Alexander Mladenow MD
@alex1708ander
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Cardiothoracic Anesthesia 💉🫀| Pediatric Cardiac Anesthesia | Echocardiography | EACVI Board Certification in TEE, TTE and CHD @dhzcharite #echofirst #3D
Berlin, @dhzcharite 🇩🇪
Joined April 2022
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#echofirst
knows how to get all 4️⃣pulmonary veins 🫁🫀with TEE in a simple way 👀⤵️
#CardioTwitter
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#echofirst
knows how 2️⃣♠️ME bicaval 👀in just 3️⃣steps, understanding the anatomy🫀is essential
#CardioTwitter
#PedsCard
👇⤵️
4
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#echofirst
knows to 👀 beyond the ❤️ if needed
#HepaticVeinFlow
matters
possible with TTE & TEE
1
49
181
#echofirst
shows the appropriate position of the CLOCK FACE in different echo modalities TTE🔁TEE🔁3D. To better understand the anatomic coordinates just 👀👇into your own 🫀using your WRIST WATCH. Fused BAV with LCC-RCC fusion is an ideal example
#CardioTwitter
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#echofirst
you are called on ICU for a patient with LVAD, doubtful of tamponade. What is this ? structure
#POCUS
23
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134
#echofirst
shows how surgical TEE view for MV-PPL (peri prosthetic leaks) localization corresponds to interventionalist’s view on fluoroscopy
#CardioTwitter
1
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134
#echofirst
is raising 🙆♂️the bar, explaining in a DETAILED overview how 2️⃣♠️different types of ASD using just 3️⃣ mid-esophageal TEE views. Dive deep into your own 🫀to better understand what’s going on in that of your patients. Here we go with part 1️⃣
#CardioTwitter
#CHD
2
44
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#echofirst
shows how 2️⃣use the laser lines 2️⃣better understand the spatial orientation in your 2D images. See what happens in 2D TEE if you push&pull la baguette magique on a 3D image⤵️
#CardioTwitter
3
31
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#echofirst
shows LUPV Thrombus 👀 in TEE in a male patient in his early 70s with past medical history of M. Hodgkin & left bronchial angiodysplasia (with hemoptysis)
#CardioTwitter
⤵️
2
24
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#echofirst
knows how to ♠️hepatic veins with TEE in just 3️⃣steps ➡️on the way you can find expected or unexpected hepatic lesions
#CardioTwitter
👀⤵️
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#echofirst
knows that abnormal AV morphology doesn’t necessarily mean abnormal AV function
#CardioTwitter
⤵️
1
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#echofirst
knows how 2️⃣♠️ a complex ASD🫀with 3D TEE using just 1️⃣view ➡️ME 4Ch & how not to confound it with the coronary sinus⤵️
#CardioTwitter
#CHD
0
24
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#echofirst
knows how 2️⃣♠️an AVSD in an 60 kg adolescent using 3D FANCY 👒TOOL➡️ volumetry is an important part of the game ⤵️
#CardioTwitter
2
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#echofirst
knows how to diagnose LSVC👉contrast injection into left-sided central venous catheter results in immediate opacification of the coronary sinus and then the RA
#CardioTwitter
1
21
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#echofirst
👀
#3DTEE
guided, individually tailored subaortic membrane resection👉 so patient & all team players are 😃 3D orientation aka clocking 🕕matters, check it by 👀 into your own 🫀
#CardioTwitter
⤵️
1
15
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#echofirst
TEE of benign brochogenic cyst
#CardioTwitter
located on the interatrial septum in a patient, 57 yo with unspecified headache and TIA. Removed in MIC technique.
1
28
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#echofirst
👀 THE LEIDEN CONVENTION👉coding, clocking & numbering of the coronary arteries🔁 the👌way 2️⃣understand spatial orientation is by 👀into your own 🫀
#CardioTwitter
1
15
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#echofirst
knows how 2️⃣♠️different types of VSD in just 1️⃣ TEE view ➡️ME RV in-out, bei pushing & pulling TEE probe
#CardioTwitter
,
#CHD
,
#PedsCard
🫀anatomy & spatial orientation matter 💡⤵️
1
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#echofirst
knows what happens in PLAX when you TILT & ROCK the TTE probe. 3D is very helpful as a learning tool for much better understanding the 2D world 🌎. Just 👀 into your own 🫀⤵️
#CardioTwitter
1
15
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#echofirst
knows that using off-axis & biplane views 🖖is important & could be very helpful 💡⤵️
#CardioTwitter
patient with gastric cancer and secondary tumor metastasis in RVOT
0
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#echofirst
🫀the 👀see what the🧠 knows⤵️
#CardioTwitter
TV SURGICAL VIEW 👉AV at 🕘, TV septal leaflet at 🕕➡️also applies for TTE 🙏
0
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#echofirst
knows 2️⃣appreciate LABELING & CLOCKING (uniform image orientation) when using images 🎆as a learning tool.
#CardioTwitter
🏷️🕥
#PedsCard
⤵️
1
17
52
#echofirst
👀3D TEE Basic Dataset👉just 1️⃣2️⃣3️⃣ 2D reference view needed
🔻switch off the respirator
🔻use multibeat (4-6)
🔻aim > 15 FPS
#CardioTwitter
⤵️
0
19
53
#echofirst
goes
#volumetric
👀intraoperative TEE from a patient in his late 60s with severe AR. When correct measured, PISA should correspond to volumes.
#CardioTwitter
👉 5️⃣TEE views you need to ♠️volumes 😀⤵️
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12
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#echofirst
knows how 2️⃣♠️ 🎱 TEE views in a simple way. You get 3️⃣by rotating & 5️⃣ by pushing the probe. Spatial orientation matters 🫀😃⤵️
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#echofirst
👀an intraoperative
#3DTEE
of a huge clot in LV 🫀in a young patient with past history of myocardial infarction👉removed in MIC approach ⤵️
#EACVI
#EuroEcho2024
CPB-weaning without inotropes👌
0
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#echofirst
if we all use an uniform CLOCKING in our images, intended as a learning tool, we wouldn’t need LABELING anymore ⤵️😀
#CardioTwitter
5
17
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#echofirst
knows how 2️⃣♠️different types of ASD in just 3️⃣TEE views. Spatial orientation is essential for better understanding of echo images, ‘cause the 👀see what the 🧠 knows
#CardioTwitter
,
#CHD
,
#PedsCard
part 2️⃣⤵️
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#echofirst
🙄normal & abnormal Coumadin ridge (with Thrombus attached on it) 👉 Thrombus was removed surgically in MIC approach (the same as for MIC-MVR) 🛜👀into your own 🫀
@NephroP
1
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#echofirst
knows the language of transducer manipulation in TTE&TEE 👉learn from M&M how to get all 3️⃣segments of MV 🫀by simple probe manipulation ➡️ ⤵️
#CardioTwitter
@NMerke
0
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#echofirst
👇the importance of spatial orientation when switching 🖖2D & 3D TEE
#CardioTwitter
1
11
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#echofirst
knows how to ace 🏆EVERY pulmonary valve in just 5️⃣ 🤌 🪄TEE views 👀
#CardioTwitter
#PedsCard
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#echofirst
👀a very challenging case of 52 yo male, without past medical history, admitted in ICU with collapse after emotional stress😩
#CardioTwitter
No coronary artery disease in angio. What is the diagnosis and what would be the right treatment 🤔⤵️
5
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#echofirst
👀how
#3DTEE
hellps you better understand 2DTEE👉SAM 💚(systolic anterior motion) in HOCM🔀👀into your own 🫀
#CardioTwitter
0
14
44
#echofirst
👀into your own🫀use the 🔌💪of 3D 2️⃣understand how TTE corresponds to TEE in a pediatric patient with perimembranous VSD 👀 at PLAX & ME AV LAX. It’s all 🏹plane. 💘spatial orientation matters 🫀💭
#CardioTwitter
,
#CHD
⤵️
0
15
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#echofirst
a routine intraoperative TEE guidance for minimally invasive mitral valve repair👉3D MV &
#volumetrics
for pre/postoperative evaluation, cannula insertion & post-repair assessment
#CardioTwitter
⤵️👀
0
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#echofirst
👀 pat with TTS, who had at the same time another not life-threatening🫀pathology 👉waiting🫸strategy is the right choice🤩transient Takotsubo syndrome ➡️he was successfully 👌operated (valve-sparing replacement of asc. Ao)
#CardioTwitter
⤵️
0
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#echofirst
goes back in the era when no 3D TEE was routinely available
#CardioTwitter
👀 a surgical removal of cardiac hemangioma guided by 2D TEE 2️⃣demontrate how 2D TEE correlates with🫀anatomy. After discussing the echo we decided 2️⃣take asc aorta as surgical approach
0
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#echofirst
shows how 2️⃣♠️ moderator band & coumadine ridge 👉structures, characteristic for left & right 🫀by simple TEE probe manipulation 👇
#CardioTwitter
0
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#echofirst
goes
#volumetric
showing a intraoperative TEE in a patient in his late 40s undergoing MIC MV-repair for type II MR, where PISA cannot be used to calculate RegVol because eccentric
#CardioTwitter
👇👀
1
7
40
#echofirst
👀an advanced TEE cardiac imaging 👉intraoperative surgical guiding for LVOTO in a symptomatic adolescent without VHD2️⃣facilitate surgical membrane resection⚠️bad things can happen ⏭️don’t forget the quality check for the volumes 😉⤵️
#CardioTwitter
3
11
40
#echofirst
how to get the 👆 upper esophageal Ao arch short axis view to ace pulmonary valve 🫁 in TEE in 3️⃣ steps
#CardioTwitter
,
#PedsCard
👇➡️➡️➡️ UE Ao arch SAX 🎷
0
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@OungSavly
Spectacular! Here intraop TEE in one of my cases from an adult with acquired Gerbode defect due to TV endocarditis
3
15
37
#echofirst
taking command of 3D stitching artifacts - use them & 3D laser lines as an easy learning tool ⤵️
#CardioTwitter
1
12
38
#echofirst
👀native pulmonary valve endocarditis & leaflet perforation in an adult male without past medical history 🫀TEE mid-esophageal & transgastric views
#CardioTwitter
0
10
38
#echofirst
wants to know which are the structures 1️⃣2️⃣3️⃣ in👇modified bicaval view aka “double barrel view” 🙄
#CardioTwitter
4
9
35
#echofirst
👀 two clinical findings in ascending & descending aorta 🫀 with similar appearance in TEE but different diagnosis & prognosis
#EACVI
#EuroEcho2024
1
11
37
#echofirst
knows how 2️⃣find SVC in 3D TEE using 🫧 tracing their road through the 🫀in a patient with incomplete AVSD.
#CardioTwitter
#CHD
⤵️
0
14
37
#echofirst
shows a TEE of a pediatric patient with ccTGA:
🔺double discordance
🔺parallel arrangement of GA
🔺Ao is anterior & leftward to PA
#CardioTwitter
⤵️
1
10
36
#echofirst
👀a young lady with suspected NVE 🫀who reached us in a critical condition & was rushed in the OR. On an intraop TEE, besides AV endocarditis on BAV, PV endocarditis was seen as well
#CardioTwitter
UE Ao Arch 🎷matters⤵️
0
12
36
#echofirst
knows how 2️⃣♠️ PE otherwise rarely seen in ME Ao asc 🎷➡️ remember👇if in doubt ⬇️
#CardioTwitter
#PedsCard
1
13
35
#echofirst
shows how & why to get aortic valve in
#3DTEE
🫀
#CardioTwitter
⤵️ u need the right 2D reference plane & good 2D images
2
8
34
#echofirst
👀 LA BONNE FAÇON 2️⃣quantify MR intraOP 👉ought to become ROUTINE ⤵️
#CardioTwitter
‘cause PISA alone doesn’t count ➡️VOLUMETRY is our quality check
2
10
35
#echofirst
👀dramatic clinical scenario in a male patient in his 60s 😳 postinfarction VSD, papillary muscle rupture 👉CPR, ECMO 👉complex surgery & finally HAPPY END ➡️aka “amazing things /never stop/happening here”
@dhzcharite
❤️NY-Presbyterian
@Columbia
0
14
34
#echofirst
goes
#volumetrics
quantifying AR. C’mon B honest with yourself 👉 check your PISA by doing volumetry
@NMerke
,
@AHagendorff
,
#EchoMath
,
#3D
,
#CardioTwitter
2
10
33
#echofirst
shows a simple (DOPPLER) 🛜way to differentiate between normal CORONARY SINUS & ASD OSTIUM PRIMUM ✨
#CardioTwitter
⤵️
0
12
35
#echofirst
importance of color flow jet origin in PR 👉 intraoperative TEE for 🫀TOF repair
#CardioTwitter
⬇️👇
#PedsCard
⬇️
1
16
32
#echofirst
👀preop TTE & intraoperative TEE in a patient with 3VD & AS undergoing CABG & AVR. 1️⃣ MV 🙄? 2️⃣ MV surgery ?
#CardioTwitter
⤵️
2
9
31
#echofirst
👀an intraoperative TEE 👉what happens with 🫀volumes immediately after surgical aortic valve replacement for AR, ‘cause
#volumetric
matter ⤵️
#CardioTwitter
2
7
31
#echofirst
patient with Kartagener syndrome, with bronchiectasias & situs inversus scheduled for DLTX 🫁 ,
#CardPeds
,
#CardioTwitter
2
14
31
#echofirst
👀a routine TEE minimum dataset protocol in a patient in his late 70s without VHD, undergoing minimally invasive CABG surgery. 1️⃣step = understanding what to acquire & why to acquire. 2️⃣step = how to acquire (only practice makes perfect). 3️⃣step = what&how to measure
1
10
31
0
14
31
#echofirst
👀RCX ⚠️as part of 🫀MV hostile environment 2️⃣ cases where preprocedural study of anatomical zones would have been of great value 🤷♂️ 👉se l’avessimo saputo ‼️Grazie mille
@fiore_corrado
#EchoDGK2024
@NMerke
#CardioTwitter
1
7
30
#echofirst
👀 2D TEE & 3D TEE
🔻”TRUE CORD”, aka moderator band in RV & 🔻”FALSE CORD”, aka false tendon in LV
#CardioTwitter
0
7
31
#echofirst
👀RV in TTE & TEE of a young patient undergoing DLTX for PPH 🫀atrial flow regulator 👉🟥systemic blood pressure
🟨RV systolic pressure (RVSP)
#CardioTwitter
⤵️
0
11
30
@echo_batman
What do you think about this LV
#echofirst
#CardioTwitter
14 yo 1️⃣Diagnosis 2️⃣Therapy
4
7
30
#PedCards
case with small ❤️
#echofirst
intraoperative TEE guiding for surgical procedure
#CardioTwitter
such small 👶weigh usually 🖖2-5 kg👉catheter insertion for intraoperative monitoring & TEE can be challenging ⤵️
0
4
28
#echofirst
knows how to get in just 2️⃣ steps the second best TEE view for 🫁 pulmonary valve 👉 deep TG PV LAX
#CardioTwitter
#PedsCard
⬇️⬇️⬇️
0
7
29
#echofirst
when you are asked by the surgeon 👩⚕️ 🧑⚕️ to 📐 geometric opening area of native pulmonary valve/pulmonary bio prosthesis
#CardioTwitter
you can do it with TEE intraoperative using this view ➡️ UE Ao Arch SAX 🎷⬇️⬇️
#PedsCard
2
11
28
#echofirst
13 yo boy with a history of Ross procedure ➡️admitted to external hospital with 🤒🥵 & abdominal pain 👉 appendectomy (no appendicitis found 😏) ➡️PV homograft endocarditis - aced in UE Ao arch SAX⬇️⤵️
#CardioTwitter
#PedsCard
1
13
28
#echofirst
knows how 2️⃣♠️the “notorious” DEEP TG LAX in a simple way👉there’s a MAGIC SPIN😳! TG 🪟 is used 2️⃣DOPPLER AV & even PV, like in👇4 months, 6kg👶 with perimembranous VSD. Don’t need to 🔂, just2️⃣🫸⬇️the probe
#CardioTwitter
#CHD
0
9
26
#echofirst
👀the crucial role of 🫀intraoperative TEE for decision making during surgery for AVSD & MITRAL CLEFT ➡️how should we grade MR👉PISA is good, but volumetry is 🔑 for quality check
0
7
26
#echofirst
shows overriding & straddling in 🫀with anomalous biventeicular & univentricular AV-connection aka DOUBLE INLET VENTRICLE
#CardioTwitter
⤵️
0
13
28
How to ace PA with
#echofirst
👉adult male with posttraumatic RPA dissection
#CardioTwitter
, treated with placement of percutaneous endovascular stent
1
8
27
#echofirst
knows how 2️⃣ find lost ASD occluder with TEE helping 👩⚕️👨⚕️ 2️⃣ choose the right surgical approach ⤵️
#CardioTwitter
#PedsCard
0
7
27
#echofirst
👀 TEE-guidance in a patient with advanced AFib undergoing successful LARIAT procedure & EPi-Sense ST ™️
@AtriCure
#CardioTwitter
⤵️
2
6
26
#echofirst
how to ace with TEE native pulmonary valve endocarditis with leaflet perforation
#CardioTwitter
in an adult patient without congenital heart disease and without history of drug use
#PedsCard
0
6
24
0
12
25
#echofirst
👀how using mnemonics in
#3DTEE
helps better learn & recall MV segments👉LAMP 💡
#CardioTwitter
⤵️P2 flail & chordae rupture undergoing MIC MV-repair
1
6
25
#echofirst
👀 2D & 3D TEE in a young female with PV endocarditis on a Melody valve
#CardioTwitter
👉 how 2️⃣♠️UE Ao Arch SAX for PV ⤵️
0
8
24
@giovannimenez10
@echo_stepbystep
@iamritu
@alexsfelixecho
@KemalogluOz
@AJamilTajik
@dr_benoy_n_shah
@mjschuuring
@ASE360
@FGraziani_Grace
@NMerke
@NadeenFaza
@NephroP
@denisamuraru
@papadocardio
@drozgeozden
@JGrapsa
#echofirst
👀how 2️⃣understand PLAX/PSAX performing TTE in an anesthetized patient using unusual position. Imagine you are doing TTE, sitting at the patient’s head side i.e. touching the pat’s head with your chest ⤵️AKA 👀into your own 🫀
2
6
26
Need to know
#echofirst
🧠orientation in 3D 🫀using reference views in 2D
#CardioTwitter
⬇️⬇️⬇️
0
8
24
0
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#echofirst
shows the correlation 🖖 2D&3D TEE with in vivo anatomy of the coronaries. Our 👀 see what our 🧠 knows. Building bridges in our 🧠 helps us thinking 3D⤵️
#CardioTwitter
0
6
24
#echofirst
different approaches with common goal for dimensions 👉anesthesiologist, 👉adult cardiologist and 👉pediatric cardiologist
1
9
24
#echofirst
shows how correspond TTE&TEE
#volumetrics
done by 2️⃣imagers INDEPENDENTLY‼️in a young male with a severe MR TYPE II, who undergoes minimally invasive MV-repair (MIC)
#CardioTwitter
⤵️
@NMerke
2
8
23
#echofirst
knows how important it is to control the CPB Ao Arch cannula position with TEE 👀 in UE Ao arch LAX 👉especially in pediatric patients
#CardioTwitter
how to do it in just 1️⃣2️⃣3️⃣steps
#CHD
0
5
21
#echofirst
👀how to guide with TEE Mitral clipping aka TEER for ischemic MR in an octogenarian
#CardioTwitter
2
6
21
#echofirst
👀intraoperative TEE in a patient with prosthetic MV endocarditis 😬undergoing surgical re-MV-replacement 👉Train your 🧠 to switch from 2D in 3D 🫣locating the small PVL otherwise w/o any hemodynamic significance
#3DTEE
0
5
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