Echo Emergencies. Outline. Michael H. Picard, MD Massachusetts General Hospital Harvard Medical School No disclosures

Size: px
Start display at page:

Download "Echo Emergencies. Outline. Michael H. Picard, MD Massachusetts General Hospital Harvard Medical School No disclosures"

Transcription

1 Echo Emergencies Michael H. Picard, MD Massachusetts General Hospital Harvard Medical School No disclosures Outline Common emergency / on call scenarios Tamponade Pulmonary embolism/rv strain Cardiogenic shock / MI complications / volume status Chest pain and LBBB Aortic dissection Transplant donor evals and OHT rejection Volume status (IVC imaging) Prosthetic valve thrombosis/obstruction Mechanical Circulatory Support malfunction Post-cardiac surgery hypotension 2 1

2 Cardiac Tamponade Echocardiographic findings in Cardiac Tamponade Pericardial effusion RV free wall inversion early diastole, respiratory variation RA inversion late diastole, early systole: >33% of cycle IVC plethora exaggerated Doppler respiratory variation in transvalvular flow IVC, TV, PV: insp, exp MV, AV: insp, exp 2

3 3

4 Gillam et al Circ 1983;68:

5 Hypotension immediate post-cardiac surgery TTE images tough Hematoma rather than free flowing fluid May be difficult to see even when images are good Often localized behind RA Doppler flow variations may be the best clue of elevated intra-pericardial pressure Clinical judgement required TEE vs. go back to OR without confirmation 10 5

6 Pulmonary embolism TTE should not be performed to diagnose PE (i.e., to look for the thrombus) It is used to assess presence of RV strain which may impact treatment decisions 11 RV strain in the setting of pulmonary embolism aka McConnell s Sign Am J Card 1996;78:

7 Chest pain and LBBB is it ACS? 13 Type I aortic dissection 7

8 Who says you can t diagnose aortic dissection with TTE? 15 Echocardiographic findings Intimal flap High frequency, low amplitude motion flow respects the boundary Artifacts Motion - Low frequency (or same frequency as adjacent structure) and high amplitude Color flow goes through +/- aortic dilation Aortic insufficiency Wall motion abnormality if flap obstructs coronary ostia 8

9 Echo for Aortic Dissection TEE Sensitivity % and specificity % in different series False negative TEE is rare: few dissections are limited to the blind spot at the inferior portion of the arch False positive TEE: Artifacts are very common (23-55%), especially in the ascending aorta. Artifacts Side-by-side: lateral resolution, side lobe, lens effect Behind, parallel motion: Reverberation Behind, opposite motion: Mirror image 9

10 Linear TEE artifacts artifacts in the aorta seen in the presence of dilated aortas Artifact distance = 2 times that of interface Transverse TEE image of dilated ascending aorta compressing LA. Note the artifact crosses borders Appelbe et al, JACC 1993;21: Clues to artifacts Cross borders motion identical to another real structure amplitude and frequency at a multiple of the real structure indistinct edges not reproduced in an orthogonal or other view color flow passes through it clues - foreign materials present catheters, prosthetic valves, grafts these are not always in the plane of view 10

11 Clues to real structures respects borders distinct edges (unless thrombus) motion intimal flaps - amplitude and frequency of motion different than cardiac cycle, respiration seen in multiple views color flow respects true borders intimal flaps keep company other pathologic processes LVAD or other Mechanical Circulatory Support potential complications Aortic dissection AI of native valve ; Aortic valve thrombosis Conduit obstruction / kinking Worsening of RV failure Inlet cannula thrombosis Overpumping Pump failure Bleeding / hematoma infection 22 11

12 LV underfilled (overpumping, RPMs too high) LVAD complications 12

13 Device malfunction due to thrombus response to changing pump speed Image at lowest pump speed, increase to maximum pump speed (2 min/intermediate stages) Normal response LVEDd decrease Decrease in AV opening duration RV stroke volume increases Increased MV deceleration time If obstruction (ie., thrombus) No change in LVEDd, AV opening, RV SV, Decreased LV deceleration time MV E wave decrease and deceleration time increase with increased LVAD pump speeds = reduction in LV diastolic pressures Estep et al JACC CV Img 2010;3:

14 61 yo with VV ECMO and hypotension RA-PA ECMO for severe COPD, awaiting lung transplant TTE for? Pericardial effusion/tamponade 14

15 15

16 Cardiac Transplant on call echoes Donor assessment Assess LV function, valve disease Transplant rejection Reduced LV function (compare to prior) Myocardial edema (increased wall thickening) Not seen with certain immunosuppressives Non-compliant LV (diastolic dysfunction) Mainly with cyclosporine Nonspecific may occur just due to increased LA pressure 32 16

17 Cardiogenic Shock (CS) after MI: etiologies and outcome from a large registry 1190 CS pts eligible but not randomized to SHOCK Trial (mechanical complications excluded) etiologies: LV failure 78.5% severe MR 6.9% ventricular septal rupture 3.9% isolated RV shock 2.8% tamponade 1.4% other (severe valve ds, hemorrhage, sepsis) 6.7% ventricular septal rupture - highest mortality (87.3%) Hochman et al JACC 2000;36: Cardiogenic shock post-mi ventricular septal rupture 34 17

18 Cardiogenic shock post-mi papillary muscle rupture 35 Cardiogenic shock post-mi pseudo aneurysm 18

19 Cardiogenic shock post-mi free wall rupture Elderly diabetic woman with several days of malaise and chest pain. Low BP in ED. TEE for aortic dissection. No dissection but LV EF reduced and pericardial effusion Bimbaum Y, et al. N Engl J Med. 2002; Edwards BS, et al. Am J Cardiol. 1984; Mann JM, Roberts WC. Am J Cardiol Cardiogenic shock just a bad LV 38 19

20 Hypotension assessing preload by IVC size 39 IVC size and respiratory dynamics 40 Normal IVC size 50% decrease in diameter = normal RA pressure Dilated IVC Normal inspiratory collapse (> 50%) suggestive of mildly elevated RA pressure (6-10 mm HG) Inspiratory collapse < 50 % RA pressure mm HG No collapse suggests markedly elevated RA pressure of > 15 mm Hg Small IVC (< 1.2 cm) with spontaneous collapse often is seen in the presence of intravascular volume depletion 20

21 Prosthetic valve thrombosis Occurs in both mechanical and biological prostheses Stenosis with or without regurgitation Gradual or sudden onset of symptoms 2X higher in MV than AV Keys on echo Movement of occlude Doppler gradients Pattern of flow / regurgitation 41 GMK 53 yo F remote hx of Hodgkin s ds (s/p XRT to chest) AS/AI, MR, TR Progressive heart failure Day 14 s/p AVR/MVR Difficult to diurese LFTs now markedly elevated New dyspnea Supratherapeutic INR On call echo to assess for TR, paravalvular leak, pericardial effusion/tamponade 42 21

22 New SOB 2 weeks after AVR/MVR

23 TTE 45 Small LV IVS flattening in diastole and systole RV volume and pressure overload Aortic bileaflet mechanical prosthetic valve = ok Peak 18 mm Hg, mean 10 mm Hg, trace valvular AI Mitral bileaflet mechanical prosthesis Restricted motion of 1 of the disks Peak 31 mm Hg, mean 17 mm Hg (2 weeks earlier mean = 6 mm Hg) Severe TR Trivial pericardial effusion Peak gradient 25 mm Hg; mean 15 mm Hg mean formerly was 6 mm Hg (2 weeks prior) 46 23

24 Before and after 47 24

Echocardiography as a diagnostic and management tool in medical emergencies

Echocardiography as a diagnostic and management tool in medical emergencies Echocardiography as a diagnostic and management tool in medical emergencies Frank van der Heusen MD Department of Anesthesia and perioperative Care UCSF Medical Center Objective of this presentation Indications

More information

ARTIFACTS: THEORY AND ILLUSTRATIVE EXAMPLES

ARTIFACTS: THEORY AND ILLUSTRATIVE EXAMPLES ARTIFACTS: THEORY AND ILLUSTRATIVE EXAMPLES Robert A. Levine, M.D. Marielle Scherrer-Crosbie, M.D. Eric M. Isselbacher, M.D. 60 year old man Cardiac source of embolus? NAME THAT MASS! 1 NAME THAT MASS!

More information

PROSTHETIC VALVE BOARD REVIEW

PROSTHETIC VALVE BOARD REVIEW PROSTHETIC VALVE BOARD REVIEW The correct answer D This two chamber view shows a porcine mitral prosthesis with the typical appearance of the struts although the leaflets are not well seen. The valve

More information

ARTIFACTS: THEORY AND ILLUSTRATIVE EXAMPLES

ARTIFACTS: THEORY AND ILLUSTRATIVE EXAMPLES ARTIFACTS: THEORY AND ILLUSTRATIVE EXAMPLES Robert A. Levine, M.D. Marielle Scherrer-Crosbie, M.D. Eric M. Isselbacher, M.D. No conflicts of interest Philippe Bertrand, Pieter Vendervoort, Hasselt and

More information

TAVR: Echo Measurements Pre, Post And Intra Procedure

TAVR: Echo Measurements Pre, Post And Intra Procedure 2017 ASE Florida, Orlando, FL October 10, 2017 8:00 8:25 AM 25 min TAVR: Echo Measurements Pre, Post And Intra Procedure Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology Echo Lab Associate

More information

Outline. Echocardiographic Assessment of Pericardial Effusion/Tamponade: The Essentials

Outline. Echocardiographic Assessment of Pericardial Effusion/Tamponade: The Essentials Echocardiographic Assessment of Pericardial Effusion/Tamponade: The Essentials John R Schairer DO FACC Henry Ford Heart and Vascular Institute No Disclosures Outline Normal Anatomy and Physiology Pathophysiology

More information

Acute Aortic Syndromes

Acute Aortic Syndromes Acute Aortic Syndromes Michael H. Picard, M.D. Massachusetts General Hospital Harvard Medical School No disclosures For everything you need to know about the aorta see Circulation 2010;121:e266-e369 And.

More information

Echo in Heart Failure

Echo in Heart Failure Echo in Heart Failure Karima Addetia, MD Heart Failure: Definition A clinical syndrome that results from impairment of ventricular filling or ejection of blood. Manifestations include dyspnea and fatigue,

More information

P = 4V 2. IVC Dimensions 10/20/2014. Comprehensive Hemodynamic Evaluation by Doppler Echocardiography. The Simplified Bernoulli Equation

P = 4V 2. IVC Dimensions 10/20/2014. Comprehensive Hemodynamic Evaluation by Doppler Echocardiography. The Simplified Bernoulli Equation Comprehensive Hemodynamic Evaluation by Doppler Echocardiography Itzhak Kronzon, MD North Shore LIJ/ Lenox Hill Hospital New York, NY Disclosure: Philips Healthcare St. Jude Medical The Simplified Bernoulli

More information

Adel Hasanin Ahmed 1

Adel Hasanin Ahmed 1 Adel Hasanin Ahmed 1 PERICARDIAL DISEASE The pericardial effusion ends anteriorly to the descending aorta and is best visualised in the PLAX. PSAX is actually very useful sometimes for looking at posterior

More information

Pericardial Diseases. Smonporn Boonyaratavej, MD. Division of Cardiology, Department of Medicine Chulalongkorn University

Pericardial Diseases. Smonporn Boonyaratavej, MD. Division of Cardiology, Department of Medicine Chulalongkorn University Pericardial Diseases Smonporn Boonyaratavej, MD Division of Cardiology, Department of Medicine Chulalongkorn University Cardiac Center, King Chulalongkorn Memorial Hospital 21 AUGUST 2016 Pericardial

More information

cardiac imaging planes planning basic cardiac & aortic views for MR

cardiac imaging planes planning basic cardiac & aortic views for MR cardiac imaging planes planning basic cardiac & aortic views for MR Dianna M. E. Bardo, M. D. Assistant Professor of Radiology & Cardiovascular Medicine Director of Cardiac Imaging cardiac imaging planes

More information

Comprehensive Hemodynamics By Doppler Echocardiography. The Echocardiographic Swan-Ganz Catheter.

Comprehensive Hemodynamics By Doppler Echocardiography. The Echocardiographic Swan-Ganz Catheter. Comprehensive Hemodynamics By Doppler Echocardiography. The Echocardiographic Swan-Ganz Catheter. Itzhak Kronzon, MD, FASE, FACC, FESC, FAHA, FACP, FCCP North Shore HS, LIJ/Lenox Hill Hospital, New York

More information

Adult Echocardiography Examination Content Outline

Adult Echocardiography Examination Content Outline Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,

More information

Choose the grading of diastolic function in 82 yo woman

Choose the grading of diastolic function in 82 yo woman Question #1 Choose the grading of diastolic function in 82 yo woman E= 80 cm/s A= 70 cm/s LAVI < 34 ml/m 2 1= Grade 1 2= Grade 2 3= Grade 3 4= Normal 5= Indeterminate 2018 MFMER 3712003-1 Choose the grading

More information

You Won t Believe What I Saw on. Disclosures. Goals. Dimensions 2013 October 18 th Michael Pfeiffer, MD. No Financial Disclosures

You Won t Believe What I Saw on. Disclosures. Goals. Dimensions 2013 October 18 th Michael Pfeiffer, MD. No Financial Disclosures You Won t Believe What I Saw on that ECHO! Dimensions 2013 October 18 th Michael Pfeiffer, MD Disclosures No Financial Disclosures Goals Review unusual and unique echocardiographic images. Briefly present

More information

Echocardiographic Cardiovascular Risk Stratification: Beyond Ejection Fraction

Echocardiographic Cardiovascular Risk Stratification: Beyond Ejection Fraction Echocardiographic Cardiovascular Risk Stratification: Beyond Ejection Fraction October 4, 2014 James S. Lee, M.D., F.A.C.C. Associates in Cardiology, P.A. Silver Spring, M.D. Disclosures Financial none

More information

7. Echocardiography Appropriate Use Criteria (by Indication)

7. Echocardiography Appropriate Use Criteria (by Indication) Criteria for Echocardiography 1133 7. Echocardiography Criteria (by ) Table 1. TTE for General Evaluation of Cardiac Structure and Function Suspected Cardiac Etiology General With TTE 1. Symptoms or conditions

More information

Federico M Asch MD, FASE MedStar Heart and Vascular Institute Georgetown University Washington, DC

Federico M Asch MD, FASE MedStar Heart and Vascular Institute Georgetown University Washington, DC TAVR: When Things go Wrong Federico M Asch MD, FASE MedStar Heart and Vascular Institute Georgetown University Washington, DC Disclosures Academic Echo Core Lab Abbott / St Jude Medical Edwards Medtronic

More information

Index. K Knobology, TTE artifact, image resolution, ultrasound, 14

Index. K Knobology, TTE artifact, image resolution, ultrasound, 14 A Acute aortic regurgitation (AR), 124 128 Acute aortic syndrome (AAS) classic aortic dissection diagnosis, 251 263 evolutive patterns, 253 255 pathology, 250 251 classifications, 247 248 incomplete aortic

More information

Echo Doppler Assessment of Right and Left Ventricular Hemodynamics.

Echo Doppler Assessment of Right and Left Ventricular Hemodynamics. Echo Doppler Assessment of Right and Left Ventricular Hemodynamics. Itzhak Kronzon, MD, FASE, FACC, FESC, FAHA, FACP, FCCP Northwell, Lenox Hill Hospital, New York Professor of Cardiology Hofstra University

More information

Pericardial Disease: Case Examples. Echo Fiesta 2017

Pericardial Disease: Case Examples. Echo Fiesta 2017 Pericardial Disease: Case Examples Echo Fiesta 2017 2014 2014 MFMER MFMER 3346252-1 slide-1 Objectives Have a systematic approach to evaluation of constriction 2014 MFMER 3346252-2 CASE 1 2013 MFMER 3248567-3

More information

M-Mode Echocardiography Is it still Alive? Itzhak Kronzon, MD,FASE. Sampling Rate M-Mode: 1800 / sec 2D: 30 / sec

M-Mode Echocardiography Is it still Alive? Itzhak Kronzon, MD,FASE. Sampling Rate M-Mode: 1800 / sec 2D: 30 / sec M-Mode Echocardiography Is it still Alive? Itzhak Kronzon, MD,FASE Honoraria: Philips Classical M-mode Echocardiography M-Mode offers better time and image resolution. Sampling Rate M-Mode: 1800 / sec

More information

Prosthesis-Patient Mismatch or Prosthetic Valve Stenosis?

Prosthesis-Patient Mismatch or Prosthetic Valve Stenosis? EuroValves 2015, Nice Prosthesis-Patient Mismatch or Prosthetic Valve Stenosis? Philippe Pibarot, DVM, PhD, FACC, FAHA, FASE FESC Canada Research Chair in Valvular Heart Diseases Université LAVAL Disclosure

More information

Breakout Session: Transesophageal Echocardiography

Breakout Session: Transesophageal Echocardiography Breakout Session: Transesophageal Echocardiography Doris Ockert, MD Andrew Schroeder, MD University of Wisconsin School of Medicine and Public Health Jutta Novalija, MD, PhD Medical College of Wisconsin

More information

Mechanical Cardiac Support and Cardiac Transplant: The Role for Echocardiography

Mechanical Cardiac Support and Cardiac Transplant: The Role for Echocardiography Mechanical Cardiac Support and Cardiac Transplant: The Role for Echocardiography David Langholz, M.D., F.A.C.C. Co-Director Cardiovascular Imaging Fredrick Meijer Heart and Vascular Institute Spectrum

More information

Prosthetic valve dysfunction: stenosis or regurgitation

Prosthetic valve dysfunction: stenosis or regurgitation Prosthetic valve dysfunction: stenosis or regurgitation Jean G. Dumesnil MD, FRCP(C), FACC, FASE(Hon) Quebec Heart and Lung Institute, Québec, Québec No disclosures Possible Causes of High Gradients in

More information

Left Ventricular Assist Device: What Should I Report?

Left Ventricular Assist Device: What Should I Report? 2017 SOTA, Tucson, AZ February 21, 2017 11:15 11:40 AM 25 min Left Ventricular Assist Device: What Should I Report? Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology Echo Lab Associate Professor

More information

Clinical Indications for Echocardiography

Clinical Indications for Echocardiography Clinical Indications for Echocardiography Echocardiography is widely utilised and potential applications are increasing with advances in technology. The aim of this document is two-fold: 1) To define clinical

More information

Pulmonary Hypertension: Another Use for Viagra

Pulmonary Hypertension: Another Use for Viagra Pulmonary Hypertension: Another Use for Viagra Kathleen Tong, MD Director, Heart Failure Program Assistant Clinical Professor University of California, Davis Disclosures I have no financial conflicts A

More information

25 different brand names >44 different models Sizes mm

25 different brand names >44 different models Sizes mm Types of Prosthetic Valves BIOLOGIC STENTED Porcine xenograft Pericardial xenograft STENTLESS Porcine xenograft Pericardial xenograft Homograft (allograft) Autograft PERCUTANEOUS MECHANICAL Bileaflet Single

More information

The Role of Mechanical Circulatory Support in Cardiogenic Shock: When to Utilize

The Role of Mechanical Circulatory Support in Cardiogenic Shock: When to Utilize The Role of Mechanical Circulatory Support in Cardiogenic Shock: Presented by Nancy Scroggins ACNP, CNS-CC CV Surgery ACNP Bayshore Medical Center The Role of Mechanical Circulatory Support in Cardiogenic

More information

Echocardiography Conference

Echocardiography Conference Echocardiography Conference David Stultz, MD Cardiology Fellow, PGY-6 September 20, 2005 Atrial Septal Aneurysm Bulging of Fossa Ovalis Associated commonly with Atrial septal defect or small perforations

More information

Optimal Imaging Technique Prior to TAVI -Echocardiography-

Optimal Imaging Technique Prior to TAVI -Echocardiography- 2014 KSC meeting Optimal Imaging Technique Prior to TAVI -Echocardiography- Geu-Ru Hong, M.D. Ph D Associate Professor of Medicine Division of Cardiology, Severance Cardiovascular Hospital Yonsei University

More information

DISCLOSURE. Echocardiography in Systemic Diseases: Questions. Relevant Financial Relationship(s) None. Off Label Usage None 5/7/2018

DISCLOSURE. Echocardiography in Systemic Diseases: Questions. Relevant Financial Relationship(s) None. Off Label Usage None 5/7/2018 Echocardiography in Systemic Diseases: Questions Sunil Mankad, MD, FACC, FCCP, FASE Associate Professor of Medicine Mayo Clinic College of Medicine Director, Transesophageal Echocardiography Associate

More information

ASCeXAM / ReASCE. Practice Board Exam Questions Monday Morning

ASCeXAM / ReASCE. Practice Board Exam Questions Monday Morning ASCeXAM / ReASCE Practice Board Exam Questions Monday Morning Ultrasound Physics Artifacts Doppler Physics Imaging, Knobology, and Artifacts Echocardiographic Evaluation of the RV Tricuspid and Pulmonary

More information

TSDA Boot Camp September 13-16, Introduction to Aortic Valve Surgery. George L. Hicks, Jr., MD

TSDA Boot Camp September 13-16, Introduction to Aortic Valve Surgery. George L. Hicks, Jr., MD TSDA Boot Camp September 13-16, 2018 Introduction to Aortic Valve Surgery George L. Hicks, Jr., MD Aortic Valve Pathology and Treatment Valvular Aortic Stenosis in Adults Average Course (Post mortem data)

More information

Role of echocardiography in the assessment of ischemic heart disease 분당서울대학교병원윤연이

Role of echocardiography in the assessment of ischemic heart disease 분당서울대학교병원윤연이 Role of echocardiography in the assessment of ischemic heart disease 분당서울대학교병원윤연이 Outline Evaluation of Chest pain Evaluation of MI complications Prediction of Outcomes Evaluation of Chest pain Evaluation

More information

New ASE Guidelines: What you must know

New ASE Guidelines: What you must know New ASE Guidelines: What you must know Federico M Asch MD, FASE, FACC Chair, ASE Guidelines and Standards Committee Medstar Washington Hospital Center Medstar Health Research Institute Georgetown University

More information

Cardiogenic Shock. Carlos Cafri,, MD

Cardiogenic Shock. Carlos Cafri,, MD Cardiogenic Shock Carlos Cafri,, MD SHOCK= Inadequate Tissue Mechanisms: Perfusion Inadequate oxygen delivery Release of inflammatory mediators Further microvascular changes, compromised blood flow and

More information

JFICMI Basic Critical Care Echocardiography (BCCE)

JFICMI Basic Critical Care Echocardiography (BCCE) JFICMI Basic Critical Care Echocardiography (BCCE) 2017 Introduction The International expert statement on training standards for critical care ultrasonography position paper published in Intensive Care

More information

CARDIOLOGY GRAND ROUNDS

CARDIOLOGY GRAND ROUNDS CARDIOLOGY GRAND ROUNDS Presentation: Speakers: Percutaneous Repair of Paravalvular Prosthetic Regurgitation Paul Sorajja, MD Director of the Center for Valve and Structural Heart Disease Minneapolis Heart

More information

Intra-operative Echocardiography: When to Go Back on Pump

Intra-operative Echocardiography: When to Go Back on Pump Intra-operative Echocardiography: When to Go Back on Pump GREGORIO G. ROGELIO, MD., F.P.C.C. OUTLINE A. Indications for Intraoperative Echocardiography B. Role of Intraoperative Echocardiography C. Criteria

More information

A case of post myocardial infarction ventricular septal rupture CHRISTOFOROS KOBOROZOS, MD

A case of post myocardial infarction ventricular septal rupture CHRISTOFOROS KOBOROZOS, MD A case of post myocardial infarction ventricular septal rupture CHRISTOFOROS KOBOROZOS, MD NAVAL HOSPITAL OF ATHENS case presentation Female, 81yo Hx: diabetes mellitus, hypertension, chronic anaemia presented

More information

Aortic Stenosis and TAVR TARUN NAGRANI, MD INTERVENTIONAL AND ENDOVASCULAR CARDIOLOGIST, SOMC

Aortic Stenosis and TAVR TARUN NAGRANI, MD INTERVENTIONAL AND ENDOVASCULAR CARDIOLOGIST, SOMC Aortic Stenosis and TAVR TARUN NAGRANI, MD INTERVENTIONAL AND ENDOVASCULAR CARDIOLOGIST, SOMC No Financial Disclosures Aortic Stenosis AS is an insidious disease with a long latency period followed by

More information

Diastolic Heart Function: Applying the New Guidelines Case Studies

Diastolic Heart Function: Applying the New Guidelines Case Studies Diastolic Heart Function: Applying the New Guidelines Case Studies Mitral Regurgitation The New ASE William Guidelines: A. Zoghbi Role MD, of FASE, 2D/3D MACCand CMR Professor and Chairman, Department

More information

New murmur: acute valvular regurgitations. A.Pasquet, MD,PhD. UCL -Cliniques Saint Luc

New murmur: acute valvular regurgitations. A.Pasquet, MD,PhD. UCL -Cliniques Saint Luc New murmur: acute valvular regurgitations. A.Pasquet, MD,PhD UCL -Cliniques Saint Luc Acute valvular regurgitation Clinical case Mr Dupont, a 53 y old men, without any particular medical history On Thursday

More information

(Ann Thorac Surg 2008;85:845 53)

(Ann Thorac Surg 2008;85:845 53) I Made Adi Parmana The utility of intraoperative TEE has become increasingly more evident as anesthesiologists, cardiologists, and surgeons continue to appreciate its potential application as an invaluable

More information

Diseases of the Aorta

Diseases of the Aorta Diseases of the Aorta ASE Review 2018 Susan E Wiegers, MD, FASE, FACC Professor of Medicine My great friend Dr. Roberto Lang Disclosure None related to this presentation 1 Objectives Aneurysm Dissection

More information

Interventions in Adult Congenital Heart Disease: Role of CV Imaging. Associate Professor. ACHD mortality. Pillutla. Am Heart J 2009;158:874-9

Interventions in Adult Congenital Heart Disease: Role of CV Imaging. Associate Professor. ACHD mortality. Pillutla. Am Heart J 2009;158:874-9 Interventions in Adult Congenital Heart Disease: Role of CV Imaging Sangeeta Shah MD, FACC, FASE Associate Professor ACHD mortality Pillutla. Am Heart J 2009;158:874-9 Adult Congenital Heart Disease Heterogenity

More information

Echo Week - Learning Objectives

Echo Week - Learning Objectives Echo Week - Learning Objectives Sunday, February 25 5-7 pm Physics Review Moderator: Mark Taylor, MD 1. Understand the ultrasound physics and apply it to image creation and optimization 2. Infer the interaction

More information

Image Library Case Listing:

Image Library Case Listing: Image Library Case Listing: 1. Giant left atrial myxoma with mitral valve damage 2. Type A aortic dissection 3. Primum ASD 4. Aortic Transection from motor vehicle accident 5. Snake thrombus in right atrium

More information

Ejection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV.

Ejection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV. Valvular Heart Disease Etiology General Principles Cellular and molecular mechanism of valve damage Structural pathology Functional pathology - stenosis/regurgitation Loading conditions - pressure/volume

More information

Echocardiographic Evaluation of Mitral Valve Prostheses

Echocardiographic Evaluation of Mitral Valve Prostheses Echocardiographic Evaluation of Mitral Valve Prostheses Dennis A. Tighe, M.D., FACC, FACP, FASE Cardiovascular Medicine University of Massachusetts Medical School Worcester, MA www.asecho.org 1 Nishimura

More information

Evaluation of the Right Ventricle in Candidates for Right Ventricular Assist Device Implantation.

Evaluation of the Right Ventricle in Candidates for Right Ventricular Assist Device Implantation. Evaluation of the Right Ventricle in Candidates for Right Ventricular Assist Device Implantation. Evaluation of RVAD Function. Ioannis A Paraskevaidis Attikon University Hospital Historical Perspective

More information

Procedural Guidance of TAVR: How to Assure it Goes Right and What to Do If It Doesn t

Procedural Guidance of TAVR: How to Assure it Goes Right and What to Do If It Doesn t Procedural Guidance of TAVR: How to Assure it Goes Right and What to Do If It Doesn t James D. Thomas, M.D., F.A.C.C. Department of Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic

More information

TRANSCATHETER AORTIC VALVE IMPLANTATION: PSCC EXPERIENCE DR HUSSEIN ALAMRI PSCC RIYADH

TRANSCATHETER AORTIC VALVE IMPLANTATION: PSCC EXPERIENCE DR HUSSEIN ALAMRI PSCC RIYADH TRANSCATHETER AORTIC VALVE IMPLANTATION: PSCC EXPERIENCE DR HUSSEIN ALAMRI PSCC RIYADH Available systems: Edwards (TA and TF) and Core valve. INTRODUCTION 3 4% 0f > 65 y. 30 40% of elderly denied surgery,.

More information

Takotsubo cardiomyopathy. Joseph L. Blackshear, MD Professor of Medicine Mayo Clinic College of Medicine Mayo Clinic Florida

Takotsubo cardiomyopathy. Joseph L. Blackshear, MD Professor of Medicine Mayo Clinic College of Medicine Mayo Clinic Florida Takotsubo cardiomyopathy Joseph L. Blackshear, MD Professor of Medicine Mayo Clinic College of Medicine Mayo Clinic Florida 79 year old woman, pre chemo echo for esophageal cancer Post chemo, dehydration,

More information

Complications of Myocardial Infarction

Complications of Myocardial Infarction Complications of Myocardial Infarction Sunil Mankad, MD, FACC, FCCP, FASE Associate Professor of Medicine Mayo Clinic College of Medicine Director, Transesophageal Echocardiography Associate Director,

More information

Acute Valve Regurgitation Catherine M. Otto, MD J. Ward Kennedy-Hamilton Endowed Chair in Cardiology University of Washington, Seattle

Acute Valve Regurgitation Catherine M. Otto, MD J. Ward Kennedy-Hamilton Endowed Chair in Cardiology University of Washington, Seattle Acute Valve Regurgitation Catherine M. Otto, MD J. Ward Kennedy-Hamilton Endowed Chair in Cardiology University of Washington, Seattle No conflicts of interest Acute Aortic Regurgitation Causes aortic

More information

Echocardiography Volume assessment. Justin Mandeville 2014

Echocardiography Volume assessment. Justin Mandeville 2014 Echocardiography Volume assessment Justin Mandeville 2014 Volume assessment and the intensivist Hypovolaemic shock Fluid tolerance Optimising cardiac output Avoiding overloading Guided fluid removal Add

More information

Echocardiographic Structural Assessment Pre- LVAD

Echocardiographic Structural Assessment Pre- LVAD None Disclosures Echocardiographic Structural Assessment Pre- LVAD LVEF ( 25% for DT LVAD) Right ventricle Valvular disease Intra- cardiac shunts Intra- cardiac thrombi Ascending aorta Case 1 50 yo M

More information

New Cardiovascular Devices and Interventions: Non-Contrast MRI for TAVR Abhishek Chaturvedi Assistant Professor. Cardiothoracic Radiology

New Cardiovascular Devices and Interventions: Non-Contrast MRI for TAVR Abhishek Chaturvedi Assistant Professor. Cardiothoracic Radiology New Cardiovascular Devices and Interventions: Non-Contrast MRI for TAVR Abhishek Chaturvedi Assistant Professor Cardiothoracic Radiology Disclosure I have no disclosure pertinent to this presentation.

More information

The Doppler Examination. Katie Twomley, MD Wake Forest Baptist Health - Lexington

The Doppler Examination. Katie Twomley, MD Wake Forest Baptist Health - Lexington The Doppler Examination Katie Twomley, MD Wake Forest Baptist Health - Lexington OUTLINE Principles/Physics Use in valvular assessment Aortic stenosis (continuity equation) Aortic regurgitation (pressure

More information

Outline. EuroScore II. Society of Thoracic Surgeons Score. EuroScore II

Outline. EuroScore II. Society of Thoracic Surgeons Score. EuroScore II SURGICAL RISK IN VALVULAR HEART DISEASE: WHAT 2D AND 3D ECHO CAN TELL YOU AND WHAT THEY CAN'T Ernesto E Salcedo, MD Professor of Medicine University of Colorado School of Medicine Director of Echocardiography

More information

Ejection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV.

Ejection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV. Valvular Heart Disease General Principles Etiology Cellular and molecular mechanism of valve damage Structural pathology Functional pathology - stenosis/regurgitation Loading conditions - pressure/volume

More information

The Role of Imaging in Transcatheter Aortic Valve Implantation

The Role of Imaging in Transcatheter Aortic Valve Implantation The Role of Imaging in Transcatheter Aortic Valve Implantation Helmut Baumgartner Westfälische Wilhelms-Universität Münster Division of Adult Congenital and Valvular Heart Disease Department of Cardiovascular

More information

PARAVALVULAR LEAK POST TAVR. Elements of Follow-up Post TAVR

PARAVALVULAR LEAK POST TAVR. Elements of Follow-up Post TAVR PARAVALVULAR LEAK POST TAVR David S Rubenson MD FACC FASE Founding Director, Cardiac Non-Invasive Laboratory Scripps Clinic Medical Group number 1 Elements of Follow-up Post TAVR JACC CV Imag 2016;9:193

More information

Case # 1. Page: 8. DUKE: Adams

Case # 1. Page: 8. DUKE: Adams Case # 1 Page: 8 1. The cardiac output in this patient is reduced because of: O a) tamponade physiology O b) restrictive physiology O c) coronary artery disease O d) left bundle branch block Page: 8 1.

More information

TEE Zebras. Case Cardiac Anesthesia Group

TEE Zebras. Case Cardiac Anesthesia Group TEE Zebras Edwin G. Avery, IV, M.D., C.P.I. Chief, Division of Cardiac Anesthesia University Hospitals Case Medical Center Associate Professor of Anesthesiology Case Western Reserve University School of

More information

Ventricular Assisting Devices in the Cathlab. Unrestricted

Ventricular Assisting Devices in the Cathlab. Unrestricted Ventricular Assisting Devices in the Cathlab Unrestricted What is a VAD? A single system device that is surgically attached to the left ventricle of the heart and to the aorta for left ventricular support

More information

LV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital

LV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital LV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital LV inflow across MV LV LV outflow across AV LV LV geometric changes Pressure overload

More information

Shock, Monitoring Invasive Vs. Non Invasive

Shock, Monitoring Invasive Vs. Non Invasive Shock, Monitoring Invasive Vs. Non Invasive Paula Ferrada MD Assistant Professor Trauma, Critical Care and Emergency Surgery Virginia Commonwealth University Shock Fluid Pressors Ionotrope Intervention

More information

2/4/2011. Nathan Kerner, M.D.

2/4/2011. Nathan Kerner, M.D. Nathan Kerner, M.D. Definition Elevated pressures - cut off usually >40 mmhg pulmonary artery systolic pressure (PASP) Usually associated with elevated pulmonary vascular resistance (PVR) measured in dynessec/cm

More information

ICE: Echo Core Lab-CRF

ICE: Echo Core Lab-CRF APPENDIX 1 ICE: Echo Core Lab-CRF Study #: - Pt Initials: 1. Date of study: / / D D M M M Y Y Y Y 2. Type of Study: TTE TEE 3. Quality of Study: Poor Moderate Excellent Ejection Fraction 4. Ejection Fraction

More information

좌심실수축기능평가 Cardiac Function

좌심실수축기능평가 Cardiac Function Basic Echo Review Course 좌심실수축기능평가 Cardiac Function Seonghoon Choi Cardiology Hallym university LV systolic function Systolic function 좌심실수축기능 - 심근의수축으로심실에서혈액을대동맥으로박출하는기능 실제임상에서 LV function 의의미 1Diagnosis

More information

Constriction vs Restriction Case-based Discussion

Constriction vs Restriction Case-based Discussion Mayo Clinic Department of Cardiovascular Diseases Mayo Clinic Echocardiography Review Course for Boards and Recertification Constriction vs Restriction Case-based Discussion Jae K. Oh, MD Samsung Professor

More information

Echocardiographic Evaluation of the Aorta

Echocardiographic Evaluation of the Aorta Echocardiographic Evaluation of the Aorta William F. Armstrong M.D. Director Echocardiography Laboratory Professor of Medicine University of Michigan The Aorta: What to Evaluate Dimensions / shape Atherosclerotic

More information

CONGENITAL HEART DEFECTS IN ADULTS

CONGENITAL HEART DEFECTS IN ADULTS CONGENITAL HEART DEFECTS IN ADULTS THE ROLE OF CATHETER INTERVENTIONS Mario Carminati CONGENITAL HEART DEFECTS IN ADULTS CHD in natural history CHD with post-surgical sequelae PULMONARY VALVE STENOSIS

More information

DOPPLER HEMODYNAMICS (1) QUANTIFICATION OF PRESSURE GRADIENTS and INTRACARDIAC PRESSURES

DOPPLER HEMODYNAMICS (1) QUANTIFICATION OF PRESSURE GRADIENTS and INTRACARDIAC PRESSURES THORAXCENTRE DOPPLER HEMODYNAMICS (1) QUANTIFICATION OF PRESSURE GRADIENTS and INTRACARDIAC PRESSURES J. Roelandt DOPPLER HEMODYNAMICS Intracardiac pressures and pressure gradients Volumetric measurement

More information

Course Learning Objectives Sunday, February 17 Friday, February 22

Course Learning Objectives Sunday, February 17 Friday, February 22 Course Learning Objectives Sunday, February 17 Friday, February 22 1. Define the physical principles of ultrasound technology and its applications for two and threedimensional (2D, 3D) imaging and use

More information

Emergency Intraoperative Echocardiography

Emergency Intraoperative Echocardiography Emergency Intraoperative Echocardiography Justiaan Swanevelder Department of Anaesthesia, Glenfield Hospital University Hospitals of Leicester NHS Trust, UK Carl Gustav Jung (1875-1961) Your vision will

More information

Rotation: Echocardiography: Transthoracic Echocardiography (TTE)

Rotation: Echocardiography: Transthoracic Echocardiography (TTE) Rotation: Echocardiography: Transthoracic Echocardiography (TTE) Rotation Format and Responsibilities: Fellows rotate in the echocardiography laboratory in each clinical year. Rotations during the first

More information

The Balancing Act Bleeding and Thrombosis in MCS. Muhammad Adil Soofi

The Balancing Act Bleeding and Thrombosis in MCS. Muhammad Adil Soofi The Balancing Act Bleeding and Thrombosis in MCS Muhammad Adil Soofi Road Map Survival and complications with LVAD What is the Burden of thrombosis and bleeding Why Bleeding and Thrombosis happen When

More information

Stress Testing in Valvular Disease

Stress Testing in Valvular Disease 2017 ASE Florida Orlando, FL October 10, 2017 2:40 2:50 PM 10 min Grand Harbor Ballroom South Stress Testing in Valvular Disease Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology Echo Lab Associate

More information

Heart Valve disease: MR. AS tough patient When to echo, When to refer, What s new

Heart Valve disease: MR. AS tough patient When to echo, When to refer, What s new Heart Valve disease: MR. AS tough patient When to echo, When to refer, What s new B. Sonnenberg UAH Cardiology CME Day 5 May 2015 Disclosures Speaker s or Advisory Boards: none Research grants: none (co-investigator

More information

Section 6 Intra Aortic Balloon Pump

Section 6 Intra Aortic Balloon Pump Section 6 Intra Aortic Balloon Pump The Intra Aortic Balloon Pump (IABP) The balloon is synthetic and is made for single use only. It is threaded into the aorta, usually via a femoral approach. The balloon

More information

ASE 2011 Appropriate Use Criteria for Echocardiography

ASE 2011 Appropriate Use Criteria for Echocardiography ASE 2011 Appropriate Use Criteria for Echocardiography Table 1. TTE for General Evaluation of Cardiac Structure and Function 1 2 Suspected Cardiac Etiology General With TTE Symptoms or conditions potentially

More information

DISCLOSURE TEST YOUR WAVEFORM IQ. Partial volume artifact. 86 yo female with right arm swelling, picc line. AVF on left? Dx?

DISCLOSURE TEST YOUR WAVEFORM IQ. Partial volume artifact. 86 yo female with right arm swelling, picc line. AVF on left? Dx? Deborah Rubens University of Rochester Rochester, NY DISCLOSURE Neither I nor my immediate family have a financial relationship with a commercial organization that may have a direct or indirect interest

More information

Basic Approach to the Echocardiographic Evaluation of Ventricular Diastolic Function

Basic Approach to the Echocardiographic Evaluation of Ventricular Diastolic Function Basic Approach to the Echocardiographic Evaluation of Ventricular Diastolic Function J A F E R A L I, M D U N I V E R S I T Y H O S P I T A L S C A S E M E D I C A L C E N T E R S T A F F C A R D I O T

More information

Cardiac Masses. Cardiac Masses: Considerations. Dennis A. Tighe, MD, FASE. University of Massachusetts Medical School Worcester, MA 4/16/2018

Cardiac Masses. Cardiac Masses: Considerations. Dennis A. Tighe, MD, FASE. University of Massachusetts Medical School Worcester, MA 4/16/2018 Cardiac Masses Dennis A. Tighe, MD, FASE University of Massachusetts Medical School Worcester, MA Cardiac Masses: Considerations Definition of the mass Nature Location Benign or malignant Presentation

More information

Diastolic Function: What the Sonographer Needs to Know. Echocardiographic Assessment of Diastolic Function: Basic Concepts 2/8/2012

Diastolic Function: What the Sonographer Needs to Know. Echocardiographic Assessment of Diastolic Function: Basic Concepts 2/8/2012 Diastolic Function: What the Sonographer Needs to Know Pat Bailey, RDCS, FASE Technical Director Beaumont Health System Echocardiographic Assessment of Diastolic Function: Basic Concepts Practical Hints

More information

UNIVERSITY OF UTAH HEALTH CARE HOSPITALS AND CLINICS

UNIVERSITY OF UTAH HEALTH CARE HOSPITALS AND CLINICS UNIVERSITY OF UTAH HEALTH CARE HOSPITALS AND CLINICS CARDIAC MECHANICAL SUPPORT PROGRAM GUIDELINES CARDIAC MECHANICAL SUPPORT: LVAD BASICS FREQUENT SCENARIOS AND TROUBLESHOOTING Review Date: July 2011

More information

DISCLOSURE. Relevant Financial Relationship(s) Off Label Usage. None. None

DISCLOSURE. Relevant Financial Relationship(s) Off Label Usage. None. None Echo for TAVR Sunil Mankad, MD, FACC, FCCP, FASE Associate Professor of Medicine Mayo Clinic College of Medicine Director, Transesophageal Echocardiography Associate Director, Cardiology Fellowship Mayo

More information

MITRAL STENOSIS. Joanne Cusack

MITRAL STENOSIS. Joanne Cusack MITRAL STENOSIS Joanne Cusack BSE Breakdown Recognition of rheumatic mitral stenosis Qualitative description of valve and sub-valve calcification and fibrosis Measurement of orifice area by planimetry

More information

Valvular Heart Disease

Valvular Heart Disease Valvular Heart Disease B K Singh, MD, FACC Disclosures: None 1 CARDIAC CYCLE S2 S2=A2P2 S1=M1T1 S4 S1 S3 2 JVP Carotid S1 Slitting of S2 S3 S4 Ejection click Opening snap Dynamic Auscultation What is the

More information

Cardiovascular emergencies. 05/March/2014 László Rudas Szeged

Cardiovascular emergencies. 05/March/2014 László Rudas Szeged Cardiovascular emergencies 05/March/2014 László Rudas Szeged Acute chest pain Acute heart failure Sudden cardiac death Acute chest pain What is the etiology? Chest pain signals emergency: - ACS - Pulmonary

More information

NOT ANOTHER TALK ABOUT A - FIB

NOT ANOTHER TALK ABOUT A - FIB NOT ANOTHER TALK ABOUT A - FIB CASES KUDOS AND A CHALLENGE Case 1 67 y/o female s/p R mastectomy 3 months earlier Second course of adjuvant chemotherapy Muga scan E.F. 35% What do we do next? Case 1 Cardiology

More information

Diastolic Function Assessment Practical Ways to Incorporate into Every Echo

Diastolic Function Assessment Practical Ways to Incorporate into Every Echo Diastolic Function Assessment Practical Ways to Incorporate into Every Echo Jae K. Oh, MD Echo Hawaii 2018 2018 MFMER 3712003-1 Learning Objectives My presentation will help you to Appreciate the importance

More information

Mechanisms of heart failure with normal EF Arterial stiffness and ventricular-arterial coupling. What is the pathophysiology at presentation?

Mechanisms of heart failure with normal EF Arterial stiffness and ventricular-arterial coupling. What is the pathophysiology at presentation? Mechanisms of heart failure with normal EF Arterial stiffness and ventricular-arterial coupling What is the pathophysiology at presentation? Ventricular-arterial coupling elastance Central arterial pressure

More information