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RA RV VOLUME OVERLOAD
the most common type being the defect with deficient aortic rim (42.1%).
APICAL 4C VIEW
SHOWING THE IAS AND 3 VEINS
DRAINING TO LA, RT LOWER
PULMONARY VEIN IS USUALLY
NOT SEEN
SUB COSTAL 4C VIEW- Useful in patients with COPD and ventilated
patients.
Xinseng et al Journal of the American Society of Echocardiography Volume 23, Issue 7 , Pages 714-721, July 2010
A-4c view & B-En face view
Ostium primum ASD
Defect in lower part of IAS
Associated sometimes with inlet VSD
Cleft mitral valve
AV Valve regurgitation
Partial attachment of mitral valve to IVS
Fig 5
Primum ASD
LV
RV
RA LA
Apical four chamber view demonstrating Colour Doppler flow image from same view
a primum atrial septal defect illustrating left-to-right shunt across the primum
atrial septal defect
CLEFT MITRAL VALVE IN PSAX VIEW POSTERIORLY DIRECTED JET OF MR
Ostium Secundum ASD
10 morphological variations of defects
MC- Deficient aortic rim (42.1%).
Central defects (24.2%)
Deficient Inferoposterior rim (12.1%)
Perforated aneurysm of the septum (7.9%)
Multiple defects (7.3%)
Combined deficiency of mitral and aortic rims (4.1%),
Deficient SVC rim (1%),
Deficient coronary sinus rim (1%).
A – INTACT IAS
TEE
Sinus venosus ASD -Color doppler in
TEE
CORONARY SINUS ASD
CRITERIA
A- PROTRUSION OF ANEURYSM
ATLEAST 15MM OF PLANE OF IAS
OR
Caveat- False Positive results due to improper gain and caval flow
streaming near septum can be misdiagnosed as ASD.
TEE TTE
TEE
2D TEE at 0 o
The transesophageal echocardiography (TEE) probe is at the mid-
lower esophageal level.
The posterior and the mitral rims are best evaluated in this view.
Rotating the probe to 30° to 40° towards the left will best profile
the aortic (Ao) rim.
The margins are evaluated by carefully moving the probe in and out
and obtaining sections at various levels.
At the level of the
atrioventricular valves (C), the septum forms once again. This
suggests that the ASD is likely to have adequate margins for
catheter closure.
In the highest plane (A), the superior venacaval (SVC)-right atrial
junction and the ascending (Asc) aorta are seen; the atrial septum is
visualized as intact.
At the mid-level (B), the septum breaks and the
margins(posterior and anterior) of the atrial septal
defects (ASD) (arrows) are clearly seen.
At the level of the atrioventricular valves (C), the septum forms
once again.
This suggests that the ASD is likely to have adequate margins for
catheter closure.
TEE at 90° to Evaluate the SVC and
IVC Rims
TEE -0 DEGREE
TEE-90 DEGREES
PFO WITH SECONDARY SEPTUM
Special tee views for Inferoposterior
rims
Retroflexed probe in the stomach and bought towards the esophagus and viewed
In the 70-90o view