Carlos El-Tallawi, MD, FACC, FASE

Conscious lump of atoms posting edutaining tweets | AUBMC cardiology | Houston Methodist Multimodality CV Imaging | Echo + CMR | Valvular heart disease — MVP

[Carlos El-Tallawi, MD, FACC, FASE @HeartToProve]

And here’s how a chord appears before rupture.

[Ritu Thamman MD @iamritu]

Rare congenital anomaly(I’ve never seen)

rudimentary aortic chordae tendineae #echofirst

seen as ruptured fibrous strand attached to RCC free edge w partial flail causing severe aortic regurgitation OR confirmed https://t.co/3ojkUClQ67

[Jad Zeitoun @jad_zeitoun]

✅ Two-parameter echo approaches work in chronic AR

🎯 In 214 Echo–CMR patients, 2 approaches anchored in LV remodeling, one requiring color Doppler, the other allowing any AR parameter, performed similarly to ASE algorithm with less quantitation needed.

https://t.co/w9D6AqfGRA

[WilliamZoghbi @WilliamZoghbi]

A defining study on evaluating MR with Echocardiography & impact on @ASE360 Guidelines. @ACCinTouch @SCMRorg

[Carlos El-Tallawi, MD, FACC, FASE @HeartToProve]

🎯 Less is more in mitral regurgitation assessment

In 177 patients undergoing near-simultaneous Echo & CMR, just 2 ASE criteria identified significant MR with 91–95% specificity.

🫀 Smarter integration, less quantification, greater diagnostic confidence

https://t.co/iFv3BRTsQJ

[WilliamZoghbi @WilliamZoghbi]

In only 1wk! interact with world-renown MMI experts: AI in CV Imaging/valvular heart/HCM/Sarcoid/amyloid... Recording available for 2 mo. Priced for global audience:25-50$! https://t.co/EGJRnbhK7G
@HMethodistCV @HMHCardioFellow @JACCJournals @SachinGoelMD @escardio @NadeenFaza

[Carlos El-Tallawi, MD, FACC, FASE @HeartToProve]

Absolutely agree. You have to pick the beat which unmasks the most suffering that valve can possibly impose on the LV myocardium.

[Jae K. Oh @JaeKOh2]

A very good thinking!
Mayo Clinic Echo Lab now recommends measuring a single highest velocity of aortic valve and LVOT to determine AV gradient and AVA. Hope this will become a part of future VHD guideline @ottoecho

[Carlos El-Tallawi, MD, FACC, FASE @HeartToProve]

Mitral valve posterior leaflet perforation.

[Carlos El-Tallawi, MD, FACC, FASE @HeartToProve]

Severe TR with IVC/HV systolic flow reversal

[Carlos El-Tallawi, MD, FACC, FASE @HeartToProve]

@bwoody58 @ahmad_70x @PWesslyMD @LucySafi @PriyaPanday27 @NadeenFaza @ASE360 @JournalASEcho The initial E1 deflection represents the emptied prolapse volume, and E2 is the atrial volume that typically follows.

[Priscilla Wessly @PWesslyMD]

🔍 What exactly is prolapse volume?

Prolapse volume is the "hidden" volume trapped between the prolapsing mitral leaflets and the annulus at end-systole.

This volume:
➡️ Is not forward stroke volume
➡️ Is not transvalvular MR
➡️ Returns to the LV during diastole
🫀 Total LV volume load = MR volume + prolapse volume
💎 A paradigm-shifting concept introduced by @HeartToProve @DipanJShah @WilliamZoghbi and colleagues that may help explain disproportionate LV enlargement and remodeling in Barlow MVP.
#ASEchoJC #EchoFirst #MVP @ASE360 #CardioX #MVP @JournalASEcho

[Priscilla Wessly @PWesslyMD]

💎 Why does the LV sometimes appear "too enlarged" for the degree of MR in MVP?

🫀 Because MR is not the entire volume load.

In the landmark work by @HeartToProve and colleagues, adding prolapse volume to MR volume strengthened the relationship between volume load and LV enlargement.

🎯 Total volume load = MR volume + prolapse volume

A powerful concept that may explain disproportionate LV remodeling in Barlow MVP.

#ASEchoJC #EchoFirst #MVP @ASE360 @JournalASEcho #CardioX

[Priscilla Wessly @PWesslyMD]

Such an elegant observation, @HeartToProve 👏

💎 The bifid-E wave may be a novel Doppler marker of advanced MVP.

Associated with:
➡️ Bileaflet MVP (33% vs 6% in single leaflet prolapse)
➡️ Larger prolapse volume
➡️ Disproportionate LV enlargement despite mild MR
➡️ LV replacement fibrosis
🔑 On multivariable analysis, the bifid-E wave was the only echocardiographic parameter independently associated with MVP-related fibrosis.
🔍 Sometimes the most important clues are hiding in plain sight on the mitral inflow Doppler.
#ASEchoJC #EchoFirst @ASE360 @JournalASEcho #MVP #CardioX

[Priscilla Wessly @PWesslyMD]

Such an important point, @HeartToProve 💎

As highlighted in your editorial 👇, not all flails are created equal.

🎯 A flail leaflet should raise suspicion for severe MR—but it is not synonymous with severe MR. An integrated assessment remains essential.

#ASEchoJC #EchoFirst @ASE360 @JournalASEcho #MVP #WhyCMR

[Priscilla Wessly @PWesslyMD]

✨ Huge thank you to everyone who joined tonight's #ASEchoJC!
What an incredible discussion on MVP, MR, MAD, ventricular arrhythmias, and the evolving concept of arrhythmic MVP. 🫀⚡️
Grateful to our outstanding guest authors Dr. Jeffrey Silbiger @LucySafi, @priyaPanday27, and for sharing their expertise and insights, and to my wonderful co-moderators @NadeenFaza and @HeartToProve. A special thank you to our #EchoFirst enthusiasts and engaged audience for contributing to such a lively, thoughtful, and high-yield discussion.
Proud to be part of this amazing global #EchoFirst community! 💙🌍 @ASE360 @JournalASEcho

[Carlos El-Tallawi, MD, FACC, FASE @HeartToProve]

@PWesslyMD @LucySafi @PriyaPanday27 @NadeenFaza @ASE360 @JournalASEcho @purviparwani @iamritu @DavidWienerMD @SIwa23288585 @EACVIPresident #ASEchoJC

[Carlos El-Tallawi, MD, FACC, FASE @HeartToProve]

@PWesslyMD @LucySafi @PriyaPanday27 @NadeenFaza @ASE360 @JournalASEcho Prolapsing valves pull on chords/papillary muscles, stretching the LV wall inward. This causes "curling" (LV crest rotates posteriorly) & the Pickelhaube sign -- a sharp late-systolic S’ wave >16 cm/s on TDI. Both are markers of increased arrhythmia risk! #ASEchoJC

[Carlos El-Tallawi, MD, FACC, FASE @HeartToProve]

@PWesslyMD @ASE360 @JournalASEcho Very important -- flail =/= severe MR! In our data a flail leaflet had 81% specificity for severe MR as defined on CMR >60 mL/50% #ASEchoJC

[Carlos El-Tallawi, MD, FACC, FASE @HeartToProve]

@PWesslyMD @LucySafi @PriyaPanday27 @NadeenFaza @ASE360 @JournalASEcho @DavidWienerMD @iamritu @purviparwani @argulian @boegel_kelly @SIwa23288585 @EACVIPresident We have shown that for the same amount of transvalvular MR, the LV volume increases with increasing prolapse volume. Be careful with using PISA in Barlow MR -- use volumetric methods instead. #ASEchoJC

[Carlos El-Tallawi, MD, FACC, FASE @HeartToProve]

@PWesslyMD @LucySafi @PriyaPanday27 @NadeenFaza @ASE360 @JournalASEcho @DavidWienerMD @iamritu @purviparwani @argulian @boegel_kelly @SIwa23288585 @EACVIPresident #ASEchoJC Blood isn't just regurgitated; it also expands the prolapsing leaflets (prolapse volume) during systole. This "retained" volume drives LV volume overload independently of MR, leading to excess LV dilation that is disproportionate to the perceived trans-valvular MR.