Our data provide preliminary evidence that concept mapping assessment reflects expected differences and change in the conceptual framework of resident physicians. Concept mapping assessment and standardized testing may measure different cognitive domains. JAMA. 2000;284:1105-1110

These data suggest that scoring systems for evaluating concept maps in postgraduate medical education may need to account for structural features of maps, if scores are to reflect changes in the developing knowledge frameworks of resident doctors. More research to further evaluate reliability and validity is critical prior to any future use of concept mapping assessment in medical education.

Absence of the pulmonary valve occurs usually in association with tetralogy of Fallot and occasionally with an atrial septal defect or as an isolated lesion. Very rarely it occurs with tricuspid atresia, intact ventricular septum, and dysplasia of the right ventricular free wall and of the ventricular septum. We present the clinical, anatomic, and histologic findings of a new case, and for the first time, the data from two patients with absent pulmonary valve and severe tricuspid stenosis, who exhibited similar histologic findings. We also reviewed the clinical and anatomic data of 24 previously published cases and compared them with the new cases. In all three new cases, the myocardium of the right ventricle was very abnormal. In the two cases with tricuspid stenosis, large segments of myocardium were replaced with sinusoids and fibrous tissue. In the case with tricuspid atresia, the right ventricular free wall contained only fibroelastic tissue. The ventricular septum in all three patients showed asymmetric hypertrophy and in two of the three patients, multiple sinusoids had replaced large segments of myocardial cells. The left ventricular free wall myocardium and the walls of the great arteries were unremarkable. Our data indicate that myocardial depletion involving the right ventricular free wall and the ventricular septum and its replacement by sinusoids and fibroelastic tissue occur not only in cases of absent pulmonary valve with tricuspid atresia but also in cases of absent pulmonary valve with tricuspid stenosis. The degree of myocardial depletion varies and is more severe when the tricuspid valve is atretic.

In long-term follow-up, both women reported improvement in their prepartum symptoms. We describe the first report, to our knowledge, of two successful pregnancy outcomes in severe POTS, including the first report of midodrine use in pregnant women.

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We report our experience with use of a ICD in a 7-month-old infant who presented with VF. We utilized an epicardial patch and active generator in the abdomen. Development of mediastinitis required explantation and eventual replacement with a subcutaneous patch and active generator in the abdomen.

The ostium of the coronary sinus opens directly into the right atrium in close proximity to the insertion of the atrioventricular values. If the coronary sinus is dilated, it can create the appearance of atrioventricular canal defect in the fetal echocardiographic four-chamber view. The diagnosis of a serious heart lesion, such as a canal defect, necessitates decisions regarding pregnancy termination or optimal timing/location of delivery. We present three women who were referred at 23, 36 and 38 weeks' gestation with a preliminary diagnosis by level II ultrasound of a fetal atrioventricular canal defect. In each patient, the targeted fetal echocardiogram demonstrated a dilated coronary sinus and no evidence of an atrioventricular canal defect. The fetal echocardiographic presentation of a dilated coronary sinus can be mistaken for an atrioventricular canal defect. Misdiagnosis can be avoided by utilizing both variable angulation in the four-chamber projection and additional transducer views to confirm an intact atrioventricular septum and two normal atrioventricular valves.

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