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: Adult CHD
EOTD#: 53
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 45 y.o. male presents with SOB and a cardiac operation.
Discussion Questions:
#1: What is the diagnosis?
#2: Discuss the variants of this diagnosis?
#3: What are the clinical ramifications of this diagnosis?
Explanation/CME Questions
Explanation: The echocardiogram shows a congenital heart defect called partial atrioventricular canal defect (formerly called encardial cushion defect).  AV canal defects occur when the atria and the ventricles fail to fuse together in utero.  Usually a single valve is present from the mitral to the tricuspid annulus and a single large hole is present where the ventricular septum should be located.  The two typs of AV canal defect are partial and complete.  Partial involves only the atrial and complete involves all four chambers.

Typically, AV canal defects are associated with chromosomal abnormalities ( Trisomy 21), medications (Accutane, Litiium), rubella infection during pregnancy, maternal diabetes, fetal alcohol syndrome, and hereditary.  The patients usually present with  cyanotic heart disease, CHF, or failure to thrive and are very young (Premature to 1-2 years old.  Congestive heart failure from recirculation of blood in the pulmonary circut occurs so operative therapy is suggested early in life.

The AV canal defect can be repaired with a single or a double patch technique or even, a no patch technique. Rarely, a double switch technique is used before the patch repair.  A one-patch procedure (Rastelli Procedure) can seal the hole in complete AV canal defect in patients and has been shown to be 90% sucessful long term.  Rastelli classified AV canal defects into type A, B and C.  Type A is where the superior bidging leaflet is almost completely adherent to the LV and is firmly attached to the septum by multiple chordae insertions.  Type B is where the superior bridging is attache to the ventricular septum by an anomalous papillary muscle of the right ventricle.  Type C is where the superior bridging leaflet is not attached to the ventriuclar septum (it is free floating).

Please answer the following questions correctly to obtain your CME.
CME is not available until you log in with a subscription to the iTEE or Advanced TEE area and have enough CME credits in your bank.
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