⚡️THE ANSWER IS IN 3D⚡️
Take a look this thread about MR assessment in a young patient referred for systolic murmur 🧵
A single #3Decho clip can explain your brainstorming in few minutes.
🔜 Never without 3D #echofirst
2/
2D-TTE shows an important prolapse of PML, likely P2 according to PLAX.
Leaflets are thickned, LA dilatated and everything seems easy.
3/
Let's push the color, but any huge jet can be detected despite a clear systolic murmur.
4/
Apical 4-Ch view. Finally a clear MR jet! But something seems wrong: how is possible that a PML prolapse generates a posterior directed jet??
Let's move to TOE...
5/
TOE Long axis view.
Where is my suspected P2 prolapse?! PML here seems fine...
6/
X-plane gives us the advice to check better near the commissures. Maybe the answer is there...
7/
Intercommissural view with color.
Huge MR jet towards the LAA! Finally we can see what we heard by auscultation..
It is a jet lateral directed.
8/
...and what about this one?
It's another jet, central, between A2-P2 with a coaptation zone apically displaced at this level due to the lifting of PM commissure.
...we need to have a surgeon's view! in motion!! 🔜 3D ⚡️⚡️
9/
3D: one of the most important imaging tools!
What's the report?
✅ P3 Prolapse
✅ Posteromedial commissure prolapse
✅ Small A3 prolapse
10/
⚡️3D COLOR ⚡️
A clear spatial and anatomic orientation of our jet originating from the posterior commissure and directed towards LAA
11/
From the basic to the advanced echocardiography.
Try never to lose orientation and think as if you were navigating inside the heart!
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