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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).

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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.
A patient presented with the following loop:
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
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