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

Post Cardioversion Success

Case#: 232

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

Presentation:
A patient was cardioverted. The CFD show a structure that was interrogated with Doppler. The 3rd and 4th PWD images were post cardioversion in the OR.

Loop(s):

Case Discussion

The videos show the left upper and right upper pulmonary veins. Pulmonary vein Doppler exhibits a systolic and diastolic flow and an atrial wave during the cardiac cycle. During aging, the diastolic wave exceeds the systolic wave in the young, becomes equalized in middle ages (50's), and the systolic wave dominates in the elderly. Cardioversion can stun the left atrium and the atrial wave can be minimal or nonexistent while the atrium recovers.

One study looked at pulmonary vein flow after cardioversion and found that re-establishment of a systolic dominance of the pulmonary vein flow pattern was predictive of patient's remaining in sinus rhythm 1 year later. While one wouldn't think there would be any difference in which vein was used for Doppler examination, they did find that if the systolic flow fraction exceeded 0.5 in the right upper pulmonary vein, that it was predictive that 95% of patients would remain in normal sinus rhythm.

CME Section

Please answer the following questions correctly to obtain your CME.

Web Links/References

Pulmonary vein flow analysis by transoesophageal echocardiography in patients with chronic atrial fibrillation; 1 year follow-up after cardioversion
Factors Affecting Pulmonary Vein Flow (PV)
Pulmonary Venous Flow Assessed by Doppler Echocardiography in the Management of Atrial Fibrillation

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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.