[HSF] Apical saline insufflation

[prasannasimha]

This is an old  picture of a repair done with a pericardial band. You 
can see the excellent coaptation while the ventricle is insufflated 
apically with the fluid egressing from the aortic root vent 
demonstrating full filling and distention of the ventricle. Such a 
result correlates very well with periop and postop TEE. Striving for 
that makes decision making simple.
Somehow for me the transmitral insufflation  seems to be faulty at times 
as usually a "lip" can "unfurl" demonstrating a leak under pressure and 
appears competent with plain transmitral insufflation.Lots of people use 
it successfully but it is not a good method in my hand. (Despite trying 
to use the parrallel line of coaptationa and fill and press rules etc 
etc. Could  people educate me on this further. I obviously am doing 
something wrong with that method though I seem to have no problems with 
the apical saline insufflation method. My colleague has become so 
convinced with apical saline insufflation that he always asks me to do 
it in addition (It is my habit to call some one else and always 
demonstrate it to them also - sort of an internal quality control)
Prasanna
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