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Echo-of-the-Day Information
The Case-of-the-Week is a presentation of 8 or more video loops to present an important topic in echocardiography. Please reveiw the image or video loops and then answer the questions below. After you have answered the questions you can view the explanation and obtain CME credit (if available).

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Preop Preop TEE or TTE
Intraop An Intraop TEE
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Case of the Month Information Table
IntraopEnd is usually a TEE after the Operation and after some event occured to show a change in the TEE
Case#: 77
AMA CME Units: 0.25 Units
Estimated Time: 15 minutes.
A patient had this echo loop.
Case Discussion
The lateral wall cannot be visualized so the wall motion cannot be directly interpreted.  However, indirect interpretation via mitral annular plane systolic excursion (MAPSE) can be predictive of left ventricular ejection fraction.  If the MAPSE is < 12 mm the LVEF is most likely less than 50%.  However, Tissue Doppler appears to be more accurate. MAPSE by M Mode does have correlation with diastolic parameters such as Tissue Doppler peak systolic annular velocity in healthy individuals but there is not effective concordance and cannot be used in place of Tissue Doppler measurements.

In this loop the lateral wall cannot be interpreted, but, given that the septal wall is hypokinetic, the apex is akinetic and the MAPSE appears less than 12 mm, we could estimate that the ejection fraction is less than 50% and the lateral wall is most likely not normal.  MAPSE does not indicate the diastolic dysfunction of the left ventricle.

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