Echo-of-the-Day

E-Echocardiograhy will go offline June 30th, 2022. CME is Offline Jan 14th, 2022

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AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.

Echo-of-the-Day Information

The Echo-of-the-Day is a presentation of 1 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).

You can change the size and the format of the image or video loops by using the links below the image or video loop.

= MP4 Video	= Ogg Video
= WebM Video	= GIF Image
Image/Video Sizes	= JPG Image
1X = 200x150 pixels 2X = 400x300 pixels	3X = 600x450 pixels 4X = 800x600 pixels

Loop Text Key
Preop	Preop TEE or TTE
Intraop	An Intraop TEE
IntraopPreOp	Intraop TEE or TTE before Operation
IntraopPostOp	Intraop TEE or TTE after Operation
IntraopEnd	Intraop TEE or TTE at End of Anesthesia
Post Op	Postop TEE or TTE

Echo of the Day Information Table

IntraopEnd is usually a TEE after the Operation and after some event occured to show a change in the TEE

Another Hole in the Heart

Case#: 210

AMA CME Units: 0.25 Units
Estimated Time: 15 minutes.

Presentation:
A patient presented with the following loop:

Loop(s):

Case Discussion

The diagnosis is ostium pimum atrial septal defect. The defect occurs at the base of the interatrial septum and is due to the failure of the formation of the septum primum.

Surgical correction has excellent results with a mortality less than 1%. The reoperation rate is less than 3%. The repair can be done through a standard incision or minimally invasive technique. A ostium primum ASD was associated with coarctation of the aorta which increases the mortality and morbidity.

Ostium primum ASDs can also be corrected by a percutaneous placement of a closure device, however, we could not find a study that focused only on ostium primum ASDs. Most of the studies were secundum ASDs with maybe a few primum ASDs included. For secundum ASDs, a 4.9% residual shunt was present for all types of anatomical presentations of the secundum ASDs (eccentric shunt with valve, widely redundant septum primum, large defect > 10 mm, cribiform ASD, tunnel form ASD, interatrial septal aneursym). While the study focused on secundum ASDs, it shows that 100% of a widely varying presentation of an ASD can be closed with a device with good results.

In one report, a highly fenestrated septum primum resulted in failure of closure by a device. Of course, ostium primum ASDs can be associated with other congenital abnormalities that may not allow the use of a device to close the defect.

CME Section

Please answer the following questions correctly to obtain your CME.

Web Links/References

Primum atrial septal defect.
Anatomical patterns of patent foramen ovale (PFO): do they matter for percutaneous closure?
Evolution of surgical techniques for atrial septal defect repair in adults: a 10-year single-institution experience.
Thoracoscopic ASD closure is a reliable supplement for percutaneous treatment.
Transthoracic three-dimensional echocardiography in the preoperative assessment of atrioventricular septal defect morphology.

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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.

The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

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.