Graphical abstract
Two-dimensional transthoracic echocardiogram, short axis view of the main pulmonary artery (MPA, left) demonstrates a saddle pulmonary embolism (PE) with the highly correlative axial display from the contrast-enhanced computed tomography scan (right). Ao, aorta; PA, pulmonary artery (From Graphical Abstract, Saddle Pulmonary Embolism Detected by Transthoracic Echocardiography in a Patient With Suspected Myocardial Infarction, Eugene Yuriditsky, MD et al.)
Graphical abstract.
Two-dimensional transthoracic echocardiogram, short axis view of the main pulmonary artery (MPA, left) demonstrates a saddle pulmonary embolism (PE) with the highly correlative axial display from the contrast-enhanced computed tomography scan (right). Ao, aorta; PA, pulmonary artery (From Graphical Abstract, Saddle Pulmonary Embolism Detected by Transthoracic Echocardiography in a Patient With Suspected Myocardial Infarction, Eugene Yuriditsky, MD et al.)
'Cause we never go out of style; We never go out of style
(from Style; written by Taylor Swift, Max Martin, Shellback and Ali Payami; 2014)
Taylor Swift is a singer.
In fact, a very talented singer, song-writer, entrepreneur and all-around entertainer.
Taylor Swift uses sound to achieve her mission.
Taylor Swift has a wide vocal range that is generally soft, but sometimes criticized as weak compared to her contemporaries.
Taylor Swift reinvents herself regularly.
Taylor Swift is known for venturing into highly diverse genres.
Taylor Swift is praised for her showmanship and has given some of the best all-time live performances.
Taylor Swift is always at the top of the charts.
Taylor Swift is a leader in social activism and a trailblazer for the rights of marginalized individuals.
Taylor Swift is 34 years old, has dated many famous celebrities and won most of the major music awards.
One of my goals for preparing these editorials (aka musings) is to entice you to read them with the hope I make you smile at least once during that perusal. I also like to challenge myself to provide ‘echo-analogies’ that may seem farfetched at first glance.
This is not one of those editorials. In fact, I think the correlation between Taylor Swift and Echocardiography is quite clear.
Echocardiography uses sound to achieve its mission.
Echocardiography has a wide range of diagnostic settings that are gentle (without risk), but sometimes criticized as weak compared to its contemporaries.
Echocardiography reinvents itself regularly.
Echocardiography is known for venturing into highly diverse imaging capabilities.
Echocardiography is praised for its real-time delivery of some of the best all-time bedside diagnostic performances.
Echocardiography is always on the top of any listing of noninvasive cardiovascular imaging charts.
Echocardiography is a leader in social activism and trailblazer for the rights of marginalized individuals.
Echocardiography is twice her age, has never dated a famous celebrity nor won a major music award. Oh well, I guess there are a few minor differences.
In this month’s issue, Mannan et al. reported on acute transvalvular MR after bioprosthetic MVR and the critically important role that TEE provides in evaluating the common and uncommon causes. They include a number of important imaging aspects to consider when confronted with this finding and used 2D and 3D images to instruct. There is an exceptional photograph of the explanted bioprosthetic valve for additional illustrative value. A report from Stein et al. tells a graphic tale about what can go wrong during a TAVI procedure indicated for severe AR in the clinical setting of end-stage heart failure with mechanical circulatory support. The authors provide readers with a number of unique approaches to the management of acute prosthetic valve embolization including their use of LVAD setting manipulation. The videos are nothing short of impressive.
Karampour et al. provide a straight-forward example of the potential clinical value of manufactured ultrasound enhancing agents to unmask the actual grade of MR, which may be underestimated when markedly eccentric (e.g. Coanda effect). Their images are compelling and can’t be ignored, despite our knowledge of the risk of over-estimating the regurgitation severity by color flow Doppler alone if not careful. Yuriditsky et al. offer another straight-forward example of the huge value of TTE for patients presenting with a clinical syndrome suspicious for an acute myocardial infarction. The differential diagnosis for this clinical constellation includes a list of acute, deadly, cardiocentric etiologies. These authors stumbled upon a dilated right heart and extended their parasternal SAX window superiorly to assess the PA bifurcation where they found a large saddle embolus. There are beautiful correlations with the CCT scan.
The article from Wood et al. appropriately fits in the Rare But Deadly Findings category. The authors have incredible serial images that tell a grim clinical story of the devasting consequences of rapidly progressive coronary artery aneurysms that ruptured, resulting in acute hemopericardium and death of a child. By seeing these images, we are better prepared for the potential catastrophic consequences if confronted with similar rapidly progressive coronary artery aneurysms. Our veterinary clinical CV medicine CASE from Genovese et al. provides a tell-tale story of the many avenues that may result in pericardial pathologies. I was completely floored by this etiology and began questioning where to walk my dog and what to avoid. The surgical video is one of the best demonstrations of epicarditis and pericarditis I have ever seen – human or dog.
Real fans of Ms. Swift (∗aka Swifties) will tell you that the song referred to at the beginning of this editorial had a secret message behind it. I feel it is my duty to confirm the conspiracy and reveal to the readers of CASE that Taylor was undoubtedly referring to echocardiography when she wrote Style, because, indeed, we never go out of style (#echofirst)!
Remember, every echo you see today has a teaching point; and every teaching point is a potential new CASE report!