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| Home->COTW AMA Category 1 Credit for Physicians Only. ASRT CME is not available. |
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Case-of-the-Week Information
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The TEE showed: The LVEF is 40%. The apex is HK. The mid Anteroseptal wall is AK. Parametric showed anterior, anteroseptal, some septal AK LVEDD 5.19 cm, LVESD 3.70 cm The RVEF is 50%. LVI: The E is 83 cm/sec, DT 246 msec, IVRT 95 msec,A 44 cm/sec, Adur(158 msec), E/A = 1 TDE: The S` is 5.8 cm/sec, E` 9.1 cm/sec, A` 14.9 cm/sec PVn: The S is 53 cm/sec, D 44 cm/sec, A 20 cm/sec (Adur 116 msec) The CMMVp is 35.3 cm/sec. The Desc Ao Grade 3, AscAo Grade 2 by TEE, Grade 4 by EA AV Vmax 1.16 m/sec, pAVG 5 mmHg, mAVG 2 mmHg. AVA by 2D TEE 2.7 cm2. TR Vmax 2 m/sec Lambl's Excressence was present. A moderator band was present. The PCWP by Adur/Adur is 10 mmHg. The PCWP by DT is < 10 mmHg. The CPCWP by TDE E/LVI Emax = 14.9 mmHg. The LAP by Emax/Vp = 16.9 mmHg. Parametric imaging, which is the conversion of a 3D loop to a still frame showing the initiation(timing) of wall excursion and the amount/direction of wall excursion, can impact the interpretation of a TEE. Toledo, Angelini, and others showed that parametric imaging of the left ventricle is accurate with an acceptable senstivity and specificity rate. Kachenoura showed that the time to first contraction are delayed in hypokinetic (150 msec) and akinetic (200 msec) segments more than normal (100 msec) segments. The mean contraction time showed the same delay pattern. The radial velocity was also lowered for akinetic (1 cm/sec) segements and hypokinetic (2 cm/sec) more than normal segements (3 cm/sec). Caiani showed that inexperienced echocardiographers improved their accuracy more but did not become more accurate than experience echocardiographers when parametric images were added to the exam (animal study). Kachenoura showed that in patients with poor acoustic windows, using parametric images along with contrast, improved the accuracy of RWMA diagnosis in inexperienced users. Myocardial dyssynchrony can be difficult to appreciate when the delay is less than 80 msec. Parametric imaging shows an image of the onset of contraction for segments where the amount of delay is easier to visualize and will even point out the segments that are delayed and the degree of the delay. While the posterolateral wall is the usually wall that is delayed in a wide QRS and decreased LVEF, O'Mara showed that this is not always the case and segments or the delay of segmental contraction can be delayed or improperly treated with a biventricular pacer with improper lead placement. Also, if multiple segments are delayed, the parametric image will help decipher where to place the leads to achieve maximum benefit. |
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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and JLS Interactive, LLC.
This activity is approved by the American Society of Radiologic Technologists (ASRT) as sonography-related continuing education (CE). Credit(s) issued for successful completion of ASRT-approved CE activities are accepted by the American Registry of Diagnostic Medical Sonography, American Registry of Radiological Technologists, Cardiovascular Credentialing International and Canadian Association of Registered Diagnostic Ultrasound Professionals. Contact the applicable registry for additional information / restrictions on their acceptance of ASRT CE credit.
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