Thread by @dr_benoy_n_shah

VALVE CASE OF THE WEEK

Each week I'll post an interesting and, hopefully, educational case related to heart valves.

This week...early systolic MR. We see late MR in prolapse, what about early systolic MR? See spectral Doppler, colour M-mode & movie clip from TOE/TEE...1/2

What's the mechanism of MR? If unsure, what views / images would you use to investigate further?

@BSEcho @ASE360 @echocardiac @doconmoney @TheBJCA @BJCA_Women_LTFT @WessexSpRs @BrHeartValveSoc @DrDanAugustine #echofirst
@hannahzr @hannahcvimaging

So...I thought the jet was pretty central. Lots of comments about possible post leaflet restriction, but what about the timing? Confined to 1st 1/2 of systole? I'll explain what I thought. Below is TOE AV long axis view, 2D and in next message with colour...(1)

Note in the colour image again the MR just seems to stop suddenly in mid-systole...

So, I found the 3D zoom of the MV really helpful. In the next tweet, you'll see the 3D from the LV aspect. Look carefully at how the valve closes...(2)

Especially on the first MV closure, does it look like the MV doesn't all close at the same time? I'll show you three still images next, a frame by frame look at this loop...(3)

Look at the image with 2 on the left side...you can see the valve is partially closed and then, in the next frame (3), is fully closed.

This is down to the broad BBB... QRS duration was >160ms. So the LV dyssynchrony results in psp muscle dyssynchrony...(4)

So the leaflets don't coapt as they normally would.

I've observed this early systolic MR a few times since this study, always in patients that had broad QRS complexes (5)

New case next week! 😁

@BrHeartValveSoc @BSEcho @ASE360 @TheBJCA @BJCA_Women_LTFT #echofirst #mitralvalve