ARDMS AE Adult Echocardiography 問題集 練習問題・模擬試験｜日本語版＆英語版対応

Explanation: Comprehensive and Detailed Explanation From Exact Extract: Constrictive pericarditis is characterized by thickening and fibrosis of the pericardium which restricts diastolic filling of the ventricles. Key echocardiographic features include a characteristic interventricular septal "bounce" or shift during early diastole due to the abrupt cessation of ventricular filling imposed by the rigid pericardium. This septal bounce reflects rapid early diastolic filling followed by a sudden halt as filling pressures equalize, a hallmark of constriction physiology. Additionally, Doppler studies show marked respiratory variation in mitral and tricuspid inflow velocities (>25%), with an inspiratory increase in tricuspid inflow and a decrease in mitral inflow velocity, reflecting ventricular interdependence caused by the noncompliant pericardium. The mitral inflow typically shows a large E-wave with a small or absent A-wave and a steep deceleration slope, but importantly these velocities vary significantly with respiration, which is not the case in restrictive cardiomyopathy. Hepatic vein Doppler often reveals a prominent a-wave and a deep y-descent with increased diastolic flow reversal during expiration, indicating elevated right atrial pressures and constrictive physiology. The inferior vena cava (IVC) is usually dilated and shows no inspiratory collapse (i.e., no normal collapse with sniff test) because of elevated right atrial pressure and impaired venous return. Therefore: Option A is incorrect because mitral inflow in constrictive pericarditis shows significant respiratory variation, not absence of it. Option B is incorrect because the hepatic vein is typically dilated with abnormal flow patterns, not normal size. Option C is incorrect because the IVC is dilated and does NOT collapse normally with inspiration/sniff in constrictive pericarditis. Option D is correct because the interventricular septal bounce is a classic feature reflecting ventricular interdependence and constrictive physiology. These findings are summarized in the "Textbook of Clinical Echocardiography, 6e" (Catherine M. Otto, MD), Chapter 10 (Pericardial Disease), pages 280C285, with key illustrations showing septal bounce, Doppler inflow variations, hepatic vein flow patterns, and IVC findings in constrictive pericarditis. The "Mayo Clinic criteria" for echocardiographic diagnosis also emphasize ventricular septal shift as a critical feature, often combined with tissue Doppler annular velocity patterns and hepatic vein diastolic flow reversal for high diagnostic accuracy

Explanation: Pulmonic stenosis is a congenital valve abnormality often seen in genetic syndromes with cardiac manifestations. Among these, Noonan syndrome is the most frequently associated with pulmonic stenosis. Noonan syndrome is a genetic disorder characterized by distinctive facial features, short stature, and congenital heart defects, with pulmonic valve stenosis being the predominant cardiac lesion. The stenosis is usually valvular and caused by dysplastic pulmonary valve leaflets, leading to obstruction of right ventricular outflow. Other syndromes listed do not typically present with pulmonic stenosis: Turner syndrome is more commonly linked with bicuspid aortic valve and coarctation of the aorta, not pulmonic stenosis. Eisenmenger syndrome refers to the advanced phase of congenital heart defects with significant pulmonary hypertension and is not a genetic syndrome. Marfan syndrome is predominantly associated with aortic root dilation and mitral valve prolapse, but not with pulmonic stenosis. This association is well documented in adult echocardiography guidelines and texts, such as the "Textbook of Clinical Echocardiography" by Catherine Otto, which clearly identifies Noonan syndrome as the syndrome most commonly associated with pulmonic stenosis among congenital heart defects 【 16:Chapter on Congenital Heart Disease†Textbook of Clinical Echocardiography, 6e 】 .

Explanation: The most appropriate echocardiographic view to measure right ventricular (RV) dimensions is the apical four-chamber view with a right ventricular-focused modification. This RV-focused apical four-chamber view is optimized by shifting the transducer laterally and slightly anteriorly to better visualize the entire right ventricle in a single plane. This approach allows for accurate assessment of RV basal and mid cavity diameters, RV longitudinal dimension, and RV area measurements. The standard apical four-chamber view often underestimates RV size because of its complex geometry and position in the chest. The subcostal four-chamber view may give some information on RV size but is limited by image quality and angle. Parasternal short axis views at the base focus more on the left ventricle and may not capture the entire RV adequately. Parasternal long axis views primarily visualize the left heart structures and do not adequately show the RV. Adult echocardiography guidelines, including the American Society of Echocardiography (ASE) chamber quantification recommendations, endorse the RV-focused apical four-chamber view as the standard for RV linear measurements and volume assessment due to its accuracy and reproducibility 【 12:ASE Chamber Quantification Guidelines†p.80-85 】【 16:Textbook of Clinical Echocardiography, 6e†Chapter on RV Assessment 】 .