Nicolas Merke

Cardiologist , #echofirst #volumetrics #EchoMath #3D

[Nicolas Merke @NMerke]

@DHZB_Akademie "3D Advanced Echocardiography Workshop" (happening January 22- 24, 2027) makes it clear why this is way "more than just 3D."
The program bridges advanced imaging with intensive clinical realities”specifically targeting ICU management, complex valvular heart disease, mechanical circulatory support (MCS), and heart failure.

Perfect for clinicians who want practical utility, not just pretty 3D pictures.
Yes, it’s a 3D workshop but we are taking it straight to the ICU
At the #echofirst Workshop , we aren't just looking at static valves. We’re tackling the tough cases:
Echo in ICU: Deep dives into ECMO hemodynamics and using echo to guide acute fluid management. 
Critical Decision Making: Using acute heart failure echo to trigger therapy (from diuretics to MCS). 
Live Knobology: Real-time mastering of GE & Philips systems.
Register & view the full program: https://t.co/tqmJDqUuqQ

Just take a look at this GOAT line up 🔝
@alex1708ander @alexsfelixecho @dr_benoy_n_shah @iceman_ex @echo_batman @FGraziani_Grace @VictoriaDe32503 @Ph_Bertrand @StellEkaterina @echo_stepbystep @fiore_corrado @LunaGargani @ArgaizR @papadocardio @eromerodorta @mauripieroni72 @KemalogluOz @JanKnierim @echotainment @DonalErwan @FH_Verbrugge

[Alexander Mladenow MD @alex1708ander]

@NMerke Different perspectives. Shared expertise. Positive outcomes.

🚀 When imagers from different specialties exchange ideas, everyone wins - especially the patient. #echofirst @NMerke

📌 2D reference plane matters
📌 3D landmarks (⛔️overzoom)
📌 3D image orientation matters

[Alexander Mladenow MD @alex1708ander]

@iamritu @ASE360 @JournalASEcho @CASEfromASE @CASivaram1 @echo_stepbystep @NMerke @OungSavly @DrRajeshG1 @rajdoc2005 @LucySafi Indeed a rare congenital anomaly ✨Rudimentary aortic chordae tendineae: a ruptured strand attached to the free edge of LCC 👀 #echofirst

[Alexander Mladenow MD @alex1708ander]

@iamritu @ASE360 @JournalASEcho @CASEfromASE @CASivaram1 @echo_stepbystep @NMerke @OungSavly @DrRajeshG1 @rajdoc2005 @LucySafi https://t.co/AHSOt31PHp
@iamritu
AR caused by aortic chordae tendineae strands (ACTS) is rare ….

[Ritu Thamman MD @iamritu]

@alex1708ander @ASE360 @JournalASEcho @CASEfromASE @CASivaram1 @echo_stepbystep @NMerke @OungSavly @DrRajeshG1 @rajdoc2005 @LucySafi #echofirst @alexsfelixecho

[Ritu Thamman MD @iamritu]

@alex1708ander @ASE360 @JournalASEcho @CASEfromASE @CASivaram1 @echo_stepbystep @NMerke @OungSavly @DrRajeshG1 @rajdoc2005 @LucySafi @alexsfelixecho agree w @alexsfelixecho seen more on aortic valve, But degenerative fenestrations typically don't affect valve function(they occur past the closing edge)
But if adjacent tissue is worn away, they stretch & strand avulses, the cusp may no longer be fully supported & can prolapse

[Alex Felix @alexsfelixecho]

@iamritu @alex1708ander @ASE360 @JournalASEcho @CASEfromASE @CASivaram1 @echo_stepbystep @NMerke @OungSavly @DrRajeshG1 @rajdoc2005 @LucySafi Totally agree with you @iamritu

[Alexander Mladenow MD @alex1708ander]

A case from the recent past - severe AR due to a RCC fenestration without cusp prolapse.

And yes @alexsfelixecho it was very difficult to repair

#echofirst @NMerke

[Nicolas Merke @NMerke]

EACVI Board election 🗳️ to shape the future of #echofirst
President @NAjmoneMarsan with strong team
Treasurer @Ph_Bertrand
Councillor @papadocardio & Vlatka Reskovic Luci

👉 https://t.co/mD0SM4qxTU

[Nicolas Merke @NMerke]

#echofirst emoticons

[Ekaterina Stellbrink @StellEkaterina]

Pericardial constraint–associated functional TR☝🏻
An intriguing case and a reminder always to ask: why TR? Not only grading, understanding the mechanism matters! And as in this case, sometimes means looking beyond the valve and the right heart chambers!

[Nicolas Merke @NMerke]

Non-atrial/non-ventricular functional tricuspid valve regurgitation: a case report https://t.co/9ChgYbV0Wa

[Nicolas Merke @NMerke]

#echofirst case report about functional TR non atrial nor ventricular
👉 https://t.co/wJRy7n3f5w
@dr_benoy_n_shah @echo_batman @echo_stepbystep @StellEkaterina

[Nicolas Merke @NMerke]

#echofirst 3D of tricuspid valve by TEE
Make sure to have good 2D as reference plane
#ALAMO is 🔑

👉 Annulus
👉 Leaflets
👉 (no) Artifacts
👉 Movement of Leaflets in the ROI
👉 Orientation landmarks
4D Zoom preparation or full volume
See more #3DEchoBerlin 3D and beyond Workshop 22.01. - 24.01.2027 Berlin
👉 https://t.co/hxJz05I162

[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

[Nicolas Merke @NMerke]

@alex1708ander #echofirst on Mars Mission ?

[Nicolas Merke @NMerke]

@echo_batman @argulian @Ph_Bertrand @dr_benoy_n_shah @purviparwani My point is less academic and more practical
#echofirst is always first and last exam performed before intervention

[Nicolas Merke @NMerke]

#echofirst question
How often is PISA EROA in primary eccentric MR suitable?
How often should we use PISA / EROA for severity quantification?

@argulian @echo_batman @Ph_Bertrand @dr_benoy_n_shah

[Nicolas Merke @NMerke]

I do not disagree with you on that point!
On the one hand following common sense volumetrics are part of our daily routine and on the other hand PISA EROA in eccentric jets can not work well (do we agree on that?)
So how should we go and with which parameters we need to present the patient for intervention

[Alexander Mladenow MD @alex1708ander]

There are 2 major forms of aortic dilatation in BAV: ascending phenotype (beyond STJ, 70%) and root phenotype (20%).

A case example of

👉 BAV (2-sinus) antero-posterior phenotype.

👉 Ascending phenotype BAV aortopathy

#GlassVue @Philips #echofirst

[Nicolas Merke @NMerke]

@jaumeaguero @argulian @echo_batman @Ph_Bertrand @dr_benoy_n_shah Thank you for this source! Should we go by eyeball to call for surgery? The surgeons need numbers to cut....
I do not condemn PISA but we need to be honest with it's value as PISA has a seat in the first row when it comes to quantification based on guidelines...