Intellectual University. Today I'm going to show you my kind of project about eye-tracking application that I'm using deep learning to do so. So the problems I'm trying to solve is I want to address the difficulties of patients or any people that are suffering from complete paralysis or some people that they were born with no limbs, no hands, no legs and basically they can do anything. So they can just like lying on the bed and you know staring at the ceiling fan. So I'm trying to help them to actively control their daily activities by using their eyes. The eyes movement I think is the only thing left that can move within them. So what I'm trying to do is to build a VR headset. It's not actually VR, it's just like a DIY VR that it has a camera over here. The camera is pointing directly to the eye, one of the eye. This one is the left eye and then the camera will monitor a video based data and we will send it to the Raspberry Byboard over here to predict. It will predict on six labels where to monitor like whether the person is looking to the left, the right or whether he is like looking up, down, center or blinking. That's why we need a video based data such kind of like a sequence of images. So we're going to use the labels and we're trying to control a wheelchair. This one is just a demo. So this is a Raspberry By Robot car that I built to control through the label wirelessly. And also this is another application. We can use the sequence of labels as a passcode just like a digit to unlock something. Let's say unlock the phone, unlock the garage or unlock the door for them. So how do I collect the data? Unfortunately, I couldn't find any public data that satisfied my requirement. So I create my own. I use the IVR headset, the device to collect the video based data. So each data boy is actually a sequence of 15 image sample over one second. So it's actually 15 FPS. And it's all contain six labels as I mentioned above. And they are all balanced because I intentionally do it. And I also samples from five different persons. Actually, I sample on my eyes the most like 60% is from my eyes and the rest is from my friends. And each session of data collection will last like 15 seconds. So within 15 seconds, you have to stare or you have to look at one direction or doing the same action within that 15 seconds. So after that, 15 data points will be created. This is a very expensive, very like a health damaging process that is I'm not going to encourage, but well, and after a very long time of data collection, I just only get like 3000 data points. Yeah, this is like my is 60% of the data. And the rest four of them is counted for 40%. So this is what the data look like a sequence. This is a blinking. So you can see an image like some of them are closed. Some of them are open. So blinking. So this is the models I'm use. I have to make sure that models is more enough and lightweight and fast enough to be deployed on the Raspberry by board, which is very slow. So I have a convolutional recurrent network. So each data frame, each image frame could be fitted into a CNN to extract some sort of features. And the sequence of features will be fit into a bidirectional LSTM to predicts the label and the soft mag layers. You can see the CS, the CNN blocks contains like a six convolutional layers. And each convolutional layers, I do convolution, batch normalization and activation. I don't use any pooling a way. So the inputs image is like 64 times 64 times three at a bottom. Okay. So I'm showing you the result validation and the testing, which is quite surprisingly good. So when I train on my own data itself from my own eyes, the accuracy is very, very high and losses also very slow. It's very, very low.  Note that this is the validation and the testing set. It's not the training, training accuracy. And also my data and my friend's data counted into like 3000 data points also get quite similar result. I also do data augmentation too. So is that something wrong? You may say like you must be something wrong with this. You have a very limited data. How can you get this high accuracy? I also very doubt. So let's try it out. I have a demo over here. Where's the mouse? Okay. So this is a demo that I try to do real-time testing controlling the car with my own eyes. I don't use any others. It's quite impressive. Like in real-time testing, I can estimate that it does make some mistakes, but real-time testing is quite like 90% loss. This one is trying to predict a sequence of labels coded as a passcode for you to unlock something. So over here, I try to replicate this example. I look to the right, up, right, and left to open the lock like that. So in real times, it's worked quite impressive, but there's a problem. It do has a problem. So let's pass through it. The problem is it only worked for me. Well, it makes sense if I train it on my own data, if I only use my own eyes. So that demo just now is that I train the models with just my eyes. But after that, I decided to collect my friend's data too. But first of all, it completely make a guess from other people. Other people's strangest eyes and sort of. And also it also fell on one of my friend's eyes. Even their eyes is inside the data, the training data set. Well, it also performed very bad in dark conditions or very strange lighting conditions like different lights or in the outside or indoors, outdoors, etc. Well, some of my friends like she has a very big eyes and it does improve a little bit. But the others, they have very small eyes, then it have no clues at all. And it fell on me too. After for a while, I didn't have a haircut. So the hair just covered my eyebrows and it fell too. And it is also very sensitive to orientation change because the eyes, the direction that you see may not align with the direction of your head. And the direction of your head align with the direction of the camera. So let's say I'm in this direction of my head, but I'm looking some over here. Then in the from the camera point of view, the direction of your eyes change. So the label just make a random guess, which is very bad too. And one interesting properties is that the softmax core is only goes to extreme, which is very strange. But I think this accounts for the problems. So whatever the class it picks, whether it is right or wrong, it always choose a high, very high score. Let's say if it correctly predict a label, then the score for that label is usually goes to 99.999 or maybe 1, 1.0. The rest of the labels called maybe like 10 to the power of negative 8, 7. Even though it predicts it wrongly, let's say it predicted as blinking, but it's actually center. The score for blinking is also still very high. It's like 0.999, which is not going to make sense. If let's say it's like if it predicts it's at blinking as wrong, it should have a very low confidence like 0.5 or something. So this is a very weird phenomena, but I'm trying to figure it out. So the problems that I'm trying to pinpoint is that it is a lack of data, only 3,000 data points, super old feeding. But more interesting is that it works well on the validation and the testing data, which is more weird. The problems is also because of the data set are so similar. There's no much diversity on the data set because I collect the data from just on my eyes and also that the lighting and the lighting condition, lighting condition are just like sometimes I sit in here, sometimes I sit in there, not much everybody, every place else. I didn't do outdoors. So it doesn't have much diversity or in the data set. Yeah, the same, the same point. So data points, each data points are so similar, despite that it is all unique, I check. I really ensure that it is unique, but it is so similar to each other. Maybe the data set didn't cover the true distribution because I only collect my eyes and my friends what the 7 billion others to. So it may not cover the true distribution of the problems at the same point, sorry. So I do pinpoint, I group up all the problems that I think it might be, it comes to the fact that it has a really lack of data. So I try to increase the data by using different techniques. You can see first I do data augmentation, I randomly rotate, I translate some of the image, I change the brightness, I change the contrast, etc. I also generate new images using an animated tools, very cool tools called Unity Eyes from Cambridge University. It has the ability to generate like an animated, as you can see, animated version of the eye. It can look around like that. So I can increase the total numbers of data points to 6,000. And I also use the generative adversarial networks to generate fake image for the training, but actually I didn't include it into the data set because as you can see over here, it was, yeah, I see on the right is the generated fake image. It doesn't really realistic so much that I put it into the training set. So what are the solutions? Actually I don't know. I'm looking for a solution. Yeah, that's all. I hope that I can find a solution from all of you talents. Thank you. Do you have any questions? Yeah, do you have any questions or answers? Okay. Have you tried to look at the ender use of heavy layers, for example, without training? It would be the end. Okay, there is existing models for the admission of position of the eye. The addition of the eye, right? And you can use, for example, four layers of this model, and the advantage is your model training, not from scratch. Even transfer learning, kind of that. I would try it because I have a constraint is that there's a many great models that I can use for transfer learning, but they are usually very big, very large, and I want to fit it into a Raspberry Pi or which is quite an impractical. It consumes a lot of memories and a lot of computational time, which is unsolvable by the Raspberry Pi. So, I didn't do that. Yeah, correct. I'm also thinking about that, but at the development time of this, I'm thinking about the productions, and I'm also thinking about deploying the models on the computers or some powerful computers. But let's say you still have to transfer the information, a sequence of images, the data to the server or something else, and that may be a latency, maybe slowing down the process of the things. So, maybe it's predicting the models on the Raspberry Pi, maybe faster than transfer the whole bunch of data to some servers and get the result back. So, I didn't. I would think about it and I would try to see maybe it better if we can use it. But another point is that I don't want to make the models big or large because it can easily overfit the data because I don't have much data and data collection is very expensive. So, here's a post that you can go home and check out. This is from Apple and it's basically using GANs. So, just use a better quality GAN. Apple had the exact same issue. So, yeah, if anyone's interested, this is on the Apple has a blog that basically shows some of the research papers that they're doing inside Apple and stuff like that. And one of their first, in fact, I think it was their first one, was basically using GANs to come up with IXs and Qs. Anyway, that's a great talk. Thank you.


Hi, I'm Christos. I'm from the Green Team, the award-winning Green Team, by the way, and I'm here to help you who are properly served through your trash. You may be like, but Christos, why is that such a big deal? It's just trash. Well, here's the thing. When all that trash gets put into recycling, it all gets thrown away. And as for the compost, the same story. None of all that food becomes soil. It all gets thrown away. Now, enough of me talking. Let's go search for it in the real world. Oh, perfect, our recycling bin right here. Let's take a look to see what's inside. Okay, looks like we got some pop corners. Someone's been snacking on those. Those definitely belong in the trash. Oh, looks like we got some wipes too. So any wipes, tissues and paper towels, those all go in the trash. So we got a lot of papers, which is good. People are using the recycling bin. Oh, look at what we got here. A glue stick. These go in the trash. Now let's look at the trash. Well, it looks pretty good except for that paper. Paper definitely belongs in recycling. All right, so let's check out the compost. We made a sign right over here that says please don't put trash in the compost bin. Let's see if they worked. So we'll open them up. Wow, that is a lot of trash.  Just because there's food inside of it doesn't mean that it should go in. In conclusion, we'll give you five tips for waste sorting that you can use in your everyday life at home, at school, anywhere, but one. In the trash, please keep it out of the recycling bin or compost bin. Gum is made out of artificial materials and it cannot break down and make nature so it has to go in the trash can. Wipes, tissues, and paper towels must be thrown out, not recycled. Even though they're all paper-like, that still doesn't mean we use them. Juice boxes belong in the trash, not recycling or compost because milk cartons and juice boxes have flats in them. That isn't good for the compost bin or the recycling bin. Good trays and paper trash bowls go in the compost and it should not go in the compost, it should go in the recycling or the trash. You want to endow the soil without. If you don't know what something is, it's better off throwing it out than risk it contaminating the recycling bin or the compost bin. In conclusion, sorting through trash can be pretty hard, but every small action you make can make a big difference. So thank you for watching and don't forget to be unified, understanding, and unstoppable.


Hey, this is a Cristiano Ronaldo workout. Now, if you're searching for that, I'm probably assuming that you're trying to get the Cristiano Ronaldo physique. And the truth is, if you wanna get that physique, you have to get your muscles a bit bigger. You're probably gonna have to do some weight lifting because there's only so much you can do with body weight exercises. You can get ripped, you can get very toned, but as far as building bigger muscles, you're gonna have to lift heavier weights. So if you want advice on that, just go to my channel and search how to build muscle or strength training or gym workout. I got a couple of videos with weight lifting exercises that you can use to get a little more size and mass. But this workout is great for getting in better total body shape.  And in this workout, I'm actually focusing on doing a very slow eccentric or down movement.  That'll make it a little more challenging and you'll get more out of these exercises.


Hi everyone, Myself Supriya Apasnoor working as an assistant professor in civil department from Walton Institute of Technology, Solaapur.  These are the learning outcomes. At the end of this session student will be able to draw the neat drawings of different building components such as the door, window and the staircase. So out of this I am just going to tell you about the door. So this is the given data. The frame size that is the window door opening. The size is given to you as 1000 mm by 2000 mm. Next is the post that is 60 by 1000 mm sorry 60 by 100 mm, top rail 100 by 35 mm, the freeze rail 100 by 35 mm, the lock rail 180 by 35 mm and this is the bottom rail that is 200 by 35 mm. And finally we have the styles that is the vertical members which are the called as the styles 100 by 35 mm. So these are the inputs of the door frame. So door frame actually it includes all the horizontal and the vertical members which have the top horizontal members and the vertical members, bottom members. So according to the input given to us that is the rails. You have actually the top rail and the bottom rail and all the intermediate rails they are called as the freeze rail and lock rail is the arrangement of the lock, the locking arrangement where it is done that is called as the lock rail. So these are the intermediate rails. So depending upon the input data given to us, we are going to decide how many panels are to be provided in the door. So as we have the top rail, the freeze rail, lock rail and the bottom rail depending upon that we have decided that it is a double shutter door and six panels are to be provided in this type of the door as we have the lock rail and the freeze rail. Suppose the input would be given to you as top rail, the lock rail and the bottom rail. So in that case we will be going for the four panel door. So depending upon the input given to us we have decided that it is a six panel door and the double shutter is given to us. So actually for the doors we have the head of the frame and the seal of the frame is also given to us but in many of the doors the seal is not provided in the doors. The seal is provided for the windows and in the doors the seal may be provided or may not be provided. So here we have the head of the frame that is the topmost member of the frame. So as with the clear opening of the frame is given to you as 1000 mm by 2000 mm that is it is one meter and if you convert it into meter it is a one meter by two meter height. One meter is the width of the opening that is the clear opening of the frame and this is the height of the frame which includes the head of the frame also in that. So here we didn't consider the seal of the door. So directly on the floor level itself the door is fixed. So here you can see that the door it is not inserted immediately. So a gap of 6 mm is left on the top of the floor so that the doors can be easily closed and opened when they are fitted. So next you have the head of the frame. So the head of the frame the size is given to you as 60 by 100 mm. So 60 is the height of the door and the 100 mm will be the thickness of the door which will be seen in the section when you take it. So now just I am going to explain you the elevation of the door that is the plan of the door. So next these are the projections you can see the projections which are taken outside over here that is it is called as the horn. So this projection it is the horizontal projection which is provided in the top and the that is the head of the frame and the seal of the frame also. So this projection it is around 15 cm. So these horizontal projections they are taken outside so that it will be embedded into the side walls so that the frame can be fixed over there. So next we have the hold fast. Hold fast these are the hold fast which are provided 3 on each side. So for the door actually the hold fast they are total 6 in number whereas for the windows there are 4 in number. So the hold fast they are made up of the mild steel flat bars they are of a section 30 mm by 6 mm and of length 20 cm. So they are fixed so that and they are in bent up at the right angles to each other that is one end of it. It is connected to the vertical member and the other end it is embedded into the wall. So next you have the top member it was the head of the frame and to the side you can see this is the post. The post size is given to you as 60 by 100 mm. So take the width as 60 mm over here and the thickness will be 100 mm which will be seen in the section. So overall now the frame thickness the frame which you have the overall thickness of the frame is 60 mm here the head the we have shown the head of the frame that is 60 mm height and this is the width that is the post width it is shown as 60 mm. So overall now we have fixed the frame size. So now next data we have the top rail and before that we have to see whether the any vertical member is given to us. So in that the vertical member is the style. These are the styles which are provided at the at the outermost that is outside of the frame. This is the outside of the frame that is the styles here you have to take the dimension as 100 mm by 35 mm. So 100 mm is the width of the style. This is the width of the style which has to be taken from this dotted portion. The dotted portion it is called as the rebate from that dotted line itself you have to take the measurement as 100 mm and take the vertical line that is the vertical member which is called as the styles. So on both the sides that is the left and the right side you have to take the vertical member which is called as the style. So this dimension the width of the style is 100 mm and 35 mm will be the width of the style. So before that just I will tell you about the scale what I have taken. The scale is 1 is to 10. That means if suppose you have the dimensions in meter that is 1 meter by 2 meter size. So you have to first of all convert that meter into centimeter. So 1 meter multiplied by 100 you convert it into centimeter. So 100 centimeter and divide it by the scale that is 10. So you get 10 centimeter. So this is how the scale has been converted. So likewise you have to draft it by the mini drafter. Now I have shown you the pick only. So but while drawing you have to use the mini drafter as you will get more fluency in that. So next you have the next dimension that is the vertical members you have drawn that is the styles and in the middle now after drawing the vertical members styles and the post just measure the distance from this corner to this corner this one two corners of the just count the remaining distance how much it is and then take the center mark the center point of that and then the vertical line is drawn and beside that you have to draw the dotted line which is called as the rebate line. Rebate is nothing but a depression which is made of 12 mm wide and the depth of that will be the same as the thickness of the shutter you have. So just the dotted portion is shown throughout the frame on one side it is shown this is the dotted line which is called as the rebate. So from that the dotted line itself you have to count 100 mm distance and mark over here and then from the dark line which you have drawn from that you have to measure 100 mm and mark the other point that is two vertical lines you get. So these the remaining the member which are shown in the vertical lines that are called as the meeting styles as they are meeting one another they are called as the meeting styles so that both the shutters can be closed easily. Next after that you have to see what the top rail dimension is given to us so the top rail dimension is given to us as 100 by 35 mm so 100 is the height of the rail and 35 is the thickness so from top of this that is the below below head of the frame you take the width as 100 mm and mark this point so that you get the top rail dimension that is the width of the top rail as 100 mm and then draw this line just mark the top rail dimension and after that you have to mark the bottom rail dimension that is first of all take the distance from the top rail and the bottom rail the bottom rail dimension is given to you as 200 by 35 mm so take this height as 200 mm so likewise just you have plotted only two lines that is the top most and the bottom most two lines you have drawn so now you have to insert the lock rail the size of the panel is not given to you but the thickness of the panel is given to you as 3 mm this is the thickness what a what is given to you the thickness of the panel is given to us that is 3 mm so before that just try to insert the locking arrangement over here so for that I have taken the dimension as from the floor level itself I have taken as 800 mm and mark this point this point I have marked so that this is the overall height of the first panel right so the height of the panel is not given to us so you can vary the height of the panel or else you can either keep the size of the panel equal in all the panels all the three panel all the six panels you can keep the height of the panel same it depends upon the architectural view and all okay so just I have taken the dimension as 800 mm from the floor level itself and mark this point so that I have got the dimension height of the panel over here so then after that the locking arrangement I have found the locking arrangement size is given to you as 180 by 35 mm so from this point itself 180 that is 180 I have marked that is 1.8 centimeter and then drawn the horizontal line and then I have calculated the distance how much is this from the top rail to the lock rail so you divide it into two parts I have taken the center line of that and from that the freeze rail dimension is fixed that is 100 mm by 35 mm so likewise these are the panels which have been drawn so the locking arrangement which which shall be provided in the lock rail itself so that it can be easily reached at a desired level height of the person so this is the locking arrangement which is provided so this is what the front elevation of a fully panel door is so all these dimensions they are in mm and the scale is 1 is to 10 so here are the MCQs given the middle horizontal member of the shutter is called dash first is the median rail second is the mid rail third is the sealed rail fourth is the lock rail hope so you have got the answer for this this is the answer for that next which of the below doors is generally used in the residential and the office buildings first is the flush door second is the rotating door third is the lower door fourth is the hinge door hope so you have got the answer for this yes flush door is the right answer these are the references thank you


Cooled by this not to wait till it's too late and this might seem like a bit of a cliche But we should live as if this very day this very minute could be our last You know and think well if I knew that this was going to be my last day. What would I do? and And to do it because you know it is a reality Sooner or later this day could be our last it could be this very night that we're cooled away And to think would I in what decision would I make if I knew? That I'm not going to get a second chance when we think about every single thing we do We're sure to make the decision which is going to to keep us on that path which will lead to eternal happiness You know often we do things thinking it doesn't matter so much because you know I'm gonna have extra time I can always correct things I can always make up for it at some future point in time that I'm always going to have a second chance But we're not we're going to have a second chance


Well, good morning everybody and welcome back to the 2023 Toronto Perry operative Echo Symposium and to those who are just joining us today. Greetings. It's Sunday, so I'm sure there'll be a few late comers, but we're going to start and try and stay on time today. Next line my name is Annette Vegas and I'm a staff anesthesiologist at Toronto General Hospital and chair of this year's planning committee. I would like to acknowledge and thank members of this year's planning committee for their efforts in contributing to the development as well as participating in the meeting. You met many of these individuals yesterday and you will meet more today in their role as curators and moderators. A special thanks to Sarah Russell, who is the conference coordinator for tying together all the loose ends. Next slide. As I mentioned earlier this year, we tried something unique by thinking outside the box and creating a virtual meeting representing truly the global expansion of echocardiography. I hope you enjoyed the international faculty that presented yesterday. They were truly multidisciplinary with anesthesiologists, surgeons, cardiologists, internists, critical care physicians, and today we'll meet some emergency medicine physicians. They are experts in their field and they're forefront of research and writing guideline papers. They are leaders and most of all they're passionate speakers. The speaker bios are available on the website, so check it out and learn a bit more about these individuals. Again, many thanks to the speakers for taking time out of their busy schedules to create and speak at this meeting. Next slide please. On day one, next slide. We covered three sessions on the left ventricle, extracardiac, tricuspid valve with groups from Europe, Montreal, and Toronto presenting. These were excellent sessions with great talks and stimulating discussion. I hope you enjoyed these sessions and importantly learned information that you can put into practice. For those of you, myself included, who need more time to digest the talks, remember the recordings will be available about 10 days after the meeting closes for you to review at your leisure. Next slide please. Today is day two. Next slide. And today we'll be covering three additional sessions on the mitral valve, structural heart, and focus. We welcome groups from South America, Boston's and individuals from across Canada and the US during the focus session. Next slide. This meeting is accredited by the Canadian Anesthesia Society for 12 hours of credit. Please remember to fill out your evaluations for your certificate of attendance. We will post a link to yesterday's evaluation as well as today's evaluations in the chat. Please take the time to fill out your evaluations today. The evaluations are important to tell us what you thought of the meeting and importantly to help plan future meetings. The evaluations will be available through a link for one week after the close of the meeting. Next slide please. I'd like to reintroduce the team of Mahmoud, who will be working behind the scenes again today to make this magical meeting occur. Thank you so much, Annette. It's a pleasure to be here supporting the second day of this symposium. My phone number is listed here on this slide, but I'm also available through the chat throughout the day. We have session evaluations for each day. I will be posting the evaluation link for yesterday's day in the chat as well as the evaluation for today. On the screen there is a QR code you can scan, but I will also be posting it in the chat. We would encourage you to have the survey open in another browser and try to complete it throughout the day. At the end of each session we will try to repost the link, but we do recommend to have it open in another tab and get the evaluation done throughout each session. For this event, we are using the Zoom webinar platform, which has three elements of engagement and interactivity available. There will be a couple of polls in one of the sessions where you will be able to vote and see results. And we will not have access, so the participants will not have access to audio and video features. These are disabled to minimize disruptions during this webinar. Please use the chat and Q&A functions to communicate with organizers, presenters, and other participants. I would like to point out an important differentiation between the chat and the Q&A function. We encourage participants to use the chat functions for feedback and dialogue with other attendees. On the other hand, the Q&A button is where you will submit your questions and the moderators will monitor the questions that come in and ask them on your behalf during the designated Q&A sessions. Attendees can also upvote questions submitted in the Q&A tab, so the ones that will be upvoted the most will be answered first and priority. This is especially important when there are a lot of questions, but not enough time during the Q&A session. With this, I'm going to hand it over to the first session's moderators. Thank you. Thank you, Annette. Thank you Fatima for the introduction. Hi everyone. Good morning. My name is Sabyo Papa and I'm a cardiovascular and physiologist at San Michael's Hospital in Toronto and also curator of this session. First of all, I'd like to thank you for being here so early on a Sunday morning. Today is the second day of our Toronto Periopty Symposium. Yesterday, we had really great talks and this morning we'll be dedicated to the mitral valve and also structural heart procedures. Our first session starts with a minimally invasive mitral valve surgery, what the surgeon needs to know, and the key importance to guide the procedure, followed by functional mark, the key assessment and the surgical implications, finishing up with mitrist analysis. If you have any questions for discussion, please use the Q&A at the bottom of the screen so you can discuss them at the end of the session. Without further ado, I would like to introduce to Dr. Zamper who will moderate the first presentation. Dr. Zamper is a good colleague and friend. He is the Cardiac Anesthesia Program Director and Cardiac Anesthesia Fellowship Coordinator at the Western University in Northern Ontario. He obtained his M.G. from the University of Sao Paulo, Brazil, and also completed his anesthesiology residency at the General Hospital of the University of Sao Paulo. Subsequently, he completed his Cardiovascular Anesthesia and Periopty and also an ultrasound fellowship at the London Health Science Centre at the University of London, Ontario, where he currently works as a staff anesthesiologist and also is the director of the Cardiac Anesthesia Fellowship Program. Rafael, thank you so much for being here. I'm going to hand over to you now. Thank you, Fabio. I hope you all can hear me and see me okay. Yeah, I know it's a great pleasure for me to be here today. I'd like to first thank the organizing committee and Annette for the invitation. It's always a pleasure to be part of such an outstanding symposium. So, when we thought about this session, on minimally invasive surgery of the mitral valve, we decided to invite two speakers, one surgeon, to present their point of view and what they expect from our exam. And also one anesthesiologist with significant experience in tea for minimally invasive mitral valve areas to present their approach on the TE exam in a program that strongly relies on echo as a decision making to in all phases of the surgery. So without further ado, we'll start the session with Dr. Michael Chu's presentation. Michael is a cardiac surgeon at London Health Science Center in Western University, where he specializes in valve reconstructive surgery, aortic surgery and transcatheter valve interventions. He very much balances echo partners and feels that they are a critical member of the team, making better as a reconstructive surgeon as echo provides constructive feedback to evaluate outcomes and continuously improve. Thank you, Michael, for being here with us today. And let's start with this presentation. Hi, everyone. It's a pleasure to be here with you today. I'm pleased to be able to present to you with Rafa and Hilda, and I would share with you a little bit about how echo has an impact on mitral repair and minimally invasive approaches. These are my disclosures. So we've been fortunate in London to have a wonderful place to work and, most importantly, a great team. We've been fortunate to work with so many wonderful cardiac anesthesiologists, residents and fellows. And what we've been able to accomplish is that, you know, we have a very broad and wide offering for minimally invasive, including minimally invasive valveular disease, hybrid operations, general operations and endoscopic cordial heart disease, which we've been doing since 2000. And we've been able to do over 2400 cases and been able to achieve a really excellent oak on December. We're very proud of that. So with patients who come with mitral gregetation, we have the whole array to be able to offer them the open sternotomy repair, minimally invasive endoscopic repair, transcatheter edge repair, or some other transcatheter options. And what I'm going to focus specifically on are two areas, echocardiographically guided valve repair and the critical role of echocardiography and ensuring safe and effective minimally invasive access. So this is my area of expertise, endoscopic mitral repair, where we use a five millimeter, a zero degree or a 30 degree endoscope and use that to be able to repair the mitral valve with some long chapter instruments. And what I'd like to share with you is, you know, how we do this and, you know, in many cases for us insurgents, we oftentimes, particularly with our trainees, wonder, you know, how do you get from A to B. And sometimes things seem unnecessarily complex. And sometimes it's a related to surgical team experience, but you know, the reality is that when we go to meetings, there's a magic element that's created and there's unnecessarily complicating terminology and techniques. And the reality is that most mitral repairs are really quite simple. And most of them involve posterior lethal disease, single segment disease, and, you know, there are reproducible techniques that we can use to do these repairs. And in our center, we like to use Neoport A loop reconstruction and around 85 to 90% of the cases where we find that, you know, you can apply it to posterior lethal disease, anterior lethal disease, commissural disease, violation of disease, you know, any and all of these combinations and get very good results.  ECHO is really the hallmark to how we do the operations. And I'm going to show you here, what's really most important is that you go through and do a very careful and thorough segmental analysis, both on 2D and 3D and correlate the regression jets to the segmental findings. And it's this careful analysis that really can allow us as a surgical team to know the plan, the details to the repair so that we're not blind going into the operation. We should have a very comprehensive idea of exactly what we're going to do to each and every segment before we even get into the operating room or before the patients, before we start the operation. And here you can see this, this, this case, you know, yes, we can look at an examine the valve with our eyes, but I would argue time and time and time again that ECHO is far more accurate than what we can actually visualize with our eyes. And here you can see that based on the TE, I knew exactly that I need to force that the neoprene loops to the anterior to the posterior and following the midline of both between anterior and posterior and then the midline from the upper lateral and the mouth. And here you can see this sort of post repair result on the saline test, you can see a nice prominent valve. And most importantly, again, checking on the post-op repair ECHO and you can see that there's nice laminar flow and there's known as a double rotation with low gradients. So the most important principle that I'll talk about today is really trusting the ECHO and not your eye.  It's a functional assessment rather than trusting what we can identify on the arresting cart, you know, just by pulling on a leaflet with an instrument. And so this is where it's important that, again, I take what I learned on the ECHO and then I check after with my eyes, not the other way around. And what I can't stand or I don't like is the idea of heading into an operation without any idea based on what the ECHO beforehand. I think that's just going to blind, adding unnecessary risk and likely belonging to a cross plant at some time unnecessarily. So in terms of neocortin implantation, it's fairly simple as very important. You know, you choose the most adjacent top area muscle. It's the posterior-middle muscle attaching the neocortate into it and then using four broken suture to attach them to the prolapse in a flail segment, which you can see here with separate sutures. And it's really a nice, simple technique. And in this case, you know, I attached some leaps posteriorly and anteriorly because of the violet and prolapse. Which I think you can see here. And I'm able to achieve a nice sort of result in the salient test. But again, similarly to what I said before, the salient test is nice. But again, what's most important is trust the ECHO after, not the neocortin implantation. And the ECHO will tell you exactly to see, you know, is there any result of regurgitation? What's the co-optation height and what are the gradients and the most important things. So some simple rules don't cross the midline. Keep anterior to anterior, posterior to posterior. Don't disrupt the immune response. You're telling me in the ECHO that the length of the neocortes is, you know, there are lots of different ways to do this. But the majority of them will rely upon eyeballing and, you know, it's trial and error. And I make the argument that these measurements are made out of static, arrested heart. And that's why, you know, I think that oftentimes when you do that, you can result in neocortes that are too long or too short. Either way, results in visual recurrence, much regurgitation, heart failure in some cases, molestice. And so that's why I think that, you know, using an echo-based method to be able to identify the length is far more accurate. So we use minisoftial views between zero and 120 degrees. You need to be able to visualize obviously the flail segment, the adjacent papillar head, and then the opposing leaflet. And in most cases, the anterior leaflet. And it's really to develop a reproducible systematic way to predict the neocortae length to simplify its use of neocortes. So for posterior leaflet, perhaps it's simple. You basically need to rotate that posterior leaflet down and subtract the additional redundant length. And so basically, you measure x from the papillary muscle, the adjacent papillary muscle up to where you want the flail segment to collapse with the anterior leaflet. And you subtract that residual portion of the posterior leaflet. So x minus y equals the posterior leaflet neocortae length. So just to show you that again, here you can see your posterior leaflet flail. And you're going to rotate that down to meet with the anterior leaflet. So again, x, which is the distance from the papillary head up to the anterior leaflet, subtract the redundant portion of the posterior leaflet being y. And in many cases, you'll find that x will be on average between 28 to 30 millimeters, y will be approximately 10 millimeters, and again neocortae length is 18. For anterior leaflet prolapses, rarely as redundant, so it's simply just measuring from the papillary head to the posterior leaflet. And bi-leaflet prolapses is simply a combination of the two techniques. And you can see that in our experience, this measurement technique is accurate 90% of the time. And in the five other patients, we had to convert it through a resection technique, and they were able to repair it successfully. And let me show you an example. So here's an anterior leaflet, a flail patient. I measured a 23 millimeter neocortae. But you can see here there's a reversal of that jet. And so I was concerned enough that I thought this wouldn't be a durable repair. So I went back and measured by hand and made a 27 millimeters length and you can see that resolved through MR. And so my error in this case was that I accepted suboptimal windows where I thought that I saw the papillary muscle and I made the measurement. And it actually wasn't the papillary muscle. I just couldn't visualize it well enough. So it's really important to try and optimize those views to be able to see the papillary head, the flail segment and the anterior leaflet. You can see that the average anterior leaflet neocortae length is around 26 to 30 millimeters, whereas the posterior is about 10 millimeters shorter and around 16 to 20 millimeters. And the most important thing is the results. So you can see that out to almost nine years, there's about 90% that are still alive. But what's most important is that the freedom from mitral augmentation greater than two plus is 98% in nine years. So really quite good. Most of the patients in the MYJ class one or two and very few read-offs or valve-related complications. You can see here just of interest when I compared minimally invasive versus strontotomy, there was no difference in terms of quality of repair from recurrent MR, nor was there between survival. The second point is about how echocardiography enables safe and effective minimally-based access. And I can't stress this point enough. If you're going to do a minimally-based operation, you need to have superior echocardiography to help guide. So just in terms of the setup, we use a 20 degree lateral to keep this position. And what's most important is the team. And here you can see one of our anesthesia fellows and this is Jill, my right-hand woman and one surgical fellow here. And it's about teaching the team to each take responsibility for each portion and to be able to have a seamless transition and save significant time and energy. And so for cannulation, this becomes really important. So ECHO really can help to guide both arterial and venous cannulation and you need to frequently recheck. So this is where it's really important that ECHO is rechecked throughout the entire pump run. You know, every 30 minutes. So you check the order every 30 minutes, make sure there's no dissection. You check the right atrium to make sure the cannulas haven't moved. They're in a good place and that the right heart isn't filling up and that there's good venous greenage. So for the neckline, we use a 16 French percutaneous arterial cannula inside the internal injector vein. And we have a protocol to do this. And what's most important is that we check on ultrasound, surface ultrasound. We see both on short and long axis, the wires in the right place. And then by TE that the wires are inside the heart and the cannula in the right place. And then after that, you check that the venous drainage is actually working properly from the neckline. And you'll see it here.  And so there's a checklist and we go through this because, you know, it's a safety mechanism. We do this on every single patient. And we put in a neckline in every patient because of randomized trial that Dan Bainbridge and I had done several years ago where we looked at randomized patients to a neckline plant or unclamp. And what we found was that there's significantly improved certain view. There's significantly improved venous drainage and a much lower CBP. And from this, we feel that a neckline is needed to support cerebral venous drainage and subsequent brain confusion in each other patient. Additionally, we also cannulate most patients with a side graph on the arterial side rather than cannula to try and reduce the risk of dissection and to main distal leg confusion. Now, last thing is an important issue that I want to highlight is about avoiding a myocardial connection injury. And this is where echo is really important. So when you give cardioplegia, you need to be there looking at the looking on echo to make sure that you can see the root fill. That there's not that much AI and that the heart's not understanding because the AI is actually shunting the blood away from the coronaries. And this is really, really, really important. And every time you give cardioplegia, you need to make sure that you try and look by echo and that the surgeon looks with direct vision. And so that initial induction goes and the view on echo is really important to look for. And traditionally, most places do not look for this at all. Additionally, you know, one of the things that that could be helpful is, you know, there's all sorts of DRA tricks. And here you can see where I've ever paired the valve and fill that ventricle with as much fluid as possible, close up the left atrium and then vent all that air out through the audit route, which you'll see here. And you look by echo, you know, to be able to see how much air is left in the ventricle and keep venting it and move the bed around so that air, you know, kind of floats up before we're moving across. And this is a small work to really help. So in summary, echo is really key to planning and executing a perfect micro repair with careful segment by segment to the analysis. The surgical team should have a comprehensive plan for the upper repair, along with backup plans before starting the operation. Echo guidance is key for safe milling of use of access. And as, you know, echo priority for you guys with the eyes and ears inside the patient that needs to be monitored frequently and often to ensure safe operation. So I'll pass it off now to Hilda and Rafa. Thanks so much. Thank you, Michael for the great talk. And to follow, I'll invite our next speaker, Dr. Hilda Faro, associate professor of anesthesia at Western University, who will present the routine at the point and the point of view of the interoperative echo cardiographer in this case the cardiac anesthesiologist. Hilda is a cardiac anesthesiologist at LHSE Western and she was trained in anesthesiology at CES University of Columbia and cardiothoracic anesthesia at UBP University of Columbia. She also has a master's in professional education at Western University. Thank you, Hilda, for joining us. It's a great pleasure to have you here today. Hello, everyone. I would like to thank the organizers for inviting me to participate in this symposium and to Rafael and Michael to share this lecture with me. So today we're going to talk about what is what does the surgeon needs for the minimal invasive microbiome repair and how does it affect the approach. Already Michael touched in some of the objectives for this presentation. I want to try to cover the rest of them. I have no nothing to disclosure for this presentation. And basically I want to establish the difference from the tea perspective with the with the open mitral valve valve approach. So I want to salvage the three important important things. The number one is this the tea has is going to have a limited time due to the participation of the anesthesiologist in some of the surgical procedures, especially cannulations. And number two, the fact that we need to use one lung ventilation during the procedure and this is going to limit the quality of our images. And finally, that in order to answer all the questions from the surgical surgical team, we need to have focus exam to be able to be time efficient. So through the years we find out that the base approach to be able to accomplish these goals is through a step by step approach. We divided the echo and three different and sorry, four different steps. The step number one is before the neckline is place. The second step is the placement of the neckline. The third step will be the assessment, the preoperative assessment and the IBC cannulation. And lastly, the assessment of the match of our repair. So for the first step, we need to keep in mind two things. The first one in our institution, we count with the support of tea person that is dedicated just to do the teas during the day so that person is the one in charge of the tea images. The anesthesiologist in the room is the one performing the procedure. But we use the same machine for the whole case. So during this step of the tea, both lungs are going to be ventilated. So is the quality of the images is going to be the best. That's the reason why we dedicate this time to the more critical information, which is to confirm the matriculation mechanism to measure the new cordae, which is the basic technique that our surgeons use in the institution, as is our tick valve and the tricuspid valve to adjust the surgical plan. So for this first step we use a lot of 3D images. We have a very good cardiology lab that provide us with excellent echo images for the surgeons to plant in advance the surgical repair. And because the time is limited, we found that 3D provide us with a significant amount of information to try to adjust and modify the surgical plan, according to the findings. Unfortunately, with our patient come after long periods after the preoperative tea have done on some of the patients, this has progressed. So we find these images help us to complete the surgical plan. It's unusual that the surgeon has to change completely their approach based on the interoperative images, but it helps the surgeon to refine the plan at this point. And as we can see in this patient as a prolapse OP2 with the consequent findings in the color. And we try to use the most the best quality of images to help the surgeon. This multi-view is really helpful as with just one image you can manipulate the angles and the planes in order to cut through the different segments with the use of minimal time to the acquisition of the image. And as I mentioned before, the most common thing that happens to us is we have new findings adding to what was already identified in the preoperative settings. This patient came for a repair of the P2 and then we find that other segments were compromised and not just prolapse but also cleft some of the same and some of the segments were fine in the interoperative echo. So the modified modifications for the surgical plan were made at this time. We confirm the size of the annulus as all our surgeons use in top of the new neocardial also annular plastic ring. So we confirm the findings through using 2D and 3D for better alignment of the annulus. And we proceed to answer the next question which is the measure of the neocardial. Michael already touched in detail in how they do the measurements. I want to emphasize in the structures that we need to have interview in order to have an accurate measurement of the cordae. So we need to have the prolapse segment interview, the annulus, the opposite leaflet in the co-optation sound and the most difficult thing to find in the SMU is the head of the papillary muscle. So according to the pathology anterior posterior wide leaflet, we modify the measurements that we do but we need all the structures for the measurement of any of those pathologies. Usually we made between four to five measurements and we get the mean length for the surgeon to the cordae. So as Michael mentioned before, when the pathology is in the posterior leaflet, we measure the distance between the head of the papillary muscle to a co-optation sound in the opposite leaflet, the anterior leaflet. And we subtract for that distance the length of the prolapse segment. When we are measuring the pathology of the anterior leaflet, we measure from the head of the papillary muscle to the co-optation sound of the posterior leaflet. And when ISA by leaflet prolapse, we proceed to do a combination of both measurements and provide the numbers to the surgeon for them to create the neocardial. The next step is to establish the severity of the ortic insufficiency if it's any. Ideally for this procedure, we want no more than mild ortic insufficiency and we found quite often that the patient has progression of the disease. So when the patient has more than mild AI, due to the difficulties for to provide adequate cardiac protection, the decision is made to convert the procedure to open. And it's important to do, assess the ortic valve early in our TE exam. The last thing that we do during this step is to assess the tricuspid valve. The decision to repair the tricuspid valve for our surgeons is based on the size of the annulus, the severity of the tricuspid regurgitation and the symptoms. We learn the findings of the preoperative echo and we try to do that before we isolate the lung. As I mentioned before, not just decrease the quality of the image, especially in the right side of the heart, but also the one lung ventilation can change the haemodynamics of the haemodynamics in general and can't make it possible to interpret the degree of tricuspid regurgitation. So we try to do this early into our TE exam. The second step is the neck, neck like placement itself. So it's the cannulation of the SVC. So for that one of our anesthetics scrub and is in the surgical field. Before that we try to pre-scrub scanner to establish an anatomy of the patient. Ideally we want to place the line in the right side. So we place two wires, one for the surgical cannula and one for our central line. For that we use a short and long axis view and we support the findings with TE. Before we provide heparin to double the ACT or get the ACT over 250. So the image in the top left we see we do a scan before we place any lines. Ideally we want to place both lines in the same side in the right side, which is make easier the drainage for the surgeons. But if the anatomy is not favorable, we place our central line in the opposite side or place also the surgical cannula on the other side. Once the wires are inside of the internal jugular vein, we visualize them in short axis and long axis view. Sometimes as you can see it's challenging because of the presence of valves. So very early into our program, we decided to confirm the presence of the two wires using TE by cable or modified by cable view, which facilitates the visualization of the two wires. After the two wires are seen in the superior vena cava, heparin is going to be applied to the patient. Some potential complications that we see during this cannulation. The most common one is the puncture of the posterior wall of the internal jugular vein creating hematomas that can expand after full heparinization is given. Less common, this is an image from my initial training where a patient, after we provide heparin to the patient, after the placement of the SVC cannula, the patient became very unstable. We decided to look what was happening, hypovolemia was found in the lead ventricle and we found a volume in the right pleura. And this patient has a dissected hematoma of the medial synom in a conversion of open technique was required to correct this. The third step is the images before we go to CPV. In this time, we complete the TE exam like in any other match of our repair. It's the same images that we do in the open repair, so we try to find the function of the lead ventricle, the presence of PFO, they need to be closed during the procedure. And have images to be able to diagnose potential complications after we come out, come out full bypass. I'm going to dedicate the time to talk about a particular case that is specific of minimally invasive is the placement of the IVC cannula. So the placement of IVC cannula is by the surgeons from the femoral vein. So the first step is to place a wire at the entrance of the SVC. So it's a dynamic procedure. So we try to use 2D and 3D to help with the placement of the line. Once the wire is in the adequate position, then the cannula is advanced around 1.5 centimeters into the SVC to get optimal drainage, venous drainage for the patient. And again, we use 2D and 3D to confirm the placement of the cannula. The most common complication is the misplacement of the cannula. We have one case of a placement of the cannula inside of the left etching, so completely rupture of the intracereal septum. It's an unusual complication. The most common complication is the impossibility to pass the cannula all the way to the SVC. So the cannula have to sit in the right etching, which can make the drainage of the venous line difficult. So we need to be aware of that and have extra monitors during the interoperative settings to be able to diagnose this problem. And the last step is the postoperative echo. In this one, we're going to use the same criteria for much of our repair in the open approach. The first step is we're going to help with the de-airing of the lead ventricle before the vent is removed. So this can take a little bit of extra time, so the T is used to guide the process. And then we are going to assess the repair itself. We use color to see the degree of residual mature degradation. Ideally, we are looking for mild level of degree. And we use the 3D to try to establish the location of the residual MR. And then decide with the surgeon if it's necessary due to the degree to go back on pump and which specific segment is compromised. So the adjustments can be done at that point. Also, we mentioned the coordination length. For that, we use again 3D and 3D to align in the segment that was corrected. And we're looking for a measurement of one, which the papers has shown that is the one that is proven to have more durability of the repair. So a co-optation length of one, we look at different views. And again, we use 3D to better alignment of the specific segment. And of course, we measure the gradients to the new repair. The complications that we can find at this stage of the TE or the operation are no particular of minimally invasive. The most common ones that we find at the beginning of our program were hematomas in the aorta for the cardioplegia cannulation site, or in more severe cases dissections that need to be repaired and converted to an open approach. This particular case was a patient with preoperative images of a prominent circumflex. When the repair was completed, we have difficulties coming out by pass and we find multiple regional wall motion anomalies in the circumflex territory. We perform an angiogram that shows partial occlusion of the circumflex. So the patient was put again into cardiopulmonary bypass and the surgeon released some stitches of the anuloplasty. After that, the angiogram showed complete flow into the circumflex and the TE confirmed regain of normal contraction of the lead ventricle. And also we find some complications typical of mitral bar repair in dependent of the approach, like for example the presence on some for the patient's hemodynamics or the quality of the repair itself. So it's important to have enough preoperative images that allow us to compare the presence of these new findings. So in summary, I can say that the TE is important tool for the performance of minimally invasive mitral bar repair. We need to keep in mind that it has a limited time to be performed. A step by step approach will help you to optimize your time and get the best quality possible of the image that help us with the information needed by the surgeon and by you to perform a success for repair. So it's important to use all the features of the machine and trying to do it in an efficient manner. I want to thank you all for attending this lecture and I hope to see you all during the question session later on. Thank you very much for the excellent content of your presentation. It is a pleasure to work with you and Michael on a databases in the OR and we'll have a chance soon to discuss more during the Q&A session. So now I'll hand over to Fabio who will introduce our next speaker. Thank you very much.


Great shot everybody. Great shot. Was that a great shot? What do you think? What are we gotten ourselves into? You know what we've gotten ourselves into?  This is absolutely incredible I can't tell for sure, but I think this bee over here is taking a nap in this flower And it is very cute. That's where I would take a nap if I were a bee Now we get to go down this That was a fun downhill, but my hands ache. How are your hands doing? Aha, so many rocks. Who put all the rocks on this trail? Oh, this is gonna be so cozy This is our turn off I'm really liking this. It may be very difficult But it's getting us to some beautiful places way out of the way. We are not seeing any humans out here at all This is the last hill for sure Guaranteed last hill It's never the last hill I thought I was gonna go to the hut and start making dinner, but there's just too much Excitement going on out here and by excitement I mean this sunset. Look at this Yeah The huts are great and all but This is the true treat of being out here in the colorado backcountry It's easy to get caught up in the western world about Just accumulating things like the more money you have the more things you can buy the more happiness, right? And I'm not so sure that's true. I certainly have some things that bring me happiness like my bicycle Brings me a lot of happiness, but these are my things right here these mountains these trips This freedom these trees Whoo, these are my things And I love it and I'm so very grateful so very grateful to be here right now I was also feeling grateful grateful that it's a Wednesday And grateful that I got to be out here for seven days Disconnected living outside of the pattern of my normal life. I feel so blessed Whoo see the smile on my face Wonderful day Matthew wonderful day wonderful day Look at that wonderful sunset. Yeah Thank you mother nature for another beautiful day on planet earth. Let's do it again tomorrow. Wow Really enjoying this quiet I'm really enjoying waking up and not looking at my phone right away and just being kind of disconnected Disconnected from like technology, but very connected To the natural world to mother nature And that makes me very happy. I think it's good for the soul to To be this close to it all Happy thursday happy happy thursday happy thursday happy happy happy.  So chef matt, what do we have tonight tonight? We have bean burrito especial Good morning, Matthew. You want to ride bikes today? Hell. Yes. I want to ride bikes today Hello shadow It's really impressive There are no easy days, which I kind of like You have to earn every day That is so cool. This is a little sketchy here. Did we take a wrong turn? This trail is scary to walk our bikes down But look where we get to go very soon That way It looks It was built in 1881 And it was considered at one time the longest running general store in the state of colorado since 1885 My mantra is like you got to believe it to achieve it You have to visualize to realize and your consciousness Will manifest Whatever you're thinking if it's good or bad or indifferent.  I love my bike But I always feel a little bit more connected to nature when I'm just walking around my own two feet This is so beautiful. I have not seen an aspen grove like this Going off in a long time and I love it. I love the smell of the leaves on the ground It's time to go out brave the cold one last day. We got this What's fun is that in not too long We're going to be down in the desert On plateaus red rocks. We're not even close to being done with the trail. Look how far we've come Those are the lasal mountains up there We are steps away from the parking lot, which means We are pretty much done with this San Juan hut tour adventure from Durango to Moab.  What an adventure starting in the high alpine and in here Yeah, now it's time to hitchhike home My friends, how's it going? I really hope you enjoyed that. There was so much beauty over those seven days It was kind of hard to choose what to pack into those 14 minutes, so I appreciate you Watching it and if you want to see more, I made an entire series. I will link that down here I'd like to send out a huge thanks to the San Juan hut systems They have all these cool routes all over the colorado backcountry for skiing and hiking and my favorite Biking I will link them down there as well. Thank you to gates They're the ones that lent us these awesome bikes with the carbon belt drives It's not a normal chain. If you look closely, it's a carbon belt drive. It's super cool I will also link them down there and if you like my content if you like what you saw Please become a patreon supporter You would help make this channel possible and a huge thanks to all of you on patreon who are already supporting I can't thank you enough I really really love creating this content for you to check out and uh, you know what? Nothing else to say. I'll see you next time everybody. Peace out


was good job. So we're all back again with another video. So we're going to check out 10 WWE wrestlers who attempted murder in the ring.  The one instance I can think of immediately is when Stone Cold had Triple H in that little car and he had like this little crane, he was lifting them up and then he pretty much dropped them. Triple H should technically be dead. Stone Cold should technically be arrested because he literally just killed someone on live television.  It's the funniness of wrestling, man.  What is going on here? But I appreciate all love and support, man. I'm not really feeling 100%. So if I sound different, I'm a little under the weather to COVID test today, came back negative. So I'm thankful for that.  So I wanted to get this video out to you guys, record this before I go KO. So hope you guys appreciate it, man. Let's get right into this bad boy. DWB superstars can quickly overstep the mark. The competitive nature of pro wrestling can quickly turn sinister and certain superstars can attempt to end their arch rival, Ponson, for all. Although these acts of violence had done in kayfabe, they certainly pushed the boundaries on what pro wrestling as an art form is truly supposed to be. Which times were they will join us now as WrestleMania looks at 10 WWE wrestlers who attempted murder in the ring. Be sure to subscribe and hit that notification bell for daily wrestling videos and follow us on Facebook. Number 10, our Undertaker hangs Big Boss Man.  After the Undertaker pinned Boss Man, the dead man alongside the brood proceeded to place a new surround Boss Man's neck and raise him along with a Hell in a Cell structure.  Just a few weeks after Boss Man's apparent demise, he went back on television and it was never explained how he survived such a heinous act. Number 9, NWO Death by Truck. Virtue match between The Rock and Hulk Hogan sold itself and it didn't need an extensive build up. However, WWE decided to book an overly complex storyline building up to the match which included the NWO attempting to murder the Great One. On the February 2002 edition of Raw, The Rock was being transported to hospital via an ambulance. But this is when the NWO hijacked the ambulance and proceeded to crash into it with a Mack truck. But when The Rock returned to television, sift nothing had happened and the Rock embraced with Hogan following their match at WrestleMania.  What? Recipes got off also. 18, The Rock. But given the man who just tried to murder him just a few weeks ago. Number 8, Seth Rollins, Death by Sledgehammer. One of the most controversial and infamous matches in recent times is the match between Seth Rollins and The Bean from Hell in a Cell 2019. The match ended in a no contest as Rollins' actions were said to be too far for a Hell in a Cell matchup.  Rollins would then utilize weapons by using a chair, a ladder, a toolbox, all impacting The Bean's head.  And this is when the referee called for the bell bringing to a close the worst received Hell in a Cell matchup of all time. Number 7, Baron Corbyn throwing a wrestler off the building. Due to the outbreak of COVID-19, WWE were forced to host the annual Money in the Bank paper view from WWE's headquarters. The match received praise for doing something that's never been done before, but it led to a lot of questions from fans, mainly questioning how Baron Corbyn got away with attempted murder. Towards the close of the match, Corbyn would throw both Rey Mysterio and Alistair Black off the roof of the WWE HQ.  And in reality, both Mysterio and Black fell on a safe platform which was placed below the roof of WWE HQ. This would be addressed by Mysterio the following night on Raw after WWE needed a clear explanation as to how Mysterio and Black had suffered such a substantial fall. Number 6, Braun Strowman being crushed in a garbage truck. A Braun Strowman was involved in a ton of near-death experiences during his time in WWE. It seemed common practice during the peak of his run in WWE for top WWE superstars to attempt to stop the monster among men by attempting to dramatically end his life. This was the case at the TLC pay-per-view in 2017, as Braun was teeming with the Miz, Kane and the bar against the trio of Dean Ambrose, Seth Rollins and Kurt Angle. But during the course of the match, a Braun's partners turned on him and they actually attempted to murder him.  A Braun returned to television just 8 days later and it was presented to the audience as if Braun had been living in the garbage truck the whole time, which truly battled fans. Number 5, The Undertaker throws Rikishi off a cell. But without question, the most famous moment in the brutal history of the Hell in a Cell is when The Undertaker threw Mankind from the top of the cell structure. However, this was in the only time that The Undertaker would attempt murder inside a Satan structure as at the 2000 Armageddon pay-per-view, six of the top superstars in the entire WWE battled it out for the title. But as The Undertaker and Rikishi were battling on the top of the cell, The Undertaker decided to push Rikishi off the top of it, which resulted in Rikishi landing on the back of a truck which was filled with sawdust. The spot was incredibly scary and Rikishi himself revealed that he told The Undertaker to tell his family that he loved him just in case anything went wrong with their biggest bump of his career. Number 4, Randy Orton Setting Alike The Fiend The feud between Randy Orton and The Fiend took a drastic 10 at the TLC pay-per-view in 2020. They competed in a Firefly Inferno match and once Orton had defeated The Fiend by setting his back on fire, Orton decided to take things one step further. Orton would douse The Fiend's body with gasoline and then proceed to set it alight. The final WWE pay-per-view of 2020 seemingly went off the air with The Fiend being burnt to death. The Fiend would eventually return to WWE television and beat it with a new appearance to show the damage of the burns, but it was never logically explained how The Fiend survived. Fans had to simply assume that this was down to his supernatural abilities. Number 3, Shane McMahon's Vehicular Murder When Kane and Mass for the first time in 2003, one of his first rivalries was with Shane McMahon. Shane was attempted to get revenge on Kane after Kane had performed a tombstone pile driver on Shane's own mother, Linda McMahon. The two would feature in a number of infamous segments including Shane knocking Kane into a dumpster, which was engulfed in fire and, more notably, Shane attempted to end Kane once and for all. During the build to their last. Last man standing match at Survivor Series, Shane would trap Kane in a limo in a parking lot, then proceed to send him helplessly into a truck, which should've killed Kane. The next week on Raw, Kane was seen waking up in a hospital room, having survived the crash, and Kane went on a destructive spree, laying out all medical personnel that fell into his path. Number 4, Paul Bearer In Cement One of the most nonsensical storylines in WWE history saw the Undertaker attempt to kill his longtime manager Paul Bearer, and this took place at the Great American Mashpaper View in 2004 as Taker would face the Dudley boys in a handicap match. The match had the added stipulation that if the Undertaker didn't forfeit the match and purposely lose, Bearer would be buried in cement. Following Taker's victory, the Undertaker decided to pull the lever on the cement truck himself, which led to Bearer being buried alive in cement. On the following edition of SmackDown, it was explained that the Undertaker no longer had any purpose for Bearer, but in reality, Bearer needed emergency surgery and needed to be written off WWE programming. Number 1, Triple H Drive-By Now, the attitude I saw were its fair share of memorable storylines, but perhaps the most memorable of all saw Stone Cold Steve Oz to get run down by a horror survivor series in 1999. This led to a year-long storyline where it was eventually uncovered that it was Rikishi who was driving the vehicle, and who was following direct orders from Triple H. And once Austin eventually found out that Triple H was behind the whole thing, he set his sights on him in a no-DQ match at the Survivor Series pay-per-view in 2000. The match came to a close as Triple H attempted to escape the arena in a car, as he simply wanted away from Austin who was thirsty to cause as much damage as humanly possible on him. As Triple H was about to escape, Austin used a forklift to raise Triple H's car 30 feet in the air before dropping it down. Triple H survived the fall and would only miss a short time away from WWE programming. The feud would continue in a month that followed culminating in an acclaimed three-stage The Hell matchup which took place at 2001's No Way Out pay-per-view. But there you have it folks, 10 WWE wrestlers who were talking murder in the ring. That's wrestling for you. But comment down below and let me know what was your favorite clip of attempted murder from this video man. Appreciate all love and support.