Roberto Ochoa

@Jcontreras75 @MSMCardsFellows @argulian @DLBHATTMD @spinneymd @robertoc8 Thank you so much, Dr. Contreras!

@MSMCardsFellows @argulian @DLBHATTMD @spinneymd Congrats @robertoc8

We’re excited to welcome Dr. Roberto Ochoa Jimenez back to Mount Sinai Morningside as an Advanced Cardiac Imaging Attending! Dr. Ochoa completed his cardiology fellowship at Mount Sinai Morningside, followed by advanced imaging at UCSF. His clinical and academic interests encompass advanced echocardiography, structural heart imaging, cardiac CT, and cardiac MRI, reflecting a commitment to cutting-edge cardiovascular diagnostics and patient care. Thrilled to have him rejoin our team! @RobertoC8a 👏👏 @MountSinaiHeart #cardiotwitter

@dranulala @MSMCardsFellows @argulian @DLBHATTMD @spinneymd Thank you very much, Dr. Lala!

@MSMCardsFellows @argulian @DLBHATTMD @spinneymd Amazing recruit!

In Europe 🇪🇺 #echofirst I have seen them even in tricuspid & pulmonary position 1️⃣ is a solo 2️⃣ is a duo 3️⃣ is a trio 4️⃣ is a team @ASE360 @EACVIPresident @iamritu @NMerke

A patient with precapillary pulmonary hypertension and atrial fibrillation. RVOT sampling shown. Why is mid-systolic notching variable?

In Atrial Functional MR can get “Hamstringing”of posterior MV leaflet due to massive LA dilation;this “atriogenic” leaflet tethering is from displaced posterior annulus onto crest of LV inlet resulting in⬆️in annulopapillary distance restricting leaflet motion #echofirst

Today in cathlab TOE, CWD in MS. Double envelope signal. What do you think about the faint “MS” signal? Fact or fiction?

A patient with shortness of breath. A CW Doppler interrogation across the mitral valve is shown. 1/2

A patient for TEE prior to cardioversion. CW interrogation across the mitral valve in the long axis view. What is the low velocity signal indicated by the arrow?

**CASE OF THE MONTH** Female, mid 20s Fit & healthy No CVS risk factors Only 💊 is COC pill Experiences central chest pain during sport (exertion), not happened before Recently has been well, no coryzal or other symptoms Here is admission ECG

DILV Apical view demonstrates - two AV valves aligned & empty into a dilated left ventricle with fine apical trabeculations. @ASE360 @iamritu @alexsfelixecho @loomba_rohit @dkthekkoott @CASivaram1 @alex1708ander @CardioNeo @sujithsp @swatigar @WGACHDChair @argulian @ACCinTouch

Spectral Doppler tracings provide important hemodynamic insights. This book is dedicated to interpretation of spectral Doppler recordings, similar to EKG books focused on EKG interpretation. Examples of some spectral Doppler patterns which may not be widely known: Notched aortic regurgitation Interrupted aortic regurgitation Phantom systole Double peak LVOT signal Notched tricuspid regurgitation Giant L wave Intermittent systolic flow reversal in hepatic veins Merged tricuspid regurgitation @EchoSoliman

📌 case of the day: massive TR of a complex etiology: functional (right atrial and ventricular dilation, RV and LV dysfunction) ➕ degenerative leaflets with fibrotic thickening. Challenging to determine the primary cause vs the consequence and challenging to manage in high- surgical-risk patient. We are increasingly encountering such mixed etiologies in valve disease. #3DEcho 🔍 shows “anatomical” regurgitant orifice @CASivaram1 @fiore_corrado @iamritu @alcantaramonica @NMerke @LHoyesWouter @echo_stepbystep @denisamuraru @alexsfelixecho @alex1708ander @najibadn @SwissHeartDoc

Recognize the cute device bouncing in the LAA? Two years after transcatheter mitral paravalvular leak closure — Amplatzer device found embolized to the left atrial appendage. A reminder: closure success is more than the immediate result #CardioTwitter #StructuralHeart @PCRonline

💡 A rare very interesting case: persistent left superior vena cava (PLSVC) + right superior vena cava (RSVC) atresia --> challenging CRT-D implantation ⭐ Echo: - Dilated coronary sinus - Bubble test (agitated saline solution) via the left antecubital vein: bubbles first in the coronary sinus and then in the right atrium --> PLSVC ⭐ CT-scan + venography: - Right superior vena cava (RSVC) atresia with the right brachiocephalic vein drained directly into the persistent left superior vena cava (PLSVC) - PLSVC drained directly into the coronary sinus ⭐ Very challenging CRT-D implantation via left subclavian vein.

NBTE nonbacterial thrombotic endocarditis - look for sterile “vegetations” (platelet fibrin deposits) along the valve leaflet’s closing edges that appear to "kiss" in this characteristic pattern #echofirst

🔎 Pneumopericardium can occur during pericardiocentesis even with slow drainage if >1L is removed. Sudden pressure shifts allow air entry. Air can be drained if the catheter is still in place. #Pericardiocentesis #CardioTwitter

@argulian CWD mixing with MR signal, peak MR velocity ~7m/s (196 mmHg). Assuming a LAP of 15 mmHg, the peak LVOT gradient would be ~81 mmHg.

A outpatient with dyspnea, BP 130/80 mmHg. Attempted interrogation across LVOT in 5CH view using CW Doppler. What is is the Doppler signal, what are the implications?

@argulian Prominent a wave reversal due to PVC at the time of atrial contraction.

A patient with palpitations. Pulmonary vein flow is interrogated during TTE. What is the wave highlighted by white arrow?

@kameldzi @iamritu @lukasz_zydzik @DrRajeshG1 @argulian @drjasondungu @KemalogluOz @purviparwani @NMerke @bwoody58 Fresh thrombi may have hypoechoic core. Hier is a case of fresh thombi, all gone after effective oral anticoagulation within 1 week