Alex Felix @alexsfelixecho Twitter profile

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Alex Felix

4 years

Tuberculous pericarditis presenting as pericardial masses. See article: #echofirst @denisamuraru @lpbadano @drzgezdentok1 @DrHaniMahmoud @purviparwani @dr_benoy_n_shah @KristinaHaugaa @alcantaramonica @RodrigogpLima @echo_stepbystep @RobertoC8a @echotalk

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Alex Felix

@alexsfelixecho

3 years

Tuberculous pericarditis. 2DTTE PSAX #echofirst @argulian @alcantaramonica @SABOURETCardio @dr_benoy_n_shah @MGibreel1 @drzgezdentok1 @RodrigogpLima @echo_stepbystep @mariovar55 @The_echo_lady @VerwerftJan @NMerke @purviparwani @fiore_corrado @lpbadano @denisamuraru @iamritu

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Alex Felix

@alexsfelixecho

2 years

🚨 Many causes of shock in this same patient and only one solution 😳 🤔 What are your thoughts? #cardiotwitter #echofirst @echo_stepbystep @NMerke @ovidiogarciav @mariovar55 @EchoSoliman @schaefers_hans @KardiologieHH @dr_benoy_n_shah @iceman_ex @fiore_corrado @KemalogluOz

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Alex Felix

@alexsfelixecho

1 year

🧵 1/17 - Thread: Echo for Diagnosis and Management of obstructive HCM Mechanisms of MR in these patients Please, share your comments and experience #echofirst #cardiotwitter #echothread @NMerke @echo_stepbystep @iamritu @JaeKOh2 @dr_benoy_n_shah @EACVIPresident @StellEkaterina

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Alex Felix

@alexsfelixecho

1 year

✨What LV is trying to tell us? Can you suspect of any etiology just looking to these images? 🤔 #echofirst #cardiotwitter @lpbadano @denisamuraru @dr_benoy_n_shah @echo_stepbystep @NMerke @FGraziani_Grace @MasriAhmadMD @JaeKOh2 @AJamilTajik @pabeda1 @dianeavilamed @iamritu

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Alex Felix

@alexsfelixecho

2 years

✨17y female. Chest pain after breaking up with boyfriend 💔 🙃Inverted Tako-Tsubo #echofirst #CardioTwitter @NMerke @echo_stepbystep @lpbadano @cardim_nuno @iamritu @purviparwani @Hragy @strain_rate @AJamilTajik @fljsoares @AntonioBarros_ @alcantaramonica @VDelgadoGarcia

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Alex Felix

@alexsfelixecho

3 years

LA compression by Achalasia with Hemodinamic instability #echofirst #CardioTwitter @SilCastelletti @lpbadano @denisamuraru @NMerke @mmamas1973 @iamritu @purviparwani @fjpinto1960 @PeroneFrancesco @echo_stepbystep @KemalogluOz @drzgezdentok1

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Alex Felix

@alexsfelixecho

2 years

✨What is your diagnosis? 🤔 #echofirst #cardiotwitter #medtwitter @echo_stepbystep @NMerke @AJamilTajik @pattypellikka @purviparwani @iamritu @DrRajeshG1 @KardiologieHH @marcelohaertel @KemalogluOz @iceman_ex @EuniceOnwordi @mariovar55 @lpbadano @denisamuraru @EchoBielefeld

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Alex Felix

@alexsfelixecho

2 years

🚨What’s the diagnosis? 🤔 #cardiotwitter #echofirst @dr_benoy_n_shah @FGraziani_Grace @KemalogluOz @DrRajeshG1 @rajdoc2005 @DrHaniMahmoud @fiore_corrado @NMerke @papadocardio @lpbadano @denisamuraru @VDelgadoGarcia @marciomp50 @AJamilTajik @pattypellikka @echo_stepbystep

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Alex Felix

@alexsfelixecho

3 years

Follow-up: BK constrictive pericarditis 🫀➡️pericardiectomy➡️discharged. #echofirst @argulian @alcantaramonica @SABOURETCardio @dr_benoy_n_shah @MGibreel1 @rafaelcastroMD @echo_stepbystep @iamritu @VerwerftJan @NMerke @purviparwani @fiore_corrado @lpbadano @denisamuraru @iamritu

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Alex Felix

@alexsfelixecho

3 years

🌟3D #echofirst in the evaluation of MR, AR and TR For the masters with gratitude 🙏🏼 @lpbadano @denisamuraru @hahn_rt @robertomlang ✌🏽 #CardioTwitter 🌎 @NMerke @echo_stepbystep @JGrapsa @iamritu @LopezOpitz @Hragy @3DEcho_Brazil @fiore_corrado @KardiologieHH @KemalogluOz

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Alex Felix

@alexsfelixecho

2 years

✨Right parasternal window Do U use it as a routine in ascending aortic diseases?🤔 #echofirst @NMerke @papadocardio @echo_stepbystep @fiore_corrado @marciomp50 @KemalogluOz @almasthela @AJamilTajik @nat_echo @DrRajeshG1 @dr_benoy_n_shah @lpbadano 🌟Stanford A Ao dissection😳

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Alex Felix

@alexsfelixecho

2 years

✨Quite curious Aortic Hematoma😳 3D #echofirst reconstruction is amazing 🌟 🤔Have U seen this aspect before? #yescct #cardiotwitter @VLSorrellImages @LopezOpitz @NMerke @echo_stepbystep @dr_benoy_n_shah @AJamilTajik @wikimagen @giselateixido @almasthela @argulian @DrRajeshG1

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Alex Felix

@alexsfelixecho

2 years

✅Mitral annular dysjunction ✅Barlow’s MV disease #CardioTwitter #echofirst @lpbadano @NMerke @denisamuraru @AntonioBarros_ @iamritu @purviparwani @mariovar55 @alcantaramonica @DrRajeshG1 @fiore_corrado @echo_stepbystep @mirvatalasnag @VLSorrellImages @AJamilTajik @ASE360

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Alex Felix

@alexsfelixecho

3 years

⭐️Metastatic neuroendocrine tumor😳 Contrast 🛁 +3D #echofirst ✅ Rare: 3,8% of patients with carcinoid syndrome (Bhattacharyya Circ 2010) ✅ Only 7% of ❤️Mx NET involve the septum (Pandya JACC2002) @lpbadano @pattypellikka @echo_stepbystep @NMerke @dr_benoy_n_shah @denisamuraru

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Alex Felix

@alexsfelixecho

2 years

✨68y👩‍🦳 triarterial CAD, previous normal LV function 🔪LIMA-LAD+Saf-Dg1/Dg2/PDA Admission in immediate PO ICU 😳 What’s happening here? 🤔 @iceman_ex @NMerke @EchoSoliman @KardiologieHH @echo_stepbystep @SABOURETCardio @Hragy @mirvatalasnag @iamritu @purviparwani @laraguima1

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Alex Felix

@alexsfelixecho

1 year

✨Can you explain this flow pattern? Young 👩🏻. SOB. Native MV. No clips or previous surgery 😉 #echofirst #cardiotwitter #eacvi2023 @NMerke @echo_stepbystep @alcantaramonica @JaeKOh2 @fiore_corrado @KemalogluOz @iamritu @DrRajeshG1 @marciomp50 @EACVIPresident @VDelgadoGarcia

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Alex Felix

@alexsfelixecho

1 year

⭐️Right parasternal view (RPV) is a game changer for Ascending Aorta visualization in transthoracic #echofirst ! 🚀Stanford A Thoracic Aorta Dissection with 3D echo from RPV 😀 #cardiotwitter @NMerke @KemalogluOz @iamritu @echo_stepbystep @vonBardelebenRS @StellEkaterina

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Alex Felix

@alexsfelixecho

4 years

40y woman, 10y mech MVP - progressive dispnea last 30d, INR=1.0. After HR control/adjusting INR - symptomatic improvement and drop of med TP gradient(17->7)/PASP(70->34),but still a frozen disc and large thrombus. Is surgery always indicated? @lpbadano @denisamuraru @purviparwani

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Alex Felix

@alexsfelixecho

1 year

🌟Unicuspid aortic valve “Dome” opening or a ballerina opening 😁 #echofirst #cardiotwitter @StellEkaterina @alcantaramonica @drozgeozden @almasthela @LopezOpitz @marciomp50 @esrakaya_dr @DrRajeshG1 @Hragy @VDelgadoGarcia @echo_stepbystep @NMerke @dr_benoy_n_shah

Alex Felix

@alexsfelixecho

1 year

✨23y 🧔🏽‍♂️ followed since childhood with the diagnosis of “Bicuspid Aortic valve” 🌱Moderate aortic stenosis. What do you think about this valve anatomy? #echofirst @NMerke @echo_stepbystep @dr_benoy_n_shah @marciomp50 @AntonioBarros_ @GoncalvesCortez @kevin_domingues

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Alex Felix

@alexsfelixecho

2 years

✨27y old male. HCM. Dyspnea on efforts / NYHA II. LVOT grad rest 70mmHg What is the thickest V. septum you have ever seen? #echofirst #CardioTwitter @echo_stepbystep @NMerke @lpbadano @alcantaramonica @marciomp50 @KardiologieHH @KemalogluOz @DrRajeshG1 @mariovar55 @DICSBC

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Alex Felix

@alexsfelixecho

4 years

Infective Endocarditis. Jet lesions demonstrated by #3decho . Left atrial mural vegetation. @3DEcho_Brazil @fazalabul @The_echo_lady @RodrigogpLima @NMerke @lpbadano @robertomlang @echo_stepbystep @alcantaramonica @marcelohaertel @DrHaniMahmoud @AnaPaulaSicili1 @denisamuraru

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Alex Felix

@alexsfelixecho

3 years

Unicuspid AV (confirmed at surgery). Severe AR. AVA 1.8cm2. Excentric systolic aortic jet - blood speckle imaging. #echofirst #CardioTwitter @lpbadano @DrHaniMahmoud @purviparwani @fiore_corrado @echo_stepbystep @dr_benoy_n_shah @argulian @hahn_rt @robertomlang @iamritu

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Alex Felix

@alexsfelixecho

3 years

AL Amyloidosis. Atrial electromechanical dissociation. RA thrombus in sinus rhythm #CardioTwitter #echofirst @lpbadano @NMerke @robertomlang @AddK007 @JaeKOh2 @jamil_tajik @echo_stepbystep @iamritu @purviparwani @denisamuraru @alcantaramonica @marcelohaertel @KemalogluOz @PezelT

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Alex Felix

@alexsfelixecho

2 years

Need input from #cardiotwitter community 😃 Young pt. with MAD + MV bileaflet prolapse /Billowing (Barlow) Any thoughts about this structure? #echofirst @lpbadano @NMerke @echo_stepbystep @DonalErwan @donoxorn @AJamilTajik @purviparwani @denisamuraru @iamritu @robertomlang

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Alex Felix

@alexsfelixecho

3 years

Less is more 🤩 Successful PMBV in a 🙋‍♀️ with Rheumatic MS #echofirst @alcantaramonica @lpbadano @denisamuraru @AnaPaulaSicili1 @NMerke @PPibarot @vonBardelebenRS @rajdoc2005 @echo_stepbystep @robertomlang @SABOURETCardio @purviparwani @iamritu In the sequence + images/results

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Alex Felix

@alexsfelixecho

7 months

🌕 Cardiac Myxomas 1/🧵 🔘The most prevalent cardiac tumors 🔘95% are sporadic and 5% are familial (Carney’s complex) 🔘3👩🏻 : 1 👨🏽 (non-familial) #echofirst 📝Reynen K. Cardiac myxomas. NEJM 1995

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Alex Felix

@alexsfelixecho

2 years

37y 🚹, Hepatic Mx - NET unknown origin. ⚠️Carcinoid heart disease with typical TV and PV lesions #echofirst #CardioTwitter @NMerke @dr_benoy_n_shah @mariovar55 @iceman_ex @lpbadano @pattypellikka @purviparwani @iamritu @echo_stepbystep @AJamilTajik @fiore_corrado @DrRajeshG1

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Alex Felix

@alexsfelixecho

4 months

🌟Tuberculous Pericarditis - a silent killer 🚨 In this case constrictive pericarditis with thick layer of dense pericardial effusion The patient was operated (pericardiectomy) and treated clinically with good outcome 🌟 #echofirst Great discussion about differential

Alex Felix

@alexsfelixecho

4 months

🌟Young patient. Weight loss and low fever over months…. 🤔Whoever saw it once never forgets Diagnosis?? #echofirst @NMerke @KemalogluOz @argulian @echo_batman @dr_benoy_n_shah @AntonioBarros_ @ctinocomesquita @drozgeozden @DrRajeshG1 @echo_stepbystep @EACVIPresident

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Alex Felix

@alexsfelixecho

2 years

✨Peripartum cardiomyopathy: a deadly disease 🚨 30y 👩🏻 NYHA III 🌟So much information from a 3DTTE #echofirst #cardiotwitter @EchoBielefeld @echo_stepbystep @NMerke @DrMarthaGulati @purviparwani @iamritu @dr_benoy_n_shah @mariovar55 @thaiscoutinhoCV @SABOURETCardio @DrRajeshG1

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Alex Felix

@alexsfelixecho

4 months

🌟Young patient. Weight loss and low fever over months…. 🤔Whoever saw it once never forgets Diagnosis?? #echofirst @NMerke @KemalogluOz @argulian @echo_batman @dr_benoy_n_shah @AntonioBarros_ @ctinocomesquita @drozgeozden @DrRajeshG1 @echo_stepbystep @EACVIPresident

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Alex Felix

@alexsfelixecho

8 months

🌟Differential diagnosis of cardiac masses using UEA perfusion (“contrast” #echofirst ) 🤔 a good lecture for “Cooks Island Echo Summit?”😂 @dr_benoy_n_shah #cardiotwitter 📝Great review: @RMankadMD @echo_stepbystep @NMerke @iamritu @alcantaramonica

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Alex Felix

@alexsfelixecho

3 years

P2 Flail (3 ruptured chords) successfully repaired 👍🏼 #echofirst #cardiotwitter @lpbadano @denisamuraru @NMerke @echo_stepbystep @dr_benoy_n_shah @robertomlang @iamritu @purviparwani @3DEcho_Brazil @ASE360 @alcantaramonica @masiqueirajr @CuitlhuacArroy1 @fljsoares @marciomp50

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Alex Felix

@alexsfelixecho

3 years

✨Persistent left superior vena cava 😎3D demonstration with bubbles #echofirst #cardiotwitter @lpbadano @echo_stepbystep @NMerke @iamritu @purviparwani @AJamilTajik @JaeKOh2 @JGrapsa @Ivan_Echocardio @fiore_corrado @alessia_gimelli @dr_benoy_n_shah @DonalErwan @MAecocardio

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Alex Felix

@alexsfelixecho

1 year

✨Tricuspid Valve Fungal Infective Endocarditis - IV drug user 3D transthoracic #echofirst @lpbadano @denisamuraru @marcelohaertel @NMerke @echo_stepbystep @AntonioBarros_ @robertomlang @AJamilTajik @JaeKOh2 @VDelgadoGarcia @marciomp50 @dr_benoy_n_shah @FGraziani_Grace

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Alex Felix

@alexsfelixecho

11 months

🌟Obstructive HCM ✨Medio-ventricular dynamic obstruction After 3rd slide - Valsalva maneuver: From 10mmHg to >70mmHg medio-ventricular with no gradient in LVOT ✅ - 😳Look at Ao valve M-mode during maneuver 🔆 #echofirst #cardiotwitter @NMerke @echo_stepbystep

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Alex Felix

@alexsfelixecho

1 year

✨23y 🧔🏽‍♂️ followed since childhood with the diagnosis of “Bicuspid Aortic valve” 🌱Moderate aortic stenosis. What do you think about this valve anatomy? #echofirst @NMerke @echo_stepbystep @dr_benoy_n_shah @marciomp50 @AntonioBarros_ @GoncalvesCortez @kevin_domingues

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Alex Felix

@alexsfelixecho

2 years

🌟62y🥸 🚨VSD Post-RCA infarction ~1y ago, without reperfusion 💫CABG: LIMA-LAD +Patch 👌🏽 #echofirst #cardiotwitter @NMerke @lpbadano @echo_stepbystep @mariovar55 @mariovar55 @AntonioBarros_ @ecocardio_cl @DrRajeshG1 @iamritu @purviparwani @almasthela @EchoAshwag @nat_echo

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Alex Felix

@alexsfelixecho

2 years

✨ Any thoughts about possible etiology for this cardiomyopathy? 👉🏽Tip: 🦄 of #echofirst #cardiotwitter @NMerke @echo_stepbystep @dr_benoy_n_shah @DocStrom @iamritu @purviparwani @DrRajeshG1 @JaeKOh2 @AJamilTajik @KemalogluOz @fiore_corrado @JGrapsa @VLSorrellImages @fazalabul

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Alex Felix

@alexsfelixecho

1 year

❤️ Whatever you do, do it with passion! 🫶🏾 Tako-Tsubo CMP -> normal after 1week For + passionate #echofirst follow 🌟 @lpbadano @denisamuraru @echo_stepbystep @fiore_corrado @marcelohaertel @marciomp50 @RODRIGOVISCONT1 @FGraziani_Grace @dr_benoy_n_shah @argulian @almasthela

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Alex Felix

@alexsfelixecho

2 years

✨Loeffler’s endocarditis ✨ 👉🏽In this case: Chronic Eosinophilic Leukemia - hypereosinophilic syndrome resulting in Loeffler’s endocarditis: restrictive cardiomyopathy / endomyocardial fibrosis +mural thrombi 👍🏼review: #echofirst @iamritu @EGarciaSayan

Alex Felix

@alexsfelixecho

2 years

✨What is your diagnosis? 🤔 #echofirst #cardiotwitter #medtwitter @echo_stepbystep @NMerke @AJamilTajik @pattypellikka @purviparwani @iamritu @DrRajeshG1 @KardiologieHH @marcelohaertel @KemalogluOz @iceman_ex @EuniceOnwordi @mariovar55 @lpbadano @denisamuraru @EchoBielefeld

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Alex Felix

@alexsfelixecho

8 months

🌟Unicuspid Ao Valve is not an 🦄! Underdiagnosed in daily practice✨ Another patient (25y🙋🏽‍♂️) with a lifelong diagnosis of bicuspid Ao valve. In fact, it is an unicuspid Ao valve ✌🏽 3D echo makes the difference: look the aspect of the valve base (looks like Bicuspid) and when

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Alex Felix

@alexsfelixecho

1 year

✨What do U think? 🤔 🔺79y👨🏽‍🦳, NYHA II, peripheral congestion, large V wave in jugular venous pulse 🔺Late PO mechanical mitral prosthesis (lost timing) 👉🏽 ⬆️ right chambers +RV dysfunction (+persistent AF) 🌟In subcostal view: can you explain these images/flow?🤔

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Alex Felix

@alexsfelixecho

4 years

Have you seen something like this before? Young patient progressive dyspnea, abdominal pain + fever. @lpbadano @purviparwani @NMerke @iamritu @alcantaramonica @3DEcho_Brazil @AnaPaulaSicili1 @hahn_rt Necrotizing Aortitis + Giant thoracic aortic aneurism + rupture invading main PA

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Alex Felix

@alexsfelixecho

3 years

Young male. Ventricular arrhythmias. What is going on? 🤔 #echofirst #WhyCMR @filipecui @denisamuraru @lpbadano @NMerke @RobertoC8a @Clerioazevedo @MarlyUellendahl @AnaPaulaSicili1 @alcantaramonica @echo_stepbystep @Konstan68427594 @iamritu @dr_benoy_n_shah @purviparwani

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Alex Felix

@alexsfelixecho

2 years

🌟Very happy to be cited among the Top15 #echofirst influencers in the latest JASE issue Glad to be part of this spectacular community 👏🏼💫 @NMerke @vass_vassiliou @purviparwani @SeguraCardio @SilCastelletti @iamritu @fiore_corrado @Ivan_Echocardio

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Alex Felix

@alexsfelixecho

4 years

Peripartum cardiomyopathy. 37y, 5weeks postpartum. Progressive HF + ischemic stroke #echofirst @denisamuraru @lpbadano @iamritu @purviparwani @NMerke @echo_stepbystep @fjpinto1960 @SABOURETCardio @DrHaniMahmoud @KristinaHaugaa @mqueiroga2 @alcantaramonica @3DEcho_Brazil @argulian

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Alex Felix

@alexsfelixecho

2 years

🚨✨Young male, progressive SOB. Normal CATH🤔 MR under maintenance 👀 🌟Aneu x Pseudoaneu? 💡Etiology? Any thoughts? #echofirst @NMerke @lpbadano @echo_stepbystep @iamritu @purviparwani @DrRajeshG1 @ShelbyKuttyMD @SeguraCardio @dr_benoy_n_shah @ASE360 @JaeKOh2 @AJamilTajik

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Alex Felix

@alexsfelixecho

1 year

✨Happy to share our publication in ABC imaging (official journal of 🇧🇷 CV imaging department) “My approach to 3D #echofirst for Pathophysiological classification of TR” ⭐️ @alcantaramonica @papadocardio @NMerke @echo_stepbystep @lpbadano @denisamuraru

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Alex Felix

@alexsfelixecho

4 years

Young female. 3y TV bioprosthesis(IE)+PM RV lead. Accelerated degeneration by lead trauma (one leaflet destroyed). Submitted to TV redo+epicardial PM @lpbadano @alcantaramonica @denisamuraru @AnaPaulaSicili1 @NMerke @marcelohaertel @3DEcho_Brazil @ASE360 @fazalabul @purviparwani

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Alex Felix

@alexsfelixecho

3 years

ASD (Ostium secundum) + PFO #cardiotwitter #echofirst @lpbadano @denisamuraru @argulian @echo_stepbystep @DrHaniMahmoud @3DEcho_Brazil @mariovar55 @purviparwani @KemalogluOz @drzgezdentok1 @GoncalvesCortez @NMerke @JosephSecoges @GE_IanMc @marciomp50 @MuellerHolger @LopezOpitz

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Alex Felix

@alexsfelixecho

1 year

🫨What is happening here? 🩺42y 🧔🏽typical angina, continuous murmur left paraesternal border 🫀 ✨Right chambers ⬆️, moderate LV dysfunction #echofirst #cardiotwitter @NMerke @echo_stepbystep @dr_benoy_n_shah @AntonioBarros_ @lpbadano @StellEkaterina @echo_batman @rajdoc2005

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Alex Felix

@alexsfelixecho

1 year

🌟Medicine is an eternal learning 🙏🏼😃 ✨Young 💁🏾‍��️, SOB High output arteriovenous fistula for hemodyalisis evolving with high output Heart Failure + 🌊Torrential functional TR Look at the results after AV fistula closing. Incredible 🚀 #echofirst #cardiotwitter

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Alex Felix

@alexsfelixecho

2 years

🌟ASD late diagnosis Biggest RA I’ve ever seen 🚨713ml! #echofirst #CardioTwitter @lpbadano @denisamuraru @cardiopedhnn @NMerke @dr_benoy_n_shah @echo_stepbystep @AntonioBarros_ @marciomp50 @iamritu @purviparwani @JaeKOh2 @mariovar55 @DrRajeshG1 @AsyiqRaffali @KemalogluOz

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Alex Felix

@alexsfelixecho

2 years

💡Do you use right parasternal (PS) window in your #echofirst routine? - Have you tried to get 3D images from this view? 🌟 Take a look at this case, incredible details at right PS missed by conventional windows 😃 👉🏽 Poll 📝 @iamritu @purviparwani

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Alex Felix

@alexsfelixecho

2 years

🤔 How many papillary muscles are you seeing here?👂 🫀Obstructive HCM, young patient. Am I imagining in imaging?😂 MR pending ⏰ #echofirst #CardioTwitter @purviparwani @LopezOpitz @drzgezdentok1 @JGrapsa @lpbadano @argulian @NMerke @echo_stepbystep @lpbadano @AJamilTajik

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Alex Felix

@alexsfelixecho

1 year

⭐️Have you tried to use Left InsterScapular Approach (LISA) 💪🏽 to look for descending thoracic aorta dissection / aneurysm? Yes, it is possible even without pleural effusion…✅ See article: One more case to illustrate 🤩 #cardiotwitter #echofirst

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Alex Felix

@alexsfelixecho

1 year

✨Subaortic membrane You can diagnose and imagine it 😵‍💫 or you can appreciate in 3D #echofirst in realistic images 😎 #dic2023 @NMerke @echo_stepbystep @dr_benoy_n_shah @fiore_corrado @papadocardio @lpbadano @denisamuraru @DrHaniMahmoud @almasthela @iamritu @KemalogluOz

5

26

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Alex Felix

@alexsfelixecho

5 months

✨Immediate postop MV repair Pericardial Tamponade - Large efusion with strands / cloths - high mobility + suspicious color Doppler 🚨 🤔 flow inside? 🫧Agitated saline (end of video) showed no contrast inside pericardium - surgery confirmed that there was no active leak ✨

4

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Alex Felix

@alexsfelixecho

3 years

🚨Complicated Infective Endocarditis - when surgery can’t wait #EchoFirst #cardiotwitter @lpbadano @denisamuraru @DrRajeshG1 @AnaPaulaSicili1 @alcantaramonica @iamritu @ASE360 @alessia_gimelli @hahn_rt @Ivan_Echocardio @Matte_Cameli @PeroneFrancesco @echo_stepbystep @NMerke

9

34

74

Alex Felix

@alexsfelixecho

7 months

🎯Chronic severe AR Bicuspid Ao Valve Anterior mitral leaflet restriction by AR jet incidence 🌟Great value of Echo #echofirst for diagnosis and follow-up @NMerke 🗣️Reg Vol = 85ml by 3D volumetric calc (SV LV - SV RV) #cardiotwitter #cardioX @StellEkaterina @echo_stepbystep

3

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Alex Felix

@alexsfelixecho

1 year

✨LV Contractility pattern in 3D multiplanar #echofirst views shows us clear apical sparing (radial component) 👨🏽‍🦳 Familial ATTR amyloidosis All deformation components are more altered in mid-basal segments. Also amyloid infiltration in LA atrial wall + interatrial septum /

Alex Felix

@alexsfelixecho

1 year

✨What LV is trying to tell us? Can you suspect of any etiology just looking to these images? 🤔 #echofirst #cardiotwitter @lpbadano @denisamuraru @dr_benoy_n_shah @echo_stepbystep @NMerke @FGraziani_Grace @MasriAhmadMD @JaeKOh2 @AJamilTajik @pabeda1 @dianeavilamed @iamritu

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3

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Alex Felix

@alexsfelixecho

1 year

✨Heroic LV 💪🏽, trying to eject blood against a triple “outflow” obstruction 👵🏼83y old NYHA II-III What would you try to address first and preferential options for treatment? #echofirst #cardiotwitter @NMerke @alcantaramonica @StellEkaterina @echo_batman @echo_stepbystep

16

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70

Alex Felix

@alexsfelixecho

6 months

✅Young 🧔🏽‍♂️with AscAo Aneurysm ✅ Chronic Severe AR ✅ Symptomatic with ⬆️MR (prev mild➡️mod) 1🌟What influences your decision to operate or not Mitral Valve 2🌟What predicts reverse remodeling and ⬇️MR? (only address AR will do the job?) 🧵Thread 1/7 🚨Poll in the end

8

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Alex Felix

@alexsfelixecho

3 years

✅ Some unicuspid Ao valves are misclassified as bicuspid, because of the appearance of the base of the leaflet You may realize unicuspid shape looking at the tip 👉🏽nicer with 3D😎 #echofirst @lpbadano @hahn_rt @michelenahector @fiore_corrado @NMerke @echo_stepbystep @donoxorn

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Alex Felix

@alexsfelixecho

1 year

🚨The most feared complication of percutaneous balloon mitral valvuloplasty ✅ Important message: don’t rely only on Wilkins score for prediction of success/complications🤔 👀 subvalvular involvement 👀 severity of comissural calcification 👀 asymmetry: fusion / calcification

3

16

69

Alex Felix

@alexsfelixecho

2 years

Pt with + Mech prosthesis Mitral+Aortic (4y). 😏in follow-up Aortic PPM with medium grad ~25mmHg 🚨Last #echofirst ⬆️40mmHg (≠HR/SBP)- “thrombosis”?🤔 A TEE was considered and I suggested Radioscopy first.. Discs with 👍🏼mobility Often we can’t 👀 clearly the Ao discs in TEE👌🏽

4

16

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Alex Felix

@alexsfelixecho

4 years

Etiology? Any guess? #echofirst @AnaPaulaSicili1 @pattiaruta @GoncalvesCortez @alcantaramonica @AntonioBarros_ @vonBardelebenRS @barrettorbm @david_le_bihan @dr_benoy_n_shah @draisabelabispo @iamritu @purviparwani @ppsengupta1 @RobertoC8a @sorina_mihaila @denisamuraru @lpbadano

18

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Alex Felix

@alexsfelixecho

3 years

Rheumatic heart disease, still a threatening disease in developing countries. Severe MS - LA/LAA thrombi #echofirst @lpbadano @denisamuraru @NMerke @purviparwani @iamritu @jamil_tajik @DrRajeshG1 @echo_stepbystep @marciomp50 @alcantaramonica @rajdoc2005 @fiore_corrado @ASE360

8

21

64

Alex Felix

@alexsfelixecho

9 months

🚨 41y 👩🏻Ischemic stroke 🚨 large myxoma projecting to LVOT - source of emboli ✅ resected by surgery ✅ #EchoIsAGameChanger #echofirst #cardiotwitter @NMerke @echo_stepbystep @lpbadano @vonBardelebenRS @DrRajeshG1 @StellEkaterina @echo_batman @dr_benoy_n_shah @JaeKOh2

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Alex Felix

@alexsfelixecho

3 years

Rheumatic MS under the candlelight 😀🕯 Finally got Flexi-Light™️ Great technology👍🏼 @lpbadano @denisamuraru @echo_stepbystep @NMerke @MuellerHolger @JosephSecoges @JoselzaB @3DEcho_Brazil @GE_IanMc @argulian @GoncalvesCortez @CuitlhuacArroy1 @alcantaramonica @marcelohaertel

4

15

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Alex Felix

@alexsfelixecho

1 year

Real “Saddle” pulmonary artery thrombus (emboli) Beautiful imaging by @anais 👏🏼👏🏼👏🏼⭐️ #echofirst made the day ✨

Dahoumane Zahra Anais, MD

@anais_dahoumane

1 year

When Tranthoracic Echocardiography make the clear diagnosis.. Massive Pulmonary Embolism @EchoBielefeld @drahmedmohsen85 @EchofirstB @BhaskarArora_MD @ASE360 @nat_echo

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2

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Alex Felix

@alexsfelixecho

7 months

🚨Acute Aortic Dissection Stanford A 🚨Highly pressurized false lumen 🌟 AR caused by intimal flap dropping over NC leaflet 🏆 Valve sparing aortic root replacement (David) with success 👌🏽 #echofirst #cardioX #cardiotwitter @ovidiogarciav @drahmedmohsen85 @KemalogluOz

2

22

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Alex Felix

@alexsfelixecho

1 year

Amazing depiction of an VSD post myocardial infarction with superposition of Echo and incredible CT images 🤩 @Steph_Achenbach 👏🏼👏🏼

Stephan Achenbach

@Steph_Achenbach

1 year

Infarct VSD, CT and echo. #cardiotwitter @escardio @M_Marwan_ @ChrisKramerMD @Drroxmehran @Abbara_UTSW @cardiacCT @Heart_SCCT @DGK_org @YoungDgk @thiele_holger @HolgerNef @mirvatalasnag @JEscaned @RonBlankstein @JonathonLeipsic @cury_ricardo

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4

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Alex Felix

@alexsfelixecho

3 months

🌟Rheumatic mitral stenosis - In these patients, when you see this pattern on color Doppler…. what is the explanation? #echofirst #cardiotwitter @argulian @alex1708ander @NMerke @echo_stepbystep @StellEkaterina @AJamilTajik @purviparwani @iamritu @RobertoC8a @mariovar55

8

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Alex Felix

@alexsfelixecho

3 years

With the new proposed integrated classification of TR, by @FabienPraz @denisamuraru @drmaisano @hahn_rt @VDelgadoGarcia @vonBardelebenRS and co-workers ✌🏽😃 @dr_benoy_n_shah @SABOURETCardio @marciomp50 @mariovar55 @AnaPaulaSicili1 @marcelohaertel @EduPOCUS @DrHaniMahmoud @ASE360

4

19

64

Alex Felix

@alexsfelixecho

1 year

✨Young 👩🏻, mod efforts dyspnea, syncope Referred for ICD implant ⚡️ 1-baseline midventricular obstruction and no LVOT obst (reverse septal)- do we need 🏃🏻‍♀️Ex. echo? 2-This case GDMT💊not optimized, but if refractory to Tx, what else can we offer? LVOT obst not being the

5

19

64

Alex Felix

@alexsfelixecho

1 year

This is a rare case of fistula of circumflex artery to coronary sinus 😃⭐️ Many correct answers and others had great differential diagnosis for this case 🌟🤝🔝 #echofirst

Alex Felix

@alexsfelixecho

1 year

🫨What is happening here? 🩺42y 🧔🏽typical angina, continuous murmur left paraesternal border 🫀 ✨Right chambers ⬆️, moderate LV dysfunction #echofirst #cardiotwitter @NMerke @echo_stepbystep @dr_benoy_n_shah @AntonioBarros_ @lpbadano @StellEkaterina @echo_batman @rajdoc2005

9

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3

28

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Alex Felix

@alexsfelixecho

10 months

✨What is the cause? Can you point the complications? 52y 👨‍🦰, astenia, weight loss, low fever, hemorrhagic stroke 2 weeks ago. Acute pain in popliteal fossa 🤔 #echofirst #cardiotwitter @echo_stepbystep @NMerke @StellEkaterina @DrRajeshG1 @argulian @marciomp50 @AntonioBarros_

7

22

61

Alex Felix

@alexsfelixecho

4 months

👵🏼Elderly woman Syncope episodes 😳 Systolic murmur left sternal border / aortic area: 💥aortic stenosis suspected 🤔 #Echofirst - sigmoid IV septum +basal hypertrophy 👉🏽LVOT obstruction (~ 100mmHg rest) +SAM+severe MR Hypovolemic 🚨‼️ #echofirst @NMerke @echo_stepbystep

11

17

63

Alex Felix

@alexsfelixecho

8 months

✨Young patient, asymptomatic ✨ Surgery in the past - aortic coarctation What about this mitral valve??🤔 🔘Severe MR - Reg Vol: 80ml 🔘 MV area: 3,7cm2 (3D echo) 🔘⬆️ LV, LA 🔘PASP : 42mmHg 🔘GLS normal #echofirst #cardiotwitter @cardiopedhnn @ShelbyKuttyMD @NMerke

6

27

63

Alex Felix

@alexsfelixecho

11 months

“PFOous” ASD = born ASD but behaves like a PFO 🤩😜 First heard this term from my good friend Dr. Max Lacoste, master of Echo in structural intervention in LATAM 🌟 The greatest problem is these small defects are not vol. overload, but a source of paradoxal embolic events 🚨

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Alex Felix

@alexsfelixecho

11 months

✨Great example by @VerwerftJan of where right parasternal view (RPV) can save the day 😎 I always perform RPV in pts with Ao valve disease. There is data showing that in ~50% of patients we can get highest Ao grad from RPV, specially when LV-Ao root angle <115º 😀*). It is

Jan Verwerft

@VerwerftJan

11 months

AS with MG < 40 ⁉️ What is your reflex?🧐 #echofirst #AS #AorticStenosis #CardioTwitter

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Alex Felix

@alexsfelixecho

1 year

🚨 9y old boy, + 🧬Loeys-Dietz ✨Ao root: 4.5cm (Z score +10.13) 👉🏽What is your experience? Valve-sparing Ao root replacement right away? #echofirst @echo_stepbystep @NMerke @dr_benoy_n_shah @FGraziani_Grace @cardiopedhnn @ShelbyKuttyMD @schaefers_hans

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Alex Felix

@alexsfelixecho

2 years

🌟A New Kid on the Block in POCUS:“LISA”- Just published @onlineIJCS 😀 A different POCUS approach to look for descending aortA aneurysm! It is possible to obtain dorsal window even in the absence of pleural effusion in some cases. @NMerke #echofirst

A New Kid on the Block in POCUS: “LISA”

A new kid on the Block in POCUS: “LISA” Transesophageal echocardiography (TTE) and computed tomography angiography (CTA) are methods of choice for definitive diagnosis and prognostic stratification...

ijcscardiol.org

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27

61

Alex Felix

@alexsfelixecho

3 years

Cardiotoxicity in low dose AC (180mg/m2). Improvement after 4w beta/ACEi. Strain ⬆️14.9%, GCW ⬆️ 47.8%. Is there any additional role - Myocardial work in CTRCD? #cardioonc #echofirst #cardiotwitter @strain_rate @echo_stepbystep @DrLustosa @ppsengupta1 @NMerke @lpbadano @ASE360

6

20

60

Alex Felix

@alexsfelixecho

2 years

Great example of unicuspid aortic valve 🌟

Vladyslav Kavalerchyk 🇺🇦

@echo_stepbystep

5 years

The type of aortic valve ? @fiore_corrado @NMerke @KemalogluOz @falcardio @almasthela @iamritu @DavidWienerMD @ecocardio_cl @rafavidalperez @RodrigogpLima @leylaelifsade

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0

11

59

Alex Felix

@alexsfelixecho

2 years

⚠️CEUS utility for masses and tumors - looking 4 perfusion Some illustrative cases 😎 #echofirst #cardiotwitter @denisamuraru @lpbadano @NMerke @echo_stepbystep @iamritu @iceman_ex @alcantaramonica @DrRajeshG1 @alessia_gimelli @AJamilTajik @JGrapsa @dr_benoy_n_shah @mariovar55

11

19

60

Alex Felix

@alexsfelixecho

3 years

Partial AV septal defect. ASD(OP) surgical correction 25y ago. MV cleft + severe MR + subaortic membrane #echofirst #CardioTwitter @lpbadano @denisamuraru @NMerke @iamritu @purviparwani @mmamas1973 @SABOURETCardio @DrHaniMahmoud @marcelohaertel @robertomlang @HeartOTXHeartMD

8

21

57

Alex Felix

@alexsfelixecho

8 months

Beautiful 3D #echofirst image of a quadricuspid tricuspid valve 🌟👏🏼 @Joe_Aoun_ and @HMethodistCV

Joe Aoun

@Joe_Aoun_

8 months

3-D transthoracic echo of a quadricuspid tricuspid valve with severe malcoaptation! Kudos to our sonographers @HMethodistCV #echofirst @HMHCardioFellow @SLittleMD @NadeenFaza @SachinGoelMD @ChamsiPash @AlanLumsdenMD @HeartToProve @ACCinTouch @ASE360 @escardio @SCAI @cardiotwitter

9

26

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2

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60

Alex Felix

@alexsfelixecho

3 years

🚨40y 👩🏻, SOB+hypoxemia Late diagnosis of ASD OS RV ⬆️ /dysfunction +eisenmenger’s ✨How about thrombi in dilated PA in this patient? 🤔Emboli? In situ? Any thoughts? #EchoFirst @hahn_rt @lpbadano @dr_benoy_n_shah @echo_stepbystep @NMerke @iamritu @purviparwani @MAecocardio

6

20

57

Alex Felix

@alexsfelixecho

5 months

🌟👩🏻 pt with RHD with Severe MS / “moderate”(+) AR ✅Recent NYHA I->II ✅Drop EF from Normal 👉🏽45% and SGL -8,9%🚨 ✅ MV area 0,7cm2 (3D) with gradients = 11/5mmHg 👉🏽🤔 Why underestimated? - flow through PFO answers: 22+8(RAP) = LAP-11 (MV grad) = 19 LVDP ⬆️ 👉🏽surgery ASAP

5

21

59

Alex Felix

@alexsfelixecho

3 years

30y female APS with previous PE 🫁 Admitted with COVID + w/ SOB / Hemodinamic instability and ⬇️ SaO2 - new PE PA thrombus easily seen by TTE - high paraesternal SAX/PLAX #echofirst @fiore_corrado @echo_stepbystep @NMerke @dr_benoy_n_shah @iamritu @Hragy @purviparwani

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26

59

Alex Felix

@alexsfelixecho

6 months

🌟Young patient, angina. What is happening here?? Old case from IE33 (oldie but goldie 😃) #echofirst @echo_stepbystep @NMerke @StellEkaterina @echo_batman @echotalk @RodrigogpLima @danimilovanovi1 @JaeKOh2 @rafavidalperez @LopezOpitz @wikimagen @papadocardio @Lolasan07257061

5

17

59

Alex Felix

@alexsfelixecho

8 months

✨Why normal patients may have “dilated” inferior vena cava (especially young) Turn left to lateral decubitus to find out 😀 (gravity) Explanation in 🎥 🌟learned from 👉🏽 @fpmorcerf #cardiotwitter #echofirst @NMerke @StellEkaterina @echo_stepbystep @mariovar55

1

20

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Alex Felix

@alexsfelixecho

3 years

🌟All that glitters is not gold! 67y,🧔🏽‍♂️ HTN/DM/CRF + dialysis/fistula - Degenerative AR. This ⬆️ pulsatility in the neck is not caused by Hemodinamic repercussion of AR😀 #echofirst #CardioTwitter @NMerke @echo_stepbystep @dr_benoy_n_shah @Hragy @SABOURETCardio @DrRajeshG1

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58