Inter Atrial Septum Shunt

4SdB 3-A1/1/2 CW Focus -160mm CVi Gon= 6dB

4SdB 3-A1/1/2 CW Focus -160mm CVi Gon= 6dB

Measuring EchocardiographyCancer Around Heart Echo

Fig. 5. Quantification of shunt flow (Qp:Qs) requires measurement (see Anatomic and Echocardiography Overview section). Systemic flow calculation requires measurement of left ventricular outflow tract diameter (A) and the velocity time integral (VTI) by PW Doppler (B).

along with bicuspid aortic valves. The lesion results from the incomplete development of the septum secundum, leaving a central patency between the right and left atria (Fig. 7; please see companion DVD for corresponding video). Occasionally, there may be more than one opening in the septum so that a fenestrated septum results. This is often clearly delineated on transthoracic imaging with the use of color flow Doppler around the area of the central portion of the septum (Fig. 8). Shunt flow can be seen with the use of pulse wave Doppler across the defect.

Usually some transient right-to-left shunting can be seen with these defects, typically corresponding with ventricular contraction. Occasionally, with the use of intravenous agitated saline in the right heart, an echo-lucent silhouette of blood flow may be seen in the right atrium when predominant left-to-right shunting is present, the so-called "negative contrast effect." However, because saline contrast is often injected from an upper extremity, this "negative contrast effect" should be interpreted with caution as this can also be produced by contrast-free caval blood flow emanating

Pulmonic VII = U.160V Ale

Pulmonic VII = U.160V Ale

Echo Focal Septal Predominance

I Cardiac Reports

Pulmonic Dram = 2,14 cm

I Cardiac Reports

VOLUME FLOW / SHUNTS

Shunts

Systemic vs. Pulmonic

Systemic Pulmonic VT I 0.142 0.166 m Diatri 1,91 2.14 cm CSA 2.87 3.60 cm2

VOLUME FLOW / SHUNTS Qp/Qs 1.61

Systemic Pulmonic SV 40.7 597 ml CO 2,85 4.60 l/min HR 70 77 bpm —I Qp/Qs 1.61 W Qp-Qs 1.75 l/min

Fig. 6. Pulmonary flow is similarly calculated following measurement of the right ventricular outflow tract at the level of the pulmonary valve (B).

Interatrial Septum Echo Anomalies
Fig. 7. Midesophageal view of the interatrial septum with color Doppler applied shows left-to-right shunt via a secundum atrial septal defect. (Please see companion DVD for corresponding video.)

from the IVC flushing against the area of the fossa ovalis.

Secundum ASDs may be associated with other cardiac anomalies. Occasionally, atrial septal aneurysms may be seen with secundum ASDs. In these cases, the atrial septum is hypermobile and bows into either atrial chamber, varying with respiratory variation. When rheumatic involvement of the mitral valve is concomi-tantly present with an ASD, Lutembacher's syndrome is said to be present.

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