Fetal and transitional circulation
Fetal circulation is different from adult circulation. The changes occurring soon after birth constitutes transitional circulation. Respiratory gas exchange in the fetus occurs in the placenta rather than the lungs. Fetal cardiovascular system is designed so that the most saturated blood reaches the heart and the brain. Fetal circulation can be called a shunt dependent circulation because there are intracardiac and extracardiac shunts [1]. Cardiac output in the fetus is called combined ventricular output (CVO). Despite the low oxygen partial pressures in fetal blood, presence of fetal hemoglobin and high combined ventric...
Source: Cardiophile MD - April 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Fontan Circulation
Fontan repair of tricuspid atresia was initiated in late 1960s. Francis Fontan et al reported that surgical repair was carried out in three patients with tricuspid atresia of which two were successful [1]. Inferior venacaval blood was directed to the left lung and the right pulmonary artery received the superior venacaval blood through a cavopulmonary anastomosis. They mentioned that the size of the pulmonary arteries must be large enough and at sufficiently low pressure to allow flow in a cavopulmonary anastomosis. The first step was a Glenn procedure in which distal end of right pulmonary artery was anastomosed to the ...
Source: Cardiophile MD - April 20, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Source Type: blogs

Aortic erosion following ASD device closure : A reality check !
ASD device closure has become a de-facto modality for most ostium secundum defects(25/year) shall prevail over surgery in most patients with ASD.  Reference 1López-Fernández T1, Gómez de Diego JJ, Monedero MC . Aortic wall erosion after percutaneous closure of atrial septal defect.Am Soc Echocardiogr. 2011 Feb;24(2):227.e5-8     2.Amin Z Echocardiographic predictors of cardiac erosion after Amplatzer septal occluder placement.atheter Cardiovasc Interv. 2014 Jan 1;83(1):84-92.    3.Catheter Cardiovasc Interv. 2012 Aug 1;80(Percutaneous atrial septal oc...
Source: Dr.S.Venkatesan MD - April 4, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized asd device closure and aortic erosion atrial septal defect closure by amplatzer ias dynamics late migration of asd device mechanism of of aortic erosion surgery vs device asd closure transverse sinus pericardium effuion ias asd Source Type: blogs

Innovation in pediatric Interventions: Device closure of sinus venosus ASD is not forbidden
Embryology Sinus venosus ASD (also referred to as SVC ASD)  is a defect in the failure of the sinoatrial orifice to lateralize completely to the right side during atrial septation.Left venous valve, as well as the septum secundum, fails to fuse with the roof of the atria creating interatrial communication. During this process, the developing pulmonary vein overshoot to the right side making PAPVD a mandatory add-on defect. (Harley ,Thorax 1958 ) It can be referred to as embryonal venous migration defect at the level of RA. In the same sense, it is not a true defect in IAS but a defect in septation between S...
Source: Dr.S.Venkatesan MD - January 6, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized SINUS VENOSUS ASD stenting for svc asd SVC ASD device closure Source Type: blogs

Atrial septal defect
This video covers certain features of atrial septal defect including X-ray chest, ECG, echocardiogram and finally device closure of ASD. Both secundum and primum ASDs are demonstrated. Transesophageal echo images of ASD are also shown. Fluoroscopic view of ASD device with delivery cable and venous sheath is seen at the end. Another video without narration, showing TEE in dual ASD is shown below: (Source: Cardiophile MD)
Source: Cardiophile MD - November 20, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiogram Library Echocardiography ASD ASD device closure dual ASD ostium primum ASD ostium secundum ASD TEE in ASD Source Type: blogs

Echocardiograms in a few congenital heart diseases
In this series, we have echocardiograms of a few congenital heart diseases. The first one shows left ventricle to right atrium shunt associated with a perimembranous ventricular septal defect. Various possibilities are discussed. The second one shows an ostium primum atrial septal defect with tricuspid regurgitation. Associated tricuspid regurgitation is also seen. Third one shows a few views of tetralogy of Fallot (TOF). There is a patent ductus arteriosus associated with TOF in this case. The intact patch at the site of intracardiac repair of the subaortic ventricular septal defect in TOF is seen in the last few frames...
Source: Cardiophile MD - November 8, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Echocardiogram Library Echocardiography ASD LV-RA shunt ostium primum ASD perimembranous VSD TOF Source Type: blogs

ECG and CXR in ASD
ECG in atrial septal defect Atrial fibrillation may be seen in adults. Atrial flutter can occur in ASD, even after repair. Inverted P waves seen in inferior leads indicate low atrial rhythm (also known as coronary sinus rhythm) in sinus venosus atrial septal defect. This is due to defective sinus node as the septal defect is in the region of the sinoatrial node. Classical QRS pattern in ASD is the rSR’ in V1 suggestive incomplete right bundle branch block. This pattern in ASD is due to right ventricular volume overload. QRS axis is usually rightward, more so when there is severe pulmonary hypertension. Left axis dev...
Source: Cardiophile MD - October 11, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Coronary sinus rhythm crochetage sign in ASD end on vessels in ASD hilar dance in ASD Low atrial rhythm pulmonary plethora Source Type: blogs

Ostium primum ASD and clinical findings of ASD
Ostium primum ASD Ostium primum atrial septal defect is part of the AV canal defects. In partial AV canal defect, ostium primum ASD is often associated with cleft anterior mitral leaflet producing mitral regurgitation. Tricuspid regurgitation may also be noted. In complete AV canal defect, there is associated canal VSD or inlet VSD and sometimes a single AV valve. Ostium primum ASD being part of the endocardial cushion defects, may be associated with Down syndrome. They are more likely to develop pulmonary hypertension and Eisenmenger syndrome earlier. DiGeorge syndrome and Ellis-Van Creveld syndrome are the other conditi...
Source: Cardiophile MD - October 10, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Wide fixed split of second heart sound Source Type: blogs

ASD overview and secundum ASD
Atrial septal defect (ASD) is the commonest congenital heart disease in the adult, barring of course bicuspid aortic valve. ASD being a post tricuspid shunt, development of pulmonary hypertension and Eisenmenger syndrome is delayed and survival to adult age group is common. Some even argue that pulmonary hypertension in ASD is primary pulmonary hypertension which the individual was otherwise destined to develop. Anyway pulmonary hypertension is likely to develop in ASD with large left to right shunt of long duration, though the severity of pulmonary hypertension is variable. Supra systemic pulmonary arterial pressures are...
Source: Cardiophile MD - October 10, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Bimodal pattern of cyanosis in ASD ostium primum ASD ostium secundum ASD Secundum atrial septal defect sinus venosus ASD Spontaneous closure of ASD Source Type: blogs

Ventricular septal defect
Ventricular septal defects (VSD) can be divided into perimembranous, muscular, inlet and outlet VSDs, depending on the location. Of these perimembranous VSDs are the commonest. VSDs can decrease in size and undergo spontaneous closure. Spontaneous closure is most likely with small muscular and perimembranous VSD, while inlet and outlet VSDs are least likely to close. Perimembranous ventricular septal defect Perimembranous VSD with perimembranous aneurysm Echocardiogram in ventricular septal defect: Parasternal long axis view shows the subaortic perimembranous ventricular septal aneurysm (marked by arrows). The color mosai...
Source: Cardiophile MD - October 10, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC atrioventricular septal defect doubly committed VSD Eisenmenger complex Eisenmenger reaction Gerbode VSD Inlet ventricular septal defect maladie de Roger Muscular ventricular septal defect Outlet ventricular septal defect perimembr Source Type: blogs

Congenital heart disease overview
Congenital heart disease can be broadly classified into cyanotic and acyanotic. Acyanotic congenital heart disease can be further subdivided into left to right shunts, obstructive lesions and a miscellaneous group. Cyanotic congenital heart disease can be classified into those with decreased pulmonary blood flow and those with reduced pulmonary blood flow. Left to right shunts include atrial septal defect, ventricular septal defect, patent ductus arteriosus and aortopulmonary window. One person can have more than one of these shunts. Large left right shunts can induce the development of pulmonary hypertension and lead to ...
Source: Cardiophile MD - October 10, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Source Type: blogs

Chamber enlargements on ECG
Atrial enlargement  The normal P wave has a maximum amplitude of 2.5 mm (0.25 mV) and a maximum width of 2.5 mm (100 ms). In right atrial enlargement, the amplitude increases while in left atrial enlargement, it is the width (duration) which increases. Both increases in biatrial enlargement. P wave abnormalities are best assessed in leads II and V1. Normal P wave is upright in lead II. In V1, a tiny initial spike is followed by a shallow negative wave. P mitrale: P mitrale is a notched and broad P wave with taller second peak indicating left atrial enlargement. It may be noted that initial part of P wave is contribut...
Source: Cardiophile MD - September 27, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC incomplete right bundle branch block pattern Left ventricular pressure overload left ventricular volume overload LVH strain pattern P mitrale P pulmonale P tricuspidale Right ventricular pressure overload right ventricular volume ove Source Type: blogs

Heart sounds
Two normally heard heart sounds are the first heart sound (S1) and second heart sound (S2). Second heart sound has two components – aortic (A2) and pulmonary (P2). Normal A2 is heard in all auscultatory areas while normal P2 is heard only in the pulmonary area. If it is heard at the apex, it can be considered as loud P2. Normal split of second heart sound closes in expiration and is audible only in inspiration. If it is audible in both inspiration and expiration, it is called wide split. If the split increases in expiration and closes in inspiration, it is paradoxical split. Wide fixed split is audible in both inspi...
Source: Cardiophile MD - September 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Paradoxical splitting of second heart sound sail sound Wide fixed split wide split Source Type: blogs

Palpation of precordium and adjacent areas
Palpation initially confirms the findings of inspection and further looks for new findings. Apex beat: Apex beat is defined as the lowest and outer most point of definite cardiac impulse. If apex beat is not felt on left side, immediately check on right side or else we might miss a dextrocardia. There some who even palpate both sides simultaneously for this reason. Apex beat is initially felt with the palm of the hand and then localized with the index finger. Sometimes it may be difficult to palpate in obese individuals and in those with emphysema. Palpation in held expiration and in the left lateral position may help in...
Source: Cardiophile MD - September 23, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: HBC Source Type: blogs

Oxygen step up in right atrium – MCQ – Answer
Oxygen step up in right atrium – MCQ – Answer Step up in oxygen saturation on cardiac catheterization in the right atrium is suggestive of – Correct answer: a) Atrial septal defect In ventricular septal defect oxygen step up is seen at ventricular level. For example, if the oxygen saturation is 64% in the right atrium, it becomes 82% in the right ventricle due to entry of oxygenated blood from the left ventricle across the ventricular septal defect. In patent ductus arteriosus, oxygen step up is noted at the level of the pulmonary artery. Back to question (Source: Cardiophile MD)
Source: Cardiophile MD - April 1, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs

Oxygen step up in right atrium – MCQ
Oxygen step up in right atrium – MCQ Step up in oxygen saturation on cardiac catheterization in the right atrium is suggestive of: a) Atrial septal defect b) Ventricular septal defect c) Patent ductus arteriosus d) All of the above Click here for the correct answer (Source: Cardiophile MD)
Source: Cardiophile MD - March 31, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs

Pulmonary artery systolic pressure – MCQ – Answer
Pulmonary artery systolic pressure – MCQ – Answer Normal pulmonary artery systolic pressure – Correct Answer: b) 15 – 30 mm Hg Pulmonary circulation is a low pressure circulation and the pressures are much lower than that of systemic circulation. An acute rise in systolic pressure to 50 mmHg can cause right heart failure in conditions like pulmonary embolism. But gradually rising pressures are better tolerated as the right ventricle has time to compensate by hypertrophy. In severe primary pulmonary hypertension and atrial septal defect with severe pulmonary hypertension, pulmonary pressures can eve...
Source: Cardiophile MD - March 17, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs

Dyskinetic apical pulsation – MCQ
Dyskinetic apical pulsation – MCQ Dyskinetic apical pulsation can be seen in: a) Mitral regurgitation b) Ventricular septal defect c) Atrial septal defect d) Left ventricular aneurysm Click here for the correct answer (Source: Cardiophile MD)
Source: Cardiophile MD - February 25, 2020 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs

A young woman with epigastric pain. ECG Crochetage sign? What is the significance?
A former resident texted me this ECG, done for epigastric pain in an 18 year old.  The pain resolved immediately with treatment for acid reflux, and in the clinician's opinion was clearly GI in origin, but he wanted to know what the strange waves in the QRS were:See the unusual notching in II, III, aVF, and V2-V4.I had no idea what they were.  They reminded me of theDelayed Activation Wave associated with circumflex acute MI.See this case: https://hqmeded-ecg.blogspot.com/2018/05/is-there-delayed-activation-wave.html.But they are clearly different from this.I put it on Facebook EKG club and this is the ...
Source: Dr. Smith's ECG Blog - January 7, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs

Congenital heart disease and autism: A possible link?
Children born with congenital heart disease (CHD) are now surviving at extraordinarily high rates; for most, their life expectancy may be comparable to that of the general population. However, despite the great advances in medical and surgical care, many people with CHD experience long-lasting neurodevelopmental difficulties. These include problems with attention and executive function skills, learning challenges, and in some cases, lower-than-normal IQs. Study links congenital heart disease and autism A recent study published in the journal Pediatrics provides compelling evidence that there may also be an association betw...
Source: Harvard Health Blog - January 2, 2020 Category: Consumer Health News Authors: Johanna Calderon, PhD Tags: Children's Health Heart Health Parenting Screening Source Type: blogs

Gore CARDIOFORM ASD Cleared in Europe for Atrial Septal Defects
Gore won the European CE Mark for its GORE CARDIOFORM ASD Occluder, a device designed for percutaneous, transcatheter closure of ostium secundum atrial defects (ASDs). The occluder recently completed a clinical study involving 125 patients with ASD, ranging from 2 to 84 years of age, all of whom were successfully implanted with the GORE CARDIOFORM ASD and maintained closure six months later. The device is made of two discs that make contact with the tissue walls on both sides of the opening and, when engaged, come together to block the passage of blood between the atria. It was recently approved by the FDA for ASD, as ...
Source: Medgadget - October 8, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiac Surgery Cardiology Radiology Source Type: blogs

We Can Stop America ’ s Surge in Opioid-Dependent Babies
By STUART H. SMITH Imagine a massive public health crisis in the United States that affects tens of thousands of people. Now imagine that the government had a simple tool at its disposal that could prevent this kind of physical and psychological trauma. You might think that I’m writing about America’s deadly outbreak of gun violence, which has made headlines this summer from Dayton to El Paso. But actually I’m talking about a different crisis that affects even more people – all of them children — and which could be sharply reduced with one simple step that lacks the bitter political anim...
Source: The Health Care Blog - September 18, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Health Policy Patients Big pharma NAS syndrome Opioid Justice Team Opioid-Dependent Babies Opioids public health Stuart Smith Source Type: blogs

Funtabulously Frivolous Friday Five 287
Dr Neil Long Funtabulously Frivolous Friday Five 287 It's Friday. Boggle your brain with FFFF challenge and some old fashioned trivia. Funtabulously Frivolous Friday Five 287 (Source: Life in the Fast Lane)
Source: Life in the Fast Lane - July 26, 2019 Category: Emergency Medicine Authors: Dr Neil Long Tags: FFFF Anything goes Atrial septal defect Bignami Cocaine Cole Porter Kibyo Leonardo da Vinci Marchiava mercury Micheli Minamata disease Renoir Rheumatoid arthritis Strübing Source Type: blogs

GORE CARDIOFORM Approved by FDA to Treat Atrial Septal Defects
The GORE CARDIOFORM Septal Occluder has been approved by the FDA to treat ostium secundum atrial septal defects (ASD) via percutaneous closure procedures. In a clinical study of the device in 125 patients with ASD, ranging in age from 2 to 84, all who successfully received the implant maintained the closure when evaluated six months later. The GORE CARDIOFORM is made of two discs that make contact with the tissue walls on both sides of the opening and, when activated, come together to block the passage of blood between the atria. It was approved by the FDA last year for patent foramen ovale closures, as a way of reducing ...
Source: Medgadget - June 7, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiac Surgery Cardiology Radiology Source Type: blogs

Medicine MCQ Test Series 1
This Medicine MCQ Test Series contains 20 questions which can be attempted over 40 seconds each. After submission, answers and discussion will be displayed. Medicine MCQ Test Series 1 Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information ...
Source: Cardiophile MD - January 27, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs

The Doctor Who Thwarted the Charge of the General Medical Council – Part 1
By  SAURABH JHA After Dr. Hadiza Bawa-Garba was convicted for manslaughter for delayed diagnosis of fatal sepsis in Jack Adcock, a six-year-old boy who presented to Leicester Royal Infirmary with diarrhea and vomiting, she was referred to the Medical Practitioners Tribunal (MPT). The General Medical Council (GMC) is the professional regulatory body for physicians. But the MPT determines whether a physician is fit to practice. Though the tribunal is nested within the GMC and therefore within an earshot of its opinions, it is a decision-making body which is theoretically independent of the GMC. The tribunal met in 2017...
Source: The Health Care Blog - August 5, 2018 Category: Consumer Health News Authors: at RogueRad Tags: NHS #BawaGarba @roguerad Source Type: blogs

What are the factors which can produce  right heart failure following ASD surgery?
What are the factors which can produce right heart failure following ASD surgery? Age at surgery: The more the age at ASD surgery, the greater the chance of heart failure later. This is related to the extend of pulmonary vascular disease which has already developed prior to surgery. If significant pulmonary vascular disease is present prior to surgery, it may progress even after surgery and lead on the right heart failure. Atrial flutter: Atrial flutter and other macro re-entrant tachycardias can originate in relation to the atrial scar after ASD (atrial septal defect) surgery. Persistent atrial flutter...
Source: Cardiophile MD - May 24, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Source Type: blogs

GORE CARDIOFORM Septal Occluder Approved by FDA for PFO Closure
The FDA has approved the GORE CARDIOFORM Septal Occluder for patent foramen ovale (PFO) closure procedures that have shown to reduce the chance of stroke in some patients. The CARDIOFORM is already being used in the U.S. for closing of atrial septal defects up to 17 millimeters in size. The catheter-delivered device consists of two discs that make contact with the tissue walls on both sides of the PFO and come together to block the passage of blood between the atria. “The soft and conformable design of Gore’s device is ideal for providing long-term repair of PFOs of any shunt size,” said John Rhodes, MD,...
Source: Medgadget - April 6, 2018 Category: Medical Devices Authors: Editors Tags: Cardiac Surgery Cardiology Radiology Source Type: blogs

Right bundle branch block
Right bundle branch block Right bundle branch block (RBBB) is characterised by an RSR’ pattern with the R’ being slurred, producing a QRS duration of 120 msec or more. This delayed right ventricular activation is reflected as a delayed and slurred S wave in leads oriented to the left ventricle, viz. lead I, aVl, V5 and V6. The same pattern if it occurs with a QRS duration of less than 120 msec, it is generally designated as incomplete right bundle branch block (IRBBB). Mild ST segment depression and inverted T waves in anterior leads are associated with RBBB. Unlike left bundle branch block which often co-exis...
Source: Cardiophile MD - January 13, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology ECG Library Source Type: blogs

Cardiomegaly in Eisenmenger syndrome – Cardiology MCQ
Cardiomegaly (on X-ray chest PA view) is seen in: VSD (ventricular septal defect) Eisenmenger ASD (atrial septal defect) Eisenmenger PDA (patent ductus arteriosus) Eisenmenger VSD and PDA Eisenmenger Post your answer as a comment below with explanation. (Source: Cardiophile MD)
Source: Cardiophile MD - November 6, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

University of Michigan ’s Hybrid OR: High Tech Surgical Gadgetry Inside One Room
The University of Michigan in Ann Arbor sports one of the finest medical centers in America. We won’t even mention the football team. One of the reasons U of M’s clinics are at the forefront of what they do is because the university gives physicians the freedom to seek new ways of doing things. This includes building new facilities designed to handle the kind of medical practices that are expected to take place in the near future. One such facility is the recently built hybrid operating room at the Frankel Cardiovascular Center, a room which combines a high-end cath lab with a traditional open-chest surgical en...
Source: Medgadget - October 27, 2017 Category: Medical Devices Authors: Editors Tags: Cardiac Surgery Cardiology Exclusive Source Type: blogs

Cardiology MCQ Test 3
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - October 20, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Cardiology MCQ Test 2
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - October 19, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Young people, stroke and a hole in the heart (PFO)
(This post introduces my latest column on TheHeart.org | Medscape Cardiology. It’s about stroke in young people.)  *** We define stroke as the death of brain cells. The typical cause is a blocked blood vessel in the brain. Stroke usually occurs in older people who have established blood vessel disease. Stroke is bad; it may be the worst outcome in all of medicine. That’s because stroke can permanently remove basic functions of being human, things such as speech, thought, personality, movement, swallowing, and many others. Stroke is not supposed to happen in young people. But sometimes it does. And in some ...
Source: Dr John M - September 28, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

ASD on colour Doppler echocardiogram
Subcostal view showing a 15 mm secundum atrial septal defect RA: Right atrium; LA: Left atrium; ASD: Atrial septal defect; ​SVC flow: Flow from superior vena cava into the right atrium. ASD flow: Left to right shunt from left atrium to right atrium (Red colour of the flow is because flow is towards the transducer; right to left shunt will be blue in colour in the subcostal view as the flow would be away from the transducer). Slight mosaic colour of the ASD flow jet is seen, indicating mild turbulence of the stream. In this view the ASD is seen to have good rims on either side, suggesting that it may be an ideal case for...
Source: Cardiophile MD - August 31, 2017 Category: Cardiology Authors: Johnson Francis Tags: Echocardiogram Library Echocardiography ASD ASD flow Atrial septal defect left atrium left to right shunt right atrium secundum ASD subcostal view SVC flow Source Type: blogs

Multiple echo views in EMF
Parasternal long axis (PLAX) view being the first view taken in most echocardiographic studies, gives this image with dilated right ventricular outflow tract (RVOT). This pattern alone will not give a suspicion of endomyocardial fibrosis (EMF) as RVOT can be dilated along the with the rest of the right ventricle in conditions causing right ventricular volume overload like an atrial septal defect as well as in Ebstein’s anomaly of the tricuspid valve. Conditions with a dilated RVOT will have a characteristic clinical finding of RVOT pulsations, along the left sternal border, in the third intercostal space. Pulsation i...
Source: Cardiophile MD - December 16, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs

Interatrial septum in subcostal view
In an earlier post it was shown that false echo dropouts can occur in the interatrial septum as the ultrasound beam is parallel to the structure being imaged. It was also mentioned that subcostal view is best for imaging the interatrial septum. This picture in subcostal view gives an excellent image of the interatrial septum (IAS) between the right atrium (RA) above and the left atrium (LA) below. LV: Left ventricle. Most echocardiographers use this orientation for subcostal view, though it is anatomically an inverted view as the transducer is kept below the structures being imaged. On the contrary, most paediatric ec...
Source: Cardiophile MD - December 15, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs

Echo drop out in interatrial septum
An echo drop out in the interatrial septum is often noted in the apical four chamber view. This need not mean that there is an atrial septal defect. This is because the thin atrial septum in the region of the foramen ovale is often not imaged well in the apical four chamber view as the ultrasound beam is parallel to the inter atrial septum. For a good ultrasound image, the structure being imaged should be perpendicular to the ultrasound beam. In case of Doppler the beam should be parallel to the flow being imaged. LV: left ventricle; RV: right ventricle; LA: left atrium; RA: right atrium; PV: pulmonary vein; IAS: inter atr...
Source: Cardiophile MD - December 12, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs

Atrial septal defect (ASD) with bidirectional shunt
Subcostal four chamber view shows a large defect in the interatrial septum (ASD). Right atrium (RA) and right ventricle (RV) are dilated, while left atrium (LA) and left ventricle (LV) are not. Blue color on colour flow mapping indicates right to left shunt across the atrial septal defect (R>L Shunt) in the subcostal view as the flow is away from the transducer. This view shows red coloured flow across the ASD indicating a left to right shunt (L>R shunt). In addition there is a mosaic (multicoloured) jet spreading from the closed tricuspid valve into the right atrium, due to tricuspid regurgitation (TR jet). Bidirec...
Source: Cardiophile MD - November 29, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs

Subcostal four chamber view – Echocardiography
Subcostal four chamber view is excellent for visualization of interatrial septum (IAS). If an atrial septal drop out is seen in the apical four chamber (4C) view, it need not be an atrial septal defect as the IAS is parallel to the ultrasound beam in the apical 4 C view. Structures are imaged well only if they are perpendicular to the ultrasound beam. In case of Doppler, the signals are better when it is parallel to the beam. If the beam is perpendicular to the flow, there is hardly any Doppler signal picked up. Subcostal four chamber view shows right atrium (RA), left atrium (LA), right ventricle (RV) and the left ventric...
Source: Cardiophile MD - November 22, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Echocardiogram Library Echocardiography Source Type: blogs

Device closure of atrial septal defect (ASD)
Device closure of ASD Device closure of ASD is suitable for secundum ASD with a good rim all around for holding the two discs together. Trans esophageal echo (TEE) is done to assess the superior, aortic and mitral rims as well as the total septal length. It is ideal to have TEE guidance during the procedure as well. A guide wire is introduced through the femoral vein into the inferior vena cava and further through the right atrium across the ASD. The tip of the wire is placed in the pulmonary vein and a long venous sheath is introduced. Once the sheath is in position, the device attached to the delivery cable is intro...
Source: Cardiophile MD - September 17, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Structural Heart Disease Interventions Source Type: blogs

DM / DNB Cardiology Entrance New Test Series 5
Time limit: 0 Quiz-summary 0 of 30 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Information This new test series requires ...
Source: Cardiophile MD - August 6, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance New Test Series 1
Time limit: 0 Quiz-summary 0 of 30 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 ...
Source: Cardiophile MD - June 28, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 26
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 26. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated...
Source: Cardiophile MD - May 10, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

Echo Quiz – Cardiology MCQ
Type of ASD seen in this echo: a) Sinus venosus b) Secundum c) Primum d) None of these Correct answer: b) Secundum There is good rim of septal tissue between the atrial septal defect and the atrioventricular valves, suggesting secundum ASD. In sinus venosus ASD, the superior rim will not be there. (Source: Cardiophile MD)
Source: Cardiophile MD - May 10, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology X-ray DM / DNB Cardiology Entrance Echocardiography Source Type: blogs

Cardiology X-ray Quiz – Cardiology MCQ
This chest X-ray is suggestive of: a) Primary pulmonary hypertension b) Atrial septal defect with pulmonary hypertension c) Ventricular septal defect with pulmonary hypertension d) Idiopathic dilatation of pulmonary artery Correct answer: b) Atrial septal defect with pulmonary hypertension End on view of dilated pulmonary artery branches suggest increased pulmonary blood flow as the cause of pulmonary hypertension. Right atrial enlargement is not seen in ventricular septal defect with pulmonary hypertension. Read more on multi-modality imaging in atrial septal defect… (Source: Cardiophile MD)
Source: Cardiophile MD - May 10, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ Cardiology X-ray DM / DNB Cardiology Entrance Source Type: blogs

Deficiency of aortic rim an important risk factor for cardiac erosion with ASD device
Cardiac erosion is a potential nightmare of device closure of atrial septal defect (ASD) device closure, though exceedingly rare. Recent study published in Circulation [1] documented 125 erosions over a period of 12 years from a database. Erosions were diagnosed over a median of 14 days after the device closure. Deficiency of aortic rim was found to be almost universal while deficiency of any of the aortic, superior vena caval or inferior vena caval rims were the most important risk factor for cardiac erosion. The study was a case control study with age and sex matched controls. Device oversizing also contributed to t...
Source: Cardiophile MD - May 4, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Structural Heart Disease Interventions Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 23
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Source: Cardiophile MD - March 25, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 21
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Source: Cardiophile MD - March 8, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 17
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 17. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - February 16, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs