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Echo-of-the-Day
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Echo-of-the-Day Information
The Case-of-the-Week is a presentation of 8 or more video loops to present an important topic in echocardiography. Please reveiw the image or video loops and then answer the questions below. After you have answered the questions you can view the explanation and obtain CME credit (if available).

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Preop Preop TEE or TTE
Intraop An Intraop TEE
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IntraopEnd Intraop TEE or TTE at End of Anesthesia
Post Op Postop TEE or TTE
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Case of the Month Information Table
IntraopEnd is usually a TEE after the Operation and after some event occured to show a change in the TEE
Post Cardioversion Success
Case#: 232
AMA CME Units: 0.25 Units
Estimated Time: 15 minutes.
Presentation:
A patient was cardioverted. The CFD show a structure that was interrogated with Doppler. The 3rd and 4th PWD images were post cardioversion in the OR.
 
Loop(s):
Case Discussion
 
The videos show the left upper and right upper pulmonary veins. Pulmonary vein Doppler exhibits a systolic and diastolic flow and an atrial wave during the cardiac cycle. During aging, the diastolic wave exceeds the systolic wave in the young, becomes equalized in middle ages (50's), and the systolic wave dominates in the elderly. Cardioversion can stun the left atrium and the atrial wave can be minimal or nonexistent while the atrium recovers.

One study looked at pulmonary vein flow after cardioversion and found that re-establishment of a systolic dominance of the pulmonary vein flow pattern was predictive of patient's remaining in sinus rhythm 1 year later. While one wouldn't think there would be any difference in which vein was used for Doppler examination, they did find that if the systolic flow fraction exceeded 0.5 in the right upper pulmonary vein, that it was predictive that 95% of patients would remain in normal sinus rhythm.

 
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CE Sponsor: American Society of Radiological Technologists (ASRT)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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