Jerry Estep

Check out our new review article about hear transplant. @JerryEstepMD @JoseNaviaMD

Join @CleClinicHVTI for the 28th annual Valve Imaging Summit in Miami Beach 2/27-3/1🫀 Internationally recognized leaders will share best practices, the newest evidence & case-based insights across the spectrum of structural heart. Link: clevelandclinicmeded.com/live/courses/e… @AllanLKleinMD1

Cardiac Electrophysiologist Dr J Bibawy is joined by @nbc6 to raise awareness about #AtrialFibrillation warning signs, symptoms and mgmt. Delivering world class care and educating the public is the moto @CleveClinicFL @HeartVasc_CCFla @JerryEstepMD nbcmiami.com/on-air/as-seen…

@BoXuMD @NadeenFaza @nicoa002 @purviparwani @ASE360 @JournalASEcho @iamritu @EGarciaSayan @DavidWienerMD @rajdoc2005 @renujain19 @ChamsiPash @almallahmo @OKhaliqueMD @rooshaparikh @Heart_SCCT #ASEchoJC Multi-modality imaging remains key to monitoring these patients!

@NadeenFaza @nicoa002 @JerryEstepMD @purviparwani @ASE360 @JournalASEcho @iamritu @EGarciaSayan @DavidWienerMD @rajdoc2005 @renujain19 @ChamsiPash @almallahmo @OKhaliqueMD @rooshaparikh @Heart_SCCT · @JerryEstepMD @nicoa002 @NadeenFaza @purviparvani @ASE360 #ASEchoJC #CleClinicHVTI Reduce CT artifact from hardware components in LVAD: iterative metal artifact reduction algorithm, contrast window adjustment

#ASEchoJC Question 8: What are indications for the use of cardiac CT in LVAD evaluation? @nicoa002 @JerryEstepMD @BoXuMD @purviparwani @ASE360 @JournalASEcho #EchoFirst #YesCCT #CardioX #Cardiotwitter

@purviparwani @NadeenFaza @nicoa002 @BoXuMD @ASE360 @JournalASEcho @iamritu @EGarciaSayan @rajdoc2005 @CASivaram1 @renujain19 @PWesslyMD @HFSA @mahwash_kassi @noshreza @hfdocbhimaraj @BhaskarArora_MD #ASEchoJC These novel parameters can help predict freedom for AR interventions!

#ASEChoJC Novel TTE Parameters: Diastolic Acceleration and S/D Ratio published in #JACCIMG Good reference jacc.org/doi/10.1016/j.… -> Measurement of LVAD cannula diastolic acceleration and LVAD outflow cannula systolic-to-diastolic peak velocity ratio (S/D ratio) In patients with (A) no AR,  (B) trace-mild AR (C) moderate-severe AR

#ASEchoJC Question 7: How would you evaluate aortic regurgitation in the setting of #LVAD? @nicoa002 @JerryEstepMD @BoXuMD @purviparwani @ASE360 @JournalASEcho #EchoFirst #CardioX #Cardiotwitter

@NadeenFaza @nicoa002 @BoXuMD @purviparwani @ASE360 @JournalASEcho @iamritu @EGarciaSayan @rajdoc2005 @CASivaram1 @renujain19 @PWesslyMD @HFSA @mahwash_kassi @noshreza @hfdocbhimaraj #ASEchoJC The peak S/D velocity ratio of the outflow cannula is a metric that is inversely proportional to AR severity and the diastolic acceleration of outflow cannula flow is a metric that is directly proportional to AR severity

@NadeenFaza @nicoa002 @BoXuMD @purviparwani @ASE360 @JournalASEcho @iamritu @EGarciaSayan @rajdoc2005 @CASivaram1 @renujain19 @PWesslyMD @HFSA @mahwash_kassi @noshreza @hfdocbhimaraj #ASEchoJC Be familiar with novel metrics

@NadeenFaza #ASEchoJC Low -flow alarm due to inflow cannula malposition -Posteriorly positioned inflow cannula (yellow arrow) -Intermittent interaction with the endocardium associated with LVAD suction events as noted by decrements in the pump speed as noted

#ASEchoJC 🔑 points from the guidelines!

#ASEchoJC Question 6: What are potential echocardiographic findings associated with LVAD low-flow alarms? @nicoa002 @JerryEstepMD @BoXuMD @purviparwani @ASE360 @JournalASEcho #EchoFirst #CardioX #Cardiotwitter

@NadeenFaza @nicoa002 @BoXuMD @purviparwani @ASE360 @JournalASEcho @PWesslyMD @renujain19 @rajdoc2005 @iamritu @EGarciaSayan @gb_mackensen @ray_stainback @HFSA @DavidWienerMD @HeartDocSharon #ASEchoJC Low -flow alarm due to inflow cannula malposition and directed toward the distal anterolateral free wall and in close proximity to the endocardium (anterior apical position) noted by the yellow arrow.

@NadeenFaza @nicoa002 @BoXuMD @purviparwani @ASE360 @JournalASEcho @PWesslyMD @renujain19 @rajdoc2005 @iamritu @EGarciaSayan @gb_mackensen @ray_stainback @HFSA @DavidWienerMD @HeartDocSharon #ASEchoJC Important to know the ideal apical inflow cannula position directed toward to anterior MV leaflet and LVOT parallel to the IVS and free of interaction with adjacent structures as noted (yellow arrow)

@NadeenFaza @nicoa002 @BoXuMD @purviparwani @ASE360 @JournalASEcho @PWesslyMD @renujain19 @rajdoc2005 @iamritu @EGarciaSayan @gb_mackensen @ray_stainback @HFSA @DavidWienerMD @HeartDocSharon #ASEchoJC It is important to keep in mind the differential!

@NadeenFaza @nicoa002 @BoXuMD #ASEchoJC Optimize heart failure pre LVAD using swan ganz tailored therapy to achieve PCWP reduction and if low CO , IABP pre LVAD use can help to get the patient through the operation. Most of the time significant MR will improve after durable LVAD placement.

@JerryEstepMD @nicoa002 @BoXuMD how would you treat a patient with severe functional MR pre LVAD implantation? #ASEchoJC

#ASEchoJC Question 5: What are findings on echocardiography that are considered red flags in candidate selection for LVAD? @nicoa002 @JerryEstepMD @BoXuMD @purviparwani @ASE360 @JournalASEcho #EchoFirst #CardioX #Cardiotwitter

@purviparwani @NadeenFaza @nicoa002 @BoXuMD @ASE360 @JournalASEcho @EGarciaSayan @DavidWienerMD @iamritu @rajdoc2005 @boegel_kelly @PWesslyMD @renujain19 @HFSA Assessing RV remodeling (RV Size) relative to LV size is a key metric to report with a RV/LV ratio > 0.75 being a red flag as illustrated on the right #ASEchoJC

#ASEchoJC Role of echocardiography in candidate selection for #LVAD @nicoa002 @JerryEstepMD @BoXuMD @purviparwani @ASE360 @JournalASEcho @iamritu #EchoFirst #CardioX #CardioTwitter @JournalASEcho #ASEchoJC   ♥️ A comprehensive pre-LVAD implantation assessment of the AV, MV, and TV anatomy and function should be performed. ♥️ Surgical treatment of AR > mild before LVAD implantation ♥️ moderate-severe MS treatment at the time of LVAD (AS well tolerated) ♥️ MR/TR red flag as well

#ASEchoJC Question 4: What is the role of echocardiography in candidate selection for #LVAD? @nicoa002 @JerryEstepMD @BoXuMD @purviparwani @ASE360 @JournalASEcho #EchoFirst #CardioX #CardioTwitter @JournalASEcho

@NadeenFaza @nicoa002 @BoXuMD @purviparwani @ASE360 @JournalASEcho @EGarciaSayan @DavidWienerMD @iamritu @rajdoc2005 @boegel_kelly @PWesslyMD @renujain19 @HFSA Assessing RV remodeling (RV Size) relative to LV size is a key metric to report with a RV/LV ratio > 0.75 being a red flag as illustrated on the right#ASEchoJC @nicoa002 @JerryEstepMD @BoXuMD @purviparwani @ASE360

@purviparwani @NadeenFaza @nicoa002 @BoXuMD @ASE360 @iamritu @EGarciaSayan @boegel_kelly @DavidWienerMD @rajdoc2005 @HFSA @mahwash_kassi @hfdocbhimaraj @ChamsiPash #ASEechoJC

@NadeenFaza @nicoa002 @JerryEstepMD @BoXuMD @ASE360 @iamritu @EGarciaSayan @boegel_kelly @DavidWienerMD @rajdoc2005 @HFSA @mahwash_kassi @hfdocbhimaraj @ChamsiPash #ASEchoJC Question 2: How would you evaluate Impella position and function using echocardiography? #echofirst @nicoa002 @JerryEstepMD @BoXuMD @purviparwani @ASE360 #EchoFirst #CardioX #CardioTwitter Here is a useful technique for Impella CP

#ASEchoJC Question 2: How would you evaluate Impella position and function using echocardiography? @nicoa002 @JerryEstepMD @BoXuMD @purviparwani @ASE360 #EchoFirst #CardioX #CardioTwitter