I still adhere to my colleague Gabriel Aldea’s mantra “🥦 before 🍦“. One should always be able to anticipate 3D mitral findings by a comprehensive 2D exam. Here is my 3d modeling of 2D findings. Operator at head of bed (OR STYLE!). #EchoFirst @ase360 #Cardiotwitter #oxorntips

#EchoFirst @ase360 #Cardiotwitter #oxorntips Example of a unicuspid AV. Patient has most criteria mentioned in the excellent reference. Valve seen both in vivo and ex vivo. Alignments congruent (posterior at top of images)

✅ Some unicuspid Ao valves are misclassified as bicuspid, because of the appearance of the base of the leaflet You may realize unicuspid shape looking at the tip 👉🏽nicer with 3D😎 #echofirst Luigi RTHahnMD @michelenahector Corrado Fiore Nicolas Merke Vladyslav Kavalerchyk 🇺🇦 Donald Oxorn🇨🇦🌈🫀🫁🦕

Sincerity in our operating room

#EchoFirst @ase360 #Cardiotwitter #oxorntips.Complex MR. Setting of AV endocarditis with embolic LAD infarct. No MV infection. Probable localized P3 tether. PM=pap. muscle

#EchoFirst @ase360 #Cardiotwitter #oxorntips Images highlight the way our surgeons,in performing the David V proc. recreate the “crown”shaped aortic annulus by anchoring the aortic graft to the hinge points and resuspending the “crown”+ commissures within graft.[CLICK ON IMAGE]

#EchoFirst @ase360 #Cardiotwitter #oxorntips Our surgeons req.confirm. of position of venous cannula. This ones referred to as a 2 stage cannula because it drains from 2 spots(arrows). In this instance venous drainage was poor but better once redirected from hepatic vein into IVC

#EchoFirst @ase360 #Cardiotwitter #oxorntips Resurgence of Ross procedure. Excellent results from large centers. Growth in our program due to efforts of our aortic surgeons Chris Burke and Scott DeRoo

I’m a dreamer at ❤️. Love to look at cloud patterns and use my imagination

#EchoFirst @ase360 #Cardiotwitter #oxorntips For exam takers, this structure seen in the mid esophageal position with the TEE at 0° and rotated posteriorly is frequently the basis of questions! It is the spine with the dural sac in the spinal canal

#EchoFirst @ase360 #Cardiotwitter #oxorntips Haven’t personally imaged an apical hypertroph before. ME2C: The typical “ice pick” appearance (guided by colour Doppler) with mitral inflow for reference. Compare to TGLA LVOT CW. The 3D is a cropped view of hypertrophied LV apex

#EchoFirst @ase360 #Cardiotwitter #oxorntips Speaking of oddities, this pt. Had AVR for severe AR and on POD3 a routine TTE showed a “mass” in the LA. F/U TEE is shown. Hint; LV Vent was used during procedure.

#EchoFirst @ase360 #Cardiotwitter #oxorntips Inverted LAA. Sometimes seen after cardiac surgery esp. when suction is applied to the left heart ie LV vent. Because of the uncertainty he was returned to OR for LA exploration.

More on the perc myxoma removal - Simplified Extraction of Atrial Tumor with Targeted Loop Electricity (SEATtLE) Procedure! Performed with the ŌNŌCOR device. Grasping snare through the Ono and both preloaded through the loop of an electrifiable snare. TEE by Donald Oxorn🇨🇦🌈🫀🫁🦕

#EchoFirst @ase360 #Cardiotwitter #oxorntips Remember the “guide” to 2D TEE IMAGING is just a guide. Example: we are always told that the commissural view is P3__A2__P1 but in this case of flail P2, the P2 segment “breaks” the plane and appears above A2. PLEASE CLICK ON IMAGE

#EchoFirst @ase360 #Cardiotwitter #oxorntips New fellows, renewed focus on basics. Basic checkist after MVR- here mechanical. Remember proximate structures-here circumflex has been snagged

#EchoFirst @ase360 #Cardiotwitter #oxorntips Wall “motion” is not so much motion but thickening. This video amplifies the difference. The last clip on the left shows good base to apex descent. On the right there is none (LMCA occlusion). Strain helps quantify these components

#EchoFirst @ase360 #Cardiotwitter #oxorntips For the new fellows; 2 cardinal signs of rheumatic MS:🏒hockey stick deformity of AML, and immobility of PML

#EchoFirst @ase360 #Cardiotwitter A little echo levity on Monday morning: Renaissance TEE. Enjoy!!

#EchoFirst @ase360 #Cardiotwitter #oxorntips Back to basics. When confronted with a large coronary sinus (CS) always think persistent left SVC. Diagnosed with injection of agitated saline in left arm vein, appears in CS before RA.