Left Ventricular Function

Parasternal long axis view indicating poor LV contractility. 

Parasternal long axis view indicating poor LV contractility and some mitral regurgitation. Infants with perinatal depression often have some degree of myocardial ischemia. Subendocardial ischemia may manifest as papillary muscle ischemia and mitral insufficiency.  

One can notice that the colour box, which filters for velocities above 77 cm/s, is not filled despite a colour gain at 40%, potentially indicating low blood flow velocities generated by this LV with dysfunction.  

Significantly altered contractility of the LV

Parasternal short axis view. 

Other structural causes of cardiac dysfunction were rule out: coronaries were evaluated with 2D and Colour (not presented) and were normal. Aortic arch did not show any signs of obstruction. LVOT was unobstructeded. 

Isosystemic pulmonary pressures by TR jet velocity (55 RV-RA gradient). The PFO was bidirectional. 

LV dysfunction in A2C

Mild to moderate mitral regurgitation in the apical 4 chamber view

Some degree of LV dysfunction in A4C

Moderate dysfunction in the A2C

Depressed Ejection fraction by Speckle Tracking echocardiography

Parasternal long axis outlining that the LV function (systolic) is depressed. The Aortic valve is opening and closing. There is no obvious LV hypertrophy or LVOT obstruction.

PLAX with posterior sweep outlining the tricuspid valve and RV inflow. One may appreciate that the myocardium of the RV does not seem to shorten during systole (or even thickening seems impaired). 

Sweep from base to Apex. The parasternal short axis demonstrates that there is LV systolic dysfunction. The pulmonary valve opens and closes. 

One may appreciate the RCA in B-mode. We also can appreciate that there is no obvious RVOT obstruction. The pulmonary valve opens and closes. 

Visualization of the LCA in appropriate configuration. This is not explained by ALCAPA

Biventricular dysfunction. The RV is hypertrophied and the apex is trabeculated. 

Sweep from posterior to anterior. Normal configuration of great vessels. Inflow valves are opening and closing. 

RV focus view outlining moderate RV dysfunction. 

TAPSE is depressed at 3 mm

dp-dt of the MR < 1200 mmHg/s (at 844) outlining LV dysfunction (systolic). 

Flow is laminar via the LVOT. There is no LVOT obstruction. One may also appreciate the eccentric mitral insufficiency jet. 

LVOT - VTI (stroke distance) is depressed. This outlines the resulting depressed LV output. 

TDI of the RV free wall. 

Depressed RVOT-VTI (decreased stroke distance and output)

Shortening fraction is depressed at 18%. No signs of significant hypertrophy. 

There may be some early indicator of LV diastolic dysfunction with a low E/A ratio

Decreased VTI in the descending Aorta from the depressed LV output. 

Improved biventricular function in A4C (EF: 57%, FAC 37%)

At a Nyquist of 77, nice laminar flow through the LVOT into the Ascending Aorta.

Mild TR - indicating some residual RV strain

PDA small and almost closed - bidirectional

One may observe in the subcostal view the UVL at the IVC-RA junction, some degree of free fluid below the diaphragm. 

Some pericardial fluid is observed in this PSAX view. 

Some mild mitral insufficiency from the residual subendocardial ischemia to the papillary muscles of the mitral valve. 

Adequate subjective RV and LV function by A4C view. 

Sweep in the PSAX: flattening of the septum in systole (iso-systemic PA pressure), some degree of RV dilation

RV looks similar in size to the LV. there is adequate RV function. 

Normalized TAPSE. 

Normalized RV TDI. 

Although angulated, one may appreciate the low-normal systolic velocity of the LV free wall (5th beat being the clearest)

E>A velocity. 

Improved LVO

Improved RVO

Improved VTI in the descending abdominal aorta. 

Improvement in the Shortening fraction, although there is paradoxical movement of the inter-ventricular septum from the isosystemic pulmonary pressure. 

Good flow via pulmonary veins. No significant mitral insufficiency. 

Good left ventricular function with some flattening of the septal curve

E/A = 1

TAPSE has normalized

Systolic velocity of RV has normalized

Improved LV free wall systolic velocity

Improved LV septal systolic velocity

Some paradoxical movement of septum on the M-Mode (PSAX). Overall good movement of the LV posterior wall. E-seperation point normal. 

Normal RVO

normal LVO