What's the diagnosis? #CardioTwitter #EchoFirst

#ASEchoJ What does the surgeon want to know from the #EchoFirst images about the sinus of Valsalva aneurysm? What are surgical approaches?

This image suggests a Libman-sacks endocarditis vegetation

A well attended #ASEchoJC with fantastic authors Sudeep Sunthankar Nilda Espinola Zavaleta & moderators Ritu Thamman MD KELLY BOEGEL V.L.Sorrell, MD (@CASEfromASE EIC). Simultaneous discussion in English and Spanish. Thanks for everyone that joined!

#ASEchoJC measuring SOV
🔺Remember #EchoFirst measurements in PLAX & end-diastole perpendicular to long axis of Ao from leading to leading edge (≠ CT/CMR)
🔺Consider age, BSA, gender & standardize in your lab.
🔺3 methods at your fingertips w/ new @ase360 #EchoGuideApp

Nilda Espinola Zavaleta Enrique Garcia-Sayan, MD, FACC, FASE Sudeep Sunthankar V.L.Sorrell, MD (@CASEfromASE EIC) KELLY BOEGEL @CASEfromASE American Society of Echocardiography Surgical approach based on ruptured chamber,assoc lesions
Percutaneous closure an alternative w isolated RSVA but Sx for those w multiple cardiac lesions
closure depends on aneurysm size,relationship of aneurysm w adjacent structures, shape bit.ly/3X0npTT #ASEchoJC

Thank you to EVERYONE who participated in tonight’s #ASEchoJC ! ❤️

Huge shout-outs to our moderators, Enrique Garcia-Sayan, MD, FACC, FASE, KELLY BOEGEL, and Ritu Thamman MD, and our guest authors, Nilda Espinola Zavaleta, Sudeep Sunthankar, and V.L.Sorrell, MD (@CASEfromASE EIC)!

Enrique Garcia-Sayan, MD, FACC, FASE Congratulations to Enrique Garcia-Sayan, MD, FACC, FASE (with the assistance of Nilda Espinola Zavaleta) for tweeting simultaneously in two languages n the first #ASEchoJC en Español
American Society of Echocardiography

#ASEchoJC ¿Qué información ecocardiográfica de los aneurismas de los senos de Valsalva (ASV) debemos comunicar al cirujano(a)?

Raj Janardhanan, MD, MRCP, FACC, FASE Nilda Espinola Zavaleta Enrique Garcia-Sayan, MD, FACC, FASE Sudeep Sunthankar V.L.Sorrell, MD (@CASEfromASE EIC) KELLY BOEGEL @CASEfromASE American Society of Echocardiography David H. Wiener, MD Dr. Kanwal M Farooqi RTHahnMD Dr. Purvi Parwani Maybe because of the anatomy of the sinuses of Valsalva? This congenital SOVA caused by weakness at juncture of aortic media & the annulus fibrosus
is it weakest near the right coronary sinus (65%–85%), #ASEchoJC Raj Janardhanan, MD, MRCP, FACC, FASE

Enrique Garcia-Sayan, MD, FACC, FASE Nilda Espinola Zavaleta Sudeep Sunthankar V.L.Sorrell, MD (@CASEfromASE EIC) KELLY BOEGEL @CASEfromASE American Society of Echocardiography David H. Wiener, MD Raj Janardhanan, MD, MRCP, FACC, FASE Dr. Kanwal M Farooqi RTHahnMD Dr. Purvi Parwani most common cardiac defect with SVA is VSD supracristal/ infundibular,
when an SVA is in close proximity to a VSD, an unruptured SVA may be misdiagnosed as an SVA with rupture, as opposed to an intact SVA with a coexisting VSD lacks muscular conal septal support in RVOT
#ASEchoJC

#ASEchoJC Nilda Espinola Zavaleta

🔺Ruptura de ASV suele producirse a las cámaras cardiacas derechas, causar compresión del VD, coronarias, o sistema de conducción
🔺Raramente ocurre ruptura hacia VI (como en este caso), AI, AP, VCS
🔺Ruptura extracardiaca o al pericardio es muy rara

#ASEchoJC
🔺SOVA can rupture into heart chambers (usually R), cause compression (RV infow or outflow, coronaries) or affect conduction system
🔺R or L HF Sx depending on chamber affected
🔺Rarely rupture into LV, LA, PA, SVC or pericardium, but extracardiac rupture is very rare

Enrique Garcia-Sayan, MD, FACC, FASE Nilda Espinola Zavaleta Sudeep Sunthankar V.L.Sorrell, MD (@CASEfromASE EIC) KELLY BOEGEL @CASEfromASE American Society of Echocardiography David H. Wiener, MD Raj Janardhanan, MD, MRCP, FACC, FASE Antonio Carlos Leite de Barros Filho Juan Lopez-Mattei, MD Dr. Purvi Parwani Dr. Kanwal M Farooqi Nadeen N. Faza, M.D. Ashish Aneja MD FACC FAHA FASE FSCMR These SOVA are associated w other congenital anomalies, most often VSD (30–60%), bicuspid aortic valve (15–20%), & aortic regurgitation (44–50%)

Here’s anterior bicuspid aortic valve fusion RCC & NCC w SOVA rupture
bit.ly/325wxKz #ASEchoJC American Society of Echocardiography Enrique Garcia-Sayan, MD, FACC, FASE

#ASEchoJC
💥Large single-center (Mayo) series:
🔺RSOVA 70% (most common fistula to RV), NCSOVA 25% (most common fistula to RA), LCSOVA less common (5%~)
🔺Median age 45, 63% male
👉Am J Cardiol 2007; 99: pp. 1159-1164: bit.ly/3UR3wfM

#ASEchoJC
🔺En serie de Mayo Clinic: aneurismas del SV derecho 70% (usualmente fistula al VD), no-coronario 25% (usualmente fistula a AD), izquierdo es poco común (5%~)
🔺Edad media 45, 63% masculino
👉Am J Cardiol 2007; 99: pp. 1159-1164: bit.ly/3UR3wfM

Nilda Espinola Zavaleta Enrique Garcia-Sayan, MD, FACC, FASE Sudeep Sunthankar V.L.Sorrell, MD (@CASEfromASE EIC) KELLY BOEGEL @CASEfromASE American Society of Echocardiography David H. Wiener, MD Raj Janardhanan, MD, MRCP, FACC, FASE Juan Lopez-Mattei, MD Dr. Purvi Parwani Gerbode Left ventricular to right atrial communications are rare types of ventricular septal defect & present as direct or an indirect types.
LV-RA shunt in systole as left ventricular systolic pressure is greater than right atrial pressure #ASEchoJC American Society of Echocardiography Enrique Garcia-Sayan, MD, FACC, FASE

Enrique Garcia-Sayan, MD, FACC, FASE Nilda Espinola Zavaleta Sudeep Sunthankar V.L.Sorrell, MD (@CASEfromASE EIC) KELLY BOEGEL @CASEfromASE American Society of Echocardiography David H. Wiener, MD Raj Janardhanan, MD, MRCP, FACC, FASE Juan Lopez-Mattei, MD Dr. Purvi Parwani In an isolated uncomplicated VSD, Doppler shows a high-velocity systolic & a low-velocity diastolic flow

ruptured SOVA will have a left to right shunt with a continuous high velocity jet (greater than 3.5 m/sec) with lower velocity in systole #ASEchoJC Raj Janardhanan, MD, MRCP, FACC, FASE Enrique Garcia-Sayan, MD, FACC, FASE

Enrique Garcia-Sayan, MD, FACC, FASE Nilda Espinola Zavaleta Sudeep Sunthankar V.L.Sorrell, MD (@CASEfromASE EIC) KELLY BOEGEL @CASEfromASE American Society of Echocardiography Dr. Purvi Parwani Nadeen N. Faza, M.D. Dr. Kanwal M Farooqi Ashish Aneja MD FACC FAHA FASE FSCMR what’s SVA Diameter?
measure SVA diameter perpendicular to long axis of ascending aorta PLAX view at end diastole
What is the origin of SVA? (NC/R/L CC
How many cusps are involved?
Are any adjacent cardiac chambers compressed by SVA? #echofirst #ASEchoJC American Society of Echocardiography Enrique Garcia-Sayan, MD, FACC, FASE

And that's all for tonight's #ASEchoJC , which we are dedicating to the memory of our dear colleague and friend, Greg Tatum🙏

If you missed live tweets, catch up on the discussion later by searching #ASEchoJC .
👉Claim CME: bit.ly/3Ai8BGe
👉See you again in a few weeks