 Welcome. Thank you, Mike. Great to have you here. Wendy, and that looks like the whole gang is here. Jehovah, I think we're ready to go. Perfect. Mike. Thank you very much. So for, for the, for the audience, thank you very much for joining us, especially after, after, after a very interesting sessions that we have had like this morning. After the lunch, we were thinking in, in lunch in this session, and just thinking that if Indiana Jones is able to actually do his own sequel, like many, many years ago. And then repeat it today in the cinema have success or partial success. I think that we can always have a nice section about the forgotten ball. So that's what we are here. I think that I got the ball is almost everywhere forgotten about like most of the kindness don't talk about it. And I thought it was actually an interesting discussion. And, and we try to brought in like various specific members of the international community to actually be able to, to, to give us like a feedback, but from the Toronto group. I think Mike is going to introduce our lecturers. And I think it's, it's going to be a great discussion. So with no part of the notation. We will review the, a couple of clinical cases just to prime the session. I will show the cases with you, we will not discuss the cases that we will go to the presentations. And, and then we will in the Q&A talk about what will we do with those cases and open the mics for the, for the attendees to be able to actually do the Q&A. So, Mike, I'm going to actually start with the cases. Okay. And then we will talk about the behind this after. Okay. She's very quickly and sharing my screen here. We are perfect. Okay. So, so soon three try cast about, we're going to be talking about decision making and then choose presenting a couple of clinical cases. Regarding like the presence of try cast your reputation when we do surgery for the mitre above on when we do other surgeries and how, how the team thinks that we should actually act in those situations. We have no conflicts of interest to discuss with the audience. And as, as we choose to discuss that what we are going to be talking regarding the objectives of this presentation. Let me just start like the first case that we have is a 59 year old women that the best actually presented to our hospital with a total taxes syndrome. If some of the audience are not familiar. It's normally like a normality where the internal drug or domino organs. They have a different arrangement on the left to right axis of the body. And that's a fever relation severe degenerative mitre above. And in the echo report from the pre operative period, and it was actually done no more than two months before the surgery. The report was that she presented with my, my PR. And as we start to actually examine, you can see the pathology in the mitre above, but that's what we are not interested. We can, we can actually see this modified for chamber view where we can see the amount of the capital regurgitation that we have. So we pay a closer look, we got been a contract of point five. We did the RBS piece of 29. We measure the pieces of radios. We did our calculations. And at the end we got a better contract of point five pieces of radio point six, a calculated effective regurgitation or if it's a point four, and a regurgitation volume of 32 minutes. So we went a little bit further to analyze the tricuspid valve. So we went into the 60 degree angle. And then we got those pictures. We keep a screening through the Bob, we went to the 90 degrees angle. And that's the amount of TR that we have here. And then a contract almost point five RBS piece a little bit elevator with a better plane alignment with either again the piece of radios. And basically we obtain almost the same, the same numbers in a modified by cable 110 degrees, probably you can see that the amount of TR is significant. So that's how this tricuspid valve looks. And again, we repeat our measurements the main gradient through the ball one zero. We went into the apathetic pain, and then we got to study reversal. So this is a tricuspid valve in 3D. And what we could see is this mark up patient, the posterior leaflet. And the jet that the leader actor. So this is the first case, we are not going to comment anything on that case until we finish the presentations. And then we are going to go quickly with the second case that we are going to present. This is second case will be like a liver transplant candidate 67 female. This is secondary to fuming and apathetic failure hypertension chronic kidney disease. The D3 show like an asymmetric left ventricular hypertrophy, like a certain 15 millimeters normally F with the post valve salva like a huge gradients and Sam right ventricle that was normal and a trivial tricuspid regulation. This was done probably four months before the transplant. So the indication for interpretive T in this liver transplants was interpretive monitoring because of the Sam and the gradients and the asymmetric left ventricular hypertrophy. When we went into the case. Those were those were our first pictures as you can see this ventricle how thick it is. The patient was appropriately better look at the time. And then as you can see there is no Sam here. And interestingly, though, when we put color, we see that despite not having that Sam, we still have some minor regurgitation. We went into assess the right ventricle. And as you can see here, this right atrium is massive, you pay attention to the internal acceptance bulging towards the left, every single time that this atrium is failing. And here the precasted annular was only 3.5 in this patient. And then there was no PFO, but you can see how this atom is bulging every single time that the regurgitation from the tricuspid valve, which is quite significant. And in this case. So we did a measurements, depending on the contract that was up to two centimeters. RBSP estimated around like 44. Again, we take more pictures, like we increase our angle to 60. We have says the amount of regurgitation that we have here we didn't even need to know to move the baseline to see that there is flow convergence in this in this yet. And again, the radius was 1.1 for the piece of radius in the TR. And when we did the calculations, the fact of regurgitation or if it's 1.3 centimeters to the square and the regurgitation volume 60 milliliters. Compatible with severe the cost per regurgitation. We went into the liver. Check. And obviously, there was systolic reversal of the veins. Post on clamp after the, the liver was in place. We reassess. Again, the tricuspid regurgitation, you still have like a massive benacontractor, systolic flow regurgitation from the apathic veins. And going up in different angles, we still have what we consider severe TR, same calculations, the arrow here was point seven. But no matter what like regurgitation volume 55 still considered this severe. So we are going to stop here and get those cases into the back of your mind. We are going to go ahead with the presentations and Mike is going to introduce the speakers now. Thanks so much Jehovah that's terrific. Always great to have cases to get ourselves thinking about the topic. And I really wanted to say thank you to the audience for sticking with us for the last session of the day. It is great to have you here. Dr. Moreno's created an excellent program on the evaluation and intervention decision making regarding the trust. It's going to be my pleasure to introduce our speakers to you.