As an additional part of your ultrasonographic assessment, there was another ultrasound performed and this one of the abdomen and again take a look at this and we will review this in short order as well, now again, to emphasise, there are many approaches to this but based on your mitral valve, take a close look at that mitral valve and look at the excursion of it. sonography , what findings might change how you proceed, again, this doesn’t mean that we proceed definitively in this fashion but this is to illustrate how an ultrasound can change your clinical judgement as to what is exactly going on in this case, let’s review this ultrasound of the heart, what view is this and what’s remarkable here, again this is a view and what’s remarkable here is the
There is something called the EPSS, that definition is that the EPSS is the E point of the mitral valve to ventricular wall separation, lets simplify that a little bit, the E stands for Early ventricular filling via the mitral valve when the mitral valve was wide open, in other words, it’s the space between the anterior of the mitral valve and the septum, normally, the anterior of the mitral valve should almost slap the septum and this should be very little space, in fact, the distance between the mitral valve and the septum the EPSS, should be less than one centimetre, if it’s greater than two centimetres for example, the ejection fraction is considered to be less than thirty percent, now what’s the EPSS here, well, let’s take a look at the mitral valve, the image is now frozen and the mitral valve is sitting over here.
On the scale over here to the right, going from the top of the screen down to the bottom, the scale is set so the depth is sixteen centimeters, each hatch mark from here to here, from here to here and so forth represents one centimetre, so this yellow bar is showing a two centimetre separation, in other words, if this separation between the anterior leaflet and the septum is greater than this, the ejection fraction is less than thirty percent.
On the scale over here to the right, going from the top of the screen down to the bottom, the scale is set so the depth is sixteen centimeters, each hatch mark from here to here, from here to here and so forth represents one centimetre, so this yellow bar is showing a two centimetre separation, in other words, if this separation between the anterior leaflet and the septum is greater than this, the ejection fraction is less than thirty percent.