[HSF] redo mitral case part 2 of 2

[Tea Acuff]

I agree that I have much to learn, and can see that you have tried to do much of the same with less reproducable windows. Not surprisingly the most important window in all of this is the one on the opposite side of the lens from the object being viewed. This is why I so much wish to get surgeons like you and surgeons in general to be conversant in this technique collectively.

I recently heard a talk by a surgeon (Dan Drake) about proper TEE windows to correctly diagnosis the mechanisms of mitral valve failure and its subsequent solutions. He found that most of the PREOP TEE studies done by cardilogists (as in the 4 chamber view that you saw) were not interpretable, primarily because cardiologists do not understand mitral pathoanatomy and the solutions that are actually available to correct the problems.

I will have to work to get his pictures of TEE windows available to you and HSF also. This should be easily translated to CMR.

tea

----- Original Message ----
From: "Rwmfglycar at aol.com" <Rwmfglycar at aol.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, October 22, 2007 10:55:48 PM
Subject: Re: [HSF] redo mitral case part 2 of 2


Tea,
I have too tell you that the image you sent me was completely misleading in  
terms of evaluating the mitral valve. There was leaflet in which the body was  
well on the atrial side of the annular "plane" and there was one segment of  
leaflet that appeared to have a free edge, again well to the atrial side of 
the  plane.
There is no doubt that the ventricular muscle was beautifully shown. It was  
very gratifying to me to see the papillary muscle shortening as well as the  
posterior left ventricular wall, with the net effect of a movement of the tip  
towards the annulus in systole and away from it in diastole. This is what one  
would expect to happen and what we found in normal humans using echo. It 
makes a  nonsense of the claim by the sheep surgeons that the papillary tip to  
annulus distance does not change through the cardiac cycle. Our echo studies of  
normal humans show exactly what your pictures show. And all of this helps to  
understand the whole concept of papillary displacement and leaflet tethering, 
When I first wrote about this in a book chapter published in 1986 it was on 
the  basis of looking through the atrium in a beating heart filled with clear 
fluid,  looking at the outside of the ventricle and seeing it shorten, and  
looking at left ventriculgrams and rather fuzzy echocardiograms and watching the 
relative lengths and distances change through the cycle.
Anyway the issue of understanding what we are seeing of the mitral  valve is 
important. I believe you are going to have to define very clearly  precisely 
what section you are taking of the heart so that you know what part of  the 
valve is being imaged.
Yours 
Bob



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