# Beat the Heat Part 2 - Answer

## Metadata
- Content type: Blog
- Canonical URL: https://123sonography.com/blog/echo-summer-challenge-1-answer
- Published: June 21, 2022
- Last updated: June 18, 2024

## Overview
Here is the answer to our second "Beat the Heat" Challenge.

## Snapshot
- Category: Case

## Authors
- [Univ. Prof. Dr. Thomas Binder](/speaker/146) - Medical University of Vienna and founder/CMO 123Sonography, Webinar Moderation

## Tags
- Echo

## Related Courses
- [Echo BachelorClass](/course/echobachelorclass)

## Content
The correct answer is:

## Surgical chord replacement + Annuloplasty

![](https://123sonography.com/sites/default/files/styles/article_image/public/SC%2001%20Chordal%20replacement%20answ.png?itok=Txr754rO)

The echo shows a patient with myxomatous mitral Valve Prolaps (M.Barlow) who had severe mitral regurgitation. He then underwent mitral valve repair with an annuloplasty ring. But he also had artificial chords (neo-chords) implanted.

Mitral valve replacement usually involves resection of the diseased segment of the mitral valve (i.e., quadrangular resection). In contrast, Chordal replacement is a „non-resection technique “ where artificial chords are placed between the papillary muscles and the free edge of prolapsing segments. This technique can be applied in numerous forms and morphologies of mitral valve disease. In addition, Leaflet mobility and the geometry of the annulus are preserved.

On the echo, you will find the following findings: 1) typical characteristics of artificial material (polytetrafluoroethylene) and 2) a bright echo at the tip of the papillary muscle. 3) annuloplasty ring.

Don't start sweating when you have to make this diagnosis! Get your course now and beat the heat with us:

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**Yours,**
**Thomas Binder and the 123sonography team**