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

[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...

[Nicolas Merke @NMerke]

@echo_batman @jaumeaguero @argulian @Ph_Bertrand @dr_benoy_n_shah I do agree with you! There is no absolute answer! There is never!
But to be honest how many cases we have where PISA EROA does work in primary MR?
How often we offer believable and let's say correct values for the surgeon based on guidelines to decide for surgery?

[Nicolas Merke @NMerke]

I do understand your concern, had exchange about that topic with @purviparwani as well. Honest Q how do you quantify for decision making in terms of surgery a case of primary MR?
PISA does not work I think we do agree on this?
Volumetric has several limitations.
👉 But EF is part of the equation and we all do EF, so we have VOLUME INFORMATION as BYPRODUCT (total Stroke volume)
👉 We all agree on the concept of low flow?! Do we? How do we define low flow? Isn´t low flow LVOT SV and BSA?
LVOT SV is problematic as the error here is squared! But there is several back doors! In case of isolated MR the LVOT SV is the same as RVOT SV and RV SV done with 3D, therefore it is possible although not perfect.
MR severity quantification for sure not by eye balling
For sure not every surgical decision is be done with #WhyNotCMR
And of course severe MR has more to offers:
👉 LV dilatation
👉 LA dilation
👉 elevated E-Wave
👉 lung vein pattern
👉 maybe 3D VCA (not big fan!)
IMO 😎 #echofirst is strong

[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]

No comments from here?
No one having strong opinion?
My take on this, is pretty clear; PISA EROA in eccentric Regurgitation is almost always a no go to pursue...
#echofirst can do better
👉 https://t.co/ICwXGYJeXf

[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]

My #echofirst Approach to PISA EROA in Mitral Regurgitation: A Critical Review https://t.co/KitVru3FrO

[Nicolas Merke @NMerke]

#echofirst 3D Compilation
Teasing #3DEchoBerlin
22.01.- 24.01.2027 Advanced Echocardiography Workshop

Sunday 3D Hands on with GE & Philips (TomTec)
👉https://t.co/p01SiqsFD1
👉 https://t.co/p01SiqsFD1

[Nicolas Merke @NMerke]

Where to go to learn more about #echofirst 3D and even beyond?
#3DEchoBerlin 22.01. - 24.01.2027
Onsite attendance & online (Friday & Saturday lectures)
Sunday 3D Hands on with GE & Philips (TomTec)
👉https://t.co/p01SiqsFD1
👉 https://t.co/p01SiqsFD1

[Jan Verwerft @VerwerftJan]

🫀 Not registered yet? There's still time!

📅 Thu 22 Oct | 20:00 CET
🎙️ 4D Echo Workflow Tricks with Wouter L’Hoyes

🆓 register here 👇
https://t.co/T9rrua34kJ

📩 Access link emailed on Tuesday