Apical VSD ? Hey...where is it ? I cannot find it on TEE !!! скачать в хорошем качестве

Apical VSD ? Hey...where is it ? I cannot find it on TEE !!!

A 50 year old gentleman who had a strong family history of ischemic heart disease and a 20 pack year history of smoking came to us with acute myocardial infarction thrombolysed from outside hospital. My colleagues in cardiology did an echo (TTE) and coronary angiography which confirmed infarction involving the distal LAD territory with an apical VSD. A week later after his hemodynamics stabilised he was posted for CABG and closure of VSD. In the OR I had difficulty finding the VSD using TEE, reported preoperatively by my cardiology colleagues who used TTE (transthoracic echocardiography). This video elaborates how after failing to see the VSD using conventional views, it was finally seen using a view which is not a part of the conventional comprehensive 20 TEE views described in literature. Lesson learnt : Always try to perform a comprehensive TEE examination and in cases where it warrants further look for more. NB. The ME Commissural and 2C views are shown here as a part of a comprehensive TEE examination and these views are unlikely to help locate a VSD since the inter ventricular septum is not viewed in these views.