AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.
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The diagnosis is atrial septal defect of the septum secundum. The echocardiographic signs are dilated receiving chambers: RAE, RVE, pulmonary artery enlargement, and LAE. As oxygenated blood is recirculated through the heart and lungs, the chambers that recirculate the blood have to enlarge because the flow through those chambers increases.
The major echocardiographic finding is the absence of all or part of the interatrial septum. CFD will show flow though the septal defect, usually left to right. The flow through the recirculated chambers can be compared to flow through a non-recirculated chamber to indicate the severity of the shunt. In this case the flow through the tricuspid or pulmonary valve can be compared to the flow through the mitral or aortic valve. Since the flow though the pulmonary and aortic valve is more accurate a pulmonary to systemic flow ratio can be calculated. Normally, this ratio Qp/Qs is near 1. As the receiving chambers enlarge because of a high shunt (ie. Qp/Qs > 2) tricuspid regurgitation, pulmonary regurgitation, atrial fibrillation and symptoms of right heart failure can occur. Eventually, the flow through the septal defect reverses and then symptoms of left heart failure and cyanosis occur.
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