Another clinical example. Male patient, 66 years old. Previous mitral valvuloplasty for mixomatous prolapse of the anterior mitral leaflet and severe regurgitation. Follow-up outpatient exam: LV end-diastolic volume= 64 ml/m2; EF= 59 %; estimated pulmonary systolic pressure = 25 mmHg. In Figure 18, the cardiac fossa appears clearly circular, and thus the ventricle foreshortened. This time, the 2-chamber view appears correct (Figure 19). The dysfunctional LV apex in the 2-chamber view should alarm the operator as to the correctness of the “normal” LV apex in the 4-chamber view. Of note, the LV long axis is much longer in the 2-chamber than in the 4-chamber view, and this clearly demonstrates that the 4-chamber long axis is foreshortened.
Figure 20 shows the real geometry of the LV in the 4-chamber view. The real biplane EF of this LV is 37%, and the end-diastolic volume= 82 ml/m2 (mild dilatation – see Normal values here ). Because of the erroneous evaluation, the patient was left untreated for 2 years.