Echo-of-the-Day

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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).

You can change the size and the format of the image or video loops by using the links below the image or video loop.

= MP4 Video	= Ogg Video
= WebM Video	= GIF Image
Image/Video Sizes	= JPG Image
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

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

Left Ventricular Balloon

Case#: 220

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

Presentation:
A patient presented with the following echo loops:

Loop(s):

Case Discussion

The diagnosis is an inferior aneurysm. In these loops, the inferior aneurysm is seen in 2D and 3D. Sometimes an inferior aneurysm can be missed because of it's proximity to the base of the heart and behind the aortic valve and it's closeness to the TEE probe. In the TG 2CV, the aneurysm appears as an outpouching of the inferior wall at the base and sometimes the middle segement. In the ME 2CV the wall can be obscured by shadows, however, a similar appearance may occur. The myocardial wall is thinned, calcified, and dyskinetic. Spontaneous echo contrast may be seen in the aneurysm with or without thormbus formation which may obscure the thickness or contour of the aneurysmal wall or shape. Most left ventricular aneurysm occur from myocardial infarction although they can be congenital.

Indications for surgery involve complications from the aneursymal dilation. Excessive dilation can cause blood flow stasis and lead to thrombus formation which requires anticoagulation or an operation. Aneurysmal dilation can also cause right ventricular outflow obstruction. If the aneurysm causes pulmonary congestion then a surgical operation is indicated. The classic Cooley aneurysmectomy (linear suturing to close the aneurysm) or the Dor procedure can be used to treat the aneurysm and restore the LV to a more normal shape and function. The Dor procedure (suturing the aneurysm shut over a patch to close of the aneurysm) was more suitable for septal aneurysms than the Cooley technique.

CME Section

Please answer the following questions correctly to obtain your CME.

Web Links/References

Surgical treatment of left ventricular aneurysm.
A case of ventricular septal aneurysm producing right ventricular outflow obstruction in an adult patient.
Three-dimensional transesophageal echocardiographic delineation of ventricular septal aneurysm producing right ventricular outflow obstruction in an adult.
Isolated congenital ventricular septal aneurysm in an adult--a case report.
Surgical treatment of post infarction left ventricular aneurysms: our experience with double breasting and Dor's repair.
Ventricular septal aneurysm: a complication of myocardial infarction.
Echocardiographic Features of Large Posterobasal Left Ventricular Aneurysms.

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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.