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The AMVL is elongated but not really prolapsing. I would call it billowing. I can look if I find the TEE images. They nicely show the very small PMVL :)

@@heart_n_lungs I agree Doctor. I mean I have not faced this kind of case still that’s why I’m saying I would think like that. After this video my attention on posterior leaflet will be more 👍

​@@jahongirjurayev3725@jahongirjurayev3725 Absolutely, the reported incidence is extremely low (I think it is definitely underestimated, as I have seen, I think, 4 or 5 cases in the last 3 years). It does have no therapeutic implications as MR was not severe. One case I read about was a congenital absence of the PMVL-those patients normally don't survive as there is severe MR present. I will still look for the TEE images to provide them to you 🙂

@@hossam9544 hallo - freut mich wenn die Videos sinnvoll sind 😊 Videos im Sinne eines Quizzes?

Hallo nochmal. ,danke für ihre Antwort. Quizz wäre sehr hilfreich, mit tipps und tricks am Ende

@@hossam9544 ich schau mal was sich machen lässt 😊

@@heart_n_lungs danke 🙏

A funnel chest is also called pectus excavatum, which means that the front of the chest goes more inward than usual possibly causing a compression of the right heart chambers in severe forms.

@@heart_n_lungs Thank you. I'm in heart failure. I'm 62 taking care of my mom with demenita. I'm afraid I won't out live her. She does not understand that I'm sick. No one seems to take this seriously. Luckily, I go to the Mayo Clinic for treatment.

@@BLFulle I'm Sorry to hear that. It must be a stressful situation! It's good that you found appropriate treatment-best of luck!

@@heart_n_lungs Thank you

You are most welcome. I am glad if some teaching points help ☺

Working on it :)

@@heart_n_lungs thanks Soo much 💐

@@saraali-ho8fx instagram.com/reel/C-zjNTnhldy/?igsh=bDB6b2NjOG5oM3Q0 Starting on the EF with some short videos on Instagram 😊

Thanks for the kind words 🙂

You are most welcome :)

Great to hear and glad you liked it 🙂

The cause of pericardial effusion is often unknown, but in patients with a pectus excavatum, you can often see mild and even sometimes moderate collections of free fluid around the heart (meaning pericardial effusions). So yes, due to the anatomy, it is something you can find more frequently in my experience.

You are most welcome 😊

Dear colleague - thanks for your question. Let me start like this: the SVi is an arbitrary set value where we think below, it is low flow. I still think that the main problem are measurement errors by means of normal flow low gradient (how often have I seen an LVOT signal which was clearly too far in the AS spectrum and overestimated SVi and the LVOTd - it is something I think we all have to think twice when measuring it and easily mistakes can be made). That being said, there might still be some patients we cannot be sure of with our current measurements (I personally always look for the consequence of a lesion, e.g. LVH in AS, reduced strain...). The TFR I know, but I have to admit that we do not have experience with it in our echolab, so I cannot give you information about that. The SVi adapted to gender I think is good, the MPG with a different cut-off value makes sense (referring to the same paper, I hope), the TFR might be an additional measurement to utilize in specific and unclear cases (we should not forget that the measurement per se is not as easy as SVi or Vmax, there are many variables, so there will be uncertainty & errors as well). Maybe I will start using it to see how it can be implemented & to see how helpful it is. Thanks again ☺

Thanks for the answer. Yeah prospective data is missing and the study was Single Center. But the idea to add the factor time to the calculation makes sense to me, as SVi, however indexed to BSA is a static volume and does Not correspond to flow rate (like gorlins formula). Many thanks for your opinion on that topic. Have a Great day Sir

@@alexandermichel3660 absolutely agree 👍🏻

@@alexandermichel3660 as an addendum - I tried to incorporate the TFR and it did provide insides in low flow scenarios which I did not expect so it will be incorporated in our routine. I will give you an update on how it is going. Thanks again for your comment!

@@heart_n_lungsoh thats nice to hear. You re welcome. Yeah sure, dont hesitate to get in touch and Share your experiences. Thanks for the conversation so far.

With clinical information, taking a thorough medical history of your patients, ECG & lab values and experience of course (the more you scan & see the final diagnosis and follow-up the outcome, the better and more accurate you will be in any modality you are trained to use)🙂

Exactly!

Thanks a lot! EF will be a recurring topic ☺

Thanks for the kind words. Currently working on a "new version" with more details; I hope it will still be clear and easy to understand. Thanks 🙂

An example about AS (several I think) are in the video :) Valvular heart disease is complicated, about hemodynamics think always about the consequence => AS => high pressure => myocardial wall thickening; AR, MR => volume => LV dilatation e.g.

SAM has more than one reason for appearing. If the wall is thickened (basal septum in HTN or HOCMP with more segments), the MV is elongated, and the PM is closer to the basis of the heart. Then, a gradient can appear, which is not pathognomonic for HOCMP. I am working on an even more detailed video on myocardial wall thickening where I will discuss it in detail ☺

You are most welcome ☺

HFpEF is more a syndrome as a distinct disease entity. In echocardiography, we can find hints that point towards elevated filling pressures, which make the diagnosis more likely (we use the HFA-PEFF Scoring to support the diagnosis). In the echo, if I see a patient (and I talk to them and they feel dyspneic, for example, I state in the report - by means of imaging, HFpEF is likely.

If you use an ECG (which should be present with every echo in the echolab), it is not hard. Looking at diastolic function or the state of the ventricles also shows quite nicely where you are by means of timing. The colour is easily changed - with every machine, you have a button called grey maps, colour maps, colours, and Farbe (depending on the language). I implemented it in a recent video hands-on - I show in German and English how changing the colour is done!

You are most welcome! That is a very specific request. Let me see what I can find🙂the next topics I will upload, to foreshadow a bit, will include subcostal views, more hands-on & measurements hands-on, volume status with ultrasound as well as a new and extended version of diastolic dysfunction 🙂

Glad you like it 😊

Thanks a lot for your kind words ☺

Glad you like it!

Glad it helps and thx for the kind words 😊

You are most welcome 😊

Sorry to read that. I hope you have a treating physician to support you!

​@@heart_n_lungsmy cardio said not to worry and prescribed me alprazolam for restlessness and orphenadrine for chest pain..does anxiety cause DD?

Very informative video. THANK YOU

Glad to hear it helps you and your family 😊

Thank you so much for your kind and encouraging words 😊

You are most welcome!

Really glad you like it 😊 I will continue doing my best 😊

Glad you like it!

Glad if it helps 🙂

Thank you for your input - which language would you favor (I can only offer German though 🙃). A video about measuring mistakes - I will look into it and prepare something 🙂