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On your fingertips – A new aid to learn the anatomy of the secundum atrial septal defect
IHJ-890; No. of Pages 2 indian heart journal xxx (2016) xxx–xxx
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/ihj
Letter to the Editor
On your fingertips – A new aid to learn the anatomy of the secundum atrial septal defect abstract Keywords:
Though the anatomy of heart is beautifully demonstrated by two-dimensional echocardi-
Atrial septal defect
ography, it is difficult to imagine a three-dimensional structure on two-dimensional echo-
Left hand
cardiogram. It is especially difficult for a junior fellow in cardiology to conceptualize the
Learning tool
atrial septal defect (ASD) and its rims on two-dimensional echo at different angles, especially
Trans-esophageal echocardiogram
trans-esophageal echo (TEE). The left hand can be a useful tool to learn the ASD and its rims on TEE. # 2016 Cardiological Society of India. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
1. Rims of atrial septal defect (ASD) on the left hand As illustrated in Fig. 1, the left hand with its thumb and index finger stretched out represents the atrial septum (Fig. 1a). The defect with the rims is illustrated in Fig. 1b shows anteriorly the aorta and the aortic (anterior) rim and posteriorly the posterior rim. The posterosuperior and posteroinferior
margins are the SVC and IVC rims respectively. Free atrial and mitral (AV valve) rims are of the nature anterosuperior and anteroinferior respectively.
2.
Rims of ASD on trans-esophageal echo (TEE)
As illustrated in Fig. 2, the blue line represents the long axis of the TEE probe and red line the axis of the visualized plane, that
Fig. 1 – (a) The left hand image with the position of the rims. (b) The atrial septal defect as shown by the red circle and the marked rims on the left hand.
Please cite this article in press as: Phatarpekar A. On your fingertips – A new aid to learn the anatomy of the secundum atrial septal defect, Indian Heart J. (2016), http://dx.doi.org/10.1016/j.ihj.2016.02.008
IHJ-890; No. of Pages 2
2
indian heart journal xxx (2016) xxx–xxx
Fig. 2 – (a) The rims on the left hand along with the atrial septal defect. (b) The atrial and free atrial rims on left hand. (c) The atrial and free atrial rims on TEE.
Fig. 3 – (a) The aortic and posterior rims on left hand at 458. (b) The aortic and posterior rims profiled on left hand as seen on TEE. (c) The aortic and posterior rims as seen on TEE.
Fig. 4 – (a) The SVC and IVC rims on left hand at 1208. (b) The SVC and IVC rims profiled on left hand as seen on TEE. (c) The SVC and IVC rims as seen on TEE.
is the TEE visual angle. On TEE, the free atrial and the mitral rims are seen in 08 both red and blue line merged (Fig. 2b). The hand is showing both the rims (Fig. 2b) and the TEE image (Fig. 2c). As illustrated in Fig. 3, at 458, angle as shown by angulation between red and blue lines, the aortic and posterior rims are visualized (Fig. 3a). The aortic and posterior rims at 458 are profiled in the hand image (Fig. 3b) and TEE image (Fig. 3c). As illustrated in Fig. 4, at 1208 angle, as shown by angulation between the red and blue lines, the SVC and IVC rims are visualized, with slight rotation (Fig. 4a). The SVC and the IVC rims are profiled in hand image at 1208 plane (Fig. 4b) and the TEE image (Fig. 4c).
Conflicts of interest The author has none to declare.
Acknowledgment The author acknowledges Dr Vaidehi Dande.
Ankur Phatarpekar Department of Cardiology, Seth G.S. Medical College & King Edward Memorial Hospital, Mumbai, India E-mail address: [email protected] Available online xxx http://dx.doi.org/10.1016/j.ihj.2016.02.008 0019-4832/ # 2016 Cardiological Society of India. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: Phatarpekar A. On your fingertips – A new aid to learn the anatomy of the secundum atrial septal defect, Indian Heart J. (2016), http://dx.doi.org/10.1016/j.ihj.2016.02.008
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/ihj
Letter to the Editor
On your fingertips – A new aid to learn the anatomy of the secundum atrial septal defect abstract Keywords:
Though the anatomy of heart is beautifully demonstrated by two-dimensional echocardi-
Atrial septal defect
ography, it is difficult to imagine a three-dimensional structure on two-dimensional echo-
Left hand
cardiogram. It is especially difficult for a junior fellow in cardiology to conceptualize the
Learning tool
atrial septal defect (ASD) and its rims on two-dimensional echo at different angles, especially
Trans-esophageal echocardiogram
trans-esophageal echo (TEE). The left hand can be a useful tool to learn the ASD and its rims on TEE. # 2016 Cardiological Society of India. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
1. Rims of atrial septal defect (ASD) on the left hand As illustrated in Fig. 1, the left hand with its thumb and index finger stretched out represents the atrial septum (Fig. 1a). The defect with the rims is illustrated in Fig. 1b shows anteriorly the aorta and the aortic (anterior) rim and posteriorly the posterior rim. The posterosuperior and posteroinferior
margins are the SVC and IVC rims respectively. Free atrial and mitral (AV valve) rims are of the nature anterosuperior and anteroinferior respectively.
2.
Rims of ASD on trans-esophageal echo (TEE)
As illustrated in Fig. 2, the blue line represents the long axis of the TEE probe and red line the axis of the visualized plane, that
Fig. 1 – (a) The left hand image with the position of the rims. (b) The atrial septal defect as shown by the red circle and the marked rims on the left hand.
Please cite this article in press as: Phatarpekar A. On your fingertips – A new aid to learn the anatomy of the secundum atrial septal defect, Indian Heart J. (2016), http://dx.doi.org/10.1016/j.ihj.2016.02.008
IHJ-890; No. of Pages 2
2
indian heart journal xxx (2016) xxx–xxx
Fig. 2 – (a) The rims on the left hand along with the atrial septal defect. (b) The atrial and free atrial rims on left hand. (c) The atrial and free atrial rims on TEE.
Fig. 3 – (a) The aortic and posterior rims on left hand at 458. (b) The aortic and posterior rims profiled on left hand as seen on TEE. (c) The aortic and posterior rims as seen on TEE.
Fig. 4 – (a) The SVC and IVC rims on left hand at 1208. (b) The SVC and IVC rims profiled on left hand as seen on TEE. (c) The SVC and IVC rims as seen on TEE.
is the TEE visual angle. On TEE, the free atrial and the mitral rims are seen in 08 both red and blue line merged (Fig. 2b). The hand is showing both the rims (Fig. 2b) and the TEE image (Fig. 2c). As illustrated in Fig. 3, at 458, angle as shown by angulation between red and blue lines, the aortic and posterior rims are visualized (Fig. 3a). The aortic and posterior rims at 458 are profiled in the hand image (Fig. 3b) and TEE image (Fig. 3c). As illustrated in Fig. 4, at 1208 angle, as shown by angulation between the red and blue lines, the SVC and IVC rims are visualized, with slight rotation (Fig. 4a). The SVC and the IVC rims are profiled in hand image at 1208 plane (Fig. 4b) and the TEE image (Fig. 4c).
Conflicts of interest The author has none to declare.
Acknowledgment The author acknowledges Dr Vaidehi Dande.
Ankur Phatarpekar Department of Cardiology, Seth G.S. Medical College & King Edward Memorial Hospital, Mumbai, India E-mail address: [email protected] Available online xxx http://dx.doi.org/10.1016/j.ihj.2016.02.008 0019-4832/ # 2016 Cardiological Society of India. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: Phatarpekar A. On your fingertips – A new aid to learn the anatomy of the secundum atrial septal defect, Indian Heart J. (2016), http://dx.doi.org/10.1016/j.ihj.2016.02.008