Georg Wedekind

@NMerke Totally agree. There is a strong need for robust standardization. We need independent parameters to calibrate our systems. Eg compare the normal VC from a 2D image with the normal VC from MPL reconstruction of a 3D dataset. IMO it's crucial before going to 3D VC area.

We do talk a lot about quantification of severity by using our #echofirst tool box, but rarely we talk about our machine settings 👉color doppler needs good resolution for VC and even better for 3D VCA 👉 color doppler often shows color bleeding meaning that color exceeds tissue by overestimating VC or in 3D VCA Never using low FPS for color doppler most simple trick is using tight and high color box 👉 FPS goal 25-30 at least Never trust VC or 3D VCA in low FPS acquisition 👉 use reduced low velocity reject (wall filter) 👉 adapt gain settings 👉 reduce smoothing 👊more tips incoming @echo_batman @argulian

@NMerke You're totally right. Good image quality and correct settings are the fundamentals of echocardiography. This is what we should teach, in everyday practice and on stage.

Rules of #echofirst engagement  B4 showing & sharing knowledge on big stage be aware that attendees will take your images as example to follow so don’t show bad settings  👉 Color Doppler box too big  mention always why you have choosen (your goal should be best FPS, so color box not too big!) 👉 Vena contracta measurements need good resolution and gain setting optimization to avoid overestimating  👉 3D VCA must be explained with FPS! IF too low value not real! Show your settings  👉 Showing PISA EROA please make sure you have choosen correct settings with Nyquist and didn’t overestimate the radius! Mention that r > 0,9 is rarely seen  Always point out that Reg. Volume > 60 ml are rarely seen  Always show LV dimensions & Volume! Always explain that a certain high amount of Regurgitation let’s say > 60 ml is only possible if LV Volume and LVOT SV are making sense 👉🎯 please Never Show That you have stopped using only one parameter  👉 IF you use 3D Volume Show your settings (FPS) and point not only EF but also LV / RV Volumes out.  Volumes matter more than EF

@alex1708ander Echocardiography ist nothing for faint-hearted... Nice and at the same time spooky pictures 🎃

Right-heart clot-in-transit & left-heart clot-in-transit. In both cases reported mortality is very high without treatment and remains substantial even with therapy #echofirst

@NMerke @DHZB_Akademie @DEGUMeV Seeing young people grow and develop is always the greatest motivation. And you are doing it really good. 👍.

Another #echofirst basic teaching course by @DHZB_Akademie and again fully booked Attendees very interactive Proud to help teaching future imaging elite & experts and taking in 🆕 young talented speakers #JohannaKahl from Hamburg @DEGUMeV

@alex1708ander Hey nice. A large coronary sinus is always suspicious. And sometimes also the right arm is also connected to the LSVC. I've seen this only in TTE, till now 👍.

📌 LSVC usually drains into the coronary sinus (CS) 📌 When contrast is injected into a left arm vein 👉 it travels through the LSVC 🟢🟢🟢 instead of crossing to the normal right SVC #echofirst 👉 Left arm vein injection → coronary sinus opacification first → RA afterward

@CASivaram1 @NMerke @echo_stepbystep Totally right... It's a pity that three months of experience in echocardiography are often seen as sufficient to build up an expert... It's a lifelong journey

@NMerke @echo_stepbystep Echo is highly operator dependent! The journey from novice to master of echo is often decades long.

#echofirst limits of 3D. Not all “limitations” are real—many come down to technique and interpretation: - Incomplete reference planes - Poor 2D image quality - Low gain → missing or unclear structures - Low frame rate → NOT ALWAYS TRUE - Uncorrected artifacts - Suboptimal color Doppler 👉 Key point: These are operator- and technique-dependent, not true limitations of 3D echo

🫀NEW GUIDELINE🫀 Read our newest #ASEGuideline, "Recommendations for the Identification and Mitigation of Cardiac Ultrasound Artifacts!" bit.ly/4tKDSvf

#EHJCVI 🫀🧲 Same initial infarct area, different recovery 💡 In 672 first-time #STEMI patients, 🚭 quitting smoking was linked to greater infarct size reduction on #whyCMR and fewer MACE ‼️⏩Read more: doi.org/10.1093/ehjci/…

@alex1708ander Wow beautiful impressions of high end medicine. When it comes to complex intervention a good team is the most important thing and all you have. It is only strong when everybody is seen as an equal member.

The cardiac anesthesiologist’s primary environment is a specialized cardiac operating room, purpose-built for advanced hemodynamic monitoring, imaging, and extracorporeal circulation—requiring generous space and seamless team coordination #echofirst

@alex1708ander @GEHealthCare Nice essential tips 👍. By the way in some machines the wall filter is switched off by default (don't ask me why). This also causes a color blooming ... (Took me some time to find out ;-) )

How to improve visualization of the MR jet origin on a 3D Color Doppler image, using dedicated postprocessing techniques @GEHealthCare #echofirst ❌ Overgained color ❌ Color blooming ❌ Jet origin difficult to identify ✅ 2 Click Crop ✅ HD Color ✅ Flow Direction

@alex1708ander @escardio Oh yeah, this was a lot of work ,,👍😊

Do you remember this #echofirst ? #EACVI @escardio

@NMerke @escardio @EACTS Perfect example. The knowledge about methods is very important but often neglected. PISA needs a near round and constant orifice, no proximal anatomical impairment, free jet without fluid dynamically counterpressure... So, there is need of intrinsic validation (e.g.Volumetry,...)

Severity quantification in degenerative MR by #echofirst is supposed to use PISA as the @escardio & @EACTS recommend, but there is many red flags 🚩 to consider Here just some, of there is more often in PMR MR is late systolic so careful by measuring radius & tracing VTI …

@NMerke Right ventricle in 3D is always challenging (at least for me). Really nice pictures 👍

RV focused A4C view #echofirst to see tricuspid valve using #ALAMO to capture 3D 👉 Annulus 👉 leaflets 👉 (no) Artifacts 👉 movement of leaflets 👉 orientational landmarks

@alex1708ander AS alone? Never ;-). Amyloidosis or HCM? MRI will tell you...

F. 50 - would the AS alone explain the severe LV wall thickening #echofirst

@alex1708ander It's fascinating what kind of solutions are developed. And by the way: tell the patient that they have two valves which aren't located in a normal position. Otherwise you will have a stressed patient with a "dislocated" valve as an emergency in your echo lab ;-).

TricValve #echofirst alias heterotopic CAVI (caval valve implantation)

@alex1708ander @iamritu @NMerke @CASivaram1 @DrRajeshG1 @OungSavly A difficult decision. During my time at the UKW, we always told patients that we might discover something during surgery that should additionally be treated, and asked if the patient would like this. But I suspect that this procedure didn't provide any legal protection.

Teaching case/decision making 👉 M. 69 yo with severe AS scheduled for SAVR 📍preop TTE 📍intraop TEE (pre-CPB) 📍no pt’s informed consent about MV surgery Intraop TEE done by a fellow How would you proceed #echofirst @iamritu @NMerke @CASivaram1 @DrRajeshG1 @OungSavly

@alex1708ander Yepp never seen this before, and I was confused ;-) . Thanks for this teaching case 👍

@alex1708ander Well NOW you've piqued my curiosity 🧐. What happened? A complication during extra corporal circulation?

Intraop TEE in a patient undergoing surgical revascularization for CAD. Post-procedural, a new structure is seen. Thoughts #echofirst

@NMerke @iamritu Yeah and than we have to discuss why we don't have to do perform a TOE to unveil the mechanism ;-). Brilliant imaging quality!

2 different #echofirst cases of primary MR using TTE to unveil the WHY