 Okay, step five in the process, assessing the valves. Now I really do, this is kind of like the black blood one. I really want you to focus on this one. I mean, I want you to focus on all of them, but this is one where I see people run into trouble sometimes. So what we're gonna do is we're gonna assess the mitral and tricuspid valves. Now we're not gonna be doing, you know, stuff like you would do on an echo where you're measuring velocities and things across. But what I want you to know is that we're gonna look at the leaflets themselves. So spine descending aorta, left atrium, left ventricle, that makes this the mitral valve. Right ventricle, right atrium, that makes this the tricuspid valve. So just watch this for a couple of seconds. And you can see that there's a leaflet here and a leaflet here that's opening and closing. You can see that there's a leaflet here and a leaflet here that looks like it's opening and closing. That's all I want you to notice that there are distinct and separate valves here. Let's take a look at this one. Spine descending, spine descending aorta, left atrium, left ventricle, so mitral valve. I see a separate and distinct valve here. Right ventricle, right atrium, tricuspid valve. I see a separate and distinct valve, separate and distinct from this valve. So why are we focusing on that? And that's because of this entity right here. And this specific case was missed. And I'll go into a little bit why in a minute, but it's generally because someone didn't take the time to just that extra three seconds to really just look at the valve. So spine descending aorta, left atrium, left ventricle, right ventricle, right atrium. Well, first off, I'm not really seeing an atrial septum here. So I can't really compare the size of the atria, but you have this patent frame in a valley and sometimes it's hard to see. So you might not catch that, but here's where the mitral valve should be and here's where the tricuspid valve should be. If you pay attention, there's actually one giant mono valve that just keeps opening and closing. And I'm gonna pause this. So right here, we see a giant opening in the heart. There's basically nothing there right there. You open, it pops open, it pops closed. It pops open, it pops closed. This is an AV canal defect very associated with the Down syndrome. And here's why it's a problem. You have an image like this or a cine clip like this. And this is why cine clips are so important. They're so important for so many reasons. If you are doing ultrasound, particularly fetal ultrasound, without using cine clips, you are asking for a disaster. I'm telling you, it is absolutely critical. I'm gonna do a quick aside. I think some people don't do cine clips because they think they're gonna miss something on the cine clip and not see it. I guarantee you that 99.9% of the time, the cine clip is gonna help you not hurt you. So the sonographer could take a couple of pictures here. They can take the one with the valve open. They can take the one with the valve closed. A sonographer is trying to give you a picture that looks normal. If they're an experienced sonographer and they've seen this a bunch of times, they're gonna be like, oh my God, there's an AV canal. But the more inexperienced sonographer is gonna be like, I can't get a good picture of the heart here. Oh, I got a good one. Freeze it, done. So you're gonna say spine descending or left atrium, left ventricle, right ventricle, right atrium. Yeah, maybe you'd pick up the fact that you're missing a septum here, but like I said, there's a preten frame in O Valley. So maybe you'd pass it. I don't know. The ventricular sizes look about the same. There is another finding on this case that we will talk about later that would help you out here. But again, you need all, you need every opportunity you can to catch these things. So anything you can do to help yourself not miss these is gonna be critical. And again, this, which is a huge anomaly in the heart was completely missed. Just gonna give you another example, spine descending or to left atrium, left ventricle, right ventricle, right atrium. You can see here, there's this kind of large mono valve. If you stop it there, you might say, okay, left ventricle, right ventricle, left, sorry, yeah, left atrium, right atrium. Okay, I'll pass that. If you're going through quickly, you might pass that. If we look here though, and you're trying to see, is there two distinct valves? You see here, when this valve opens up, there's just a giant gaping hole. So, I don't see two distinct valve. And part of it isn't just to see the valves, but it's to give you a step in the process where you specifically evaluate for this entity.