Thanks everyone and Anne-Marie just a wonderful, wonderful chat made me think about my own identity and you know so where I come from I've always been in the software industry and we've always thought about how can software actually help change different industries and I've been in education now for about 10 years and give you a little bit of a background of myself I came from a company called Illuminate which has had a long relationship with ALSI and and we've been doing this conference now I think for a good five or six years very remote people can join in I know today we're actually using Adobe so so a wonderful product in its own right so so it's it's interesting it's interesting to actually be simulcasted in Adobe today it's always fun to fun to challenge your own identity there so let me start out I come here as as a representative of Blackboard today and I decided I would I would start out with what it is that Blackboard thinks of themselves and they have a very expansive sort of vision you know the vision really is everyone educated and I'm not really sure that we'll actually achieve that vision in my lifetime but but I think it's it's a worthwhile thing to obviously aspire towards and the idea is let's let's try to see what it is that we can do to go ahead and get education every place that there is for those who have access let's try to make it a much better experience compared to what it is today and for those who don't have the access let's try to figure out you know how do we how do we actually get there from a from a reach perspective you know Blackboard actually has a has an amazing reach 8700 different institutions from all around the globe including colleges universities k-12 corporate you know and I put this slide up not really to boast about the number of customers that Blackboard really has but the idea that that there's a lot of practice that Blackboard folks have really become used to how do we go ahead and make sure that certain things happen in certain ways and we get the most return on that investment technology is an expensive investment in education how do we make sure that from a practice perspective we are able to go ahead and figure out what the best practices there really are so Blackboard has actually gone ahead and and done a lot of that research and gone out and figured out how it is that we should go ahead and deploy these technologies to be able to get the best return that that's actually possible and you know trying to make sure you know I know that that within all see I've presented to other associations in the US for example the Sloan Consortium which I think is a similar association there the the issue always is how do we and we still seem to be stuck on this after many many years of online education how do we make sure that online education is as good as face-to-face and you know you need to go ahead and almost get beyond that question because there's research out there you know we've had research published by all see by Sloan Consortium by the US Department of Education many other places and what we've been able to do now is basically take that research put it into practice at thousands of customers and hopefully we can go ahead and help help others do the same give you a little bit of overview of what it is that Blackboard actually does most people think of Blackboard and the think of the learning management system the virtual learning environment well that just actually a very big organization now so obviously the teaching and learning the virtual learning environment is there I come from a division within Blackboard called collaborate and I'll get into a little bit more detail about collaborate but I figured I should at least mention the rest of the platforms that Blackboard actually brings to bear so the the learn environment is there the collaborative environment is there there's a there's a product and in a platform called Blackboard Connect and I believe we have some folks from the Blackboard Connect side actually in the in the stand in the exhibit hall and Blackboard Connect is there for mass notification once again the idea really is how do we figure out what technology can do to bring engagement back into education so Blackboard Connect allows you to go ahead and and pick the medium according to what the receiver wants to be so some people might want voicemails other people might want emails other people might want Facebook messages other people might want text messages in order to be able to get the information across to them as an institution you can pick which message you want to send out and then Connect allows you to go ahead and and allow the receiver to pick whichever medium that they want to receive whether it's voicemail or text or whatever the case might be Blackboard Transact is primarily a US based operation and it's really to ensure that when you get the student ID card the student ID card can go ahead and be used in a wide variety of things you can use it for for transactions on your campus for buying meals for using at the bookstore or even going off campus and doing transactions with with local customers or with local merchants and security aspect so being able to get access to the right dormitory room or whatever the case might be so that's the transact piece and the Linux is a brand new piece that Blackboard has just acquired from from a company called iStrategy just at the beginning of this year and the idea there really is how do we make sure that we are able to take all of this data that exists in all the different silos within a university system and be able to go ahead and make decisions based on that you know to a large extent I sort of feel like education is actually a step behind the commercial entities and in this space you know when I'm in the U.S. I sort of use the example of a bookstore they're called Borders Borders had been around for probably 50 years and and just actually finally is going out of business in fact it was the situation was so bad they couldn't find anybody to even buy out the name so the stores are completely being liquidated and I think you know that's sort of a very stark example of an institution which didn't really make that transition to what it is that consumers today really want and I think to a large extent from an educational perspective you know we're getting these consumers you know who are now students or who are now teachers and we need to make sure that that we're able to go ahead and adapt our educational environment so blockbusters was or sorry borders was competing with the with Amazon.com and Amazon.com you know they they're fans of data they collect data on everything that there is they collect data on what you buy they collect data on what it is that you like they collect data on what it is that other people who like things similar to yours they collect reviews they collect reviews about reviews and so all of this data then is is fed into a big analytics database to figure out what is going to be the best experience possible for the person that they're trying to serve you know and from our perspective obviously that's the student and the teachers and we need to go ahead and make sure that we collect all of those analytics and are able to to transform their experience and I think that's what analytics really allows you to do. Mobile doesn't doesn't probably need a lot of a lot of indication I see lots and lots of laptops open some iPads open some some folks I'm sure are doing their email and things on iPhones. I see people pointing to each other so you know you know we don't we don't need to we don't need to talk about mobile that much we know we're experiencing that on an ongoing basis and and the entire educational experience needs to be taken there so Blackboard's obviously working on that and then the the underlying structure is the Blackboard services side so it's a it's a vast vast array of technology that that Blackboard can really bring to bear. What I'm going to talk about today is collaborating and and what it is that we do and how it is that we can really help both you know improve the student outcomes and and how do you how do you go ahead and measure sort of the dollars and cents the return on investment of all of that. I'll set the stage a little bit. The the Blackboard Collaborate Organization actually came into being just last year in August of 2010. Blackboard decided as as their want to do on an ongoing basis to figure out what else their customers might want and they acquired two companies one was called Vimba and one was called Illuminate. Let me just see a show of hands how many people knew Vimba. Good good percentage and how many knew Illuminate. Wow, wow almost the same. So this this was actually true you know across the across the world. We basically split educational institutions into a fairly 50-50 sort of a place where half the folks used Illuminate half the folks used Vimba and when Blackboard tried to get into the space they decided well the best thing to do rather than leaving one half in a lurch is to go ahead and combine all three of the organizations Blackboard and Vimba and Illuminate and and come up with something that's that's that's really best for both you know what it really allows you to do is sort of you know half the people raise their hands and remember half the people raise their hands and Illuminate if you can combine that community of users together hopefully we can go ahead and do something good and I'll share with you a little bit about what it is that we have done. Now before I go there why why you know it says Blackboard Collaborate but really why even collaboration you know what's what's the point of having a collaboration platform you know sort of I kind of talk about you know this is a pretty exciting time for education you know at a touch of a button we can go ahead and have these sorts of sessions so today I'm not sure how many folks are coming in online so 43 folks are coming in online so welcome everybody there you know and that kind of thing is possible they're probably coming in from all over the world and it's so it's it's an exciting time I can go ahead and reach people everywhere that there is but but but at the same time I think it's a it's a tough time you know I looked at the I looked at the brochure for all see and it was thriving in a colder and more challenging climate and and certainly I think we find ourselves in that you know I sort of I sort of talk about this is almost a perfect storm for further education for higher education because we're being asked to do you know three very contradictory things the first one is the number of students actually keeps growing so there's the demographic aspects of that you know more and more children in the world so we need to figure out how to go ahead and educate them there's there's the aspect of the economy where many of the folks are unemployed or underemployed and they want to be able to go ahead and retrain themselves to be doing something else so that goes ahead and increases the number of student count so larger student count than ever before at the same time we're also talking about how do we go ahead and transform education you know we heard the medical education from Anne Marie and and how for the last hundred years we've been hearing this criticism of this curriculum is too big and it's too complex and we need to do better for each of the students so we got way more students and for each student we want to have a much better experience and at the same time the funding keeps going down so the amount of money that we have on a per student basis is lower than ever so it's sort of that perfect storm and and we need to figure out how to deal with that one and I do think that an education focused collaboration environment actually goes ahead and makes a big difference you know it allows learning you know to be to be less structured to be more open you know really allows it to be more interactive more collaborative you know we talked about wikis we talked about Facebook in the in the session before with Anne Marie and and and it's you know you're absolutely right you know there there are there are transformational things that are happening and and you know having that collaboration you know how how else could you have done the the chat chat rooms that you're doing yes the 140 characters is limiting but it's sort of very freeing to be able to actually go ahead and enable this open forum as as and when you want on whichever topic that you actually want so I think that collaboration environment actually makes a big difference and you know specifically from a blackboard collaborate perspective and I think about ROI you know I sort of think about three different things you know the first one is improved outcomes you know that's that's kind of the the goal of education we want to make sure that we do as good a job as possible and adding just a little bit of interaction you know on a on a virtual learning sort of stage we know that students can feel very isolated we know that especially if they're not coming into a physical space like this if they're doing all online they can feel very very isolated so adding just even a little bit of synchronous teacher student interaction student-to-student interaction leads to significantly increased understanding and there's enough research out there on that and if if you folks are looking for that just come talk to me I have my cards and I'll be happy to go ahead and point out some of those things and and send you some papers but the second one is it actually helps universities and colleges sort of increase the revenue we know just like you know borders our our our perimeters are under attack you know we need to figure out how to go ahead and work in this globalized environment so I've got Arizona State University I live in Phoenix Arizona in the United States it's now the largest university that there is in in the States 70,000 students from all over the country and all around the world actually come to Arizona State used to be if I was in a university I could pretty much count on you know the students who are around me as they graduate from high school that they're they're going to come to my university well that's not true anymore right University of Phoenix is all over the place the open university is all over the place Arizona State is all over the place we need to figure out how to go ahead and and be able to deal with those sorts of institutions and I think having a having an environment which allows you to engage students no matter where it is that they happen to be which allows you to engage your community no matter where it is that they are in engage even with your alumni after the leave the the educational process you know helps significantly and then last but not least on the return on investment side is just the reduction of costs in order to really accommodate this many more students who are coming in we can't build enough facilities you know it's just not possible so I know many of our customers instead of doing that what they'll say is instead of meeting in a physical environment three days a week let's just meet in the physical environment once a week or maybe even once a month and the rest of the meetings are all going to happen virtually and it actually leads to being able to accommodate a far larger number of students in the existing space that you've actually got you can go ahead and use the same instructors you can go ahead and reduce travel things like that so so that's kind of the overall view of why it is that you would want to do collaboration in general what does blackboard really do give you just a quick sense of of that piece the blackboard collaborate platform really is three different things and most people are probably used to us from the web conferencing side the web conferencing pieces what we're doing for example with adobe today you know we're going ahead and and broadcasting this event so 43 other people from everywhere can go ahead and use us and and and get access to that content beyond that we've actually got two other pieces of technology one is called the enterprise instant messaging technology this comes to us from the Wimba side of the house Wimba used to have a product called pronto did anybody use Wimba pronto here so we have a few actually that's pretty good that's very good so you know the presence and and chat piece is is actually great you know the the web conference is sort of this formal structure you know you schedule a meeting you schedule a session at a certain time everybody comes together and you're able to go ahead and do the interaction the instant messaging and presence piece is sort of the more informal learning it's the hallway conversations that happen in a physical space you know outside the the structured side so so for example using the blackboard IM as it's called now used to be called Wimba pronto now we call it blackboard IM what you can do is as soon as somebody installs it we'll go out and talk to the virtual learning environment figure out all the different courses that the student is actually enrolled in and we'll go ahead and bring that down we'll also bring down all the different teachers that they have the different classmates that they have the different student services setups that universities might have so financial aid or online libraries any of those sorts of things we can bring all of those services down to IM and now the student can go ahead and have that sort of informal conversation if I'm a working adult I come home at 10 o'clock at night I need to be able to go ahead and finish up what it is that my homework is due for tomorrow how do I do that you know I'm able to go ahead and go out into this blackboard IM environment and just double-click and figure out who else is online and I'm able to go ahead and chat with them and and do my do my homework with those with those folks and all the both the IM and the web conferencing piece are sort of supplemented by the voice authoring pieces is more of an asynchronous piece within the virtual learning environment how do I add personalization so I can go ahead and record an introduction to the course I can go ahead and have students discuss things back and forth using their voice I can even do quizzes for foreign languages and courses like that it's it's much nicer to be able to go ahead and have that voice functionality there and then all three of these functionalities are sort of deeply integrated into whichever learning management system that that you might have so we're able to go ahead and ensure that piece I'm going to go ahead and flip through a few slides and just sort of talk to you a little bit about the impact that we're having so let me show you this video for a second hi my name is dr. Michael Sherman I'm the associate vice president of instructional technology support here at Traxler University in Philadelphia we support the collaborate suite all across the direction University community that's 13 colleges and schools it gets broad use it's accepted by many many different academic units and administrative units as the go-to product when they need to engage their learners their colleagues and very purpose of bringing a tool like the collaborate tool into the environment was to give it that more personal touch in the old days I say the old days you know when we first learned to create distance education courses it almost become like just a static textbook online but once we were able to have this environment that we can utilize like the collaborate environment now it's not only just a student to instructor relationship but it's also a student to student relationship as well so it creates that environment that the students are looking for as well as the instructor converted our curriculum from quarters to semesters and with faculty spread all over the state and with the state budget being really tight with money right now it's difficult to travel so anything that we can do online or electronically having virtual meetings is a tremendous asset for the faculty and for me and for the the budget of this blackboard collaborative plays a very important part in fact without that I think that we could not really truly be a what I call a very efficient and functioning online school that is the one key component to me that makes it worthwhile so that sort of gives you an idea for how it is that people are are actually going ahead and using blackboard collaborate I know I'm short on time so let me go ahead and end on this slide you know the idea behind blackboard collaborate really was to have a single platform which allows you to go ahead and have that informal collaboration between students and teachers and the school entities and services at large to a very formal sort of you know we can go ahead and do classroom sessions we can go ahead and do virtual events you know all sort of combined into one product which is all completely focused around education you know the the blackboard organization 90% of our customers are our education related so we really you know live and breathe education on an ongoing basis and that's you know that's that's really all our all that we all that we really think about you know I'll actually leave it at that and see if there's there's any questions that that I might be able to answer at this point okay once again can we take a question from the floor and please wait for a microphone let's start down the front here hi there David Kernahan from JISC I just wanted to ask you about the very first slide that you showed actually the corporate model of blackboard the everyone educated thing yeah do you see education as something that's got a defined endpoint ah very good point very good question and you know I'm not sure that that education has a defined endpoint you know I know all of us are still learning but I know that many folks don't have access to any education at all so while I don't think that there's an end point for people who have access there's certainly the beginning point that's missing for a lot so I think from our perspective what we really want to be able to do is throughout the life of a learner you want to make sure that the experience of education is better than what it is today and for those who don't have any access at all we want to be able to find ways and work with educational institutions and work with others to figure out how do we go ahead and get them access to at least provide that beginning point you know which which everybody should have access to but no I don't think that that there is an endpoint you know we're continuously learning we're continuously figuring out what it is that we need to do and you know somebody told me you know if I if I think about what's the biggest educational institution right now that might actually be Google you know when I have a question you know I'm usually not going to a textbook I'm usually not going back to my professors I'm actually going and doing that just in time learning and people do that on a daily basis you know billions of times a day so so I don't think that there's an end point at all thanks do you in fact see a time point in the future where something like Google or Blackboard might actually take over managing universities you know it's it's it's interesting you know so Google actually had a thing called the Google Teacher Academy education is a very very complex task and I think so much of the learning actually happens in this interaction you know that we're having right now and and so much of the interaction so much of the learning for each student happens when the students interact with other students and students interact with the teachers and I'm not sure that all of that you know the just in time piece is great you know once I have that critical foundation that got laid for me about how to actually ask a question when I when I need to learn something how do I actually ask that question and then whatever information is coming to me how do I critically understand it and make sure that I can draw the right conclusions from it and I think that education process is not something that that can completely be taken and and learned you know without this interaction piece at all and I think that interaction is really necessary to us think you know when by actually used to have a slogan people teach people you know it's I think that that teacher student piece and the student student piece is very very key and I don't think that that's actually ever going to go with we've we've done that now for 5,000 years and and we know that learning can actually happen that way and it happens that we're very very nicely so to me that continues on I don't think that's actually ever going to go away I don't think Blackboard is someday going to publish a course that says you know start here when you're 5 and then continue taking these courses from 5 to 12 and and you'll have a degree and and that'll be good I don't think that that's that's ever going to happen I think that teacher student interaction is always going to be needed and and and I think you know the breadth of technologies that I showed you from Blackboard you know that's that's a that's a reflection on that we know that it's not just you know create content and create a flow in one piece for for something that can go ahead and flow throughout I think I think the interaction that we've got is always going to be needed thanks could I take an online question of course it's an interesting one is Blackboard nimble enough to provide what Anne Marie was talking about by giving recipients what they want and find ways in which we can professionally accommodate those wants and needs are we nimble enough it's a leading question you know Blackboard has been in business now only for about 15 years and so I think you know to a large extent we still view ourselves as as a fairly small company and you know even though from an educational perspective Blackboard's got a very large footprint you know from a Wimba illuminate perspective the two companies that just became part of Blackboard last year iStrategy which was the analytics company just became part of Blackboard at the beginning of this year you know we always think of ourselves as actually fairly small entities and we're working with customers on an ongoing basis in fact you know nothing that we did I didn't talk a little bit about you know the new product that we just launched we just launched something called Blackboard Collaborate 11 that's the combination of Wimba and illuminate sort of coming together built on the illuminate architecture but inherited the interface design that Wimba had been working on for their future product called livex but every single thing that we did there was as a result of talking to our product advisory council we have product advisory council of 60 different institutions and we met with them you know at the beginning it was once a month then we met into once a week and then we actually went to twice a week where we were forever cycling you know here's what we're building is this a good thing or should we change something different here's option A and option B which one do you think makes more sense to do so to me nimbleness is is in the attitude I don't think it's in the size of the organization and I think as we go ahead and continue to go ahead and cycle through the through the experience that our customers really want I think we can be I think we can be nimble enough I think we can be there to go ahead and provide provide the information and the solutions that people are looking for it's it is the Wild West as as Anne-Marie said you know it's something that you know we're learning on an ongoing basis what should be the what should be the the deal with the Facebook or with Twitter or with Flickr or any of these other wide open consumer technologies in the educational space how do we go ahead and do that balance of privacy versus sharing you know and I think we're learning from our customers we're learning you know what it is that works we're trying to provide parallel solutions so you may not feel very comfortable with you know with just putting everything on Facebook but you need to be able to go ahead and interact with it in some way or the other so we're forever learning on on what it is that we need to do and I think as long as we're doing that and we're talking to customers I think we'll be nimble enough okay on the notes of further learning I'm afraid we're going to have to bring this session to the Thanks once again. Thank you. Thank you very much


CHAPTER XXX. At ten minutes before two the following day, Monday, I arrived at my office. I had spent the morning putting my affairs in shape and in a trip to the stable. The afternoon would see me either a free man or a prisoner for an indefinite length of time, and, in spite of Johnson's promise to produce Sullivan, I was more prepared for the latter than the former. Blobs was watching for me outside the door, and it was clear that he was in a state of excitement bordering on delirium. He did nothing, however, save to tip me a wink that meant, as man to man I am for you. I was too much engrossed either to reprove him or return the courtesy, but I heard him follow me down the hall to the small room where we kept our outgrown law-books, typewriter supplies and, incidentally, our wraps. I was wondering vaguely if I would ever hang my hat on its nail again when the door closed behind me. It shut firmly, without any particular amount of sound, and I was left in the dark. I groped my way to it, irritably, to find it locked on the outside. I shook it frantically, and was rewarded by a sibilant whisper through the keyhole. Keep quiet, Blobs was saying, huskily.  I'm going to lock the whole bunch in and throw the key out of the window. Come back here, you imp of Satan, I called furiously, but I could hear him speeding down the corridor and the slam of the outer office door by which he always announced his presence.  I was apoplectic with rage one minute, and choked with laughter the next. It seemed an hour before Blobs came back. He came without haste, strutting with new dignity, and paused outside my prison door. Well, I guess that will hold him for a while, he remarked comfortably, and proceeded to turn the key. I've got him fastened up like sardines in a can, he explained, working with the lock. Gee whiz, you ought to hear him. When he got his breath after the shaking I gave him, he began to sputter. How would I know, he demanded so golly. You nearly broke your neck in a way the other time, and I haven't got the old key. It's lost. Where's it lost, I demanded with another gesture toward his coat-color. Down the elevator shaft. There was a gleam of indignant satisfaction through his tears of rage and humiliation. And so, while he hunted the key and the debris at the bottom of the shaft, I quieted his prisoners with the assurance that the lock had slipped, and that they would be free as lords as soon as we could find the janitor with the pass-key. Stewart went down finally and discovered Blobs with the key in his pocket, telling the engineer how he had tried to save me from arrest and failed. When Stewart came up he was almost cheerful, but Blobs did not appear again that day. With the finding of the key came Hodgkis, and we went in together. I shook hands with two men who, with Hodgkis, made a not very animated group. The taller one, an oldish man, lean and hard, announced his errand at once. A Pittsburgh warrant, I inquired, unlocking my cigar drawer. Yes, Allegheny County has assumed jurisdiction, the exact locality where the crime was committed being in doubt. He seemed to be the spokesman. The other, shorter and rotund, kept an amiable silence. We hope you will see the wisdom of waving extradition, he went on. It will save time. I'll come, of course, I agreed. The sooner the better. But I want you to give me an hour here, gentlemen. I think we can interest you. Have a cigar? The lean man took a cigar. The rotund man took three, putting two in his pocket. How about the catch of that door, he inquired jovially. Any danger of it going off again? Really considering the circumstances, they were remarkably cheerful. Hodgkis, however, was not. He paced the floor uneasily, his hands under his coattails. The arrival of McKnight created a diversion. He carried a long package and a corkscrew, and shook hands with the police and opened the bottle with a single gesture. I always want something to cheer on these occasions, he said. Where's the water, please? Everybody ready? Then, in French, he toasted the two detectives. To your eternal discomforture, he said, bowing ceremoniously.  If you take Monsieur Blakely with you, I hope you choke. The lean man added gravely. Prosit, he said, but the fat one leaned back and laughed consumedly. Hodgkis finished a mental synopsis of his position and put down his glass. Gentlemen, he said pompously. Within five minutes the man you want will be here, a murderer caught in a net of evidence so fine that a mosquito could not get through. The detectives glanced at each other solemnly. Had they not, in their possession, a seal-skin bag containing a wallet and a bit of gold chain, which, by putting the crime on me, would leave a gap big enough for Sullivan himself to crawl through? Why don't you say your little speech before Johnson brings the other man, Lawrence? McKnight inquired. They won't believe you, but it will help them to understand what is coming. You understand, of course, the lean man put in gravely, that what you say may be used against you. I'll take the risk, I answered impatiently. It took some time to tell the story of my worst-than-useless trip to Pittsburgh and its sequel. They listened gravely, without interruption. Mr. Hodgkis here, I finished, believes that the man Sullivan, whom we are momentarily expecting, committed the crime. Mr. McKnight is inclined to implicate Mrs. Conway, who stabbed Bronson and then herself last night. As for myself, I am open to conviction. I hope not, said the stout detective quizzically. And then Allison was announced. My impulse to go out and meet her was forestalled by the detectives, who rose when I did. McKnight, therefore, brought her in, and I met her at the door. I have put you to a great deal of trouble, I said contritely, when I saw her glance around the room. I wish I had not. It is only right that I should come, she replied, looking up at me. I am the unconscious cause of most of it, I am afraid. Mrs. Dallas is going to wait in the outer office. I presented Hodgkis and the two detectives, who eyed her with interest. In her poise, her beauty, even in her gown, I fancy, she represented a new type to them. They remained standing until she sat down. I have brought the necklace, she began, holding out a white-wrapped box, as you asked me to. I passed it, unopened, to the detectives. The necklace, from which was broken the fragment you found in the seal-skin bag, exclaimed. Miss West found it on the floor of the car, near Lower Ten. When did you find it? asked the lean detective, bending forward. In the morning, not long before the wreck. Did you ever see it before? I am not certain, she replied. I have seen one very much like it. Her tome was troubled. She glanced at me, as if for help, but I was powerless. Where? the detective was watching her closely. At that moment there came an interruption. The door opened without ceremony and Johnson ushered in a tall, blond man, a stranger to all of us. I glanced at Alison. She was pale, but composed and scornful. She met the newcomer's eyes full and, caught on a wares, he took a hasty backward step. Sit down, Mr. Sullivan, McKnight beamed cordially. Have a cigar. I beg your pardon, Alison. Do you mind this smoke? Not at all, she said compositely. Sullivan had had a second to sound his bearings. No. No thanks, he mumbled. If you will be good enough to explain. But that's what you're going to do, McKnight said cheerfully, pulling up a chair. You've got the most attentive audience you could ask. These two gentlemen are detectives from Pittsburgh, and we are all curious to know the finer details of what happened on the car Ontario two weeks ago. The night your father-in-law was murdered. Sullivan gripped the arms of his chair. We are not prejudiced either. The gentlemen from Pittsburgh are betting on Mr. Blakely over there. Mr. Hodgkiss, the gentleman by the radiator, is ready to place ten-to-one odds on you, and some of us have still other theories. Gentlemen, Sullivan said slowly, I give you my word of honour that I did not kill Simon Harrington, and that I do not know who did. Fiddledy D., cried Hodgkiss, bustling forward, why, I can tell you, that McKnight pushed him firmly into a chair and held him there. I am ready to plead guilty to the larceny, Sullivan went on. I took Mr. Blakely's clothes, I admit. If I can reimburse him in any way for the inconvenience. The stout detective was listening with his mouth open. Do you mean to say, he demanded, that you got into Mr. Blakely's birth as he contends, took his clothes and forged notes and left the train before the wreck? Yes. The notes, then? I gave them to Bronson yesterday. Much good they did him, bitterly. We were all silent for a moment. The two detectives were adjusting themselves with difficulty to a new point of view. Sullivan was looking dejectedly at the floor, his hands hanging loose between his knees. I was watching Allison. From where I stood behind her, I could almost touch the soft hair behind her ear. I have no intention of pressing any charge against you, I said with force civility, for my hands were itching to get at him, if you will give us a clear account of what happened on the Ontario that night. Sullivan raised his handsome, haggard head and looked around at me. I've seen you before, haven't I? he asked. Weren't you an uninvited guest at the laurels a few days or nights ago, the cat, you remember, and the rug that slipped? I remember, I said shortly. He glanced from me to Allison and quickly away. The truth can't hurt me, he said, but it's devilish unpleasant. Allison, you know all this. You would better go out. His use of her name crazed me. I stepped in front of her and stood over him. You will not bring Miss West into the conversation, I threatened, and she will stay if she wishes. No, very well, he said with assumed indifference. Hodgkes just then escaped from Richie's grasp and crossed the room. Did you ever wear glasses? he asked eagerly. Never. Sullivan glanced with some contempt at mine. I'd better begin by going back a little, he went on sullenly. I suppose you know I was married to Ida Harrington about five years ago. She was a good girl and I thought a lot of her, but her father opposed the marriage. He'd never liked me, and he refused to make any sort of settlement. I had thought, of course, that there would be money, and it was a bad day when I found out I'd made a mistake. My sister was wild with disappointment. We were pretty hard up, my sister and I. I was watching Allison. Her hands were tightly clasped in her lap, and she was staring out of the window at the cheerless roof below. She had set her lips a little, but that was all.  The day came when old Harrington put us both out of the house at the point of a revolver, and I threatened. I suppose you know that, too. I threatened to kill him. My sister and I had hard times after that. We lived on the continent for a while. I was at Monte Carlo, and she was in Italy. She met a young lady there, the granddaughter of a steel manufacturer, and at Eris, and she sent for me. When I got to Rome, the girl was gone. Last winter I was all in, social secretary to an Englishman, a wholesale grocer with a new title, but we had a row, and I came home. I went out to the Heaton Boys Ranch in Wyoming and met Bronson there. He lent me money, and I've been doing his dirty work ever since. Sullivan got up then and walked slowly forward and back as he talked, his eyes on the faded pattern of the office rug. If you want to live in hell, he said savagely, put yourself in another man's power. Bronson got into trouble, forging John Gilmore's name to those notes, and in some way he learned that a man was bringing the papers back to Washington on the flyer. He even learned the number of his birth, and the night before the wreck, just as I was boarding the train, I got a telegram. Hodgka stepped forward once more importantly. Which read, I think, men with papers in lower ten, car seven, get them. Sullivan looked at the little man with sulky blue eyes. It was something like that anyhow. But it was a nasty business, and it made matters worse that he didn't care that a telegram which must pass through half a dozen hands was more or less incriminating to me. Then, to add to the unpleasantness of my position, just after we boarded the train, I was accompanying my sister and this young lady, Miss West, a woman touched me on the sleeve, and I turned to face, my wife. That took away my last bit of nerve. I told my sister, and you can understand she was in a bad way, too. We knew what it meant. Ida had heard that I was going. He stopped and glanced on easily at Allison. Go on, she said coldly. It's too late to shield me. The time to have done that was when I was your guest. Well, he went on, his eyes turned carefully away from my face, which must have presented certainly anything but a pleasant sight. Miss West was going to do me the honor to marry me, and you scoundrel, I burst forth, thrusting past Allison West's chair. You, you infernal cur. One of the detectives got up and stood between us. You must remember, Mr. Blakely, that you are forcing this story from this man. These details are unpleasant, but important. You were going to marry this young lady, he said, turning to Sullivan, although you already had a wife living. It was my sister's plan, and I was in a bad way for money. If I could marry, secretly, a wealthy girl and go to Europe, it was unlikely that Ida, that is, Mrs. Sullivan, would hear of it. So it was more than a shock to see my wife on the train, and to realize from her face that she knew what was going on. I don't know yet, unless some of the servants. Well, never mind that. It meant that the whole thing had gone up. Old Harrington had carried a gun for me for years, and the same train wouldn't hold both of us. Of course, I thought that he was in the coach just behind ours. Hodges was leaning forward now, his eyes narrowed, his thin lips drawn to a line. Are you left-handed, Mr. Sullivan? he asked. Sullivan stopped in surprise. No, he said gruffly. Can't do anything with my left hand. Hodges subsided, crestfallen but alert. I tore up that cursed telegram, but I was afraid to throw the scraps away. Then I looked around for lower ten. It was almost exactly a cross. My birth was lower seven, and it was, of course, a bit of exceptional luck for me that the car was number seven. Did you tell your sister of the telegram from Bronson? I asked. No. It would do no good, and she was in a bad way without that to make her worse. Your sister was killed, I think. The shorter detective took a small packet from his pocket and held it in his hand, snapping the rubber band which held it. Yes, she was killed, Sullivan said soberly. What I say now can do her no harm. He stopped to push back the heavy hair which drooped over his forehead and went on more connectedly. It was late, after midnight, and we went at once to our births. I undressed and then I lay there for an hour, wondering how I was going to get the notes. Someone in lower nine was restless and wide awake, but finally became quiet. The man in ten was sleeping heavily. I could hear his breathing, and it seemed to be only a question of getting across and behind the curtains of his birth without being seen. After that, it was a mere matter of quiet searching. The car became very still. I was about to try for the birth when someone brushed softly past and I lay back again. Finally, however, when things had been quiet for a time, I got up, and after looking along the aisle, I slipped behind the curtains of lower ten. You understand, Mr. Blakely, that I thought you were in lower ten, with the notes. I nodded curtly. I am not trying to defend myself, he went on. I was ready to steal the notes. I had to, but murder. He wiped his forehead with his handkerchief. Well, I slipped across and behind the curtains. It was very still. The man in ten didn't move, although my heart was thumping until I thought he would hear it. I felt around cautiously. It was perfectly dark, and I came across a bit of chain about as long as my finger. It seemed a queer thing to find there, and it was sticky, too. He shuddered, and I could see Allison's hands clenching and unclenching with the strain. All at once it struck me that the man was strangely silent, and I think I lost my nerve. Anyhow, I drew the curtains open a little, and let the light fall on my hands. They were red, blood red. He leaned one hand on the back of the chair and was silent for a moment, as though he lived over again the awful events of that more than awful night. The stout detective had let his cigar go out. He was still drawing at it nervously. Richie had picked up a paperweight and was tossing it from hand to hand when it slipped and fell to the floor, a startled shudder passed through the room. There was something glittering in there, Sullivan resumed, and on impulse I picked it up. Then I dropped the curtains and stumbled back to my own birth. Where you wiped your hands on the bed-clothing and stuck the dirt into the pillow. Hodgkes was seeing his carefully built structure crumbling to pieces, and he looked chagrined. I suppose I did. I'm not very clear about what happened then. But when I rallied a little, I saw a Russia leather wallet lying in the aisle almost at my feet, and, like a fool, I stuck it with a bit of chain into my bag. I sat there shivering for what seemed like hours. It was still perfectly quiet except for someone snoring. I thought that would drive me crazy. The more I thought of it, the worse things looked. The telegram was the first thing against me. It would put the police on my track at once when it was discovered that the man in lower ten had been killed. Then I remembered the notes, and I took out the wallet and opened it. He stopped for a moment, as if the recalling of the next occurrence was almost beyond him. I took out the wallet, he said simply, and opening it held it to the light. In guilt letters was the name Simon Harrington. The detectives were leaning forward now, their eyes on his face. Things seemed to whirl around for a while. I sat there almost paralyzed wondering what this new development meant for me. My wife I knew would swear I had killed her father. Nobody would be likely to believe the truth. Do you believe me now? He looked around at us defiantly.  After a bit the man in lower nine got up and walked along the aisle toward the smoking compartment. I heard him go, and leaning from my birth watched him out of sight. It was then that I got the idea of changing birth with him, getting into his clothes and leaving the train. I give you my word I had no idea of throwing suspicion on him. Allison looked scornfully incredulous, but I felt that the man was telling the truth. I changed the numbers of the birth, and it worked well. I got into the other man's birth, and he came back to mine. The rest was easy. I dressed in his clothes, luckily they fitted, and jumped the train not far from Baltimore, just before the wreck. There is something else you must clear up, I said. Why did you try to telephone me from M? And why did you change your mind about the message? He looked astounded. You knew I was at M? He stammered? Yes. We traced you. What about the message? Well, it was this way. Of course I did not know your name, Mr. Blakely. The telegram said, man with papers in lower ten, car seven. And after I had made what I considered my escape, I began to think that I had left the man in my birth in a bad way. He would probably be accused of the crime. So, although when the wreck occurred I suppose that everyone connected with the affair had then killed, there was a chance that you had survived. I've not been of much account, but I didn't want a man to swing because I had left him in my place. Besides, I began to have a theory of my own. As we entered the car, a tall dark woman passed us, with a glass of water in her hand, and I vaguely remembered her. She was amazingly like Blanche Conway. If she too thought that the man with the notes was in lower ten, it explained a lot, including that piece of a woman's necklace. She was a fury, Blanche Conway, capable of anything. Then why did you counterman that message, I asked curiously. When I got to the Carter House, and got to bed, I had sprained my ankle in the jump. I went through the alligator bag I had taken from lower nine. When I found your name, I sent the first message. Then, soon after, I came across the notes. It seemed too good to be true, and I was crazy for fear the message had gone. At first I was going to send them to Bronson. Then I began to see what the possession of the notes meant to me. It meant power over Bronson, money, influence, everything. He was a devil, that man. Well, he's at home now, said McKnight, and we were glad to laugh and relieve the tension.  When I was able to walk, went on the selling voice. I came at once to Washington. I tried to sell the notes to Bronson, but he was almost at the end of his rope. Not even my threat to send them back to you, Mr. Blakely, could make him meet my figure. He didn't have the money. McKnight was triumphant. I think you gentlemen will see reason in my theory now, he said. Mrs. Conway wanted the notes to force a legal marriage, I suppose? Yes. The detective with the small package carefully rolled off the rubber band and unwrapped it.  These things, Mr. Blakely, we found in the seal-skin bag Mr. Sullivan says he left you. This wallet, Mr. Sullivan, is the one you found on the floor of the car? Sullivan opened it and, glancing at the name inside, Simon Harrington, nodded affirmatively. And this went on the detective. This is a piece of gold chain? It seems to be, said Sullivan, recoiling at the blood-stained end. This, I believe, is the dagger. He held it up and Allison gave a faint cry of astonishment and dismay. Sullivan's face grew ghastly and he sat down weakly in the nearest chair. The detective looked at him shrewdly, then at Allison's agitated face. Where have you seen the dagger before, young lady? He asked kindly enough. Oh, don't ask me, she gasped, breathlessly. Her eyes turned on Sullivan. It's, it's too terrible. Tell him, I advised, leaning over to her. It will be found out later anyhow. Ask him, she said, nodding toward Sullivan. The detective unwrapped the small box Allison had brought, disclosing the trampled necklace and broken chain. With clumsy fingers he spread it on the table and fitted into place the bit of chain. There could be no doubt that it belonged there. Where did you find that chain? Sullivan asked hoarsely, looking for the first time at Allison. On the floor, near the murdered man's birth. Now Mr. Sullivan, said the detective civilly, I believe you can tell us, in the light of these two exhibits, who really did murder Simon Harrington. Sullivan looked again at the dagger, a sharp little bit of steel with a florentine handle. Then he picked up the locket and pressed a hidden spring under one of the cameos. Inside, very neatly engraved, was the name and a date. Gentlemen, he said, his face ghastly. It is of no use for me to attempt a denial. The dagger and the necklace belong to my sister, Alice Curtis. End of Chapter 30 Chapter 31 of The Man in Lower Ten. This LibriVox recording is in the public domain, recording by Marianne. The Man in Lower Ten by Mary Robert's Reinhardt. Chapter 31. And only one arm. Hodgkis was the first to break the tension. Mr. Sullivan, he asked suddenly, was your sister left-handed? Yes. Hodgkis put away his notebook and looked around with an air of triumphant vindication. It gave us a chance to smile and look relieved. After all, Mrs. Curtis was dead. It was the happiest solution of the unhappy affair. McKnight brought Sullivan some whiskey, and he braced up a little. I've learned through the papers that my wife was in a Baltimore hospital, and yesterday I ventured there to see her. I felt if she would help me to keep straight that now, with her father and my sister both dead, we might be happy together. I understand now what puzzled me then. It seemed that my sister went into the next car and tried to make my wife promise not to interfere. But Ida, Mrs. Sullivan, was firm, of course. She said her father had papers, certificates, and so on, that would stop the marriage at once. She said also that her father was in our car and that there would be mischief to play in the morning. It was probably when my sister tried to get the papers that he awakened, and she had to do what she did. It was over. Say for a technicality or two, I was a free man. Allison rose quietly and prepared to go.  McKnight saw her, with Mrs. Dallas, to their carriage and came back again. The gathering in the office was breaking up. Johnson had slipped away as un ostentatiously as he came. Sullivan, looking worn and old, was standing by the window, staring at the broken necklace in his hand. When he saw me watching him, he put it on the desk and picked up his hat. If I cannot do anything more, he hesitated. I think you have done about enough, I replied grimly, and he went out. I believe that Richie and Hodgkess led me somewhere to dinner, and that, for fear I would be lonely without him, they sent for Johnson. And I recall a spirited discussion in which Hodgkess told the detective that he could manage certain cases, but that he lacked induction. Richie and I were mainly silent. My thoughts would slip ahead to that hour, later in the evening, when I should see Allison again. I dressed in savage haste, finally, and was so particular about my tie that Mrs. Clopton gave up into spare. I wish, until your arm is better, that you would buy the kind that hooks on, she protested almost tearfully. I am sure they look very nice, Mr. Lawrence. My late husband always. It's a lover's knot you've tied this time, I snarled, and jerking open the bow knot she had so painfully executed, looked out the window for Johnson, until I remembered that he no longer belonged in my perspective. I ended by driving frantically to the club and getting George to do it. I was late, of course. The drawing room and library at the Dallas home were empty. I could hear billiard balls rolling somewhere, and I turned the other way. I found Allison at last on the balcony, sitting much as she had that night on the beach, her chin and her hands, her eyes fixed unseemly on the trees and lights of the square crossed. She was even whistling a little, softly. But this time the plaintiveness was gone. It was a tender little tune. She did not move as I stood beside her, looking down. And now, when the moment had come, all the thousand and one things I had been waiting to say, forsook me, precipitantly beat a retreat, and left me unsupported. The archmoon sent little fugitive lights over her hair, her eyes, her gown. Don't do that, I said unsteadily.  She glanced up at me, and she did not stop. She did not stop. She went on whistling softly, a bit tremulously, and straight away I forgot the street, the chants of passersby, the voices in the house behind us. The world doesn't hold any one but you, I said reverently. It is our world, sweetheart. I love you. And I kissed her. A boy was whistling on the pavement below. I let her go reluctantly, and sat back where I could see her. I haven't done this the way I intended to at all, I confessed. In books they get things all settled, and then kiss the lady. Settled, she inquired. Oh, about getting married and all that sort of thing, I explained, with elaborate carelessness. We, we could go down to Bermuda, or, or to Jamaica, say in December.  I believe you are afraid, she declared. I refuse to marry you unless you propose properly. Everybody does it. And it is a woman's privilege. She wants to have that to look back to. Very well, I consented with an exaggerated sigh.  I had to pass her to close the door behind us. But when I kissed her again she protested that we were not really engaged. I turned to look down at her. It is a terrible thing, I said exultantly, to love a girl the way I love you, and to have only one arm. Then I closed the door. From across the street there came a sharp crescendo whistle, and a vaguely familiar figure separated itself from the park railing. Say, he called in a horse whisper, shall I throw the key down the elevator shaft? End of Chapter 31 and the end of the Man in Lower Ten. Read by Marianne Spiegel in Chicago, Illinois, March 17, 2010.


Okay, good afternoon again, and I hope you enjoyed from this meeting so far. So my second lecture is about 3DT clinical applications, and again I'm going to talk about 3DT clinical application in relation with inter-HR septum. This is the anatomy of the heart when we open the right atrium, and we look at the inter-HR septum from the right side. It shows the different type of the ASD. So the most common type of ASD is the second-dom ASD, is in that of Fosau-Valis. It's about 75 to 80 percent of all ASDs. The second most common is Primome ASD, is about 10 to 15 percent of all ASD, and that Primome ASD can be a part of AVST or AV canal, we used to say, in all time. Sinus venous ASD, it can be SVC type, it can be IVC type. IVC type is rare, we had only four or five cases in the last three years, but SVC type is about overall like five percent of all ASDs. Unroofed conicinous ASD is very rare, I am going to show you one case. If you look at this anatomy, you see the SVC is at the top, and aorta beside that. SVC is in the right side of the aorta, right side of the body, and it's a little bit more posterior compared to the aorta. Aorta is anterior, SVC is posterior. IVC is the most posterior structure of the heart. The case number one is not actually ASD, by definition, is a PFO. It's a patient, 44-year-old male, presented with two episodes of stroke. That is the PFO, as you see, the shunt is from left to right. Shunt of PFO is from left to right always, except the right side pressure increased, like during valsalval, or coughing, or pulmonary hypertension, anything happens. So that's the PFO, you can see it by color. You can see it by 3D nicely, I will show you better now. You can see the gap of the PFO is a tunnel shape, but this gap during the inspiration will increase, and this is a large PFO. If you open this PFO in the OR, maybe it's like a 1 centimeter. So that PFO is from LA side. If you make it bigger, it's about, we measured about 0.6, multiplied by 0.8 centimeter, or 6 by 8 millimeter. But as I said, usually this size PFO in the OR is much, much bigger than this. So this patient had an indication to be closed by device, by all guidelines, had a two stroke already. This is an amplizer PFO device, that the right side disk is bigger than left side, and here the amplizer device is in place. The case number two is a 52-year-old male, presented with palpitations. You can see there is a second of ASD, it's like a moderate size. So this is the 3D of that ASD, showing the ASD from RA. This is the SVC, should be at 11 o'clock, and this is a part of the station valve that you can see it. This is the ASD from LA side, and SVC is down again, the IVC is down, SVC is around 12 to 1 o'clock, and right upper movement should be at 1 o'clock, that we are not seeing here. And this is the measurement of the ASD. And this patient had a device, you can see the amplizer device, is sandwiching the two rims very well, and you can see the device nicely sitting in the LA side. We have to always be sure that device is not pushing the ortho, it's not pushing any permanent vein, and there is a talk about this tomorrow. The case number three is a 26-year-old female, presented with palpitations. As you see it in transters, you see very large RV, and very large RA, and big second-dom ASD. You can see it by the color as well. And when we do TE, you see the ASD is very big. Here, we are trying to see the IVC rim, and aortic rim as well. There's no rim here, and no rim IVC. Just for aortic rim, we know that it's not a problem during the device closure. We can use a bigger device and overlap under the ortho, but IVC rim is very important. So we have to be sure that there is or there is no IVC rim. Many times, there is IVC rim, but we don't see it, because IVC and SVC, they are not at the same level. To see the IVC rim, you have to do a retrograde flexion of the probe, like this one. We did a retrograde or retroflexion of the TE probe. Now, you can see the rim better. So anytime you don't see the IVC rim, it doesn't mean it's not there. It might be there, and we are not seeing, because we didn't do retroflexion of the probe. And the reason is IVC and SVC, they are not in the same plane. IVC is more posterior, and SVC is a little bit anterior. So to look at the IVC, you have to do a retroflexion, or look at the posterior. When we did the 3D, we were able to bring the IVC rim as well. This is IVC rim, but it is small. It may be four, five millimeter. That's enough to, is not enough to hold the device. So the size of the defect is 4.3 by three centimeters, very large. The largest device that we have, I think is 36. So this AST was big by the size, and IVC rim was there, but was not enough. So this is surgical view of that AST. Look at the right side of the RA, right atum. This is the SVC, the IVC, and this is the SVC, and the Aorta. Surgeon is standing here. So IVC is in the right hand of the surgeon. SVC is in the left hand of the surgeon. Aorta is more anterior. That's all. So this is Dr. Al-Khaldi in our center. He opened the right atum. You can see the large defect here, and he's showing me the rim. So that's a rim in the IVC side. There is a rim, but it's not big. This is the IVC canola. This is the SVC canola. So he's closing this AST by a precardial patch. Some surgeons, they treat the precardial patch in the OR with growth or height, and some surgeons, they just use the fresh precardial patch. So this is a fresh precardial patch, and he's closing the defect by the surgeon. It is very good to wash the surgery all the time when you are doing tea in the water, if you have time, because watching the actual surgery, it will enable us to look at the post-stop repair much, much better. So this is a patch in post-stop echo. You can see the patch is pushing from LA to RA, and you can see the patch from the right side. This is the patch from the right side. The whole size of the patch, you can see it, and this is a patch from left side. You can see the patch in left side is a little bit deep down, because left side pressure is more than right. It will push the precardial patch down towards the RA. Case number four is a 60-year-old female presented with shortness of breath. Here in this case, you can see a multiple AST. This is at least two AST by color. When we do the saline contrast, you can see the saline is injecting in the arm, going to the RA, and you will see the negative effect of contrast. Two negative effects. Shantis from LA to RA, but you see the two negative effects. Here is this very nice 3D of this two defect, larger AST, a smaller AST, and you see that there is a tissue, remnant tissue between these two AST. This remnant tissue looks very fragile, and it looks like it cannot hold any device. For example, if you want to put two devices side by side, maybe it's not able to hold it. But in real life, when you open the patient in the RA, this tissue is good. It's strong. That's one of the pitfalls of 3D. This 3D, because it doesn't have a good, special resolution, will show the tissue a little bit weaker than actual RA. Here you will see it in the RA. I will show you in a minute. You see it has a good tissue. Anyway, we decided to close it by surgically, because this T is done in 2012, and we were not very good to put two devices together, or one large device. That's two devices together, two AC together, maybe like 3.6, so it's big. Again, this is another view showing the two AC together from the right side, and you can see the coronary sinus here, beside the septal difference of the tricuspid valve. This case is in the war now. This is Dr. Arifi, our surgeon in my previous center in Riyaz. He's opening the RA, and he's going to show us the EST. This is the RA, and then you can see the camera is more close now. You can see the large defect here. That's a larger defect close to the SVC side, and this is a smaller defect that we saw it in 3D. So this is exactly like a 3D. The only difference is this tissue between these two EST and 3D, we look at that it was very loose and fragile tissue, but here you think it's a very strong tissue. So that is one of the problems of the 3D. So this is our case number 5, 65-year-old male investigated for severe permahypertension. This is a TEE. We did the transplants, we got first, we didn't see an EST, this is TEE, the first view. Again, we are not seeing any secondoma EST. And then when we look at the upper part of the SVC, you see that sinus venous as EST. This is sinus venous as EST in 3D. So you see this is the LA and SVC is behind. So the defect is between SVC and LA. That's a defect. This is a good image compared to the year that I did it in 2011. This is that zero degree. You can see the communication between LA and SVC through the sinus venous as EST. And again, you can see the defect by 3D. And you can see here in the OR, the rim of that defect, sinus venous as defect between SVC, SVC is here. This is SVC cannula. And this is IVC cannula. So this defect is between SVC and LA. LA is in the back. This is a defect. LA is the place that this suction is there. That's a post-stop. You see the patch here, especially when they use the single patch, you're seeing that SVC is compressed by the patch, but many times SVC is open totally. But it's better to check it, especially with 3D, to see that SVC is open or not. And you might even check by color. Should not be a turbulent velocity. Should not be more than 1.2 meter per second. And you can do even bubble study to see how the bubble goes inside the RA. These are techniques of sinus venous as EST closure, SVC type. This is the actual defect with pulmonary vein draining to the SVC. This is single patch technique, closing the ASD and redirecting the pulmonary vein towards the LA that is in the back. Two-patch technique or double-patch technique. When they close the ASD, just to check that SVC is open enough, you might augment the SVC. So augmentation, use another patch. That's the reason they call it double-patch technique. But sometimes the pulmonary vein is draining very high up to the SVC. The surgeon cannot reach from here, from the partitioning the SVC, cannot reach the pulmonary vein. So they have to cut the SVC from the top, above the connection of anomalous pulmonary vein, and direct the flow of the pulmonary vein, throw this SVC to the LA, close this defect, and then the rest of the SVC can be connected to the RA appendage. So the flow of the SVC comes from RA appendage to the RA. The flow of these two pulmonary, anomalous pulmonary vein through the previous SVC goes to the LA. This is case number six. 47 year old female presented this palpitation. You can see this patient has a primal ASD. Primal ASD is a part of the AVST. We used to call it AV canal when we were medical students. Now we call it AVST. And this valve is called left side valve, right side valve. Both of these valves are leaking. This is the 3D. This is the tricuspid valve, mitral valve. See, they are side by side, and aorta is not wedged at the middle. It's unwedged. This is one of the criteria of AVST. Aorta is unwedged. It's outside of tricuspid and mitral. You can see the cleft mitral valve here. You can see the cleft mitral valve nicely. Look at this cleft. It's looking to the tricuspid valve. But if the patient has isolated cleft mitral valve, that cleft is looking to the aorta. So this is the cleft that we see it as a part of the AVST. That's after the repair. There's no MR. We have to always be careful. No MS. This is an example of coronary sinus ASD. As I told you, it's very rare. I've seen maybe three, four cases only. And that kind of coronary sinus ASD has unroofed coronary sinus. So if you do a bubble study from left arm, the bubble comes to the LA at first, then coronary sinus, and then RA. So LA, coronary sinus, RA. And this is unroofed coronary sinus. I don't have 3D of this example. So I'm not very good in publication of the papers, but I'm very good in writing books. This is three textbook of Echo. And in all these three textbook, the chapter of the 3DTE and 3DTE in OR is written by me. It's not advertised for books because the money doesn't go to me. But if you want to look at the many example of nice 3D and especially the surgical clips, you can look at this book has lots of DVD. So in summary, majority of second-dom ASDs can be closed by percutaneous devices. 3DTE has a great impact on selection of cases and monitoring of the procedures. There is a recent interest in nonsurgical correction of SVC-type sinus venous ASD by covered stents. Patient selection is currently based on advanced imaging and 3D printing technology as we do it in sectional hospital. T and 3DTE with balloon interrogation can confirm the complete occlusion of the defect which is unobstructed for my veins draining to the LA. In the UK, especially Shaquille Oreschi team that he, I think he was the first person to close the sinus venous ASD by device, he did lots of cases only by 3DTE in the cat lab, not by CT. In patients with large second-dom ASDs or ASD with infrapostero extension, that is very difficult to see the IVC, primal ASD and non-eligible sinus venous ASD who are surgical candidates. Pre- and post-op 3DTEs are the major player in decision-making in the cardiac OR. So, thank you very much for listening to this lecture. I hope you enjoy from the rest of the lectures.