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Transgastric Abdominal Ultrasonography View #5

Video Author: A. Y. Denault
Published on: 08.20.2021
Associated with: September 2021, Volume 133, Issue 3; Anesthesia & Analgesia. 133(3):630-647, September 2021

Animated description on the technique to obtain right portal Doppler interrogation using the Vimedix Simulator from CAE Healthcare. With permission of Denault et al. for the international study on the clinical significance of portalhypertension after cardiac surgery (NCT03656263).

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Video 4: Dilated cardiomyopathy seen in the PLAX

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Video 5: Rheumatic mitral disease seen in the PLAX

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

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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

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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

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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.

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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

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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

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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

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

Creator: Dr. Josh Zimmerman, MD, FASE

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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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