I t has been proposed that the ventricular myocardium, both right (RV) and left (LV), exists as a continuous muscle band. 1-4 The band is oriented spatially as a helix formed by basal and apical loops. We hypothesize that this unique anatomy and spatial configuration of the myocardial muscle determine the way the ventricular ejection and filling take place. 5,6 Further, knowledge of this unique morphologic and physiologic characteristic should facilitate development of more effective surgical procedures in congestive heart failure. Unwrapping of the Ventricular Myocardial Band Careful anatomic studies have established the way the cardiac band should be unrolled. 3,4 Unwrapping occurs easily (Figure 1), with least resistance, along a natural cleavage plane. Dissection of the ventricular myocardial band can be accomplished in three steps. In the first step (Figure 2, A), the basal loop is unrolled. The superficial fibers of the anterior aspect of the left ventricle are cut along the anterior interventricular sulcus (see arrow) to pull apart the RV free wall (Figure 2, B). Dissection can then proceed posteriorly following the cleavage plane. In this way the complete basal loop is extended in its full length (Figure 2, C, black and dark gray areas). In the second step (Figure 2, C and D), the aorta is dismounted, which involves separation along the cleavage plane (see arrow in Figure 2, C) defined by the two muscular strata, the fibers of the descending segment (white) and the fibers of the ascending

In PVT, the thrombus size imaged with TEE is a significant independent predictor of outcome. Transesophageal echocardiography can identify low-risk groups for thrombolysis irrespective of symptom severity and is therefore recommended in the management of prosthetic valve thrombosis.

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Ticagrelor, beyond its antiplatelet efficacy, exerts cardioprotective effects by reducing necrotic injury and edema formation via adenosine-dependent mechanisms.

Simultaneous study with TCD and TEE showed an almost perfect concordance in PFO detection and RLS quantification.