Thread by @NMerke

#echofirst approach to eccentric MR
TEE always need for diagnostic purpose?
@eromerodorta @HenrykDreger @SKelle_Berlin

#echofirst TTE for sure first line of defense in diagnostic workup as we look for dimension, volumes and function to follow GL for decision making

but once #echofirst made clear that there is significant pathology with consecutive enlargement of LV and LA we must hunt down the jet, here we see 2 jets. Now call for TEE or can we proceed with TTE?

#echofirst TEE goes 3D, important to start from good 2D, optimize resolution using 4D zoom preparation, take landmarks for orientation, better taking more 3D datasets (me taking always from all 3 apical views)

Most important #echofirst step b4 activating 4D is to optimize the 2 planes. Must capture whole zone of interest with orientation landmarks for MV aortic valve and LAA.

#echofirst for 3D use your planes as large as needed and as small as possible

#echofirst shows with surgical orientation (AV at 12) the defects, bileaflet lesion. Post processing 🔑 to magic:
2D Gain Amplifies all the receiving US Information
Amplifies also noise = smoke
4D Active Mode Deletes weak signals
Deletes noise and weak Image-information

#echofirst still frame with the diagnostic images of this case