Bernard E Bulwer

Cardiology Point-of-Care Ultrasound Solutions: Integrating Hardware, Software, Artificial Intelligence, Education, and Training: The EchoScope Project

[Bernard E Bulwer @bebulwer]

"For the heart to effectively pump, it must first effectively fill."
Ventricular Diastolic Function: FEATURES: 351 pages, > 2,000 Illustrations and Images. Publication date: Jan 16, 2022.
LOOK INSIDE: https://t.co/96BTFGdyAU

[American Society of Echocardiography @ASE360]

🫀PRODUCT OF THE MONTH🫀
#AdvancedEcho 2026 online course is a comprehensive program designed to update cardiology and imaging professionals on the forefront of cardiovascular ultrasound.

Sign up: https://t.co/xPARaiaItB

[Alexander Mladenow MD @alex1708ander]

Great point @NephroP 🌟

Yes - in acute PE the septal shift is often most pronounced in late systole and early diastole rather than uniformly throughout systole.

👉 adult and pediatric patients with acute PE #echofirst

👉 TG mid SAX

[Ritika Tuli @RitikaTuliMD]

#CardioNuggets™

TEE views for fellows starting out🫀

Your FIRST view should usually be the mid-esophageal 4 chamber (~0–20°).

Why?
Because it helps orient you to:
• RA vs LA
• RV vs LV
• Mitral vs tricuspid valve
• Septum
• Overall probe position

Everything else builds from this view.

ProTip:
• The UMN TEE Simulator app is incredibly helpful for understanding how probe movement changes anatomy in real time

#CardioNuggets™ #CardioTwitter #TEE #EchoFirst

[Ritu Thamman MD @iamritu]

What is best formula to estimate mPAP on #echofirst?
📝 finds minimal end-diastolic PR pressure best correlation (R = 0.92) & diagnostic accuracy AUC 0.96 https://t.co/MCbDFf6aSN in almost 600 pts referred for RHC for PH dx, integrates both PR & TR signals

At 24.5 mm Hg cutoff, mPAPDPmin 89% sensitivity, 94% specificity

At 20 mm Hg, mPAPDPmin sensitivity⬆️99% w/ net reclassification driven by more accurate downgrading of pts w/o PH

[American Society of Echocardiography @ASE360]

We quantitatively assessed the degree of echogenicity in the proximal and mid segments of both coronary arteries to determine its additional diagnostic value in 109 patients with clinically suspected Kawasaki disease.

Read our @JournalASEcho article: https://t.co/fYoKY23ayt

[CardiovascularCorner @TrackYourHeart]

How many cusps does this aortic valve have?
1️⃣ Unicuspid
2️⃣ Bicuspid
3️⃣ Quadricuspid

[Bernard E Bulwer @bebulwer]

Artifacts in Echocardiography: Complementary charts and infographics. References: Echocardiography Illustrated: Ultrasound Physics: B-Mode Echocardiography and Introduction to Doppler (Echocardiograhy Illustrated Vols 9 and 10; 590 pages).
Vol 9: https://t.co/BgZ4j2emyO
Vol 10: https://t.co/RLkQFgy5uu

[Bernard E Bulwer @bebulwer]

Artifacts in Echocardiography: Complementary charts and infographics. References: Echocardiography Illustrated: Ultrasound Physics: B-Mode Echocardiography and Introduction to Doppler (Echocardiograhy Illustrated Vols 9 and 10; 590 pages).
Vol 10: https://t.co/RLkQFgy5uu ; Vol 9: https://t.co/BgZ4j2emyO

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

In the fourth 👶, when a markedly dilated coronary sinus is seen : think about associated PLSVC, which can coexist with D-TGA. @iamritu @ASE360 @CASivaram1 @alex1708ander
@loomba_rohit @SIwa23288585 @CardioNeo @WithAScalpel @AEPCcongenital @swatigar @sujithsp

[American Society of Echocardiography @ASE360]

This video provides a structured approach for healthcare professionals to teach patients the Instructed Valsalva maneuver while identifying and correcting common imaging artifacts.

Learn more about our new "Goal Directed Valsalva Education Series!" https://t.co/cC9Q3ESKVN

[Alexander Mladenow MD @alex1708ander]

During intraoperative TEE in a septuagenarian undergoing aortic valve replacement and coronary artery bypass grafting, eccentric mitral regurgitation is identified. Which echocardiographic parameter should be relied upon to accurately quantify its severity?#echofirst

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

In prosthetic MVR, a comet-tail artifact is a classic form of complex reverberation artifact caused by the highly reflective metallic components of the valve. @ASE360 @iamritu @CASivaram1 @alexsfelixecho @loomba_rohit @alex1708ander @SIwa23288585 @WithAScalpel @swatigar

[American Society of Echocardiography @ASE360]

We evaluated and compared the diagnostic performance of 5 echocardiographic formulas for estimating mPAP in a large cohort of consecutive patients undergoing both RHC & TTE, applying the updated hemodynamic PH definition.

Read our @JournalASEcho article: https://t.co/NJE98bn09b

[American Society of Echocardiography @ASE360]

This document provides a uniform & structured approach to managing ultrasound artifacts, including the appearance of the artifact, the mechanism behind the artifact generation, the clinical impact of the artifact on the diagnosis, & examples of real cases. https://t.co/wST56DL1ZH

[CardiovascularCorner @TrackYourHeart]

Standard echocardiographic imaging planes and the standard 17-segment model.😍

[Alexander Mladenow MD @alex1708ander]

Comprehensive tricuspid valve TEE analysis (mid-esophageal & transgastric views) @iamritu @OungSavly @CASivaram1 @NMerke @DrRajeshG1 @alexsfelixecho @WithAScalpel

1️⃣ ME 4Ch
2️⃣ ME RV in-out
3️⃣ ME bicaval

💚 anterior TV leaflet
💛 septal TV leaflet
💙 posterior TV leaflet

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

Which all parameters to decide severity of MR in such jets?

[American Heart Association @American_Heart]

The American Heart Association mourns the passing of the legendary cardiologist Eugene Braunwald, M.D., widely recognized as one of the most influential figures in the history of cardiovascular medicine. Over seven decades, his work reshaped the understanding and treatment of heart disease, leading many to call him the father of modern cardiology.

Braunwald was a lifelong contributor to the American Heart Association, helping advance its research and scientific mission, and was honored with some of the Association’s highest honors for his lasting influence on cardiovascular care and research. His influence extended well beyond his own discoveries, as generations of Association‑supported investigators, clinicians and academic leaders were trained by Braunwald or guided by the clinical trial standards and mentorship models he helped establish.

https://t.co/ieZuHYMyOP

[Benigno Valderrábano Salas @MDBeni]

🫀 Did you know where the recommendation to place the pulsed wave Doppler sample volume 0.5–1 cm from the aortic valve to measure LVOT VTI comes from?

The answer is more interesting than it seems. It doesn’t come from a single study or an experiment designed for that purpose. It comes from a historical chain spanning nearly 40 years:

🔬 1982–1984 — The physical foundation
Pasipoularides and Murgo demonstrated using invasive catheters and mathematical models that in aortic stenosis there is a real zone of flow acceleration in the LVOT, just proximal to the valve, without any second anatomic obstruction. Pure hemodynamics — no Doppler yet.
👉 Bird et al. Circulation 1982 → https://t.co/oCXGNgWsPF
👉 Pasipoularides et al. Am J Physiol 1984 → https://t.co/cfvNMpEgzG

📐 1984 — The apical 5-chamber view
Lewis, Kuo and Quinones were the first to validate cardiac output measurement using pulsed wave Doppler from the cardiac apex. They described placing the sample volume “immediately proximal to the aortic valve leaflets” — but without specifying any distance in centimeters.
👉 Lewis et al. Circulation 1984 → https://t.co/lRVjLuYMEs

📏 1985 — The first numerical distance
Skjaerpe, Hegrenaes and Hatle (the Norwegian group) were the first to quantify this in Doppler: they empirically observed that flow acceleration began 0.5 to 1.5 cm proximal to the valve, and placed the sample volume just proximal to that zone. They directly cited Pasipoularides as supporting evidence. This was the first time a numerical distance appeared in the technique.
👉 Skjaerpe et al. Circulation 1985 → https://t.co/rf7l2FQUs4

📊 1986–1988 — Practical consolidation
Otto et al. used ~1.0 cm. Oh, Tajik and the Mayo Clinic group explicitly established the range of 0.5 to 1.0 cm in 100 patients, justifying it as necessary to avoid the subvalvular acceleration zone. This is the figure we all recognize today.
👉 Otto et al. JACC 1986 → https://t.co/avke1qOy4x
👉 Zoghbi et al. Circulation 1986 → https://t.co/KFiChfBNuc
👉 Oh et al. JACC 1988 → https://t.co/1C8sHRSMPq

📋 2002 — It becomes “official”
Quinones, Otto, Zoghbi and colleagues codified it in the ASE guidelines as “~5 mm proximal to the aortic valve”… but without citing any specific study to support it. It had already become expert consensus.
👉 Quiñones et al. JASE 2002 → https://t.co/U3hXFns4jx

⚔️ 2017 — The debate reopens
Baumgartner et al. (EACVI/ASE) maintained the 0.5–1 cm recommendation. However, Hahn and Pibarot responded with a critical letter pointing out that the original articles from the 1980s measured at the aortic annulus, not 0.5–1 cm below it, and that moving away from the annulus introduces errors due to the elliptical and irregular shape of the subannular LVOT.
👉 Baumgartner et al. Eur Heart J Cardiovasc Imaging 2017 → https://t.co/iu07xBTwQS
👉 Hahn & Pibarot. JASE 2017 → https://t.co/uqgcv8kzO7

💡 Bottom line:
The 0.5–1 cm figure was never experimentally validated as the optimal distance. It emerged from empirical observations in the 1980s aimed at avoiding a flow acceleration zone that had been demonstrated with invasive catheters. It was adopted through accumulated clinical practice and later elevated to a formal recommendation by consensus. The debate over whether to measure at the annulus or 0.5–1 cm below it remains open to this day.

One of those recommendations we all follow but few know where it actually came from 🙂

Dr Benigno Valderrábano Salas
@MDBeni
@JaeKOh2 @ottoecho @WilliamZoghbi @ASE360 @EACVIPresident @NephroP @iamritu @PPibarot @hahn_rt @MAecocardio @SISIACOficial @SONECOM_AC @VazyurVasquez @Cardiotweets83 @HEARTof_echo @echobasics

[American Society of Echocardiography @ASE360]

Anatomically corrected malposition of the great arteries is an exceptionally rare congenital cardiac anomaly.

We report a 50-year-old patient with exertional dyspnea who was initially misdiagnosed as having atrioventricular septal defect. https://t.co/M0OtoORnB4 @CASEfromASE