In the delicate world of cardiac anesthesia, every heartbeat contains the mystery of life, and for a young anesthesiologist who is setting sail on a journey of cardiac anesthesia, every step of exploration is full of challenges and growth. As a novice who is full of longing for transesophageal ultrasound (TEE) but is full of confusion, I stand at the starting point of this medical exploration, holding not only the scepter of anesthesia, but also the endless curiosity and desire for the unknown. In the face of TEE, the "perspective glass" of cardiac anatomy, both theory and practice are almost zero, but the three-dimensional sense of space in my comprehension ability has become a stumbling block on my way forward.
Recently, I had several cases of mitral valve surgery anesthesia, and I was impressed by the senior doctor's smart TEE technique, and I was also surprised that the teacher could immediately determine which division of the mitral valve was it, so I searched for books and online resources about the division of the TEE mitral valve, but I never found a way of thinking that suits memorization.
So, a spark of inspiration lit my mind – what if the bridge between theory and practice could be built with the simplest physics simulations? I tried to bend my fingers to simulate the spatial layout of the aorta and the anterior and posterior leaflets of the mitral valve, but this seemingly immature act unexpectedly became a breakthrough for me to understand the perspective of TEE and grasp the mitral valve partition.
Here, I will share this unique learning journey, from the perspective of a novice in cardiac anesthesia, record those clumsy but sincere learning moments, and how to gradually find your own "heart" perspective in the challenge, I hope this sharing will help to remember the mitral valve partition from different angles of TEE.
First of all, let's understand the anatomical position relationship between different section angles of TEE:
Secondly, four commonly used sections of the mitral valve are introduced through the mid-esophagus:
v 食管中段四腔心切面（four-chamber view） 0～10°
v 食管中段二尖瓣闭合缘切面（commissural view） 45～60°
v 食管中段两腔心切面（two-chamber view）90°
v 食管中段左室长轴切面（LAX view）130°
For the mitral valve partition in the four angles in the above figure, I remember the method of mitral valve partitioning as follows: the index finger and middle finger represent the anterior and posterior leaflets of the mitral valve respectively, which are divided into 123 areas from front to back, and the thumb and index finger circle are located in the aortic valve, simulating the structure of the above figure, which is summarized in the following four figures.
During this challenging journey of cardiac anesthesia, I used my pen as a boat and my heart as my rudder, gradually recording and exploring the mysteries of the heart. Through finger simulation, I learned to perceive the subtle structure of the mitral valve in a unique and practical way, making abstract knowledge accessible to me.
The above is just some of my insights in the process of further study, if there is anything incorrect, teachers are welcome to leave comments to guide me to continue to improve.
Fuwai study Xiaobai - the third marshal of Bincheng
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