Adult Congenital Cardiologist with expertise in cardiac critical care and cardiac imaging
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I’ve never been a fan of closing a membranous vsd with a closure device. I find they often don’t sit well and leave large residual leaks. In patients that are surgical candidates, I would advocate a surgical approach as the primary choice. #ACHD ❤️🩹
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Nice example of peaked P waves in Ebsteins patient. So tall that computer inadvertently counted as a qrs, giving a ventricular rate of 134!! #ACHD ❤️🩹
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Nice example of RCA fistula to the SVC. The RCA is non dominant and the native coronary is diminutive in size compared to the fistula. #ACHD ❤️🩹
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Someone collapsed at the gym. We called 911, attached the AED, and gave asa. Once EMS arrived, the system worked. But spent 15 min on hold with 911. We can have the best medical care in the world but it means little if we underfund the system that gets people to it. ❤️🩹
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Leads cause TR by impinging on leaflets and tether by fibrosis
1 in 20 ACHD pts has a device. Currently no great solutions exist as diuretics can lead to kidney injury correct while lead revision or extraction carries risk or otherwise not practical #ACHD ❤️🩹
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Cardiac CT quality depends on the protocol. Scanner tech, contrast, meds, timing, and operator preferences all matter.
For coronary CTA, I use double-dose nitro with a 5-min delay prior to injection. It produces clear coronary images. The protocol is central to image quality.
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The picture is fascinating. It does however make me sad, behind every intriguing pathology is a person and family who suffers. I try to remember that as I’m sure others do as well ❤️🩹.
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Exercise and medications generally provide additive not necessarily interchangeable benefit. But if it was a pill it would inarguably be one of the most effective drugs ever developed.
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Reading echos on a random Sunday. When you have innumerable imaging studies to read this can fly under the radar if you get preoccupied. Nice example of apical HCM #ACHD
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Nice example of acute angulation of the left main at its origin with a short interarterial course in a patient with D-TGA and arterial switch. Sometimes the surgical repair for this is higher risk than leaving it alone as surgical success is not guaranteed. #ACHD ❤️🩹
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Nice example of a slightly posterior directed aortic valve regurge jet leading to restriction of mitral valve inflow due to some restricted opening of anterior mitral leaflet . #ACHD ❤️🩹
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Nice example of post MI scar. While the apex is not viable, the anterior wall is viable, giving opportunity to consider revascularization and functional recovery. #whymri ❤️🩹
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One thing I always remember is that in secundum ASDs, anomalous pulmonary veins do occur. So before we jump into percutaneous closure , we have to assure there are no anomalous veins that would change the strategy to surgical. #ACHD ❤️🩹
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When measuring the aorta in a repaired dissection measure the true and false lumen individually and together. The critical number for risk assessment is measured in a line including both lumens perpendicular to blood flow (5.5 cm being the general intervention cutoff) #ACHD ❤️🩹
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One of my favorite ECG tricks: flip an inferior STEMI tracing upside down/backwards. V1–V3 become posterior leads (V7–V9), and that “ST depression” reveals true posterior ST elevation → inferoposterior MI. #CCU ❤️🩹
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At first glance, this appears to be a large mid-muscular VSD. Look closer: an angled VSD patch incorporates part of the RV cavity into the systemic ventricle, surgical anatomy redefining physiology. #ACHD ❤️🩹
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Anytime I see a small PDA , to me it looks like a small flame 🔥 and I instantly start thinking about the song “like a moth to flame burned by desire…” . I have no idea why I do this. #achd ❤️🩹🎶🎤
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