CASE – Do You See What They See?

The latest issue of CASE, ASE’s online case reports journal, is available, and includes “Complicated Double-Orifice Mitral Regurgitation: Combined Hemodynamic Assessment Using Echocardiography and Four-Dimensional Flow Magnetic Resonance Imaging,” by Jeesoo Lee, PhD, Nadia El Hangouche, MD, Aakash N. Gupta, BS, Michael Markl, PhD, Susan Kim, MD, Jane Wilcox, MD, MSc, and James D. Thomas, MD, FASE. “This case may help add guidance to the real-world dilemma we all encounter when cases just don’t simply follow the guidelines. Staying on top of the latest literature is essential,” suggests co-Editor-in-Chief Karen Zimmerman. Dr. Thomas states, “Myxomatous mitral valve disease can produce complex regurgitant jets that are challenging to quantify.  We present a puzzling case with mitral annular disjunction, moderate late systolic MR arising medially and laterally along the closure line in the 2-chamber view, history of syncope, VT on the treadmill, and sudden cardiac death in both parents. We combined proximal convergence analysis with 4D flow MRI to provide better guidance on severity and management showing the value of multimodality imaging. And, yes, there’s a Pickelhaube sign!”

Symptomatic Left Ventricular Outflow Tract Obstruction Caused by Mitral Annular Calcification,” from Pristera et al. rounds out this section on the not-so-simple mitral valve. Additionally, we have case reports on LVOTO caused by MAC, a phantom systole, COVID-19 and RV dysfunction, using bubbles to trace flow to find a diagnosis, apical thrombus formation with CRT, questionable endocarditis, aortic valve disease in both the young and the old, complicated congenital heart disease cases, an air gun projectile in a dog, and interventions for pulmonary artery and valve stenosis with anomalous connections in canines.

Test your echo acumen with the new What is this Image? quiz. Congratulations to Bonita Anderson, MAppSc(MedUlt), DMU(Cardiac), ACS, FASE, FASA, Matthew Lambert, CCP, PGDip MTEX, GradDipCardiacUlt, Natalie Edwards, BExSci, MCardiacUlt, ACS, FASE, FASA, and Gregory Scalia, MBBS(Hons), MMedSc, FRACP, FACC, FCSANZ, FASE, from The Prince Charles Hospital, Brisbane, QLD, Australia for supplying the quiz text and image. Don’t forget to check out the CASE articles in press.


CASE is a valuable tool for all clinicians, educators, mentors, and sonographers. CASE co-Editors-in-Chief, Karen G. Zimmerman, BS, ACS, RDCS, RVT, FASE, and L. Leonardo Rodriguez, MD, FASE, FACC, are continually grateful to the all the authors and reviewers who have dedicated their time and effort to CASE’s mission of publishing high-quality educational experiences where cardiovascular imaging has been used to solve clinical dilemmas. We will enter 2021 with exciting new cases, continual optimism, and open arms to receive your opinions and questions. Email managing editor, Deborah Meyer, at

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