EchoBlog http://blog.echojournal.org A collaborative blog by EchoJournal community Sun, 17 Mar 2013 19:29:29 +0000 en hourly 1 http://wordpress.org/?v=3.3.1 aortic stenosis: the problem of approach of graduation http://blog.echojournal.org/aortic-stenosis-problem-approach-graduation/ http://blog.echojournal.org/aortic-stenosis-problem-approach-graduation/#comments Sun, 17 Mar 2013 19:29:29 +0000 Jorg Emmel, MD http://blog.echojournal.org/?p=1961 Hello, the aortic stenosis can differentiate in 3 parts: 1. high grade aortic stenosis with impaired LV-EF (EF < 50%, SVI < 35 ml/m^2 surface area); the transaortic PGmean in cw will underestimate the grade of aortic stenosis; the continuity-formula can help, but the problem is the right measurement of LVOT-diameter (frquently we measure the LVOT-diameter too small; beside the “real” LVOT-area is not round but rather oval). In my opinion the planimetria with TEE is one of the optimal procedure to graduate the aortic stenosis. Stress-echocardiography can show us the contractile reserve of LV (“will there be an increase of LV-myocardial function after aortic-surgery.”) and we can see, whether there is a “pseudostenosis” (“no full aperture of aortic stenosis because of low LV-contractility.”) or a real “fixed” stenosis. What do you think: will the dimensionless index (LVOT-VTO/ Aortic-VTI < 0,25) show us the real graduation of aortic stenosis? 2. aortic stenosis with preserved LV-EF (EF > 50%, SVI > 35 ml/ m^2 surface area); the transaortic PGmean in cw often shows us the “real” graduation aof aortic stenosis, but body size/ body surface area and the measurement of LVOT-area will be a problem to graduate the aortic stenosis in the right way. But what is with “inconsistent gradient”? What is your way to solve that problem with “inconsistent gradient”: Aortic-area < 1 cm^2 as a sign for high grade aortic stenosis and  a PGmean < 40 mmHg as a sign for middle grade aortic stenosis. I Think that in that case the clinical affictions will show us, whether the patient can treat conventional or surgical. 3. high grade aortic stenosis with preserved LV-EF but low stroke volume (LV-EF > 50%, SVI < 35 ml/m^2 surface area); the reason is a distinct mitral valve insufficiency/ tricuspid valve insufficiency, LV-hypertrophy (small LV-cavum, that means a small stroke volume) or atrial fibrillation with impaired LV-filling or distinct diastolic impairment. Is the planimetria by TEE enough for that patients? Do you have any idea ofr right measurement? At the end: do you think, that invasive measurement (using Golrin-formula) can show us the right way??? I think, that Gorlin-formula shows us the “anatomical” aortic area but not the “effective”/ clinically relevant aortic area of aortic stenosis. Overall in my opinion the graduation of aortic stenosis is a real challenge for all of us and I have to confess, that it is sometimes very difficult. I look foward to any comment and hope that you have some hints, tipps and tricks. Best wishes and regards to you, Jörg.

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]]> http://blog.echojournal.org/aortic-stenosis-problem-approach-graduation/feed/ 0 Stroke volume http://blog.echojournal.org/stroke-volume/ http://blog.echojournal.org/stroke-volume/#comments Mon, 14 May 2012 21:40:00 +0000 Pablo Blanco, MD http://blog.echojournal.org/?p=1944 Hello everybody: In everyday practice (criticalecho) I calculate stroke volume (or surrogate) with LVOT VTI (PW doppler). Practically in all patients it can be measure in A5C view. In some conditions LVOT VTI is really representative of stroke distance? For example: In aortic stenosis, is there some problem with LVOT VTI? I assume not because we are measure with PW doppler not in a stenotic area and  stroke distance in LVOT still is useful. But of course, measure with CW doppler in an estenotic valve yes will give erroneously LVOT integrals. So, are you agree? In LVOT dinamic obstruction (hypertrophic miocardiopathy or simply LVH and  hypovolemia) we measure in some point of stenotic area with PW doppler…so..this integrals are not valid.! are you agree? In significant aortic regurgitation…some volume back to LV in every systole so LVOT VTI could appear normal because this regurgitant volume elevate LVEDV and flow by LVOT …but…is not really true because again is lost in every systole…are you agree? In conclusion, in LVOT dinamic obstruction and in significant aortic regurgitation LVOT VTI are not valid for estimation of stroke volume. In aortic stenosis there will be no problem. What do you think? And lastly.. in conditions that we can´t measure LVOT VTI… what could it use? Well, I used supraesteral view and measure VTI with PW doppler in aorta… ascending aorta and descending aorta. In ascending aorta (not always reliable) is better because there is no lost of flow  (internal carotid and subclavian) like in descending aorta, but is not always reliable. What do you think about this approach? In echojournal I will post a clip about it! Best my friends Pablo  

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]]> http://blog.echojournal.org/stroke-volume/feed/ 5 Global Contractility http://blog.echojournal.org/global-contractility/ http://blog.echojournal.org/global-contractility/#comments Wed, 02 May 2012 03:16:00 +0000 Pablo Blanco, MD http://blog.echojournal.org/?p=1822 Hi everybody. In TTE what window you use for LV eyeballing assessment of  global contractility? Some use apical 4C…others a sum of views… I prefer PSAX at midpapillary level…some authors says that because the predominant contraction pattern of LV is circumferential and this pattern is look well in short views… What do you think? Best PB

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]]> http://blog.echojournal.org/global-contractility/feed/ 2 dimensionless index of aortic insufficiency? http://blog.echojournal.org/dimensionless-index-of-aortic-insufficiency/ http://blog.echojournal.org/dimensionless-index-of-aortic-insufficiency/#comments Mon, 30 Apr 2012 18:46:31 +0000 Jorg Emmel, MD http://blog.echojournal.org/?p=1817 Hey everyone! Does anybody know a dimensionless measurement of aortic insufficiency, exspecially in aortic insufficiency with impaired left ventricular myocardial function? We know a dimensionless index of aortic stenosis (V-LVOT/V-aortic valve) derived from continuity equation that helps us to estimate the severity of aortic stenosis without dependence on myocardial function and not dependent on correct measurement of LVOT-diameter (that could be very difficult and it is very error-prone!!). But is there a dimensionless measurement for estimation of aortic insufficiency?? Actually I use pressure half-time (PHT) – but that is dependent on LV-mass and ejection-fraction – and detection of diastolic regurgitation in subclavian arteries to estimate whether there is a high grade aortic insufficiency. But is that sufficient and correct enough? Thanks a lot for helpful comments.   Jorg.

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]]> http://blog.echojournal.org/dimensionless-index-of-aortic-insufficiency/feed/ 4 Fantastic idea this blog!! http://blog.echojournal.org/fantastic-idea-this-blog/ http://blog.echojournal.org/fantastic-idea-this-blog/#comments Mon, 30 Apr 2012 18:26:40 +0000 Jorg Emmel, MD http://blog.echojournal.org/?p=1810 Congratulations on the whole team of EchoJournal for this great idea of creating a blog! That will help us to discuss about interesting cases and tell each other something new. Thank you very, very much for invitation to join that blog!

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]]> http://blog.echojournal.org/fantastic-idea-this-blog/feed/ 1 Welcome to the EchoJournal Blog http://blog.echojournal.org/welcome-to-the-echojournal-blog/ http://blog.echojournal.org/welcome-to-the-echojournal-blog/#comments Sat, 28 Apr 2012 04:28:02 +0000 David Winchester, MD http://blog.echojournal.org/?p=1792 We at EchoJournal have been uploading videos since March of 2009 with over 400 clips on the site.  Thanks to our prolific users like magehana47, Emmel, ohtusabes (and many more) we have millions of views, with our most popular video at over 40,000 views. Now we are launching a new feature for our community, blog.echojournal.com. The blog will let us talk about videos in a little more detail and additional commentary, as well as linking multiple clips together. For example, here are two clips from a mitral insufficiency case that I previously posted on EJ that you can now see all at once. This is obviously just the beginning of some great content we can create together here at EchoJournal and EchoBlog! David Winchester Editor  

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]]> http://blog.echojournal.org/welcome-to-the-echojournal-blog/feed/ 0 Slider Manager http://blog.echojournal.org/portfolio/port-slider-manager/ http://blog.echojournal.org/portfolio/port-slider-manager/#comments Fri, 06 Jan 2012 22:53:39 +0000 admin http://themes.goodlayers.com/modernize/?post_type=portfolio&p=1057 You can manage slider via slider manager…Easy! Cras mattis consectetur purus sit amet fermentum. Vestibulum id ligula porta felis euismod semper. Donec ullamcorper nulla non metus auctor fringilla. Praesent commodo cursus magna, vel scelerisque nisl consectetur et. Nullam quis risus eget urna mollis ornare vel eu leo. Vivamus sagittis lacus vel augue laoreet rutrum faucibus dolor auctor. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec ullamcorper nulla non metus auctor fringilla. Nulla vitae elit libero, a pharetra augue. Sed posuere consectetur est at lobortis. Cras mattis consectetur purus sit amet fermentum. Lorem ipsum. Lodolor sit amet, consectetur adipiscing elit. Duis mollis, est non commodo luctus, nisi erat porttitor ligula, eget lacinia odio sem nec elit. Nullam id dolor id nibh ultricies vehicula ut id elit. Maecenas faucibus mollis interdum. Vestibulum id ligula porta felis euismod semper. Etiam porta sem malesuada magna mollis euismod. Cras justo odio, dapibus ac facilisis in, egestas eget quam.

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]]> http://blog.echojournal.org/portfolio/port-slider-manager/feed/ 0 New Page Builder http://blog.echojournal.org/portfolio/new-page-builder/ http://blog.echojournal.org/portfolio/new-page-builder/#comments Fri, 06 Jan 2012 22:49:05 +0000 admin http://themes.goodlayers.com/modernize/?post_type=portfolio&p=1052 Our page builder is the most flexible tool to create page. We provide much much options for each items,  moreover, you can easily manage items via drag-drop module. Click to see video… Nullam quis risus eget urna mollis ornare vel eu leo. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Nulla vitae elit libero, a pharetra augue. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Maecenas sed diam eget risus varius blandit sit amet non magna. Nullam quis risus eget urna mollis ornare vel eu leo. Sed posuere consectetur est at lobortis. Sed posuere consectetur est at lobortis. Maecenas sed diam eget risus varius blandit sit amet non magna. Donec id elit non mi porta gravida at eget metus. Etiam porta sem malesuada magna mollis euismod. Nulla vitae elit libero, a pharetra augue. Aenean lacinia bibendum nulla sed consectetur. Praesent commodo cursus magna, vel scelerisque nisl consectetur et. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Etiam porta sem malesuada magna mollis euismod. Sed posuere consectetur est at lobortis. Fusce dapibus, tellus ac cursus commodo, tortor mauris condimentum nibh, ut fermentum massa justo sit amet risus. Fusce dapibus, tellus ac cursus commodo, tortor mauris condimentum nibh, ut fermentum massa justo sit amet risus. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Maecenas sed diam eget risus varius blandit sit amet non magna. Vestibulum id ligula porta felis euismod semper.

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]]> http://blog.echojournal.org/portfolio/new-page-builder/feed/ 0 Access to Elements Color http://blog.echojournal.org/portfolio/access-to-elements-color/ http://blog.echojournal.org/portfolio/access-to-elements-color/#comments Fri, 06 Jan 2012 22:40:07 +0000 admin http://themes.goodlayers.com/modernize/?post_type=portfolio&p=1070 You can access almost every elements color easily via admin panel. Now creating unique website is not a big deal anymore! Morbi leo risus, porta ac consectetur ac, vestibulum at eros. Nulla vitae elit libero, a pharetra augue. Aenean eu leo quam. Pellentesque ornare sem lacinia quam venenatis vestibulum. Maecenas faucibus mollis interdum. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nullam quis risus eget urna mollis ornare vel eu leo. Curabitur blandit tempus porttitor. Vivamus sagittis lacus vel augue laoreet rutrum faucibus dolor auctor. Aenean lacinia bibendum nulla sed consectetur. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec sed odio dui. Cras mattis consectetur purus sit amet fermentum. Donec ullamcorper nulla non metus auctor fringilla. Donec ullamcorper nulla non metus auctor fringilla. Nullam quis risus eget urna mollis ornare vel eu leo. Nullam id dolor id nibh ultricies vehicula ut id elit. Lorem ipsum dolor sit amet, consectetur adipiscing elit.

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]]> http://blog.echojournal.org/portfolio/access-to-elements-color/feed/ 0 3 Custom Post Types http://blog.echojournal.org/portfolio/3-custom-post-types/ http://blog.echojournal.org/portfolio/3-custom-post-types/#comments Fri, 06 Jan 2012 22:26:27 +0000 admin http://themes.goodlayers.com/modernize/?post_type=portfolio&p=1063 We provide 3 custom post types for most flexibility of usage. We have portfolio post type which also has its own single page style. Testimonial, you can call testimonial easily by categorizing it. Price table, just the same principle as testimonial which is really flexible. See how nice it is. Donec id elit non mi porta gravida at eget metus. Duis mollis, est non commodo luctus, nisi erat porttitor ligula, eget lacinia odio sem nec elit. Duis mollis, est non commodo luctus, nisi erat porttitor ligula, eget lacinia odio sem nec elit. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Nullam id dolor id nibh ultricies vehicula ut id elit. Fusce dapibus, tellus ac cursus commodo, tortor mauris condimentum nibh, ut fermentum massa justo sit amet risus. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Cras justo odio, dapibus ac facilisis in, egestas eget quam. Maecenas faucibus mollis interdum. Nullam id dolor id nibh ultricies vehicula ut id elit. Fusce dapibus, tellus ac cursus commodo. Tortor mauris condimentum nibh, ut fermentum massa justo sit amet risus. Aenean eu leo quam. Pellentesque ornare sem lacinia quam venenatis vestibulum. Fusce dapibus, tellus ac cursus commodo, tortor mauris condimentum nibh, ut fermentum massa justo sit amet risus. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Nullam quis risus eget urna mollis ornare vel eu leo. Curabitur blandit tempus porttitor. Fusce dapibus, tellus ac cursus commodo, tortor mauris condimentum nibh, ut fermentum massa justo sit amet risus. Nulla vitae elit libero, a pharetra augue.

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