The latest issue of CASE is now available with intriguing reports, including “Multidirectional Blood Flow During Cardiopulmonary Bypass Mimicking an Iatrogenic Aortic Dissection During Transesophageal Echocardiographic Examination.” CASE Editor-in-Chief Vincent Sorrell, MD, FASE, remarked, “Foster et al. remind us all of one of the very important reasons this Journal has been such a success to our Society. These authors elegantly describe a common finding during cardiopulmonary bypass that may result in potentially devastating clinical consequences when not recognized. They performed a series of basic scientific steps to solve the root cause for understanding an image that initially appeared to be an aortic dissection. In doing so, they describe the pattern of multidirectional blood flow within the aorta that accompanies bypass cannulation. Next, they demonstrate the change in Doppler findings when the bypass flow is held. Lastly, they include post-operative tomographic imaging for further education. Readers unfamiliar with this finding may be spared an unnecessary poor outcome. Other readers may use this approach as a guide to their own CASE report when they are confronted with an echo/Doppler artifact.”

A second Intraoperative Echocardiography report follows the sequence of intraoperative clinical events that resulted in severe hypoxemia during aortic valve surgery, using TEE as a primary investigative tool. In the Congenital Heart Disease category, Fahim et al. expound upon their echo findings in an adult with a double-chambered right ventricle, including excellent correlative CMR images to enhance their echo insights. The next case highlights the critical value of peripheral ultrasound with a patient whose pseudoaneurysm found on vascular ultrasound uniquely had a second pseudoaneurysm evolving from the first. Just Another Day in the Echo Lab rounds out this issue with a reminder that serial TEE is crucial after placement of a left atrial appendage occlusion device.

Be sure to read Dr. Sorrell’s editorial as he shares insights from patients on how to better engage them in the echo process, so they can feel like informed, active participants in their progression of care.

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FOR IMMEDIATE RELEASE

Contact: Angie Porter
919-297-7152
APorter@ASEcho.org

ASE Publishes Updated Guideline to Improve Care for Heart Failure Patients
with Implanted Medical Devices

(DURHAM, NC, September 10, 2024)—A new guideline from the American Society of Echocardiography (ASE) aims to provide more detail on the best imaging strategies for managing and improving care for heart failure patients with surgically implanted left ventricular assist devices (LVADs) and temporary mechanical circulatory support (TMCS) devices.

Advances over the past several years prompted the need for an updated perspective on the role of echocardiography and multimodality imaging to evaluate and manage potential complications associated with temporary and durable LVADs and TMCS devices. Recommendations for Multimodality Imaging of Patients with Left Ventricular Assist Devices and Temporary Mechanical Support: Updated Recommendations from the American Society of Echocardiography is an update to the Society’s original guideline published in 2015.

“This new guideline document serves as an update to the 2015 comprehensive ASE LVAD guideline. We provide detailed information and recommendations on TMCS devices, and we define the contemporary role of echocardiography and multimodality imaging in patient selection, pre-intra-and post-procedural surveillance, and troubleshooting with focus on the HM3 LVAD,” said lead author Dr. Jerry Estep, the Division Chair of Cardiovascular Medicine at Cleveland Clinic Florida in Weston. “We hope the framework we provide will improve patient outcomes by providing the best imaging strategies before and after durable and temporary device implantation.”

Many principles and recommendations detailed in ASE’s original 2015 guideline are still current and valid, and this updated document includes several of the previously published key points for the use of echocardiography. Additionally, it addresses new devices, expands upon the role of multimodality imaging and acknowledges the growing role of point-of-care ultrasound in evaluating patients with mechanical circulatory support. The writing group includes experts from multiple disciplines who hope the document will encourage future studies to continue advancing the field.

The new guideline is published in the September 2024 issue of the Journal of the American Society of Echocardiography. All guidelines published by ASE are available at ASEcho.org/Guidelines.

About American Society of Echocardiography
The American Society of Echocardiography (ASE) is the Society for Cardiovascular Ultrasound Professionals™. ASE is the largest global organization for cardiovascular ultrasound imaging serving physicians, sonographers, nurses, veterinarians, and scientists and as such is the leader and advocate, setting practice standards and guidelines for the field. The Society is committed to advancing cardiovascular ultrasound to improve lives. For more information, visit the ASE website ASEcho.org or social media pages on Facebook, X (formerly Twitter), LinkedIn, or Instagram.

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FOR IMMEDIATE RELEASE

Contact: Angie Porter
919-297-7152
APorter@ASEcho.org

New ASE Guideline Clarifies Cardiac Point-of-Care Ultrasound Nomenclature
The guideline aims to standardize the nomenclature around cardiac point-of-care ultrasound to facilitate collaboration, reduce confusion and enhance patient safety

(DURHAM, NC, September 10, 2024)—A new guideline from the American Society of Echocardiography (ASE) addresses the ambiguity in the current terminology used for cardiac point-of-care ultrasound (POCUS).

The guideline, titled Recommendations for Cardiac Point-of-Care Ultrasound Nomenclature, outlines specific recommendations establishing a deliberate vocabulary of cardiac POCUS-related terms to improve consistency in patient-care and research settings.

Clinicians use cardiac POCUS to examine heart and vascular systems at a patient’s bedside. However, because this diagnostic tool is utilized by a multitude of clinicians from numerous specialties in different settings, there are currently inconsistencies in the language and terms surrounding cardiac POCUS.

“Many terms have been proposed to describe the use of ultrasound by bedside clinicians to image the heart, and the words we use matter,” said Chair of the Guideline Writing Group Dr. James N. Kirkpatrick, Professor of Medicine and Bioethics and Humanities, and Director of the Echocardiography Laboratory at the University of Washington Medical Center in Seattle. “We believe our recommended terms and definitions can be an important step in bringing together the different specialties that use cardiac POCUS to standardize what we do—all for the good of the patient.”

The writing group is co-chaired by Dr. Nova Panebianco, Professor of Emergency Medicine and Director of Emergency Ultrasound at the University of Pennsylvania, and Dr. Jose Luis Diaz-Gomez, Institute Chair—Integrated Hospital Care at Cleveland Clinic Abu Dhabi and Adjunct Professor of Anesthesiology at Baylor College of Medicine. Additionally, it includes healthcare professionals from multiple stakeholder medical societies and a specialist in medical linguistics.

The guideline focuses on four main areas:

1. Review the evolution of cardiac POCUS-related terms.
2. Outline specific recommendations, distinguishing between intrinsic and practical differences in ‘‘basic cardiac POCUS/FoCUS,’’ ‘‘advanced cardiac POCUS,’’ ‘‘consultative echocardiography,’’ and ‘‘ultrasound assisted physical examination.’’
3. Address implications of these recommendations for current practice.
4. Discuss the implications for novel technologies and future research.

Drs. Kirkpatrick, Panebianco and Diaz-Gomez believe that a standard nomenclature can set the stage for future consensus building around the coordination of imaging studies, credentialing processes, billing practices, liability considerations, training protocols, and research.

“We intend for this cardiac POCUS nomenclature to be a starting point for future work in more specific areas. Establishing a deliberate vocabulary is the foundation for the accurate and efficient transfer of medical knowledge among healthcare professionals, educators, administrators, insurance providers, credentialing bodies, and most importantly, patients,” Dr. Kirkpatrick commented.

This document is endorsed by the American College of Chest Physicians (CHEST), the American College of Emergency Physicians (ACEP), the American Institute of Ultrasound in Medicine (AIUM), the American Thoracic Society (ATS), the Society of Critical Care Medicine (SCCM), World Interactive Network Focused on Critical Ultrasound (WINFOCUS) and 26 ASE International Alliance Partners.

The new guideline is published in the September 2024 issue of the Journal of the American Society of Echocardiography. All guidelines published by ASE are available at ASEcho.org/Guidelines.

About American Society of Echocardiography
The American Society of Echocardiography (ASE) is the Society for Cardiovascular Ultrasound Professionals™. ASE is the largest global organization for cardiovascular ultrasound imaging serving physicians, sonographers, nurses, veterinarians, and scientists and as such is the leader and advocate, setting practice standards and guidelines for the field. The Society is committed to advancing cardiovascular ultrasound to improve lives. For more information, visit the ASE website ASEcho.org or social media pages on Facebook, X (formerly Twitter), LinkedIn, or Instagram.

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