It’s gonna be a funky new year;
Can’t remember when I ever felt worse.
What year is this anyway?
The Eagles, “Funky New Year,” B-side to “Please Come Home for Christmas” (Asylum Records, 1978)
Thanks for reading the first CASE editorial of the new year. Like many of you, it’s almost inevitable that at this time of the year, I find myself pondering how I got to 2026. What were the circumstances at work, at home, and across the globe that created the individual I am today? Some factors were impactful and highly visible, leading to obvious changes. Other factors were undoubtedly subtle, and their impact may remain unrecognized. Nevertheless, each of these factors collectively helped shape the person writing (or reading) this editorial.
Similarly, our echocardiography laboratories go through their own evolution to become the laboratories we currently work in. Although not common, major changes create major disruptions and influence how we practice echocardiography. Some previously discussed examples include the transition from analog to digital (“Video Killed the Radio Star”) or the incorporation of contrast (“The Revealing Nature of Contrast…and Contrast in Nature!”). Much more commonly, our laboratories evolve slowly while incorporating new technologies or adopting new acquisitions to meet published guidelines and standards (e.g., including left atrial strain to meet the most contemporary diagnostic approach to diastology). Striking the perfect balance between the incorporation of new techniques and the discontinuation of older processes requires careful input from the entire echocardiography laboratory team of sonographers, physicians, nurses, and administrators. Continuous quality improvement is the oversight method to address inevitable imbalances.
I’m happy to remind each of you that CASE provides a tool for your quality improvement and offers reports aimed at helping guide you through the process. By introducing you to reports that teach new technologies, or new acquisition styles, or pathologies previously less understood, your laboratory can be fine-tuned as warranted. Some laboratories will find CASE reports that will drive changes to study acquisition. Other laboratories may find CASE reports to help them continue what they are already doing. Last, some laboratories may use CASE to support the discontinuation of outdated concepts.
In this new monthly issue of CASE, which starts our funky new year, we have prepared many new reports carefully revised through the editorial process with your educational value emphasized as a high priority. In “Unveiling the Transverse Fold: An Underrecognized Cause of Severe Aortic Regurgitation,” the authors help us explore yet another potential cause for primary aortic regurgitation (AR). They include outstanding still and video images to guide readers to a better appreciation of the aortic transverse fold as a mechanism for severe type II AR. There are gross pathologic images of the excised aortic valve leaflets as well as their correlative histopathologic features. These authors should be congratulated for unveiling this novel mechanism for AR. (Shortly after reviewing this report, I found a patient who met this diagnosis in our laboratory who had been followed with an unknown etiology of AR before this appreciation.)
As you continue your reading in CASE to help foster laboratory growth and a balanced evolution, the authors of “Annular Tear following Percutaneous Mitral Commissurotomy: The Need to Look Beyond the Annulus” bring us their insights in a relatively rare complication after percutaneous balloon mitral valvuloplasty. With expertise developed from across the ocean (India) and outside of a conventional echocardiography laboratory (a department of cardiac anesthesia), the clinical presentation of this early postintervention complication is clearly described and matched to the associated two-dimensional and three-dimensional echocardiographic findings. The management, including emergent mitral valve replacement, was carefully illustrated for enhanced understanding of how to proceed if similarly confronted with this complication. All echocardiography laboratories, whether conventional cardiology suites or nonconventional critical care, anesthesiology located, should be familiar with this complication if they participate in interventional echocardiography.
In “Intracardiac Echocardiography as the Sole Imaging Modality for Guidance of a Challenging Commissural Mitral Valve Transcatheter Edge-to-Edge Repair,” CASE readers are treated to an exceptional series of images that accompany their percutaneous structural heart intervention. Using intracardiac echocardiography alone, the authors use outstanding illustrations and simply gorgeous correlative intracardiac echocardiographic images to demonstrate this unique approach. Given the likelihood that this represents a growing future approach to these interventions, I anticipate that CASE readers will lean on this to help advance their own diagnostic evolution.
In an important hemodynamic CASE report, the authors of “Left Ventricular Diastolic Collapse in a Multiloculated Malignant Pericardial Effusion” provide readers with an elegant description of localized left ventricular tamponade. The associated M-mode images and videos are simply breathtaking and important for all sonographers, trainees, and physicians to fully comprehend.
In another striking series of images, the authors of “Symptomatic Giant Pericardial Cyst” provide CASE readers with a collection of figures and videos that are a visual delicacy. From the initial chest radiograph (compared with the postoperative radiograph) to the striking two-dimensional transthoracic echocardiogram or the unbelievable cardiac magnetic resonance findings, this pericardial cyst really is gigantic. The report concludes with thoracoscopic photographs to help readers fully appreciate what they are seeing with x-rays, ultrasound, and magnets. During the editorial review process, the authors were questioned regarding the definition of “giant” pericardial cyst, and they took that challenge to carefully review the literature and included a table of 14 case reports to help readers better contextualize that label. Of note, they found one report of a 28-cm cyst (their patient’s cyst was “only” 16.5 cm).
And last, in “A Tale of Two Membranes: Unmasking the Spectrum of Cor Triatriatum in Hypoplastic Left Heart Syndrome—A Prenatal Diagnostic Challenge,” the authors help pediatric and fetal echocardiography laboratories with important, but nuanced improved understanding of left atrial pathologies. For readers who manage patients with complex congenital heart diseases, such as hypoplastic left heart syndrome, the consistent use of accurate nomenclature is of high importance to aid in risk stratification and guide percutaneous or surgical intervention planning.
As we begin another (funky) new year, it is time to once again review our echocardiography laboratories and investigate opportunities to improve our balance of new and old. I hope that CASE can help you in this effort as you fine-tune your operations for maximal quality and efficiency.
According to the online Merriam-Webster dictionary, the most common definitions for “funky” include (1) having an offensive odor; (2) having the style and feeling of older African American music (such as blues or gospel), characterized by rhythmic elements similar to those of funk; and (3) (informally) odd or unconventionally stylish. Feel free to select the definition of funky that best suits your echocardiography laboratory, but I’m leaning toward the establishment of an unconventional, stylish laboratory with rhythmic elements (while trying to avoid the first definition).
Remember, every echo you see today has a teaching point and every teaching point is a potential new CASE report!