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.

Intracoronary ultrasound is a rapidly evolving imaging modality and the increasing number of published studies indicates that the technique is safe and provides incremental and more detailed diagnostic information than coronary angiography. The technique has the potential to study the pathobiology of atherosclerosis, to clarify the significance of angiographically equivocal lesions and has helped us to understand the mechanisms, effects and complications of catheter-based revascularization procedures. Combinations of imaging and therapeutic devices are being developed for both guidance and assessment of the revascularization procedure. Three-dimensional reconstruction of coronary segments is now possible in real time and provides the opertor with more detailed information on coronary pathology. In this monograph, leading experts in the field present the state of the art of all these new developments.

Why a book on contrast echocardiography? Over the past dozen years enough experience has accumulated to warrant a more extensive treatment of this method. Furthermore, there are new developments that suggest increased clinical utility for contrast echocardiography in the future. This book aims to summarize the "state of the art" for those interested in echocardiography - presumably mainly cardiologists, but here and there those of a more technical bent will find useful information as well. We feel that a more basic understanding of microbubble dynamics is necessary to advance research for such applications as transmission through the lungs, videodensitometric quantitation of cardiac output, intracardiac shunts, etc. All of these topics are extensively dealt with. The reader will note that many of the clinical chapters are written by pediatric cardiologists. This is only natural, since shunt detection and analysis of flow relationships are relatively more important in congenital heart diseases, and cur rently represent the most important uses for contrast echo cardiography in day-to day practice."

The extension of conventional M-mode to two-dimensional echocardiography has been a major advance for the evaluation and management of cardiac disease. Their combined use is optimal for a comprehensive analysis of anatomy and structure function and thus best serving the patient. This book critically examines the validity of the applications of these ultra sound techniques in common cardiac disorders. In addition to the clinical value of contrast and Doppler echocardiography, several chapters are devoted to problems related to quantitation of both M-mode and two-dimensional echocardiography. This volume is specifically aimed at the practicing cardiologist and provides an in-depth appreciation of most recent echocardiographic advances. J. ROELANDT LIST OF CONTRIBUTORS Anliker, M., MD, Department of Cardiology, University Hospital Zurich, R imistrasse 100, 8091 Zurich, SWITZERLAND. Carroll, J.D., MD, Department of Cardiology, University Hospital of ZUrich, R imistrasse 100, 8091 Zurich, SWITZERLAND. Cate, F.J. ten, MD, Harbour Hospital, Haringvliet 2, 3011 TD Rotterdam, THE NETHERLANDS. Cikes, I., MD, Institute of Cardiovascular Disease, School of Medicine, University of Zagreb, Kispaticeva 12, 41000 Zagreb, YUGOSLAVIA. Domburg, R.T. van, PhD, Thoraxcenter, Academic Hospital Dijkzigt and Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, THE NETHERLANDS. Ernst, A., MD, Institute of Cardiovascular Disease, School of Medicine, University of Zagreb, Kispaticeva 12, 41000 Zagreb, YUGOSLAVIA. Hanrath, P., MD, Department of Cardiology, University Hospital Hamburg-Eppendorf, Mar tinistrasse 52, 2000 Hamburg 20, BRD. Hess, D.M., MD, Department of Cardiology, University Hospital Zurich, R imistrasse 100, 8091 ZUrich, SWITZERLAND."

Recent technological developments have brought long-term ambulatory electro cardiography to the front of clinical cardiology. Its application for solving clinical problems potentially related to cardiac arrhythmias is rapidly increasing. In the meantime, the method has found widespread use in the identification of patients at risk for cardiac death as well as in the assessment of therapeutic interventions. It was the purpose of this symposium to bring together an international group of authorities in order both to provide an overall view of the field and to discuss critically the value of clinical, epidemiological and research applications of long term ambulatory electrocardiography in the light of new concepts and recent advances. The first section of this volume discusses the methodology and the performance criteria of the equipment and analysis systems. In the second section, the potentials and problems encountered in the use of long-term ambulatory electrocardiography for solving clinical questions and for predicting the occurrence of clinically important arrhythmias are extensively as continuous ST segment monitoring, blood dealt with. New applications such pressure measurement and other physiologic parameters are also included. Prevalence variability and prognostic aspects of ventricular arrhythmias, both in normals and in patients with cardiac disease, are the subject of section 3. The last section provides a critical review of the use of the method for the evaluation of therapeutic interventions with drugs. The editors feel that this volume represents the 'state of the art' in this newly important area of clinical cardiology."

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.

The introduction of quantitative Doppler echocardiography gave rise to explo- sive interest in the application of this method in clinical cardiology. However, before cardiologists could fully validate its clinical utility, they were confronted with a further development, namely color-coded Doppler flow imaging. This new technique allows a comprehensive study of the direction, velocity, uniformity and timing of intracardiac blood flow, while simultaneously revealing cardiac struc- tures and their movement. 'Color Doppler' facilitates the diagnosis of a variety of cardiac conditions, and an overwhelming amount of information is available at any instant. Interpretation of these fascinating images requires a substantial experience and theoretical background. This monograph updates the application of color Doppler to both congenital and acquired heart disease. The work comprises 15 chapters written by authorities in the field, each of whom presents his most recent experience in the field. In addition, further advantages in the clinical use of pulsed and continuous wave Doppler in pediatric and adult cardiol- ogy are presented. This book contains, of course, many color plates. 1. Roelandt, M. D. VII Contents Preface V List of contributors IX 1. Technical aspects and physical principles revisited Structure and performances of mono- and bidimensional pulsed Doppler systems 3 P. Peronneau, B. Diebold, J. P. Guglielmi, O. Lanusel, R. Bele, J. Souquet Estimation of transvalvular pressure drops hy Doppler echocardiography: the Bernoulli equation revisited 19 H. Rijsterborgh, 1. Roelandt Factors influencing fluid velocity measurements in valvular regurgitation 29 B. Wranne, P. Ask, D.

Today, coronary artery disease is one of the major causes of mortality and morbidity in the Western World. In the last decade many major diagnostic and therapeutic advances have been made, considerably furthering our potential in the management of coronary artery disease. At the same time, a new generation of cardiac tools has appeared. The field which has, perhaps, undergone the most important technological innovations is echocardiography. Nowadays, in fact, the world of ultrasounds ofters the cardiologist a wide range of technical applicatons: two-dimensional real-time imaging, intra-and extra-cardiac Doppler flow measurements, real-time imaging of cardiac struc ture and flow by 2D color Doppler, high resolution cardiac imaging by transesophageal echocardiography, tissue characterization by analysis of ultrasound wave characteristics, information on myocardial perfusion by con trast echocardiography, etc. Thanks to these technical improvements and to its consequent increased potentiality, echocardiography now plays an impor tant and irreplaceable role in the management of all cardiac diseases. In the field of coronary artery disease, echocardiography can reliably be used not only in the acute phases of the disease to derive useful functional and prog nostic information but also as a stress diagnostic procedure (thanks to new stress modalities and the continuing improvement of reviewing digital sys tems) for the diagnosis of coronary artery disease and for the evaluation of various therapeutic interventions. Furthermore, other promising applications of ultrasounds in this disease are currently being investigated: tissue charac coronary artery anatomy terization, myocardial contrast echocardiography, and flow evaluation by specially-designed ultrasound catheters."

Intracoronary ultrasound is a rapidly evolving imaging modality and the increasing number of published studies indicates that the technique is safe and provides incremental and more detailed diagnostic information than coronary angiography. The technique has the potential to study the pathobiology of atherosclerosis, to clarify the significance of angiographically equivocal lesions and has helped us to understand the mechanisms, effects and complications of catheter-based revascularization procedures. Combinations of imaging and therapeutic devices are being developed for both guidance and assessment of the revascularization procedure. Three-dimensional reconstruction of coronary segments is now possible in real time and provides the opertor with more detailed information on coronary pathology. In this monograph, leading experts in the field present the state of the art of all these new developments.