Roberto Garcia

Pediatric Cardiologist / Ped Echo / #echofirst

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

Absence of inlet VSD results from complete fusion of the SBL & IBL to the crest 👉🏻 Seal the ventricular component of the AVSD @ASE360
@iamritu @WGACHDChair @CASivaram1 @echoleolopez @loomba_rohit @alex1708ander @alexsfelixecho @SIwa23288585 @cardiopedhnn @sujithsp @CardioNeo

[American Society of Echocardiography @ASE360]

We've released a #new State-of-the-Art Review, "The Effect of General Anesthesia and Mechanical Ventilation on the Echocardiographic Evaluation of Cardiac Function!"

Read it now: https://t.co/cbmJ46fd5C

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

TOF, RVOTO, associated with complete LPA agenesis & exclusive MAPCA-dependent perfusion of the left lung
@iamritu @WGACHDChair @AEPCcongenital @CASivaram1 @echoleolopez @loomba_rohit @alex1708ander @DavidWienerMD @alexsfelixecho @SIwa23288585 @cardiopedhnn @sujithsp @CardioNeo

[American Society of Echocardiography @ASE360]

🫀NEW GUIDELINE🫀
Read our new #ASEGuideline, "Guidelines for the Intraprocedural Imaging for Mitral Valve Transcatheter Edge-to-Edge Repair!" https://t.co/mPEUDziCfD

[CardioNova @AppCardioNova]

🚨 Nuevos grados de severidad en el corazón derecho según la ASE.

Cambia la evaluación del VD, la AD y la arteria pulmonar:
❌ menos “normal/anormal”
✅ más grados de severidad
✅ más valor pronóstico

Si quieres estar al día en Eco, este hilo es para ti 👇🏼 🧵#CardioNova #Eco

[EHJ-IMP Editor-in-Chief @EHJIMPEiC]

📄 Can we finally measure RV volume accurately with simple echocardiography?
🔗 DOI: https://t.co/cHII0FgTLH
🫀 The right ventricle (RV) remains one of the most challenging chambers to assess—especially in congenital heart disease (CHD).
👉 Gold standard? Cardiac MRI
❗ But: expensive, time-consuming, and often requires sedation
✨ This study proposes a simple, fast, and accurate 2D echo-based method for RV volumetry—bringing us closer to true bedside quantification.
✨ The key idea:
👉 Model the RV using a cone-based geometric approach
➡️ Using only 2 standard echo views:
Apical 4-chamber (A4CH)
Parasternal short-axis (SAX)
📐 With just a few parameters:
✔ Cross-sectional areas (A4CH, ASAX)
✔ Tricuspid valve diameter
📊 Performance vs MRI:
🔥 Excellent agreement:
Systolic volume → ICC 0.98
Diastolic volume → ICC 0.96
📉 Minimal bias:
Δ systolic volume ≈ 0.1 mL
Δ diastolic volume ≈ 5.2 mL
➡️ Clearly outperforms traditional 2D models
💡 Why this matters clinically:
👉 Enables:
✔ Rapid bedside RV assessment
✔ Reduced need for repeated MRI
✔ Easier follow-up in paediatric & CHD patients
👉 Particularly valuable in:
Post-operative monitoring
Serial evaluations
Resource-limited settings
🚀 Key innovation:
👉 A mathematically robust yet practical model
➡️ Balancing accuracy + simplicity
➡️ Adaptable to different RV shapes
🚨 Bottom line:
2D echocardiography—when combined with smart modelling—can approach MRI-level accuracy for RV volumetry.
#Cardiology #Echocardiography #RightVentricle #CongenitalHeartDisease #CardiacImaging #CMR #Innovation #MedTech #PediatricCardiology 🫀📊

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

Coronary Anatomy in d-TGA — Yacoub Classification📚

👉Type A: LCA from sinus 1 and RCA from sinus 2 — the usual and most common pattern.
👉Type B: Single coronary ostium, from either sinus 1 or sinus 2, with early branching between the great arteries.
👉Type C: Two separate but closely adjacent ostia, usually near the posterior commissure; often managed like a high-risk transfer pattern.
👉Type D: LAD from sinus 1 and RCA + LCx from sinus 2 — LCx courses posteriorly around the pulmonary root.
👉Type E: RCA + LAD from sinus 1 and LCx from sinus 2, often with side-by-side great arteries and complex looping.

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

Anomalous Aortic Origin of a Coronary Artery (AAOCA) #2: Surgical Concept of Unroofing

👉Unroofing opens the shared aortic–coronary wall of an intramural segment, converting a tunneled coronary course into a wide, non-compressed neo-ostium.
👉It is best suited when the intramural course runs above the aortic valve; if the course is below the AoV, unroofing may be unsafe or inappropriate.
👉If dynamic compression persists in the Ao–PA corridor after unroofing, coronary reimplantation may be required to fully relieve ischemic risk.

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

PA Banding in Single Ventricle Physiology👌

👉In single ventricle physiology, excessive pulmonary blood flow diverts cardiac output away from the systemic circulation.
👉PA banding increases resistance to Qp, limits pulmonary overcirculation, and reduces systemic ventricular volume overload.
👉The surgical objective is controlled pulmonary blood flow — optimizing Qp/Qs balance while preserving systemic perfusion as a bridge to staged palliation.

@OungSavly @escardio @WGACHDChair @iamritu @AEPCcongenital @echoleolopez @EACVIPresident @dkthekkoott @loomba_rohit @AEPCcongenital @alexsfelixecho @alex1708ander @SIwa23288585 @AmerAcadPeds

[AATS @AATSHQ]

Surgeons at CHOP say the birth day of the week is associated with surgical timing and postoperative brain injury in neonates with #congenital heart disease. Read more in #JTCVS Open: https://t.co/BlsufFd9qV

@JLynchMDPhD

[Sara Moscatelli @saramoscatelli7]

🫀 Are we underestimating sudden cardiac death risk in HCM?
📊 For years, risk stratification in hypertrophic cardiomyopathy (HCM) has relied on clinical scores…
But are these models too simplistic for such a complex disease?
🔍 A recent editorial challenges the paradigm:
👉 Moving from risk scores → precision cardiology
⚠️ The problem with current models:
✔️ Based on static variables
✔️ Limited integration of imaging & genetics
✔️ “Low-risk” patients can still experience events
💡 Example:
A 5-year SCD risk of 4–6% translates to only ~0.8–1.2% per year…
👉 Small differences, big clinical uncertainty
🧠 New insight: the atrium matters
Traditionally, we focus on the LV… but:
➡️ The left atrium reflects chronic diastolic burden
➡️ Dysfunction may precede structural changes
📈 In “low-risk” HCM patients:
👉 Impaired LA strain (LA-GLS) predicted adverse outcomes
👉 Even when conventional scores were reassuring
🔬 Where are we heading?
The future of SCD prediction in HCM is multidimensional:
✔️ Advanced imaging (CMR, strain, LGE)
✔️ Genetics (variants, polygenic risk)
✔️ AI-driven ECG analysis
➡️ Not one tool… but integration of all
🚀 Take-home message:
We need to move beyond rigid risk categories and embrace a dynamic, patient-specific approach.
👉 Precision cardiology is no longer a concept—it’s becoming a necessity.
#Cardiology #HCM #SuddenCardiacDeath #CardioImaging #CMR #StrainImaging #CardioGenetics #PrecisionMedicine #AIinMedicine #CardiologyResearch #PhDLife 🧬✨

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

Damus–Kaye–Stansel Procedure #2: Side-to-End DKS Anastomosis

👉The side-to-end DKS technique connects the transected MPA to the lateral AAo, establishing an enlarged systemic outflow pathway.
👉Flap or patch augmentation may be required to optimize the anastomotic geometry, especially in side-by-side great artery relationships or size mismatch.
👉The key technical consideration is preservation of pulmonary root geometry and semilunar valve integrity to minimize late valve dysfunction.

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

Left-sided thoracotomy 👉 CoA repair / Vascular ring repair

[Jorge Faerron @cardiopedhnn]

#ICE from the #left_heart chambers to guide #electrophysiology procedures

https://t.co/HI0DkNa83h

#echofirst

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

PAPVR (RUPV–SVC): Anatomy, Hemodynamics, and Surgical Repair

👉PAPVR of the RUPV to the SVC/RA creates a significant L→R shunt, especially when the right pulmonary veins are involved.
👉Repair requires redirecting anomalous pulmonary venous flow to the LA while preserving unobstructed SVC drainage.
👉The double-patch technique and Warden procedure are two key strategies to balance pulmonary venous pathway, systemic venous pathway, and sinus node safety.

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

Balanced vs Unbalanced AVSD — From Anatomy to Strategy

👉Balanced AVSD supports a primary biventricular repair when ventricular size and AV-valve inflow are well matched.
👉Unbalanced AVSD requires careful assessment of AVVI, RV/LV inflow angle, indexed VSD, valve regurgitation, and ventricular function.
👉The goal is to choose the most durable pathway—biventricular repair, staged strategy, or single-ventricle palliation—based on anatomy and physiology.

[Nicolas Merke @NMerke]

Rules of #echofirst engagement 
B4 showing & sharing knowledge on big stage be aware that attendees will take your images as example to follow so don’t show bad settings 
👉 Color Doppler box too big 
mention always why you have choosen (your goal should be best FPS, so color box not too big!)
👉 Vena contracta measurements need good resolution and gain setting optimization to avoid overestimating 
👉 3D VCA must be explained with FPS! IF too low value not real! Show your settings 
👉 Showing PISA EROA please make sure you have choosen correct settings with Nyquist and didn’t overestimate the radius! Mention that r > 0,9 is rarely seen 
Always point out that Reg. Volume > 60 ml are rarely seen 
Always show LV dimensions & Volume!
Always explain that a certain high amount of Regurgitation let’s say > 60 ml is only possible if LV Volume and LVOT SV are making sense
👉🎯 please Never Show That you have stopped using only one parameter 
👉 IF you use 3D Volume Show your settings (FPS) and point not only EF but also LV / RV Volumes out. 
Volumes matter more than EF

[Society for Cardiovascular Magnetic Resonance @SCMRorg]

🎓 SCMR Webinar | The Congenital Heart Disease You May Be Missing
Could congenital heart disease be overlooked despite standard imaging protocols? Learn key clues that may help identify missed diagnoses.

👉 Register now: https://t.co/BpFsVpjNNb

[EHJ-IMP Editor-in-Chief @EHJIMPEiC]

📄 Hypertension-related LVH: not all phenotypes carry the same risk
🔗 DOI: https://t.co/W1SFC0ZCz6
🫀 Hypertension is the most common cause of LV hypertrophy—but its cardiac expression is far from uniform.
This large UK Biobank CMR study (n >24,000) provides a comprehensive look at LVH phenotypes and their prognostic impact.
✨ Four CMR-defined phenotypes:
👉 Normal LV
👉 LV remodelling
👉 Eccentric LVH
👉 Concentric LVH
📊 As shown in the graphical abstract (page 2):
➡️ each phenotype has distinct structural and functional signatures
✨ Key findings:
🔹 Eccentric LVH = worst phenotype
➡️ Most impaired LV function (EF + strain)
➡️ Largest chambers
➡️ Highest risk:
MACE → HR 2.5
Heart failure → HR 9.0
🔹 Concentric LVH:
➡️ Highest wall thickness and native T1 (fibrosis)
➡️ ↑ Heart failure risk (HR 4.1)
➡️ No significant MACE association
🔹 LV remodelling:
➡️ Intermediate phenotype
➡️ Smaller chambers, milder changes
📊 Key pathophysiological insight:
👉 LVH is not a binary condition—but a spectrum of myocardial adaptation
➡️ From remodelling → concentric or eccentric hypertrophy
➡️ Driven by pressure load, volume load, and myocardial response
💡 Clinical take-home message:
👉 Not all LVH is equal
✔ Eccentric LVH → high-risk phenotype
✔ Concentric LVH → fibrotic, HF-prone phenotype
👉 CMR enables:
precise phenotyping
improved risk stratification
potential tailored treatment strategies
🚨 Bottom line:
In hypertension, LV geometry matters—because different phenotypes carry very different prognoses.
#Cardiology #CMR #Hypertension #LVH #CardiacImaging #HeartFailure #RiskStratification #PrecisionMedicine #UKBiobank 🫀📊

[Jorge Faerron @cardiopedhnn]

@OungSavly @WGACHDChair @iamritu @CASivaram1 @ASE360 @alex1708ander @echoleolopez @SIwa23288585 @loomba_rohit @WithAScalpel @sujithsp @Prasannasimha @CardioNeo There are 4 types of #AP_window defects.

- Proximal, distal, total & intermediate.

- simple, complex (depends on associated #CHD )

-small, moderate, large

https://t.co/iEIqw6YsZf

https://t.co/zkj4cnyGlE

#cardioped