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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
IntraopPreOp Intraop TEE or TTE before Operation
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IntraopEnd Intraop TEE or TTE at End of Anesthesia
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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
A Missing Structure
Case#: 49
AMA CME Units: 0.25 Units
Estimated Time: 15 minutes.
A patient had the following echo loop>
Case Discussion
The diagnosis is atrial septal defect of the septum secundum.  The echocardiographic signs are dilated receiving chambers: RAE, RVE, pulmonary artery enlargement, and LAE.  As oxygenated blood is recirculated through the heart and lungs, the chambers that recirculate the blood have to enlarge because the flow through those chambers increases.

The major echocardiographic finding is the absence of all or part of the interatrial septum.  CFD will show flow though the septal defect, usually left to right.  The flow through the recirculated chambers can be compared to flow through a non-recirculated chamber to indicate the severity of the shunt.  In this case the flow through the tricuspid or pulmonary valve can be compared to the flow through the mitral or aortic valve.  Since the flow though the pulmonary and aortic valve is more accurate a pulmonary to systemic flow ratio can be calculated.  Normally, this ratio Qp/Qs is near 1.  As the receiving chambers enlarge because of a high shunt (ie. Qp/Qs > 2) tricuspid regurgitation, pulmonary regurgitation, atrial fibrillation and symptoms of right heart failure can occur.  Eventually, the flow through the septal defect reverses and then symptoms of left heart failure and cyanosis occur.

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