VTI taken in aorta, ascending aorta and descending aorta. Look at VTI in descending aorta, lower than ascending aorta (because some flow is lost in carotid and subclavian arteries). This could be another way to calculate (or estimate) stroke volume when significant aortic regurgitation or LVOT dinamic obstruction exists. Do you know some value of VTI in descending aorta that correlates with good stroke volume?

Added by: ohtusabes
Tags: suprasternal view, VTI
Date: 2012-05-14

about 35 y old patient with condition after mitral-valve reconstruction (Carpentier-ring 36 mm) because of severe high-grad symptomatic mitral-valve insufficiency caused by mitral-valve prolapse and implantation of mechanical aortic prosthesis because of bicuspid aortic valve (SJM double tilting disk-prosthesis 25 mm). You can see a small prolapse of posterior mitral valve but no relevant m itral valve insufficiency, no elevated transprothetic gradient (PGmean 2,7 mmHg). I used tissue-imagening to demonstrate mitral-valve movement.

Added by: Emmel
Tags: TEE ER mitral-valve reconstruction carpentier-ring mechanical aortic prosthesis
Date: 2012-05-13

... in that vid you can see an floating structure high-suscipious for endocarditic vegetation with distinct elevation of transprothetic gradient. Besides we could found a severe dynamic mitral valve regurgitation with excentric regurgitation jet without signs of mitral valve prolapse.

Added by: Emmel
Tags: TEE ER endocarditis aortic bioprosthesis
Date: 2012-05-13

about 80 y old patient with cardial decompensation (known severe RV-insufficiency) with distinct peripheral oedema, pleural effusion and clinical afflictions of infection with distinct radidly increased inflammatory values. The patient has a complicated clinical history. The most importatnt thing is condition after implantation of aortic bioprosthesis (SJM 23 mm) and within of 1 year an endocarditis of aortic bioprosthesis (early-endocarditis of prothesis!!!) about 2 years ago. But then the patient was treated like a late-endocarditis of prothesis (treatment like endocarditis of native valve), no result of bacterial tests. Actually in TTE we found some interesting things: distinct elevated transprothetic gradient above the aortic bioprosthesis (PGmax. 90 mmHg, PGmean 50 mmHg, max. velocity 4,8 m/sec), middle till hicghgrade mitral-valve insufficiency with excentric regurgitation jet; and a decompensated right ventricle with severe increased pulmonary pressure (PAPsystol. 85 mmHg, high-grade tricuspid insufficiency, RAP assessed on dilatated IVC without collapsility about 10-15 mmHg > PAPs about 100 mmHg!!!!). Look at the Part 2 (TEE).... Unfortunately I couldn´t convert my pictures of distinct elevated transprotehtic gradients.

Added by: Emmel
Tags: TTE ER endocarditis aortic bioprosthesis
Date: 2012-05-13

about 70 y old patient with condition after cardiac surgery 2 years ago with implantation of aortic bioprothesis because of severe aortic endocarditis with distinct paravalvular abscess. Actually the patient was admitted to our ER/ hospital with chills, fever and other clinical afflications of severe infection. In TTE we couldn´t found any signs of endocarditis and no elevated transprothetic Gradient of aortic bioprosthesis (SJM 25 mm). In TEE you can see a typical paraprothetic abscess of aortic bioprosthesis. Besides we found a mild till moderate mitral valve insufficiency and a sweeping atrial pacemaker-lead into the right ventricle (condition after implantation of DDDR-pacemaker because of intermittend high-grade AV-block and chronotropic incompetency). Pacemaker leads are definitely free of endocarditic vegetations.

Added by: Emmel
Tags: TEE ER endocarditis aortic bioprosthesis paravalvular abscess
Date: 2012-05-13

63 yo male copd patient with 12 hours of thoracic pain. In ECG ST elevation in inferior leads and V1 alone, V4R and V5R. Because of COPD the windows in TTE are very bad! In subcostal view we see RV dilation and hypokinesia of free RV inferior wall. In A4C hypokinesia of RV lateral wall (TAPSE 12 mm). In MM we see IVS and PW of LV with good movement (although an oblique view). SV is good, CO too. LA area is normal, mitral inflow pattern too. This is another example of critical care echocardiography, not always a good scenario for echo, but...here we are./n

Added by: ohtusabes
Tags: LV inferior and RV infarction
Date: 2012-05-02

type A aortic dissection with bad image on tte

Added by: magehana47
Tags: aortic dissection aorta
Date: 2012-04-29

when we suspect aortic dissection we have to do a quick transthoracic echo.even when we have bad images on tte,we always get some signs (dilatation of the aorta,suspicion of tear..)which allow to continue explorations:TEE,ct scan..to make the diagnosis.

Added by: magehana47
Tags: aortic dissection aorta echocardiography
Date: 2012-04-29

Scroll down to the comments for findings in this clip.

Added by: drdavemd
Tags: cardiology board review
Date: 2012-04-25

...Part 2 of that- in my opinion - very interesting case. We send that patient to cardia surgery with documetated current increased LVOTO-gradient.

Added by: Emmel
Tags: ER TEE mitral valve bioprosthesis aortic valve bioprosthesis
Date: 2012-04-21

about 30 y old patient with condition after implantation of bioprosthesis in mitral-valve- and aortic-valve-position in africa (NO documents available; indication isn´t known: mitral-valve- and aortic stenosis caused by rheumatic fever?? The patient told that the cardiac valves were very stiff.). The patient was admitted to our ER with recurrent subfebrile fever and dyspnoea, In TTE we found a very interesting result: the mitral-valve bioprosthesis seemed to be downwards tilted into the LVOT with obstruction of LVOT (PG mean 45 mmHg!!). The aortic valve was presented tenuous without pathological gradient but a little bit to small in its diameter.

Added by: Emmel
Tags: TTE ER mitral valve bioprosthesis aortic valve bioprosthesis
Date: 2012-04-21

about 90 y old patient with sudden drop down without dyspnoea but hypotension, tachycardia. In TTE I could visualize that echocardiographic picture of RV-ballooning with D-sign of LV. New high grade tricuspid valve insufficiency (PAPs ca. 40 mmHg + CVP) in comparison with prior echocardiographic results. Unfortunately the patient had also a fracture of the right leg with bleeding complication caused by the drop.

Added by: Emmel
Tags: TTE ER pulmonary embolism
Date: 2012-04-20

here the TEE of further patient with severe HOCM with SAM of AMS and following high grade mitral valve insufficiency and fluttering aortic valve respectively mesosystolic closure of aortiv valve (unfortunately I still can´t convert my M-Mode-pictures of SAM and mesosystolic closure of aortic valve).

Added by: Emmel
Tags: TEE HOCM ER
Date: 2012-04-20

about 60 y old patient with known metastasised lung cancer with condition after radiatio and chemotherapy but with distinct progress under that therapy. The patient was admitted to our ER with severe dyspnoe, tachykardia, hypotension, "kussmaul"-sign (inspiratory dilated jugular veins) and peripheral low voltage in ECG. In TTE we could see a pleural and pericardial severe effusion with signs of tampoonade (collapse of RA and RV, undulation of transtricuspidal flow > 45%) and dilated IVC. The results of tapping showed an infection (> 500 leucocytes/µl and malignant cells).

Added by: Emmel
Tags: ER TTE pericardial effusion tamponade
Date: 2012-04-19

Abozt 70 y old patient with suspicioon of sinu-atriale bradycardia and dyspnoea. In TTE we found a distinct lv-hypertrophy with LVOTO (PGmax. 110 mmHg) at rest!! and a consecutive high grade mitral valve insufficiency.

Added by: Emmel
Tags: HOCM ER ICU
Date: 2012-04-19

about 50 y old man with distinct dyspnoea in context of lung oedema. In TTE and TEE we found a severe mitral valve insufficiency with regurgitation in pulmonary veins caused by mitral valve prolapse in context of rupture of chorda tendinea. The reason of the ruptur of chorda tendinea is not clear: no myocardial ischemia (no elevated troponin, no coronary occlusion in cardiac catheter) and no sign of endocarditis (no elevated values of inflammation). Some idea? After recompensation the patient was admitted to cardiac surgery for mitral valve reconstruction.

Added by: Emmel
Tags: TEE ER ICU mitral valve prolapse mitral valve insufficiency
Date: 2012-04-17

First part with echo with some depreased contractility?...by eyeballing...good SV and CO. US B lines... In evolution this patient shows ARDS (B lines in fact because permeability edema) and profound arterial hypotension with good peripheral perfusion and requires noradrenaline 0.3 g/kg/min. This is the echo. Look at MM and look motion...posterior wall, IVS, Rv...looks hyperdynamic... and echohemodynamics:/nSV: IVT LVOT 40 cm!!!. LVOT area: 3.43= 137 ml! HR= 75 bpm CO= 10 l/min!!!/nWhat do you think now? first Echo...contractility was good? some depressed? hyperdynamic?/nBest and I wait your comments!

Added by: ohtusabes
Tags: septic shock, multiorgan disfunction
Date: 2012-04-16

65 yo male patient immediate postoperatoy of acute lithiasic colangitis. Spontaneously breathing, arterial hypotension no fluid responder, noradrenaline 0.3 g/kg/min needed for MAP equal 65, anuria. Hemodinamic calculations: VTI LVOT: 21.14; LVOT Area: 3.43 SV: 72.5 ml HR: 95 bm CO: 6.8 l/min Stroke distance (IVT LVOT x HR): 20.1 cm min (normal= 10-20). LVEDd normal. IVC is not plethoric (post 2500 ml cristaloids) US B lines in both hemithorax...LA area by planimetry is normal and mitral inflow pattern too... EF (Simpson, A4C) is 63 %...but eyeballing? contractility of LV is really good? in context of low afterload (right this patient in septic shock) contractility is not expected to be more hyperdinamic? I mean EF 70 % or more? US B lines are for increased capillary permeability or hydrostatic by some cardiac depresion? Well...some dudes...I share with you.

Added by: ohtusabes
Tags: systolic function non-dilated sepsis multiorgan disfunction
Date: 2012-04-12

Patient with type 2 DM and arterial hypertension with acute ischemic stroke. His echo reveals depressed LV contractility (severe), LV dilatation and LA dilatation. Cardiac rythm is irregular, rapid ventricular heart rate... No thrombus in LA...but...it is a TTE...probably cardioembolic... Note ultrasound B lines at the end, an expresion of high LVEDP...in accord with echo most probably because cardiac failure...

Added by: ohtusabes
Tags: stroke dilated LV dilated LA
Date: 2012-04-12

A linear structure is noted extending from the interatrial septum to the posterior aspect of the RA, consistent with a eustachian valve.

Added by: drdavemd
Tags: eustachian valve TEE
Date: 2012-04-12