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Peritoneal Fluid

Video Author: A. Y. Denault
Published on: 08.17.2021
Associated with: September 2021, Volume 133, Issue 3; Anesthesia & Analgesia. 133(3):630-647, September 2021

Free peritoneal fluid in an unstable patient after cardic arrest. Transgastric view at 0o showing free fluid between the stomach, the left lobe of the liver and the heart.

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Video 1: Normal parasternal long axis

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:08

The right ventricle is under the transducer. There is normal excursion and coaptation of the aortic and mitral valves. The chambers are normal in size. There is brisk excursion of the aortic root, brisk opening of the mitral valve, a normal descent of the base of the MV, and normal thickening of the left ventricular segments.

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Video 2: Significant aortic stenosis seen in the PLAX

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Video 3: Mitral valve prolapse seen in the PLAX

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In systole, the body of both mitral leaflets is above the level of the mitral annulus.

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Video 4: Dilated cardiomyopathy seen in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:08

The RVOT, LA, and LV are all dilated and appear proportionally large compared to the aortic annulus and root. Compare the relative sizes with Video 1 (normal PLAX.) There is evidence of decreased LV systolic function, with decreased motion of the aortic root, decreased excursion of the anterior mitral leaflet, decreased mitral annular excursion, and decreased thickening of the left ventricular segments. There is also a left pleural effusion.

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Video 5: Rheumatic mitral disease seen in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:05

Left ventricular and aortic valve function appear normal. There is thickening of the tips of the mitral leaflets, with diastolic bowing seen particularly in the anterior mitral leaflet (the “hockey stick” appearance). The left atrium appears enlarged as well, consistent with elevated left atrial pressure from mitral stenosis.

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Video 6: Systolic anterior motion of the anterior mitral leaflet in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:07

Multiple beats are shown in this clip and the image does not remain still because the patient was severely dyspneic. The patient has significant hypertrophy of the anterioseptal wall of the left ventricle. In multiple cardiac cycles the anterior mitral leaflet can be seen to impinge on the left ventricular outflow tract.

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Video 7: Both pleural and pericardial effusions seen in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:05

The descending thoracic aorta is outside the pericardium, and a pericardial effusion will be seen extending between the heart and the aorta in this view while a pleural effusion will be seen deep and lateral to the aorta.

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Video 8: Normal parasternal short axis (PSAX.)

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:07

The right ventricle is seen to the left of the screen, with the anterior portion of the left ventricle closest to the probe. The papillary muscles are seen, identifying this as the mid-portion of the left ventricle. Six segments of the left ventricle are seen, representing all three main coronary artery territories.

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Video 9: Parasternal short axis (PSAX) with akinesis of the inferior segment

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:06

The thinning of this segment suggests a scar consistent with previous myocardial infarction.

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Video 10: Parasternal short axis (PSAX) showing a pericardial effusion

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:07

A pericardial effusion around the heart, hyperdynamic left ventricular systolic function, and decreased LV filling in diastole.

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Video 11: Parasternal short axis (PSAX) in a patient with septic shock.

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:07

Septic shock, decreased left ventricular (LV) afterload, and increased cardiac output. The LV is full in diastole and empty in systole, consistent with the patient’s low-afterload state.

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Video 12: Parasternal short axis (PSAX) showing RV pressure overload

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:08

The interventricular septum (IVS) is normally convex with respect to the left left ventricle throughout the cardiac cycle. In this case the IVS is flat in both systole and diastole, suggesting that the right and left ventricular pressures are similar (near systemic pulmonary artery pressures.)

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Video 13: Normal apical four chamber (A4).

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:08

The apex of the left ventricle is directly under the ultrasound transducer. All four chambers can be visualized. There is normal global and regional biventricular systolic function, normal excursion and coaptation of the mitral and tricuspid valves, and normal chamber sizes.

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Video 14: Apical four chamber showing ischemia in the LAD territory

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:11

A large portion of the myocardium at the LV apex is not thickening. There is decreased global LV systolic function and left atrial enlargement as well.

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Video 15: Apical four chamber showing prolapse

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:09

Prolapse of both anterior and posterior mitral leaflets with left atrial enlargement.

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Video 16: Apical 4 chamber showing an abnormal mitral valve opening in a patient with rheumatic heart disease

Creator: Dr. Josh Zimmerman, MD, FASE

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Abnormal mitral valve opening in a patient with rheumatic heart disease. The tips of the mitral leaflets are thickened. The left atrium appears qualitatively enlarged compared with the size of the left ventricle.

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Video 17: Apical four chamber showing an enlarged right ventricle with decreased RV systolic function

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Video 18: Apical four chamber zoomed in on the tricuspid valve

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:11

Apical four chamber zoomed in on the tricuspid valve. This valve does not coapt well in systole, suggesting the presence of significant tricuspid regurgitation.

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Video 19: Normal subcostal four chamber (SC4)

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:10

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Video 20: Subcostal four chamber with right ventricular dilation and hypertrophy

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:10

Subcostal four chamber with right ventricular dilation and hypertrophy. The free wall of the RV appears as thick as the left ventricle. The RV appears larger than the LV, suggesting significant enlargement.

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Video 21: Subcostal four chamber in a patient with pericardial effusion and tamponade.

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:11

Subcostal four chamber in a patient with pericardial effusion and tamponade. The effusion is seen as a large echolucent space around the heart. The right atrium appears collapsed in ventricular systole and the right ventricle appears compressed in ventricular diastole. These findings are both consistent with tamponade physiology.

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Video 22: Normal subcostal IVC view (SC IVC)

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:19

The liver is at the top of the screen, with the thin-walled IVC seen entering the right atrium. There is more than 50% collapse of the IVC when the patient sniffs.

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Video 23: Subcostal IVC in a patient with cardiac tamponade

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:10

Subcostal IVC in a patient with cardiac tamponade. The IVC appears dilated and does not collapse as the patient sniffs.

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Video 24: Subcostal IVC in a patient with hypovolemia

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:14

Subcostal IVC in a patient with hypovolemia. The IVC is small and collapses completely as the patient breathes.

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February 2017 A&A Video Summary

Creator: Jeanette Esau

Duration: 2:33

Video summary of featured articles in Anesthesia & Analgesia for February 2017.

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September 2016 A&A Video Summary

Creator: Jeanette Esau

Duration: 2:22

Video summary of featured articles in Anesthesia & Analgesia for September 2016.

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July 2015 A&A Video Summary

Creator: Jeanette Esau

Duration: 1:36

Video summary of featured articles in Anesthesia & Analgesia for July 2015.

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June 2014 A&A Video Summary

Creator: Edward C. Nemergut, MD

Duration: 5:10

Video summary of featured articles in Anesthesia & Analgesia for June 2014.

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June 2013 A&A Video Summary

Creator: Edward C. Nemergut, MD

Duration: 6:09

Video summary of featured articles in Anesthesia & Analgesia for June 2013.

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