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Focused Cardiac Ultrasound for the Evaluation of Heart Valve Disease in Resource-Limited Settings

  • Valvular Heart Disease (J Dal-Bianco, Section Editor)
  • Published:
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Abstract

Purpose of reviews

There are many places in the world where comprehensive echocardiography is not available, including remote or rural regions of high-income countries and outside urban centers of low- to middle-income countries. In this review, we discuss the use case for focused cardiac ultrasound (FoCUS) in remote and low-resource settings including its use by non-expert providers as well as its accuracy and limitations in the assessment of the most common heart valve lesions.

Recent findings

FoCUS requires a different workflow compared to comprehensive echocardiography including a system for remote review and reporting by experts who are usually not on site. Multiple approaches used to train novice users to acquire limited FoCUS views, including protocols placing high importance on the parasternal long-axis view, have demonstrated success. Many approaches focus on rheumatic heart disease (RHD) screening and evaluation given its high worldwide prevalence. Models of task-shifting, cloud-based storage, and telemedicine will make diagnosis of heart valve disease more accessible in resource-limited settings.

Summary

FoCUS has been increasingly studied as a useful tool to screen for RHD and assess for valve disease in low-resource settings. However, FoCUS is limited in the full evaluation of valvular lesions and requires remote or local expert support, and patient transfer may be necessary for comprehensive echocardiography when appropriate.

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Authors and Affiliations

  1. Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, USA

    Sheila L. Klassen MD

  2. School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Maria C.P. Nunes MD, PhD

  3. Department of Medicine, Queen’s University, Kingston, ON, Canada

    Amer Johri MD, MSc

  4. Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, MA, USA

    Carlene McClanahan RDCS & Michael H. Picard MD

  5. Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Michael H. Picard MD

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  1. Sheila L. Klassen MD
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  2. Maria C.P. Nunes MD, PhD
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Correspondence to Sheila L. Klassen MD.

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Klassen, S.L., Nunes, M.C., Johri, A. et al. Focused Cardiac Ultrasound for the Evaluation of Heart Valve Disease in Resource-Limited Settings. Curr Treat Options Cardio Med 23, 74 (2021). https://doi.org/10.1007/s11936-021-00945-y

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