Mitral paravalvular leaks (PVL) occur when there is dehiscence between the prosthetic sewing ring and the native annulus, allowing blood to regurgitate around the valve rather than through it. The prosthesis itself may function normally, while a high velocity eccentric jet produces significant physiologic consequences. These leaks are often associated…
One of the first things I look for when performing transesophageal echocardiography (TEE) for a mitral valve replacement is how the new valve is functioning as we prepare to separate from cardiopulmonary bypass. A mechanical mitral valve is engineered for crisp, nearly effortless leaflet excursion; however, the following 3D TEE…
Left ventricular (LV) thrombus is typically a result of stasis from myocardial hypokinesis/akinesis. A segment of myocardium stops moving, blood lingers in the cul-de-sac of an akinetic apex, and the endocardial surface becomes a scaffold for clot. Large anterior infarctions, end-stage heart failure, and dilated ventricles can set the stage…
Gerbode defects create an abnormal communication between the high-pressure left ventricle (LV) and the right atrium (RA), thereby completely bypassing the right ventricle. That pathway sets up a distinctive left-to-right shunt with hemodynamics that can be subtle or profoundly destabilizing, depending on the size of the communication and the clinical…
McConnell’s sign is an echocardiographic finding classically described as akinesis of the right ventricle’s (RV) mid-free wall with preserved apical contractility on echocardiography. It’s often associated with acute pulmonary embolism (PE) and is thought to reflect regional wall motion abnormalities from acute RV pressure overload and tethering of the apex…
Paravertebral nerve blocks (PVBs) are regional anesthetic techniques that target the paravertebral space (PVS), where spinal nerves emerge from the intervertebral foramina. They allow for segmental, unilateral anesthesia without the sympathectomy and motor blockade seen in neuraxial techniques. To facilitate extubation in the OR and a shorter overall hospital course,…
B-lines are a vertical “comet-tail” artifact seen on lung ultrasound. They represent interstitial edema or increased lung water in thickened subpleural interlobular septa. In other words, B-lines represent fluid in the lungs (e.g., pulmonary edema, heart failure, etc.). When performing lung ultrasound, I use a high-frequency linear probe and begin…
A pericardial window is a surgical procedure designed to relieve pressure caused by fluid accumulation around the heart, known as pericardial effusion. This fluid can lead to cardiac tamponade, a life-threatening condition where the heart’s ability to fill and maintain a cardiac output is jeopardized. Compared to a pericardiocentesis, where a needle is…
The normal aortic valve is trileaflet and comprised of the non, left, and right coronary cusps. Quadricuspid aortic valve (QAV) is an extremely rare malformation occurring in only 0.008% of autopsies and 0.043% of cases examined through echocardiography. Hurwitz and Roberts proposed seven classes of QAV based on the arrangement…
Aortic dissection is a life-threatening condition characterized by a tear in the innermost layer of the aorta (tunica intima), permitting blood to enter and separate the intima from the aorta’s middle layer (tunica media). This event creates a false lumen (FL) alongside the true lumen (TL) of the aorta. Typically,…