Echocardiography has been in wide use over the past decade in most cardiac diseases for both diagnostic and prognostic purposes. This is because of its portability, high temporal resolution, absence of radiation, and low costs. It is also true that image analysis, including quantification and reporting, has become extensively resource-sensitive and time-consuming. The recent advent of artificial intelligence (AI) technology has created an environment in which AI confers the ability for automation, image acquisition, analysis, and interpretation in a more predictive manner. In spite of a few challenges that are yet to be overcome, AI in echocardiography seems to be promising because of its benefits obtained from automated analysis and interpretation.

Background: Left atrial dissection presents as a rare complication post-mitral valve surgery. Its presentation can be varied, from asymptomatic to severe hemodynamic instability, which needs a prompt diagnosis. Case presentation: Here we present a case of left atrial dissection late after aortic and mitral valve replacement, identified on preoperative transesophageal echocardiography which facilitated proper diagnosis and management..

Aim: To assess rare causes of systolic anterior motion (SAM) of the mitral valve (MV) after MV repair. Background: A preoperative assessment of the MV apparatus is done to predict postoperative SAM in all patients undergoing MV surgery. These parameters include the lengths of MV leaflets and the ratio between them, the aortomitral angle, the distance between the coaptation point and septum, and septal thickness. When predicted, surgical repair is planned with the goal of avoiding the occurrence of SAM. Case description: A 45-year-old man with MV prolapse and severe mitral regurgitation (MR) underwent MV repair after intraoperative transesophageal echocardiography (TEE) assisted confirmation of feasibility. The postoperative risk of SAM was ruled out. Although there was no SAM in the immediate postrepair TEE, he developed hemodynamic instability, which, on reevaluation, was found to be due to new onset SAM. Transgastric imaging revealed inferior wall hypokinesia and right ventricle (RV) dysfunction, which infrequently causes SAM. Medical management was sufficient to address this manifestation. Conclusion: Systolic anterior motion (SAM) may be caused by right ventricular dysfunction even in the absence of other TEE-described predictors. Clinical significance: It is important to identify medically reversible causes of SAM so as to avoid a redo of surgical intervention with a return to cardiopulmonary bypass, especially in the absence of preoperative predictors.

The treatment for renal cell carcinoma (RCC), with tumor thrombus extending into the supradiaphragmatic inferior vena cava (IVC) and right atrium (RA), is IVC thrombectomy with radical nephrectomy. Intraoperative transesophageal echocardiography (TEE) plays a vital role in such cases and is essential for accurate surgical planning. TEE aids in defining tumor mobility, adherence, and fragility, assessing adequacy of tumor removal, placement of central venous catheter (CVC), and continuous hemodynamic monitoring. We present a case of RCC with supradiaphragmatic extension of IVC thrombus where real-time TEE imaging was pivotal in changing the operative approach to the tumor thrombus and averting cardiopulmonary bypass (CPB) and its antecedent complications.

Background: Left ventricle false tendons (LVFTs) are discrete and relatively rare, fibromuscular structures of varying length and thickness that traverse the left ventricle (LV) cavity. Routine transthoracic echocardiography (TTE) is the commonly used diagnostic technique to diagnose and evaluate LVFT. Case description: Thickened LVFT not oriented in either longitudinal or transverse fashion was misdiagnosed as a case of LV mass on two-dimensional (2D) echo and cardiac magnetic resonance index (MRI) in a young patient. He was listed for excisional surgery. Preoperative transesophageal echocardiography (TEE) revealed it to be LVFT and the surgery could be averted. Conclusion: Though TTE and cardiac MRI are the commonly used diagnostic techniques to diagnose and evaluate cardiac masses, TEE provides superior image resolution and better visualization of cardiac masses.

Aim: To devise a technique for producing a view that can be utilized to perform strain analysis of the left atrium (LA) by transesophageal echocardiography (TEE). Background: Advancement in the field of echocardiography has led to the development of strain and speckle tracking. The magnitude of LA deformation is utilized to determine the diastolic function by means of strain rate imaging. It is difficult to accommodate all the borders of LA in an image by TEE. Technique: Hereby, I would like to present a TEE view that is identical to the subcostal view of transthoracic echocardiography (TTE). This may be named as “deep transgastric four-chamber view” (deep TG-4C), and it is unique compared to the 28 TEE views. I have devised a technique for producing this view on TEE, and I have used it to analyze LA strain intraoperatively for 50 cases. Echocardiography was performed using a CVx TEE probe (Philips Healthcare, Andover, Massachusetts) and strain analysis was performed by Tomtec Autostrain software. The exact maneuvers to produce this view are also devised by me. Conclusion: The deep TG-4C view is helpful in performing LA strain analysis by TEE. Clinical significance: The deep TG-4C view of TEE accommodates all the borders of the LA and is helpful in performing LA strain analysis.