Left ventricular systolic dysfunction (FICE)

By Dr Bea Besteiro

Severe left ventricular dysfunction. Assessment of the left ventricular systolic function can often have treatment and prognostic implications for ICU patients.

Video 1: PLAX. Note the poor (almost non-existent) excursion of the left ventricular walls in systole. The mitral valve leaflets also have very little excursion in diastole, which might make us think of a valvular disease. However, the leaflets are thin and mobile and this simply represents the lack of ‘suction’ in diastole from a diseased left ventricle (the reduced transmitral flow results in decreased separation of the leaflets during diastole). In fact, the minimum distance between the tip of the anterior mitral valve leaflet (AMVL) and the septum has been correlated with LV function (< 6 mm usually correlates with normal LVF).

Video 2: PLAX. Increasing the depth a significant pleural effusion can be seen. Note the fluid is posterior to the descending aorta. Also, a minimal amount of fluid between the pericardial layers allows us to clearly differentiate the pericardium in this case.

Video 3: PLAX, Color Doppler. Mild jet of central mitral regurgitation likely due to annular dilatation.

Video 4: PSA at the level of the papillary muscles. Significant global hypokinesia.

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