Hi All, Have a question I was asked today by either an MD or CRNA and I'd like to ask it of you here... Observing a CT Surgeon today for a beating heart case, but I was told to introduce myself to the Anesthesiologist by the Surgeon because she knows I want to be an anesthesiologist So I did. I did so when the TEE was being used to visualize the chambers at the beginning of this really long case...which was the wrong time apparently... Well the first mistake was the surgeon introducing me as a med student, which is sweet, but I'm not. And who am I to correct said heart surgeon. I made the mistake of asking about the leaflets of the mitral valve (which I could see on the TEE) and that was this guy's cue to ask me 1003 questions in the next 3 minutes, 2 of which I had an answer for. I have watched TEE videos on U Mich website and Yale's website and in certain views, longitudinal for example, I can make out some obvious anatomy The one question that I thought I got right but was told to "guess again" was the following. Is mitral regurgitation a systolic or diastolic problem? We were looking at the valve at the time of this question and he was nice enough to show me the layout of the heart from this view. Reminding me to think Aorta then Anterior then posterior leaflet. (from right to left). Anyway, I thought a second and said Systolic. Actually, I'm not sure what I said, so I'm asking you guys. He said, "Guess again." So I got it wrong, that much I remember. But I forget at this point what the answer was. 6 hours of heart surgery followed, it was a long day. Can someone explain? I really thought that systole is when the LV contracts and fills the aorta, thus the higher pressure in the aorta in systole, when it's full of blood, than diastole. And I thought systole happens as the mitral valve opens, allowing blood into the ventricle, then the aorta? Is this right? If so, then when the valve closes, (but not fully during regurgitation,) it's during Diastole. So mitral valve regurgitation is a diastolic problem? What's the correct answer to this guy's question???? I would love an anesthesiologist to clarify for me if possible. Thanks, D712 p.s. my anesthesia nugget of the day was learning that protamine reverses heparin.