0:00

So based on these images presented here

0:03

like to put up the last polling question the

0:06

correct diagnosis based on the cine images shown in

0:09

four chamber

0:10

two chamber right two chamber right

0:13

on the right side.

0:14

And four different four chambers on the left

0:17

side. Either of these five arvd Epstein's

0:20

normally also normally transportation to charge

0:23

your fellow.

0:25

Okay, good. Excellent. Epstein's anomaly. That's the correct diagnosis notice the

0:28

apical displacement of the SEPTA leaflet of the tricuspid valve

0:31

which Rises very apically on the septum. This is

0:34

a patient who had and the right ventricles dilated. There's Tran cuspid

0:37

insufficient is the patient has an Epstein's anomaly of

0:40

the right ventricle.

0:42

Um, there's atrialization of a portion of

0:45

the right ventricle proximal to the interage approximal

0:48

to the attachment of these subtly to track custom valve. The

0:51

anterior leaflet is dysplastic sale, like the simply

0:54

flit is displaced apically features of epsteins anomaly.

0:57

Okay. We have the second polling question based on

1:00

this case, please.

1:01

Which are the following is the most common associate lesion epsteins

1:04

are normally can be an isolator that can be in Associated lesion with

1:07

Epstein's a communist Associated. Lesion is one of

1:10

the five.

1:11

VST patronum Valley iot compact

1:14

valve or a PDA

1:17

the correct answer is a patient for amino Valley or an as

1:20

small ASD can be associated with Epstein's anomaly.

1:24

The correct answer is a PFO vsd is

1:27

an unusual normally, but can occur.

1:29

The others are all of much much rarer, but

1:32

Communists normally is appear for our second name

1:35

ASD associated with the name stands. Anomaly. There's one more question

1:38

based on this case. Can we have Paul question three,

1:41

please?

1:42

Which is following statements Falls, there's a false fault statement regarding

1:45

epsteins are normally we'll just keep that up for a few seconds and take a

1:48

poll.

1:50

Okay, the correct answer is actually number five epsteins is

1:53

defined by displacement of the centrally fled

1:56

of the tricuspiral by 8 millimeter per meter Square, not 20.

2:02

8 by 8 if you take the body surface area and

2:05

divide by the measurement in millimeters from

2:08

the presumed attachment of the assembly flipped

2:11

to where it is actually attached divide that with the body

2:14

surface area. And if you get a number above 8 diagnosis of

2:17

epsteins are normally can be made not 20 but 8 the

2:20

others are correct. It's a recognition hard disease maternal

2:23

lithium therapy can read to abstains. Normally the product

2:26

the the Continental clinical features in infancy or

2:29

even an adult hood are cyanosis right side

2:32

heart failure means in certain cardiac death. It's important

2:35

to monitor the right ventricle for size and Progressive right

2:38

ventricular dilatation. Arithmia or symptoms

2:41

are an indication for surgical correction. Echo is the diagnostic

2:44

test of choice MRI should be performed when

2:47

echocardiographic images are poor particularly when

2:50

the patient's body actors does not permit or when evaluation

2:53

of the right ventricular accurately with respect to its size and function

2:56

is not possible. But Echo is initial diagnostic testing patients

2:59

the epsteins anomaly space Epstein.

3:02

Normally apical displacement of the simply for the tricuspid valve

3:05

by greater than 8 millimeters per meter Square dilated right

3:08

ventricle atrialization of a portion of the right ventricle RV

3:11

dilatation dysfunction tricuspid insufficiency. The

3:14

key Cardinal feature here is apical displacement of

3:17

the central leaflet of the tricuspid valve towards the apex of

3:20

the right ventricle and a dysplastic set

3:23

this plastic

3:27

ant really leaflet, which is thin and Flame like almost like a

3:30

like the Sailor for boat Epstein's normally

3:33

of the tank has been valve.

3:34

Okay. Excellent. Thank you very much. It is 4:59. We

3:37

have a minute remaining. Are there

3:40

any questions based on these cases here?

3:42

Okay. Thank you very much.

3:44

Thank you. Have a good day.