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Page 2 of 6 Rao. Vessel Plus 2022;6:35 https://dx.doi.org/10.20517/2574-1209.2021.109

systolic, diastolic, and continuous types. The systolic murmurs are further divided into ejection systolic and
holosystolic murmurs. The more common etiologies of ejection systolic murmurs are aortic stenosis,
pulmonary stenosis, atrial septal defect (ASD), coarctation of the aorta, and functional heart murmurs. The
causes of holosystolic murmurs are ventricular septal defect (VSD), mitral insufficiency (MI), and tricuspid
insufficiency (TI). The diastolic murmurs are classified into early, mid and late (or presystolic) diastolic
murmurs. The early diastolic murmurs are caused by aortic insufficiency (AI), pulmonary insufficiency, and
pulmonary hypertension. Mid-diastolic murmurs are produced by increased flow across the mitral valve
[secondary to large shunts across a VSD or patent ductus arteriosus (PDA) or moderate to severe MI] or
increased flow across the tricuspid valve (due to ASD, partial or total anomalous pulmonary venous
connection or moderate to severe TI). Other causes are Carey-Coombs murmur of rheumatic fever, Austin-
Flint murmur of AI, and stenosis of the atrio-ventricular valves. The presystolic murmurs are produced by
stenosis of the mitral or tricuspid valve and atrial myxoma. The continuous murmurs are more commonly
produced by PDA, venous hum, or aorto-pulmonary shunt procedures. There are many other less common
causes. Careful auscultation and other findings in history, physical examination, chest roentgenogram, and
electrocardiogram will frequently help come up with an accurate diagnosis. Echo-Doppler studies are
valuable and confirmatory in making the diagnosis, in quantifying the problem, and are very useful in
directing the type of and timing of management.

[2]
In the next paper, Dr. Uppu from our institution described imaging of the defects in the atrial and
ventricular septae. He stated that ASDs and VSDs account for the majority of the CHDs, and that these
defects may be seen as isolated lesions or may occur in association with other defects. Clinical features are
largely related to the size of the defect. ASDs produce right ventricular volume overload, while VSDs cause
left heart volume overload. Initially, he reviewed the embryology of each defect separately, followed by a
detailed anatomic description. Four types of ASDs, namely, ostium secundum, ostium primum, sinus
venosus, and coronary sinus defects, were reviewed, presenting the location of the defect in beautifully
drawn colorful heart models and then showed echocardiographic, MRI, and CT examples. Then, he
reviewed all four types VSDs, i.e., perimembranous, inlet, muscular, and outlet VSDs demonstrating the
echocardiographic features of each of these defects. He concluded that the understanding of embryology
and anatomy is essential for correct diagnosis and planning for transcatheter and/or surgical interventions.

[3]
In the following paper, Ivy et al. from the University of the Incarnate Word School of Osteopathic
Medicine, San Antonio, and the Children’s Hospital of San Antonio, San Antonio, Texas, reviewed the role
of three-dimensional (3D) visualization modalities [augmented reality (AR), virtual reality (VR) and 3D
printing] for CHD surgery. They discussed the utility of 3D visualization modalities such as 3D printing,
AR, and VR, and suggested that these techniques have changed the discipline of surgery in the last few
years. These techniques have confirmed their value in planning preoperatively, in procedural training, and
in guidance during surgery in many surgical spheres. They explored the existing applications of 3D
visualization techniques in surgery and investigated their utility and potential in the sub-discipline of
surgery for CHDs. The authors acknowledged limitations of these techniques, namely, high initial set-up
costs, need for ready access to imaging technologies like CT or MRI, and availability of reconstruction tools.
The authors concluded that all three modalities had been found to be useful in surgery in that they help the
surgeons in pre-procedure planning, reduce postoperative complications, curtail the surgical duration, and
advance the critical patient-physician relationship. Finally, they suggested that existing evidence indicates
that these new imaging modalities are likely to result in better patient outcomes.

[4]
In the subsequent three papers, I presented an overview of echocardiography. In Part I of this review, I
described principles of echocardiography and Doppler, outlined the technique of recording echo-Doppler