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💥Question 10 #ASEchoJC❓
What are the #EchoFirst criteria to determine suitability for PBMV (aka PMBV or PMBC)? After PBMV, how do we define success, and do we identify severe MR?
@SLittleMD @senguptasp @pattypellikka @iamritu @ash71us @JournalASEcho @ASE360
What are the #EchoFirst criteria to determine suitability for PBMV (aka PMBV or PMBC)? After PBMV, how do we define success, and do we identify severe MR?
@SLittleMD @senguptasp @pattypellikka @iamritu @ash71us @JournalASEcho @ASE360
#ASEchoJC
🔺PBMV if symptomatic severe MS, pliable valve, <2+ MR & no LAA thrombus
🔺Consider in asymptomatic severe MS & PASP>50 mmHg
🔺Wilkins score <=8
🔺Importance of careful #iEcho guidance, watch for severe acute MR
🔺PBMV if symptomatic severe MS, pliable valve, <2+ MR & no LAA thrombus
🔺Consider in asymptomatic severe MS & PASP>50 mmHg
🔺Wilkins score <=8
🔺Importance of careful #iEcho guidance, watch for severe acute MR
#ASEchoJC Wilkins score for assessing suitability for PBMV. Can consider >8 in very selected cases based on specific morphologic features.
💥Question 3 #ASEchoJC❓
What are the pitfalls and potential sources of error in assessing rheumatic MS severity by direct planimetry or CWD spectral display of mitral inflow (mean gradient, VTI, PHT)?
@SLittleMD @senguptasp @pattypellikka @iamritu @ash71us @JournalASEcho
What are the pitfalls and potential sources of error in assessing rheumatic MS severity by direct planimetry or CWD spectral display of mitral inflow (mean gradient, VTI, PHT)?
@SLittleMD @senguptasp @pattypellikka @iamritu @ash71us @JournalASEcho
#ASEchoJC
🔺MG influenced by HR (ok only between 60-80 bpm), cardiac output, mixed valve disease
🔺Always report rhythm and heart rate
🔺PHT >150 ~ MVA <1.5 cm2 in RHD, assuming normal LV & LA compliance (unreliable in calcific MS)
🔺Trace mid-diastolic slope
🔺Avoid after PMBV
🔺MG influenced by HR (ok only between 60-80 bpm), cardiac output, mixed valve disease
🔺Always report rhythm and heart rate
🔺PHT >150 ~ MVA <1.5 cm2 in RHD, assuming normal LV & LA compliance (unreliable in calcific MS)
🔺Trace mid-diastolic slope
🔺Avoid after PMBV
#ASEchoJC
🔺2D planimetry should transect leaflet tips perpendicular to LV axis
🔺Overestimation is common; look at the shape of LV in SAX (⭕️vs🥚)
🔺Caution with gain settings
🔺Consider biplane imaging & 3D #EchoFirst
🔺2D planimetry should transect leaflet tips perpendicular to LV axis
🔺Overestimation is common; look at the shape of LV in SAX (⭕️vs🥚)
🔺Caution with gain settings
🔺Consider biplane imaging & 3D #EchoFirst
Tweetorial on Challenges in Quantification of Aortic stenosis before tonight’s #ASEchoJC on @PPibarot & @E_Guzzetti 📝 bit.ly/2NNIJgC
~1/3 pts have DISCORDANT indices: AVA is severe <1 cm2 yet mean gradient is low <40 mmHG bit.ly/3dWmJuy
Low Gradient types👇
~1/3 pts have DISCORDANT indices: AVA is severe <1 cm2 yet mean gradient is low <40 mmHG bit.ly/3dWmJuy
Low Gradient types👇
2/low gradient severe AS
types:
1.Classic:both flow SVI EF⬇️(classical Low flow CLF)
2. Paradoxical: EF nl BUT low flow SVI (Paradoxical Low flow PLF )
3. Both EF and flow are nl (Normal Flow NF)
Low flow⬆️💀mortality
Paradoxical Low flow &
Classical Low flow #ASEchoJC
types:
1.Classic:both flow SVI EF⬇️(classical Low flow CLF)
2. Paradoxical: EF nl BUT low flow SVI (Paradoxical Low flow PLF )
3. Both EF and flow are nl (Normal Flow NF)
Low flow⬆️💀mortality
Paradoxical Low flow &
Classical Low flow #ASEchoJC
3/ low gradient represents more advanced cardiac disease stage
D2: classical low flow low EF low gradient
D3: paradoxical low flow nl EF low gradient
D? normal flow nl EF low gradient
#ASEchoJC
D2: classical low flow low EF low gradient
D3: paradoxical low flow nl EF low gradient
D? normal flow nl EF low gradient
#ASEchoJC
@hahn_rt 📝 #ASEchoJC
Can a single cycle length method can be used to calculate aortic EOA in aortic stenosis w nonsinus rhythms?
100 AS pts w R-R variability identified:55 w atrial fib AF & 45 w frequent atrial or ventricular premature contractions FE bit.ly/3or3ufk
Can a single cycle length method can be used to calculate aortic EOA in aortic stenosis w nonsinus rhythms?
100 AS pts w R-R variability identified:55 w atrial fib AF & 45 w frequent atrial or ventricular premature contractions FE bit.ly/3or3ufk
2/#ASEchoJC
LVOT TVI by PWD & AV VTI CWD measured over 5-10 consecutive beats in AF group & over 3-5 consecutive sinus beats in FE,EOA & DVI calculated as guidelines standard
In all patients, LVOT diameter was measured in midsystole, within 2-4 mm apical to annulus
LVOT TVI by PWD & AV VTI CWD measured over 5-10 consecutive beats in AF group & over 3-5 consecutive sinus beats in FE,EOA & DVI calculated as guidelines standard
In all patients, LVOT diameter was measured in midsystole, within 2-4 mm apical to annulus
3/#ASEchoJC Aortic EOA & DVI Calculated by Single Cycle Length Method
RR intervals matched
AF pts, a single VTIAV was measured & then matched to a VTILVOT of similar cycle length defined as R-R intervals w/in 10% of each other,EOA & DVI calculated for short & long R-R cycles
RR intervals matched
AF pts, a single VTIAV was measured & then matched to a VTILVOT of similar cycle length defined as R-R intervals w/in 10% of each other,EOA & DVI calculated for short & long R-R cycles
#ASEchoJC #Tweetorial on #WASE
World
Alliance
Societies of Echocardiography
Normal Values Study
#Echofirst most widely used imaging modality BUT
WHAT IS NORMAL for ❤️ size & function?
bit.ly/32pKxAC @JournalASEcho
World
Alliance
Societies of Echocardiography
Normal Values Study
#Echofirst most widely used imaging modality BUT
WHAT IS NORMAL for ❤️ size & function?
bit.ly/32pKxAC @JournalASEcho
2/ Prior ❤️measurement studies:
❤️used VARIOUS methods- M mode, M mode & simpsons, 2D
❤️No standard analysis or core lab
❤️Only single race or country/region
❤️?? State of the art machines or techniques
❤️Need for a prospective international observational study #WASE was born
❤️used VARIOUS methods- M mode, M mode & simpsons, 2D
❤️No standard analysis or core lab
❤️Only single race or country/region
❤️?? State of the art machines or techniques
❤️Need for a prospective international observational study #WASE was born
3/#DiversityandInclusion
@ASE360 @escardio #EACVI recommended normal values used all over the 🌎 but only represent normal Caucasian people from USA & Europe
bit.ly/3irijv5 #ASEchoJC
@ASE360 @escardio #EACVI recommended normal values used all over the 🌎 but only represent normal Caucasian people from USA & Europe
bit.ly/3irijv5 #ASEchoJC
1/Tweetorial on #TMVR for #ASEchoJC 12/11 8 pm
bit.ly/2EiJQ1v
transcatheter mitral valve replacement #TMVR for failed valve & ⬆️ #STS risk
#VHD 2017 update reoperation➡️ reintervention bit.ly/2P9bX4G
🎈expandable SAPIEN S3 only @FDA bioprosthesis for implant
bit.ly/2EiJQ1v
transcatheter mitral valve replacement #TMVR for failed valve & ⬆️ #STS risk
#VHD 2017 update reoperation➡️ reintervention bit.ly/2P9bX4G
🎈expandable SAPIEN S3 only @FDA bioprosthesis for implant
2/#Transeptal developed @MayoClinicCV 48 pts
After 🇨🇦 initial experience with #transapical 2009
sick patients with ⬇️ EF #transeptal preserves EF better avoids apical purse string suture
Currently #TMVR registry
>50 % are transeptal & in house mortality 7%
After 🇨🇦 initial experience with #transapical 2009
sick patients with ⬇️ EF #transeptal preserves EF better avoids apical purse string suture
Currently #TMVR registry
>50 % are transeptal & in house mortality 7%
1/#Tweetorial #papillary #fibroelastoma for
#ASEchoJC 10/23
🐙= #PFE 1975 named #papillary #fibroelastoma by #armed #forces #institute of #pathology
#papilloma 1973
#Collagen core with elastic fibers & matrix covered by endothelium sheath
Attached by stalk
multiple fronds
#ASEchoJC 10/23
🐙= #PFE 1975 named #papillary #fibroelastoma by #armed #forces #institute of #pathology
#papilloma 1973
#Collagen core with elastic fibers & matrix covered by endothelium sheath
Attached by stalk
multiple fronds
2/ What is the incidence of #PFE 🐙 compared to #myxoma (diagnosed in same time period)?
#PFE 511 vs. #myxoma 112
#PFE incidence ~1/1000
common “benign”primary ❤️tumor #modern #EchoFirst (Most common @MayoClinicCV)
#myxoma (autopsy based prevalence)
bit.ly/2Am05Y9
#PFE 511 vs. #myxoma 112
#PFE incidence ~1/1000
common “benign”primary ❤️tumor #modern #EchoFirst (Most common @MayoClinicCV)
#myxoma (autopsy based prevalence)
bit.ly/2Am05Y9
3/How to tell if a #PFE🐙by #echofirst ?
(Vs.Atypical myxoma,SBE,
Llambl’s)
small mobile mass attached #endocardial surface frondlike extensions #independent motion stippled border
Usually on atrial surface of AV valves or either side of semilunar valves,🚫interfere valve Fxn
(Vs.Atypical myxoma,SBE,
Llambl’s)
small mobile mass attached #endocardial surface frondlike extensions #independent motion stippled border
Usually on atrial surface of AV valves or either side of semilunar valves,🚫interfere valve Fxn
Curious about how #POCUS is taught? This #Tweetorial is for U
#Preview for #ASEchoJC 🔜9/4 8pm EST
Point-of-Care Cardiac Ultrasound POCUS: State-of-the-Art in Medical School Education bit.ly/2wxD4PZ by @amerjohri
#POCUS not 🐇🎩, not short #TTE
#Preview for #ASEchoJC 🔜9/4 8pm EST
Point-of-Care Cardiac Ultrasound POCUS: State-of-the-Art in Medical School Education bit.ly/2wxD4PZ by @amerjohri
#POCUS not 🐇🎩, not short #TTE
2/ Current #goals #Cardiac #POCUS #MedEd
(1) introduce concepts of ultrasound- common imaging views, correlate with anatomy, & physical examination skills
(2) develop scanning techniques➡️ basic competence
(3) recognize & differentiate b/w normal anatomy & basic pathology
(1) introduce concepts of ultrasound- common imaging views, correlate with anatomy, & physical examination skills
(2) develop scanning techniques➡️ basic competence
(3) recognize & differentiate b/w normal anatomy & basic pathology
3/ When Do We Start? Prerequisite knowledge for #POCUS teaching
"priming effect" of preclinical education
Big machine 1st over handheld Martinez et al bit.ly/2wzCcJB @UMMC
Start 1st year @Hoppmann et al bit.ly/2Q4ECsO @UofSCSOM
"priming effect" of preclinical education
Big machine 1st over handheld Martinez et al bit.ly/2wzCcJB @UMMC
Start 1st year @Hoppmann et al bit.ly/2Q4ECsO @UofSCSOM
