JuanfeEcho♥️

Cardiac sonographer. Accredited in echo CHD by EACVI-ESC and BSE. Intensive care, mechanical circulatory support and LVAD. Royal Brompton Hospital Hospital.

[NephroPOCUS @NephroP]

How to do SVC #POCUS 📹 + an illustration of abnormal SVC Doppler patterns.
#VExUS #eVExUS #Nephpearls
From 🔗J Am Soc Echocardiogr. 2023;36(5):447-463. doi: 10.1016/j.echo.2023.01.017

[Fumiya Yoneyama, MD, PhD | WithAScalpel @WithAScalpel]

Complete AVSD Repair — Two-Patch Technique✌️🎥

👉Ventricular component closure: anchor the VSD patch while preserving adequate LAVV orifice size and respecting the displaced conduction axis.
👉LAVV cleft closure: restore leaflet coaptation and control AV valve regurgitation without creating left AV valve stenosis.
👉Primum ASD patch closure: complete atrial septation while avoiding injury to the displaced AV node and conduction tissue.

[Fumiya Yoneyama, MD, PhD | WithAScalpel @WithAScalpel]

Outlet VSD Spectrum📝

👉Outlet septal VSDs include three main anatomic types: perimembranous with outlet extension, muscular with outlet extension, and doubly committed juxta-arterial VSD.
👉The short-axis echo view is especially helpful.

[Fumiya Yoneyama, MD, PhD | WithAScalpel @WithAScalpel]

VSD Patch Closure:

🎥VSD patch closure with running suture
🪡Patch materials: autologous pericardium (glutaraldehyde-treated), PTFE (Gore-Tex), polyester (Dacron) patch material, or bovine pericardium.

@OungSavly @ASE360 @ACCinTouch @AEPCcongenital @iamritu @WGACHDChair @CASivaram1 @alexsfelixecho @loomba_rohit @SIwa23288585 @swatigar

[SONECOM @SONECOM_AC]

ECO SKILLS | Venas pulmonares
La valoración ecocardiográfica de las venas pulmonares aporta información clave sobre la función diastólica, presiones de llenado y severidad de valvulopatías.
Analizar su patrón de flujo permite complementar la evaluación del paciente

[Fumiya Yoneyama, MD, PhD | WithAScalpel @WithAScalpel]

LV Distension on VA-ECMO: The Hidden Load

👉Peripheral VA-ECMO raises aortic afterload → suppresses LV ejection and risks AoV closure, promoting LV distension and pulmonary congestion.
👉Early assessment is critical—confirm AoV opening and initiate LV unloading (LA vent/Impella) before thrombus or myocardial injury develops.

[JuanfeEcho♥️ @EchoJuanfe]

@NephroP @Ivan_Echocardio The coronary sinus with a thrombus.

[Irina Akhmedova @Irina67790690]

TGA after a Mustard procedure (intra-atrial switch) performed before 1 year of age.

Image isinverted❗️ 4-chamber view.

The child is now 8 years old.

[Fumiya Yoneyama, MD, PhD | WithAScalpel @WithAScalpel]

Fetal Circulation #2 — Preferential Streaming of Oxygenated Blood

👉Oxygenated placental blood returns via the umbilical vein and is shunted through the ductus venosus into the IVC, where the Eustachian valve directs it across the foramen ovale.
👉This preferential stream supplies the left atrium, left ventricle, and ascending aorta, optimizing cerebral and coronary perfusion.
👉In contrast, SVC-derived blood enters the right ventricle and, with high fetal PVR, is diverted through the ductus arteriosus to the descending aorta.

[Anurag Sahu @achdDoc12]

At first glance, this appears to be a large mid-muscular VSD. Look closer: an angled VSD patch incorporates part of the RV cavity into the systemic ventricle, surgical anatomy redefining physiology. #ACHD ❤️‍🩹

[Fumiya Yoneyama, MD, PhD | WithAScalpel @WithAScalpel]

AVSD: Unwedged Aortic Valve and LVOTO

👉The AoV is displaced anteriorly in an unwedged position, no longer seated between the two AV valves.
👉This characteristic geometry elongates the LVOT and can contribute to LVOTO.

[CardiovascularCorner @TrackYourHeart]

Evaluation of aortic regurgitation.
📸: ASE

[Dr G Rajesh (Gopalan Nair Rajesh). @DrRajeshG1]

This patient was referred as a case of VSD with severe PH from TR jet. What can lead to erroneous diagnosis of PH in this case?

[Fumiya Yoneyama, MD, PhD | WithAScalpel @WithAScalpel]

Peripheral VA-ECMO #2: Femoral Perfusion Physiology

👉Femoral VA-ECMO generates retrograde aortic flow.
👉It competes with native LV ejection, creating a shifting watershed zone.
👉Proximal desaturated ejection can cause differential hypoxia.
👉Distal limb perfusion must also be monitored.

[JuanfeEcho♥️ @EchoJuanfe]

@hemo_shk It looks like a Scimitarr syndrome ?..

[Fumiya Yoneyama, MD, PhD | WithAScalpel @WithAScalpel]

Atrial Septal Defect (ASD): Four Types

👉Primum ASD: Low ASD near the AV valves, within the AVSD spectrum.
👉Secondum ASD: Fossa ovalis defect and the most common ASD type.
👉Sinus venosus ASD: Venous inflow defect near the SVC/IVC, often with PAPVR.
👉Coronary sinus ASD: An unroofed coronary sinus, often associated with LSVC.

[Oung Savly MD FACC FASE FESC FAAP FEACVI 🇰🇭 @OungSavly]

11-month-old, Complete AVC.
📌 LAVV regurgitation is the strongest predictor of late reoperation after AVSD repair @iamritu @WGACHDChair @AEPCcongenital @CASivaram1 @echoleolopez @loomba_rohit @alex1708ander @DavidWienerMD @alexsfelixecho @SIwa23288585 @cardiopedhnn @sujithsp

[Fumiya Yoneyama, MD, PhD | WithAScalpel @WithAScalpel]

EuroFontan registry (21 centers):

📌Contemporary Fontan outcomes are strong—early mortality 1.0%
📌Composite adverse outcome 5.1% (death/LCOS/stroke/takedown)
📌Non–tricuspid atresia morphology predicted higher early risk (OR 2.2)

#FontanSurgery #UniventricularHeart #PediatricCardiology #CongenitalHeartDisease
@ESCardio, @ESC_Journals, @ehj_ed

[Fumiya Yoneyama, MD, PhD | WithAScalpel @WithAScalpel]

DORV #2 — Clinical Classification

DORV is clinically grouped by physiology driven by VSD position and RVOT obstruction:

👉VSD-type (overcirculation, treat like large VSD ± PA band, plan LV–Ao baffle),
👉TOF-type (PS → cyanosis, TOF repair, RVOT relief),
👉TGA-type (subpulmonary streaming, ASO+VSD closure),
👉Remote VSD (complex BiV vs SV).

[Oung Savly MD FACC FASE FESC FAAP FEACVI 🇰🇭 @OungSavly]

5-month-old, 5kg. Large Anterior muscular VSD. https://t.co/rRPpfzO9WT
@ASE360
@iamritu @WGACHDChair @EACVIPresident @AEPCcongenital @CASivaram1 @DavidWienerMD @alexsfelixecho @loomba_rohit @alex1708ander @SIwa23288585 @Prasannasimha @konstantinov_ie @argulian @WithAScalpel