defect device closure. There is also no mention of the commercial availability of a micromultiplane 4-mm probe introduced 2 years ago and on the market last year.
Although the fetal echocardiography chapter by Rychik and associates, Chapter 40, is a generally good review, it does not show a lot of anatomic examples but uses mainly hemodynamic flow curves and Doppler evaluation. The first figure in that chapter, the fetal echocardiography views, Figure 40.1a and 40.1b, has been reproduced and is blurry and hard to see.
The value of this new textbook is that it is an attractive, well-illustrated, comprehensive resource on pediatric and adult CHD, echocardiography, and like most modern texts, purchase allows access to a series of online echocardiography clips. Like many multiauthor textbooks, there are areas that are redundant and duplicative scattered through the various chapters. For the most part, the quality of the echocardiography illustrations is excellent; the quality of the anatomic and diagrammatic illustrations is superb.
True to the Mayo tradition, Drs Eidem, Cetta, and O’Leary have produced a high-quality and informative publication, based substantially on the Mayo experience, that should be useful to trainees in pediatric and adult CHD and to practitioners. It has been almost 8 years since a new book on this subject has been made available, and we can in general strongly recommend this textbook as a good addition to the library of anyone interested in CHD management and CHD imaging.