Alexsander Pretto

@MAecocardio Amazing

Strain …..It is good to be able to laugh at ourselves

A large thrombus in transit through a PFO 🪱🪱 @gamzebaburguler @ASE360 @EmergencyEcho @echotalk @echo_stepbystep @drozgeozden

Crypt or diverticula? Pt is a woman, 55y no symptons @alcantaramonica @alexsfelixecho @RodrigogpLima @marciomp50 #echofirst @echo_stepbystep @cardiotwitt

🌟 STROKE - Vascular territories and neurodeficits

🧵Atrial strain 1/ In Norway, we have an idiom: “The north wind is just as cold, from wherever it blows”, meaning the basic properties of something doesn’t change with the perspective you apply.

New multicenter registry data in #JACCImaging including > 3700 patients with isolated moderate-to-severe degenerative MR (DMR) on the prognostic impact of pulmonary hypertension (PHTN) measured by Doppler echocardiography. jacc.org/doi/epdf/10.10… Key messages: - SPAP response to the significant DMR is heterogeneous: 25% had classic severe PHTN (SPAP ≥ 50 mm Hg), and 30% had moderate PHTN (ie, 35-49 mm Hg). - excess mortality emerges for SPAP levels much below classical thresholds, with moderate PHTN (35-49 mm Hg) independently associated with excess mortality under medical management, which is eliminated after surgical correction of DMR. - severe PHTN (SPAP ≥ 50 mm Hg) is associated with more severe excess mortality, which is attenuated but not suppressed after surgical correction of DMR. - SPAP by Doppler is not just a surrogate for DMR severity, but is incremental to the Doppler EROA, RVol, and clinical characteristics in predicting outcome -> it is pivotal to obtain SPAP during #echofirst throughout the spectrum of DMR severity. In conclusion, consider moderate PHTN (35-49 mm Hg) in the decision-making for early surgical repair in patients with severe DMR to restore their life expectancy.

Unroofed coronary sinus 🔺shunt direction is predominantly L to R: LA to CS (conduit) to RA 🔺atrial-level shunt to RA, due to lower diastolic compliance of RV relative to LV 🔺When LV diastolic dysfunction develops,⬆️in L-to-R shunt 🔺> 60% unroofed CS have persistent LSVC to LA left upper arm #UEA 🫧enters CS then LA/LV before RA/RV) 🔺Due to direct CS-LA, filling of LA can be instantaneous/ indistinguishable from filling of CS isolated LSVC with an intact CS would only opacify RA bit.ly/3v1Wca2

✅50% of Neuroendocrine tumors 👉🏽 carcinoid syndrome (CS) ✅~50% of patients with CS 👉🏽 carcinoid heart disease ✅Left-sided valve disease is rare (<10%) and occurs when there is: right to left shunt, pulmonary (bronchial) carcinoid or very high levels of vasoactive substances 🌟 👉🏽Fox DJ, et al. Heart 2004 👉🏽Lundin L, et al. Circulation 1988 #echofirst #CardioTwitter @pattypellikka @onco_cardiology @AntonioBarros_ @echo_stepbystep @ShariqShamimMD @smlungpathguy @CMichaelGibson @DrRajeshG1 @md_harrington @dr_benoy_n_shah @purviparwani @iamritu @AJamilTajik @DrMarthaGulati @VLSorrellImages @DrJayMohan @ASE360 @EACVIPresident @OungSavly

#echofirst #CardioTwitter #3DTEE normal pulmonary valve in a pediatric patient seen from the pulmonary artery aspect

30 days after right jugular catheter. Asymptomatic. #echofirst

✨We can obtain so much information from a single Transthoracic Echo in patients with cardiac amyloidosis 🌟 🎯Be aware of clinical and #echofirst red flags for an early diagnosis 💛 🎯Don’t be afraid to communicate/report your suspicion to foster further investigation, correlating always with clinical findings 🗣️ 🎯Strain has important prognostic information and may be used to follow patients during treatment ✨Posted from Chile 🇨🇱 @iamritu @MasriAhmadMD @ISA_Amyloidosis @NMerke @echo_stepbystep @KemalogluOz @fiore_corrado @echo_batman @StellEkaterina @thaiscoutinhoCV @mariovar55 @onco_cardiology @purviparwani @lpbadano

#echofirst #CardioTwitter Intraop TEE in a patient in his 70‘s with severe calcification of the native pulmonary valve and post-stenotic dilation of the pulmonary artery. PV disease was known since childhood, but no surgery.

#echofirst cheat sheet How to approach MR? B4 the exam: -hemodynamic status - GMDT in SMR? - AF? - Symptoms? - Need for stress test (after exam) Step by step approach inside a structured and comprehensive minimum dataset followed by pathology based data set The complete diagnosis is the result of putting together different information from the echo exam like putting together pieces of a puzzle 🧩 The Guideline Directed Triangle of the Truth: GDTT 👊how much 👊why 👊structural integrity 1how much? 🫵Volumetric parameters from minimum data set as LVOT SV, total LV SV with its plausibility check by looking at RVOT SV & tot. RV SV 🫵Increased E wave inflow velocity > 1,2 m/s & DVI 🫵Vena contracta 🫵PISA EROA in case it has been suitable to use 2why? 🔑Leaflet position 🔑Jet direction 🔑3D confirming 3 structural integrity 📏LVEDS 🛢️LAVI LVEF, GLS “sPAP”

80yo male who presents to the ED in a comatose state. Echo images at initial evaluation. Final diagnosis: bilateral internal carotid occlusion.😔@EmergencyEcho #POCUS @ImagenCardiaca #echofirst

#echofirst #CardioTwitter @echotalk 🫀How to identify the coronary artery ostia in TEE ?🫀 🔻LCA - ME AV SAX 🔻RCA - ME AV LAX or ME bicaval 🔻2D TEE versus in vivo = horizontally & vertically mirrored 🔻2D TEE versus 3D TEE = horizontally & vertically mirrored

Cor triatriatum @escardio #Cardiotwitter @UniFAU @YoungDgk

The mechanism of left ventricular outflow tract obstruction (LVOTO) is complex in hypertrophic cardiomyopathy (HCM). We aimed to evaluate the impact of mitral valve geometry on LVOTO by echocardiography. Read our @JournalASEcho article: bit.ly/3LXwA32

✅9-month-old “ Stridor” ❤️@ASE360 @AEPCcongenital

GDM (~20% of pregnancies) is associated w subclinical CVD on echo and endothelial fxn testing yrs later, even without diabetes. Excited to see in press collaboration betw @UPMC @hopkinsheart @JHUWelchCenter supported by @AHAScience

9/ Recently, LA stiffness index (LASI) has been introduced as LASI = (E/e’)/LARS. If LARS had been a measure of LA stiffness, which it isn’t, the ratio of E/e’ divided by LARS would have been a measure of LA elastance, so it isn’t. Instead we have even more confounders: