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The Echo Manual
FOURTH EDITION
Jae K. Oh, MD
Samsung Professor of Cardiovascular Diseases, Mayo Clinic
Director, Echocardiography Core Lab, Mayo Clinic
Co-Director, Integrated CV Imaging, Mayo Clinic
Director, Heart Vascular Stroke Institute, Samsung Medical Center, Korea
President, Asian-Pacific Association of Echocardiography
Garvan C. Kane, MD, PhD
Professor of Medicine, Mayo Clinic
Director, Stress Echocardiography, Mayo Clinic
Co-Director, Echocardiography Laboratory, Mayo Clinic
Vice Chair, Division of Cardiovascular Ultrasound, Mayo Clinic
James B. Seward, MD
Nasseff Professor of Cardiology (Emeritus) in Honor
of Dr. Burton Onofrio, Mayo Clinic
Director (Emeritus) Mayo Echocardiographic
Laboratory
Professor of Adult and Pediatric Cardiology
(Emeritus), Mayo Clinic
Professor (Emeritus) Department of Cardiovascular
Medicine, Mayo Clinic
A. Jamil Tajik, MD
Thomas J. Watson Jr Professor (Emeritus) in Honor
of Dr. Robert L. Frye, Mayo Clinic
Chairman (Emeritus), Department of Cardiovascular
Medicine, Mayo Clinic
Director (Emeritus), Mayo Echocardiographic
Laboratory
Director, Cardiac Specialty Center, Aurora St. Lukes
Medical Center, Milwaukee, Wisconsin
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Fourth Edition
Copyright 2019 by Wolters Kluwer
2019 Mayo Foundation for Medical Education and Research. All rights reserved.
This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, recording, or otherwise, without written permission from Mayo Foundation, Section of Scientific Publications, Plummer 10,200 First Street SW, Rochester, MN 55905. Nothing in this publication implies that Mayo Foundation endorses any of the products mentioned in this book.
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Printed in China
Cataloging in Publication data available on request from publisher
ISBN 978-1-4963-1219-8
This work is provided as is, and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturers package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work.
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To Pioneers of Echocardiography
To our Echo Colleagues
To our Families
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List of Contributors
Sahar S. Abdelmoneim, MD
Research Associate/Collaborator, Echo Core Lab
Department of Cardiovascular Medicine
Mayo Clinic
Rochester, Minnesota
Karima Addetia, MD
Assistant Professor of Medicine, Section of Cardiology
University of Chicago Medical Center
Chicago, Illinois
Naser Ammash, MD
Professor of Medicine
Consultant, Division of Structural Heart Disease Director, Heart Brain Clinic, Department of Cardiovascular Medicine
Mayo Clinic
Rochester, Minnesota
Lori A. Blauwet, MD, MA
Associate Professor of Medicine
Consultant, Department of Cardiovascular Medicine
Mayo Clinic
Rochester, Minnesota
Allison K. Cabalka, MD
Associate Professor of Pediatrics
Consultant, Division of Pediatric Cardiology
Mayo Clinic
Rochester, Minnesota
Frank Cetta, MD
Professor of Medicine and Pediatrics
Division of Pediatric Cardiology
Department of Cardiovascular Medicine
Mayo Clinic
Rochester, Minnesota
Sung-A Chang, MD, PhD
Associate Professor
Division of Cardiology
Department of Medicine
Heart Vascular Stroke Institute Imaging Center
Samsung Medical Center
Sungkyunkwan University School of Medicine
Seoul, Republic of Korea
Thais Coutinho, MD
Chief, Division of Cardiac Prevention and Rehabilitation
Chair, Canadian Womens Heart Health Centre
Division of Cardiology
University of Ottawa Heart Institute
Ottawa, Ontario, Canada
Michael W. Cullen, MD
Assistant Professor of Medicine
Consultant, Department of Cardiovascular Medicine
Mayo Clinic
Rochester, Minnesota
Ral E. Espinosa, MD
Assistant Professor of Medicine
Consultant, Department of Cardiovascular Medicine
Mayo Clinic
Rochester, Minnesota
Covadonga Fernndez-Golfn, MD
Director, Cardiac Imaging Unit
Department of Cardiology
University Hospital Ramn y Cajal
Madrid, Spain
David A. Foley, MD
Assistant Professor of Medicine
Consultant, Department of Cardiovascular Medicine
Mayo Clinic
Rochester, Minnesota
William K. Freeman, MD
Professor of Medicine
Consultant, Department of Cardiovascular Medicine
Mayo Clinic
Scottsdale, Arizona
Jeffrey B. Geske, MD
Associate Professor of Medicine
Consultant, Department of Cardiovascular Medicine
Mayo Clinic
Rochester, Minnesota
Ariana Gonzlez, MD
Director, Valvular Heart Diseases
Department of Cardiology
University Hospital Ramn y Cajal
Madrid, Spain
Donald J. Hagler, MD
Professor of Medicine and Pediatrics
Consultant, Division of Pediatric Cardiology
Department of Cardiovascular Medicine
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