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Crossed Swords Sign: A 3-Dimensional Echocardiographic Appearance

Gao, Zhifeng MD*,†; Bortman, Jeffrey M. BS; Mahmood, Feroze MD; Matyal, Robina MD; Khabbaz, Kamal R. MD

doi: 10.1213/XAA.0000000000000937
Echo Rounds

Intraoperative evaluation of mitral regurgitation is a complex undertaking. Bileaflet prolapse/flail can result in divergent mitral regurgitation jets with a characteristic “crossed swords sign” appearance. We present a case of divergent mitral regurgitation jets that were detected intraoperatively and evaluated using 3-dimensional imaging. The accurate assessment of eccentric mitral regurgitation jets, especially bilateral eccentric mitral regurgitation jets, is challenging before surgical repair. Intraoperative 3-dimensional transesophageal echocardiography with and without color-flow Doppler can significantly improve the localization of the anatomical lesion.

From the *Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China

Department of Anesthesia, Critical Care and Pain Medicine

Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Accepted for publication November 1, 2018.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the HTML and PDF versions of this article on the journal’s website.

Address correspondence to Feroze Mahmood, MD, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215. Address e-mail to

Copyright © 2019 International Anesthesia Research Society
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