{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:38:34Z","timestamp":1787071114833,"version":"build-2736575974"},"reference-count":8,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>The \u201ccrossed swords sign,\u201d demonstrating the divergent jet, is visualized on 2-dimensional color Doppler imaging and indicates complicated mitral regurgitation (MR). We describe the cases of two patients with varying patterns of the crossed swords sign. In the first patient, the crossed swords sign was detected during the holosystolic phase. In the second patient, the direction of the MR jet changed according to the phase of systole: The crossed swords sign was formed by two regurgitation jets during different phases of systole. The crossed swords sign implies two patterns and is useful for the accurate diagnosis of complex MR.<\/jats:p>","DOI":"10.4103\/aca.aca_167_19","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T07:18:01Z","timestamp":1613114281000},"page":"499-501","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Two Patterns of the \u201cCrossed Swords Sign\u201d for the Accurate Diagnosis of Diverse Mitral Valve Regurgitations"],"prefix":"10.4103","volume":"23","author":[{"given":"Kazuto","family":"Miyata","sequence":"first","affiliation":[{"name":"Department of Anesthesia, NewHeart Watanabe Institute, Hamadayama 3-19-11, Suginami-Ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayaka","family":"Shigematsu","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, NewHeart Watanabe Institute, Hamadayama 3-19-11, Suginami-Ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,10,19]]},"reference":[{"key":"R1-20250921","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.echo.2014.01.005","article-title":"Intraoperative transesophageal echocardiography for surgical repair of mitral regurgitation","volume":"27","author":"Sidebotham","year":"2014","journal-title":"J Am Soc Echocardiogr"},{"key":"R2-20250921","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1016\/j.echo.2011.06.011","article-title":"Comparative accuracy of two- and three-dimensional transthoracic and transesophageal echocardiography in identifying mitral valve pathology in patients undergoing mitral valve repair: Initial observations","volume":"24","author":"Ben Zekry","year":"2011","journal-title":"J Am Soc Echocardiogr"},{"key":"R3-20250921","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.echo.2006.11.030","article-title":"The crossed swords sign: Insights into the dilemma of repair in bileaflet mitral valve prolapse","volume":"20","author":"Beeri","year":"2007","journal-title":"J Am Soc Echocardiogr"},{"key":"R4-20250921","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1053\/j.jvca.2016.08.027","article-title":"A case of divergent mitral regurgitation jets","volume":"31","author":"Amador","year":"2017","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R5-20250921","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1213\/XAA.0000000000000937","article-title":"Crossed swords sign: A 3-dimensional echocardiographic appearance","volume":"12","author":"Gao","year":"2019","journal-title":"A Pract"},{"key":"R6-20250921","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJM199907013410101","article-title":"Prevalence and clinical outcome of mitral-valve prolapse","volume":"341","author":"Freed","year":"1999","journal-title":"N Engl J Med"},{"key":"R7-20250921","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.jacc.2015.10.098","article-title":"Effect of recurrent mitral regurgitation following degenerative mitral valve repair: Long-term analysis of competing outcomes","volume":"67","author":"Suri","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"R8-20250921","doi-asserted-by":"crossref","first-page":"322","DOI":"10.5761\/atcs.ra.15-00145","article-title":"Robot-assisted cardiac surgery","volume":"21","author":"Ishikawa","year":"2015","journal-title":"Ann Thorac Cardiovasc Surg"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.ACA_167_19","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:41:41Z","timestamp":1787067701000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.ACA_167_19"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10]]},"references-count":8,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_167_19","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10]]},"assertion":[{"value":"2019-11-05","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-03-09","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}