Aortic regurgitation during systolic-phase accompanied by mitral regurgitation in patients with continuous-flow left ventricular assist device.

results along with previous studies by the same group are relevant to the scientific community for several reasons. Three-dimensional echocardiography and software developments open a new field of research on cardiac physiology and pathological conditions previously limited to experimental animal models. Continuous development of new therapeutic surgical and interventional devices challenges non-invasive imaging techniques. This way, complete understanding of cardiac anatomy and physiology based on imaging, mainly echocardiography, plays a key role in the clinical arena. For the first time, non-invasive assessment of the MAC is feasible with reproducible and semiautomatic quantification of different parameters available. A first description of the MAC in the normal heart is performed as well as preliminary insight of its behaviour in valvular heart diseases and its change after intervention. However, non-invasive MAC needs to be further evaluated in different cardiac conditions and different degrees of valvular heart diseases before and after intervention. This way, possible clinical applications, others than the physiological and anatomical evaluation, may be explored. Even though, TEE 3D echocardiography acquisition is straightforward, standardized software availability and expertise limits its applicability. In addition, this findings need to be reproduced by other groups before this type of analysis can be expanded to clinical decision-making. Buck T et al. EAE/ASE recommendations for image acquisition and display using threedimensional echocardiog-raphy. A study of functional anatomy of aortic-mitral valve coupling using 3D matrix transesophageal echocardiography. Effect of mitral valve repair on mitral-aortic coupling:a real-time three-dimensional transesophageal echocardiographic study. A three-dimensional echocardiographic study on aortic-mitral coupling in transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2013. A 78-year-old male underwent continuous flow left ven-tricular assist device (LVAD) implantation due to ischaemic cardiomyopathy as a destination therapy. Routine echocardiogram performed 6 days after the surgery showed 'systolic-phase' aortic regurgitation (AR); the timing of regurgitation jet starting at the mid-systolic phase and ending at the early diastolic phase [Panel A, the colour Doppler M mode at the aortic valve (AV), white arrow]. The AR occurred slightly after the onset of mitral regurgitation (MR) (Panel B, the colour Doppler M mode at the mitral valve, yellow arrows), and both MR and AR timings were consistent with the sys-tolic phase (See Supplementary data online, Videos S1 and S2). No remarkable AR jet was documented during the diastolic phase. The AV was mostly closed throughout the cycles, which opens once every 8–10 beats (Panel C). The mean pressure gradients of the …