Legend of figures
Figure_1
2D transthoracic echocardiogram on admission, PSAX view at MV level
showing interventricular septal flattening on diastole due to RV volume
overload
Figure_2
Transthoracic echocardiogram with continuous wave doppler (CWD)
interrogation across the tricuspid valve on admission showing RV
systolic pressure (RVSP) of 66 mm Hg with severe pulmonary hypertension
Figure_3
2D transthoracic echocardiogram with color doppler on admission, A2C
view showing a central jet of severe grade IV MR
Figure_4
2D transthoracic echocardiogram with color doppler on admission, PLAX
view demonstrating severe grade IV MR (before starting ARNi)
Figure_5
2D transthoracic echocardiogram with color doppler on admission,
modified RV view depicting a central jet of severe grade IV TR
Figure_6
2D transthoracic echocardiogram with color doppler on admission, A4C
view demonstrating severe grade IV TR and severe grade IV MR
Figure_7
Transthoracic echocardiogram with pulsed wave doppler (PWD)
interrogation across hepatic Vein on admission illustrating hepatic vein
systolic flow reversal due to severe TR
Figure_8
Transthoracic echocardiogram with pulsed wave doppler (PWD)
interrogation across mitral valve on admission showing restrictive
pattern grade III diastolic dysfunction
Figure_9
Transthoracic echocardiogram with tissue doppler imaging (TDI)
interrogation across mitral valve annulus (septal mitral annulus) on
admission showing reduced mitral annular velocity with high E/E’ ratio
of 36
Figure_10
Baseline 12-leads Electrocardiogram (ECG) showing sinus rhythm with wide
QRS complex and Interventricular conduction delay with increased
duration of QRS complex ≥ 125 ms
Figure_11
X-ray chest (Antero-posterior) on hospital admission showing pulmonary
congestion with cephalization of the pulmonary vessels, Kerley B lines
with the ”bat wing” pattern and patchy shadowing with increased cardiac
size
Figure_12
Transthoracic echocardiogram showing LV Ejection fraction improvement to
45% by biplane method of disks (modified Simpson’s) after two weeks of
starting Sacubitril/Valsartan
Figure_13
2D transthoracic echocardiogram, A2C view showing reduction of MR
severity to grade II after two weeks of starting Sacubitril/Valsartan
Figure_14:
2D transthoracic echocardiogram, A4C view showing marked reduction of
severe grade IV TR to mild grade I TR
Figure_15
Transthoracic echocardiogram with continuous wave doppler (CWD)
interrogation across the tricuspid valve two weeks after starting
Sacubitril/Valsartan, showing RV systolic pressure (RVSP) dramatically
improved to 30 mm Hg compared to 66 mm Hg on admission
Figure_16
Transthoracic echocardiogram with pulsed wave doppler (PWD)
interrogation across mitral valve after initiating ARNi, showing
improved LV diastolic function to grade I compared to grade III on
admission