Posts Tagged ‘echocardiogram’

Aorta  is connected to the left ventricle  like a hose pipe.The energy  generated within the LV myocardium is efficiently delivered to  the root of the aorta. Mechano -coupling of LV with  aorta  is important means by which  blood is  is ejected into systemic circulation .

Even though aorta  has  mainly passive  contraction and ( The  wind- kessel effect) ,  the most  powerful contractile force  of aorta comes from   the  transfer of kinetic energy from  left ventricle .

This helps  us to  measure the LV function  simply by  looking at the aortic wall motion.Since aorta is the final common exit for LV  it effectively represents the global LV  function . The  ubiquitous errors during  LV border tracing  and it’s subsequent mathematical  amplification  can be avoided. Here is a  patient with severe LV dysfunction  whose  aortic  motion is depicted . We refer to this as   ” rail roading” sign of Aorta  which  implies  a critically dysfunctional LV . His EF was 23 %  The aortic motion is esepcailly useful in categorizing severe LV dysfunction  from moderate LV dysfunction (The sensitivity we feel is as high as sophisticated tissue motion Doppler protocols .Of course  it may lack specificity !* as hardened  aorta due to aging can confound the aortic motion )

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Mitral valve can be termed as  the most important valve of heart . The reason  for this  : It is the only valve that is dependent on the  Left ventricular function (The  parameter  which   determines the  ultimate outcome in any form CAD ! )

So , indirectly mitral valve function will invariably be affected by some degree  at least in  most  patients with LV dysfunction. (After all LV free wall , is a component of mitral valve apparatus.)

While , we have numerous modalities to assess mitral valve function  ,  the one that has fascinated the surgeons during  mitral  valve surgery is the intra operative TEE.

Many believe TEE provides live  images  of mitral valve   which are not possible  even under  direct vision ! The eye of the  TEE sees the mitral valve  from a  posterior location , (of -course It can see at any angle !)   while surgeon can see in one angle . The  types of repair , the adequacy  of repair, the annulus status,  even a trial mitral run ,  can be done with the help of TEE.

The TEE probe silently does  this job sitting inside the esophagus   , without  obstructing the surgeon’s operative field .

The success of TEE as an investigative tool did not come easy.Decades of  observation , innovation and learning( Especially from  department of cardiac science  Mayo clinic USA , where they standardized the views. )  are involved .

Now we have omni plane, real time 3D TEE probes .

The books  which are  considered the best for  TEE aspects of mitral valve  and it’s  repair are

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