Echo-of-the-Day

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

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).

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	= Ogg Video
= JPG Image	= GIF Image
Image/Video Sizes
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
	= Legacy/Old Video Formats

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

Left Atrial Appendage Velocity

Case#: 80

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

Presentation:
We did a PWD of a LA appendage and had a forward velocity of 17 cm/s and a negative velocity of 13-17 cm/sec.

Loop(s):

Case Discussion

If the velocity of the LAA is low, one would expect that stasis and an environment for thrombus formation would be present. Where you measure LAA velocity is important. The velocity is higher 1 cm below the LAA orifice than 1 cm from the LAA apex. The normal LAA velocity exceeds 50 cm/sec.

In patients with atrial fibrillation, the LAA emptying velocity drops. One study found that elderly patients with low LVEF (< 40%) and a LAA velocity (LAAV) < 20 cm/sec were more likely to develop LAA thrombi. A TTE will measure about the same velocities as TEE so the modality is not important. One study showed that TTE measured LAAV at 50 cm/sec were measured at 47 cm/sec.

CME Section

Please answer the following questions correctly to obtain your CME.

Web Links/References

Advanced age
low left atrial appendage velocity
and Factor V promoter sequence variation as predictors of left atrial thrombosis in patients with nonvalvular atrial fibrillation.
Transthoracic Doppler echocardiography for the assessment of left atrial appendage size and blood flow velocity: a multicentre study.

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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.