Echo of the Day
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AMA PRA Category 1 Credit(s)TM for Physicians Only.
ASRT CME Not Available
Echo-of-the-Day Information
The Echo-of-the-Day is a presentation of one to four image or 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.
= Windows Media Video = MP4 Video
= QuickTime = WebM Video
= Flash = JPG Image
Video Sizes = GIF Image
1X = 200x150 pixels
2X = 400x300 pixels
3X = 6000x450 pixels
4X = 800x600 pixels
EOTD Information Table
Title: Another Hole in the Heart
EOTD#: 210
AMA CME Units: 0.25 Units
Estimated Time: 15 minutes
CME Requirements: Active CME Session and must be a paid, active subscriber to iTEE or eTEE AND have enough CME credits in your bank. AMA CME ONLY.
Presentation: A patient presented with the following loop:
Discussion Questions:
#1: What is the diagnosis?
#2: What is the risk to fix the diagnosis by surgery?
#3: What is the risk to fix the diagnosis by percutaneous device?
Explanation/CME Questions
Explanation: 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.

Please answer the following questions correctly to obtain your CME.
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