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@JournalASEcho

@ASE360

@dr_benoy_n_shah

@TOMTEC_IMAGING

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Ritu Thamman MD

@iamritu

Mar 2, 2021

@PPibarot

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👇

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

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

Read 10 tweets

Ritu Thamman MD

@iamritu

Oct 27, 2020

@hahn_rt

@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

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

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

Read 8 tweets

Ritu Thamman MD

@iamritu

Jan 22, 2019

1/#Tweetorial 3D Echo(TTE/TEE) & CT methods Tricuspid annulus & valve assessment in severe TR #ASEechoJC Today 8 pm
bit.ly/2FFWk3I
pts with severe tricuspid regurgi, semiautomated indirect planimetry results in agreement b/w TEE & CT for Tricuspid annulus sizing & TVA

2/TEE_direct of the TA allows the most accurate measurement of diastolic stroke volume for the calculation of regurgitation severity compared with 3D vena contracta area.

This is first study to validate use of 3D TEE planimetered annular area to quantify the regurgitant volume

3/Imaging tricuspid valve (TV) is challenging & often requires nonstandard views because of variable anatomy, thin valve leaflets, shadowing/artifacts from the lungs, L sided valve prostheses/intracardiac leads, & the anterior position of the right ventricle inside of the chest

Read 16 tweets

Ritu Thamman MD

@iamritu

Dec 8, 2018

@FDA

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

@MayoClinicCV

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%

3/#EchoFirst #TTE
#PLAX & off-axis( inflow can be II to septum not apex/posteriorly & eccentric/coanda
👀 origin MR➡️#TMVR may 🚫resolve severe paravalvular MR
#Apical
#CWD #MV proximal flow convergence location: on ventricular side in regurgitation & on atrial side in stenosis

Read 10 tweets

Ritu Thamman MD

@iamritu

Oct 22, 2018

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

@MayoClinicCV

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

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

Read 10 tweets

Ritu Thamman MD

@iamritu

Sep 3, 2018

@amerjohri

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

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

@UMMC

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

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