1/ 🧵Why is the TOE essential when approaching to a complex Barlow repair? #echofirst ✅Mechanism ✅Anatomical description ✅Measurements ✅SAM risk stratification ✅ Post repair assessment

2/ 👉Mechanism: 2 different jets coming from 2 different valve's areas make repair more difficult. 1⃣ P3-PMC prolapse due to chordae rupture--> jet towards LAA 2⃣ P1 prolapse due to ch. rupture--> jet anteromedially directed

3/👉 Anatomical Description: 3D-TOE allows to get the best imaging in motion in order to plan proper surgical approach , enlighting anatomical details and secondary lesions.

4/ 👉Measurement and SAM risk stratification: ✅Anteroposterior and intercommissural diameter ✅AML & PML lenght ✅ AML/PML ratio ✅ C-septum distance ✅ Mitro-aortic angle calculation

5/ 👉 SAM risk factors

6/ 👉 Check final result: ✅Valve anatomy ✅Coaptation lenght (at least 6-8 mm) ✅ Any residual jet ✅Mean gradient ✅SAM What about repair here: 👉P1 neochord 👉P3-PMC re-lock technique 👉 large annuloplasty (ring size 40 mm)

What a complete review! Thanks! Great 2023!😍👏👏👏