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.

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.

Present day cardiology is in great need of non invasive, non toxic, and inexpensive devices which permit the delineation and visualization of normal and abnormal intracardiac structures, the calculation of intra cardiac volumes and study of contractility of the cardiac muscle. All of these may become within our reach if the principles outlined in this book and the preliminary clinical experience can be validated in general cardiac practise. The gist of one of the devices (visualization of the in vivo moving heart recorded on a short motion picture) is available to the interested reader on a 16 mm filmstrip. Rotterdam, June 1972 P. G. Hugenholtz Professor of Cardiology CONTENTS CHAPTER I INTRODUCTION TO ECHOCARDIOGRAPHY 9 1. General remarks 9 2. Purpose of this study 10 CHAPTER II PRINCIPLES OF ULTRASOUND 12 The piezo-electric effect 1- 12 2. Some physical properties of ultrasound 13 a. Attenuation 13 b. Reflection of sound 13 c. Near and far field 13 3. Scanning and recording techniques 15 a. Example of depth sonar 15 b. A-scan and Time-Motion recording 17 c. Single element 8-scan techniques 17 4. The Doppler effect 17 CHAPTER III PRESENT APPLICATIONS IN CARDIOLOGY 19 1. General remarks 19 2. Mitral stenosis 20 3. Pericardial effusion 23 4. Other applications 26 a. Mitral insufficiency 26 b. Tricuspid stenosis 26 c. Idiopathic hypertrophic subaortic stenosis 26 d. Aortic valve study 26 e. Internal dimensions 27 5. On the use of Doppler 28 6."

Echocardiology comprises all aspects of diagnostic application of ultrasound to cardiac patients. It is probably the fastest growing non-invasive technique today. Almost all progress in this young and exciting field has been the positive result of close co-operation between medical and technical scientists. This book contains a series of lectures held at Erasmus University Rotterdam in June 1977 and is divided in three sections: - clinical echocardiology, consisting of both an introduction to the basic principles as well as a wide variety of applications aimed at the clinically oriented reader. - Doppler methods, where in addition to its clinical applications also the engineering of new developments will be presented. - the two dimensional real-time imaging where many new techniques including com puter methods, holography and acousto-optical systems will be discussed. We hope that this book will stimulate communication between scientists of various disciplines and nationalities. N.Bom J. Roelandt P.G. Hugenholtz Rotterdam, June 1977 III Preface The last three decades have seen a remarkable advance in diagnostic instrument ation in diseases of the circulation. In the 1940's the only diagnostic aids were the electrocardiogram and simple X-ray. These were quickly followed by the cardiac ca theter, phonocardiography, radio isotope methods and angiocardiography. The de velopment of cardiac surgery provided the impetus to developing more accurate methods of diagnosis, preferably those that did not need invasion of the patient. The introduction of ultrasound has contributed towards this aim in the last few years.