The use of ultrasound to provide noninvasive evaluation of cardiac structure and function was a revolutionary advancement in cardiac care in the late 20th century (1). Development of the field of echocardiography has allowed detailed serial examinations of the development, structure, and function of the human heart in normal physiological states and in pathological conditions. Echocardiography has increased the diagnostic accuracy of noninvasive cardiac evaluation and provides a tool for the monitoring of diagnostic and therapeutic procedures. The goals of this chapter are to: (1) provide a brief overview of the types of echocardiography in clinical use today, (2) review the physical principles that underlie this clinical tool, and (3) demonstrate how echocardiography can be used to assess cardiac structure and function.

Prior to the 1970s, diagnosis of congenital and acquired heart disease was achieved by the combination of physical examination, electrocardiography (ECG), and invasive cardiac catheterization. Unfortunately, clinical examination and ECG are often not very specific diagnostic tools. Cardiac catheteriza-tion, although greatly augmenting noninvasive clinical information, can be a stressful and risky procedure, particularly in the young or very ill patient. Initial attempts at imaging the heart using reflected sound waves were made in the 1950s, with improvement in the experimental technology and its initial

From: Handbook of Cardiac Anatomy, Physiology, and Devices Edited by: P. A. Iaizzo © Humana Press Inc., Totowa, NJ

clinical application in the 1960s (1). During the 1970s, simple motion-mode (M-mode) or linear images were available to define cardiac structures, but these were not adequate for providing great diagnostic detail in complex congenital heart disease. During the 1980s, the technology to provide 2D real-time imaging of the heart was developed, and this subsequently revolutionized noninvasive evaluation of cardiac structure and function. in the late 1980s, techniques of Doppler ultrasound, including color mapping, were developed to extend the analyses of cardiac function and hemodynamics (1). By the late 1980s, many cardiac defects could be diagnosed accurately and repaired completely without invasive testing.

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