title: Hand-held Echo is Not So Handy in Everyone's Hands: Misdiagnosing Congenital Septal Defects in Patients with Heart Murmurs.
abstract: BACKGROUND
  Echocardiography is a highly operator-dependant technique which requires adequate training and skills that are frequently not present, considering the widespread use of cardiovascular ultrasound. This could particularly be true for hand-held echo devices which made echocardiography more accessible but are frequently used by non-cardiologists and non-experts.
  
  
  METHODS
  We present a 45-year-old female and a 37-year-old male with heart murmurs due to atrial and ventricular septal defect, respectively. Congenital septal defects were undiagnosed in both patients during several outpatient examinations due to challenging image acquisition. C reful re-evaluation revealed that, depending on the scanning technique, it was possible to detect or overlook the real cause of the murmur using either hand-held or high-end echo device.
  
  
  CONCLUSIONS
  Our report underlines the need of adequate knowledge and training of medical professionals performing pocket-size hand-held echocardiography, since potential misdiagnoses may not be related to limited imaging capabilities of pocket-sized echo devices only, but also to inability of insufficiently trained users to obtain good quality images and interpret them adequately.
authors.forename: Biljana
authors.initials: B
authors.lastname: Putniković
authors.forename: Ivan
authors.initials: I
authors.lastname: Stanković
authors.forename: Predrag
authors.initials: P
authors.lastname: Miličević
authors.forename: Miloje
authors.initials: M
authors.lastname: Marjanović
authors.forename: Aleksandar N
authors.initials: AN
authors.lastname: Nešković
mesh_terms: D000328:Adult; D004452:Echocardiography / Q000295:instrumentation*; D005260:Female; D006337:Heart Murmurs / Q000151:congenital / Q000175:diagnosis*; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000175:diagnosis*; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems