RESUMO
BACKGROUND: Anesthesiologists frequently use intraoperative transesophageal echocardiography (TEE) to aid in the diagnosis and management of hemodynamic problems during liver transplantation (LT). Although the use of TEE in US centers continues to increase, data regarding international use are lacking. METHODS: This prospective, global, survey-based study evaluates international experience with TEE for LT. Responses from 252 LT (105 US and 147 non-US) centers representing 1789 anesthesiologists were analyzed. RESULTS: Routine use of TEE in the United States has increased in the last 5 y (from 37% to 47%), but only 21% of non-US LT anesthesiologists use TEE routinely. Lack of training (44% US versus 70% non-US) and equipment (9% non-US versus 34% US) were cited as obstacles. Most survey participants preferred not to perform a complete cardiac examination but rather use only 6 of 11 basic views. Although non-US LT anesthesiologists more frequently had additional clinical training than their US counterparts, they had less TEE experience (13% versus 44%) and less frequently, TEE certification (22% versus 35%). Most LT anesthesiologists agreed that TEE certification is essential for proficiency. Of all respondents, 89% agreed or strongly agreed that TEE provides valuable information needed for immediate clinical decision-making, and >86% agreed or strongly agreed that that information could not be derived from other sources. CONCLUSIONS: The use of TEE for LT surgery in the US LT centers is currently higher compared with non-US LT centers. This may become a standard monitoring modality during LT in the near future.
Assuntos
Ecocardiografia Transesofagiana , Transplante de Fígado , Padrões de Prática Médica , Humanos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Estudos Prospectivos , Padrões de Prática Médica/tendências , Pesquisas sobre Atenção à Saúde , Anestesiologistas , Monitorização Intraoperatória/métodos , Monitorização Intraoperatória/estatística & dados numéricos , Hemodinâmica , Competência Clínica , Anestesiologia/educação , CertificaçãoRESUMO
Introdução: A ecocardiografia é uma ferramenta diagnóstica de crescente utilização na prática clínica, aplicada a diversos cenários médicos. Os cuidados e os processos de manutenção preventiva ou corretiva dos equipamentos são ainda pouco padronizados. O objetivo do presente estudo foi descrever o processo de manutenção atualmente aplicado a equipamentos ecocardiográficos em um laboratório. Descrever o processo inclui a caracterização de danos e aplicações de manutenção preventiva ou corretiva. Métodos: Estudo observacional descritivo e exploratório realizado em centro único. As informações de dados do processo de manutenção de equipamentos ecocardiográficos foram obtidas de arquivos eletrônicos do sistema de gestão de equipamentos de um laboratório de médio porte de um hospital público de nível terciário com características de ensino, no período de 2003 a 2018. Resultados: Foram identificados dez tipos de avarias mais comuns, como dano a programas (23,8%), peças (23,1%) e relacionadas à queda de energia e de acessórios (13,8%). Após a implementação do processo de manutenção preventiva, houve significativa redução dos custos de manutenções (US$ 44.472,10 versus US$ 25.807,59; p= 0,029). Mesmo após a manutenção preventiva, os custos de manutenção corretiva em equipamentos aplicados à ecocardiografia transesofágica (US$ 7.789,17) foram maiores que aqueles a equipamentos aplicados a outras modalidades (US$ 3.184,37 em ecocardiografia transtorácica e US$1.813,00 em estresse). Conclusão: O processo de manutenção de equipamentos ecocardiográficos foi descrito. Danos a equipamentos ecocardiográficos estão relacionados a altos custos, principalmente naqueles aplicados a modalidades especiais, como ecocardiografia transesofágica. As manutenções preventivas reduziram significativamente os custos de manutenção. (AU)
Introduction: Echocardiography is a diagnostic tool that is increasingly used in clinical practice in different medical scenarios; however, the preventive (PM) or corrective maintenance (CM) care and processes for this equipment are still poorly standardized. To describe the maintenance process currently implemented for echocardiographic equipment (ECHO) in a medium-sized laboratory in a tertiary-level public teaching hospital. The description of the process includes damage characterization and MP and MC implementation. Methods: This was a descriptive and exploratory single-center observational study. Data on the maintenance process of echocardiographic equipment were obtained from electronic files from the hospital's equipment management system between 2003 and 2018. Results: Together with the description of the equipment maintenance process, the ten most common types of malfunctions were identified, including software (23.8%), parts (23.1%), and power outage and accessory damage (13.8%). The implementation of the PM process significantly decreased the maintenance costs (USD 44,472.10 vs USD 25,807.59, p = 0.029). Even after the MP, the CM costs related to transesophageal echocardiography equipment (TEE) (USD 7,789.17) were higher than those with other equipment modalities (USD 3,184.37 for transthoracic echocardiography equipment (TTE) and USD 1,813.00 for stress testing). Conclusion: The maintenance process for ECHO equipment was described. ECHO equipment damage has high costs, especially in special modalities such as TEE. PM significantly reduced maintenance costs. (AU)
Assuntos
Humanos , Ecocardiografia/economia , Manutenção de Equipamento/métodos , Análise Custo-Benefício/estatística & dados numéricos , Economia e Organizações de Saúde , Equipamentos e Provisões/economia , Fatores de Tempo , Ecocardiografia Transesofagiana/estatística & dados numéricos , Instituições de Assistência Ambulatorial/organização & administração , Hospitais de Ensino/organização & administraçãoRESUMO
El siguiente trabajo detalla un enfoque integral para la evaluación y el manejo intraoperatorio de la cirugía en la válvula mitral. Los avances tecnológicos han hecho de esta técnica un instrumento fundamental en el manejo intraoperatorio de estos pacientes. Las nuevas técnicas quirúrgicas de reparación de la válvula mitocondrial han determinado que el abordaje ecotransesofágico bi-dimensional se ha convertido en un examen de rutina, sin embargo, el advenimiento del ultrasonido tridimensional (3D) nos ha permitido aprender más sobre la anatomía funcional de la regurgitación de la válvula mitral, el mecanismo fisiopatológico predominante, y realizar evaluaciones en tiempo real de los resultados de una reparación o reemplazo quirúrgico. Estas contribuciones han contribuido a la capacidad de toma de decisiones de los equipos quirúrgicos, resultando en una mayor tasa de éxito para la reparación de la válvula mitral y una reducción de las complicaciones quirúrgicas.
The following work details an integral approach to the evaluation and intraoperative management of surgery on the mitral valve. Advances in technology have made this technique a fundamental instrument in the intraoperative management of these patients. The new surgical techniques of mitochondrial valve repair have determined that the bi-dimensional ecotransesophageal approach has become a routine examination, however, the advent of three-dimensional ultrasound (3D) has allowed us to learn more about the functional anatomy of the mitral valve's regurgitation, the predominant pathophysiological mechanism, and to conduct real-time evaluations of the results of a surgical repair or replacement. These contributions have contributed to surgical teams' decision-making capabilities, resulting in a greater success rate for mitral valve repair and a reduction of surgical complications.
O seguinte trabalho, faz uma abordagem integral da avaliação e manipulação intraoperatória da cirurgia na valva mitral. Os avanços na tecnologia tem feito dessa técnica um instrumento fundamental na manipulação intraoperatória desses pacientes. As novas técnicas cirúrgicas de reparação valvar mitral determinaram que a ecocardiografía transesofágica bidimensional tornou se um exame de rotina, no entanto o ultrassom tridimensional (3d) nos permitiu saber mais sobre a anatomia funcional da valva mitral, o mecanismo fisiopatológico predominante, assim como a avaliação em tempo real dos resultados da reparação ou substituição cirúrgica. Essas contribuições tem contribuído para a toma de decisões da equipe cirúrgica resultando numa maior taxa de sucesso de plastias da válvula mitral, assim como uma redução nas complicações cirúrgicas.
Assuntos
Humanos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Período Intraoperatório , Valva Mitral/cirurgiaRESUMO
BACKGROUND: Anticoagulation remains a controversial issue among hyperthyroid patients with atrial fibrillation (AF). We aimed to evaluate the prevalence of the thrombogenic milieu (TM), detected using transesophageal echocardiography (TEE), among patients with AF related to hyperthyroidism, and to correlate these findings with the clinical embolic risk classification (CHA2DS2-VASc). METHODS: CHA2DS2-VASc score, thyroid hormonal status, time since hyperthyroidism diagnosis, transthoracic echocardiography (TTE) and TEE were assessed in 47 consecutive patients aged between 18 and 65years with AF related to hyperthyroidism. The following TEE parameters defined TM: dense spontaneous echo contrast, thrombi, or left atrial appendage (LAA) blood flow velocities <0.20m/s. Non-classic TM was defined as non-dense SEC plus LAA flow velocity 0.20-0.40m/s. RESULTS: Pulmonary hypertension was present in 39/47 (81.4%) and TM in 22/47 (46.8%) patients. Despite a low CHA2DS2-VASc score of 0/1, 10 of 19 (52.6%) patients had a TM, whereas 16 of 28 (57.1%) patients with score ≥2 had none. The probability of having a TM did not correlate with CHA2DS2-VASc scores. On regression binary analysis, hyperthyroidism diagnosed more than 12months previous was independently associated with non-classic TM (p=0.031). CONCLUSION: Among patients younger than 65years of age with AF related to hyperthyroidism, pulmonary hypertension and TM on TEE were highly prevalent. There was no association between CHA2DS2-VASc with TEE markers of TM. Thyroid status, especially longer duration of hyperthyroidism might influence thrombogenic abnormalities. TEE adds useful information that may change antithrombotic therapy if otherwise guided solely by clinical risk classification.
Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/epidemiologia , Ecocardiografia Transesofagiana/estatística & dados numéricos , Hipertireoidismo/epidemiologia , Índice de Gravidade de Doença , Tromboembolia/prevenção & controle , Adulto , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Brasil , Estudos de Coortes , Comorbidade , Feminino , Hospitais Universitários , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Segurança do Paciente/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Taxa de Sobrevida , Testes de Função TireóideaRESUMO
Fundamento: A ecocardiografia transesofágica (ETE) tem atraído grande atenção e está se tornando um campo científico importante e rapidamente crescente. Objetivo: Analisar a contribuição e as características das publicações científicas sobre ETE na Ibero-América. Métodos: Uma pesquisa bibliográfica foi realizada no PubMed (US National Library of Medicine National Institutes of Health) para identificar publicações científicas sobre ETE indexadas até 1º de maio de 2015. Os termos utilizados na pesquisa bibliográfica incluíram "ecocardiografia transesofágica", "ecocardiograma transesofágico", ecocardiografia transesofágica 3D" e "ecocardiografia tridimensional". Esses termos foram vinculados a cada país ibero-americano. Dados adicionais sobre as revistas de cada publicação científica foram obtidos a partir do SCImago Journal & Country Rank. Resultados: A Ibero-América originou 4% de todas as publicações sobre ETE. O número de publicações da Ibero-América aumentou de zero antes de 1990 a 60 em 2015. A Espanha, o México e o Brasil originaram 75% de todas as publicações da região. Cerca de 30% dos textos completos eram de acesso livre. A maioria das publicações científicas era em inglês. Cerca de 90% das publicações eram relatos de casos ou séries de casos sobre endocardite infecciosa, tumores ou massas cardíacas, doença cardíaca congênita, fontes cardioembólicas de acidente vascular cerebral e cardiologia intervencionista invasiva. A Espanha e a Argentina foram os países que originaram manuscritos com maior probabilidade de serem publicados em revistas estrangeiras. Cerca de 40% das publicações ibero-americanas foram em revistas classificadas no quartil superior das revistas científicas em seu respectivo campo. Conclusões: A produção científica sobre ETE na Ibero-América é limitada, mas vem aumentando. O número e as características das publicações sobre ETE mostram diferenças notáveis entre os países ibero-americanos. (Int J Cardiovasc Sci. 2016;29(6):422-430)
Transesophageal echocardiography (TEE) has attracted great attention and is becoming an important, rapidprogressing scientific field. Objective: To analyse the contribution and characteristics of scientific publications on TEE from Iberoamerica. Methods: A literature search was conducted in PubMed (US National Library of Medicine National Institutes of Health) to identify scientific publications on TEE indexed before May 1, 2015. Terms used for the literature search included "transesophageal echocardiography", "transesophageal echocardiogram", "3D transesophageal echocardiography", and "threedimensional echocardiography". These terms were combined with each Iberoamerican country. Additional data from the journal of each scientific publication were obtained from the SCImago Journal & Country Rank. Results: Iberoamerica originated 4% of all publications on TEE. The number of publications from Iberoamerica increased from zero before 1990 to 60 in 2015. Spain, Mexico, and Brazil originated 75% of all publications from the region. About 30% of fulltexts were freely available. Most of the scientific publications were in English. About 90% of the publications were case reports or case series about infectious endocarditis, tumors or cardiac masses, congenital heart disease, cardioembolic sources of stroke, and invasive interventional cardiology. Spain and Argentina were the countries that originated manuscripts with a higher likelihood of being published in foreign journals. About 40% of Iberoamerican publications were in journals ranked in the top 25% of scientific journals in their field. Conclusions: The scientific production on TEE from Iberoamerica is limited, but is increasing. The number and characteristics of publications on TEE show notable differences between Iberoamerican countries.
Assuntos
Humanos , Bases de Dados Bibliográficas/estatística & dados numéricos , Ecocardiografia Transesofagiana/história , Ecocardiografia Transesofagiana/estatística & dados numéricos , Sistemas de Avaliação das Publicações , Publicações Científicas e TécnicasRESUMO
BACKGROUND: Transesophageal echocardiography (TEE) plays an important role in evaluating cardioembolic sources of emboli. The identification of a patent foramen ovale (PFO) is reportedly improved with TEE compared with transthoracic echocardiography (TTE), but the Valsalva maneuver during TEE may be difficult or suboptimal. The aim of this study was to assess the efficacy of the Valsalva maneuver for PFO diagnosis using TEE compared with TTE by evaluating patients with ischemic stroke referred for echocardiography. METHODS: Only patients able to perform the Valsalva maneuver during TTE were included; efficacy was defined by a 20 cm/sec decrease in transmitral E velocity. A PFO was judged present when microbubbles of agitated intravenous saline were seen in the left chambers within three cycles after right atrial opacification. RESULTS: Of 108 patients (mean age, 55 ± 15 years; 61 men), 48 (44%) were judged to have PFOs by TEE and/or TTE. In 36 patients (33% of the total, 75% of those with PFOs), microbubbles were observed both by TEE and TTE, in seven patients only during TTE, and in five patients only during TEE. In patients able to satisfactorily perform the Valsalva maneuver during TEE, 22 PFOs were found, and two shunts (9%) were missed, whereas in patients unable to perform this maneuver, 26 PFOs were observed, with five shunts missed (19%) (P < .05). When a PFO was missed by TTE, either the echocardiographic window was suboptimal or the shunt was small. CONCLUSIONS: An adequate Valsalva maneuver is crucial for diagnosis of PFO; most patients with stroke may be screened using TTE with contrast and the Valsalva maneuver, with TEE indicated in case of suboptimal transthoracic images.
Assuntos
Ecocardiografia Transesofagiana/estatística & dados numéricos , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Manobra de Valsalva , Brasil/epidemiologia , Causalidade , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To provide the first detailed review of the indications and clinical utility of transoesophageal echocardiogram (TEE) in the Caribbean. DESIGN AND METHODS: Data for patients who had TEE performed at the Heart Institute of the Caribbean over a three-year period were abstracted and reviewed. Information gathered included demographic data, indications for the procedure, findings and clinical recommendations. The effect of age and sex on these variables was assessed using the Chi-square or Fishers Exact tests. Significance was set at a p < or = 0.05. RESULTS: Of the 116 procedures performed between 2005 and 2008, medical records were reviewed for 107 (50 male, 57 female) patients. The patients ranged in age from 15-86 years with a mean age of 45.4 +/- 18.5 years. With the exception of four patients, all attempted TEE were completed. The most common indications for the procedure were valvular heart disease (41.1%), strokes (17.8%), shunts (10.3%) and infective endocarditis (11.2%). Less common indications included arrhythmias, cardiac masses, aortic dissection and shortness of breath. Transoesophageal echocardiogram altered the treatment course in about 30% of all patients including 66.6% of patients referred for suspected infective endocarditis. Furthermore, TEE resulted in recommendation for surgery in 43% of patients referred for evaluation of severity of valvular disease. Minor complications occurred in two persons. No severe complications or deaths occurred as a result of the procedure. CONCLUSIONS: Transoesophageal echocardiogram has been most commonly performed to evaluate valvular heart disease in Jamaica without any major complications resulting from the procedure. It provides additional information that supplements transthoracic echocardiography in a wide range of clinical conditions. Measures should be put in place to make TEE more widely available and accessible in Jamaica.
Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Ecocardiografia Transesofagiana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Países em Desenvolvimento , Feminino , Recursos em Saúde , Humanos , Jamaica , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The purpose of this study was to test if parameters measured by intraoperative transesophageal echocardiography (TEE) could be useful to evaluate the hemodynamic status of high-risk cardiovascular patients and if this information was sufficient to make changes in intraoperative management. DESIGN: Prospective clinical study. SETTING: Single-university hospital. PARTICIPANTS: Ninety-eight patients undergoing noncardiac surgery. INTERVENTIONS: Every patient was assessed with a baseline examination of 2-dimensional, color, pulsed, and continuous Doppler images. Intraoperative changes in any of the evaluated and measured parameters led to a specific change according to the protocol. MEASUREMENTS AND MAIN RESULTS: After continuous monitoring with TEE during surgery, all patients were assigned to 1 of the following groups: (1) TEE was of no use, (2) TEE-directed intraoperative management changes, (3) intraoperative TEE-directed changes in postoperative management, and (4) TEE successfully used as a substitute for pulmonary artery catheter monitoring. Two patients (2%) were assigned to group 1, 47 (48%) patients to group 2, 25 (25%) patients to group 3, and 24 (24%) patients to group 4. The most frequent modifications in intraoperative management were changes in drug therapy and fluid administration. Postoperative management changes were mostly made because of new diagnosis (14%) and new left ventricular wall motion abnormalities (9%). CONCLUSION: These results strongly suggest that objective measurements made by intraoperative TEE are effective in unveiling relevant clinical findings and useful information in high-risk patients undergoing noncardiac surgery.
Assuntos
Abdome/cirurgia , Doenças Cardiovasculares/diagnóstico por imagem , Ecocardiografia Transesofagiana/estatística & dados numéricos , Cuidados Intraoperatórios/instrumentação , Monitorização Intraoperatória/instrumentação , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Razão de Chances , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de RiscoRESUMO
OBJECTIVES: We sought to detect cardiac thrombi by transthoracic and transesophageal echocardiography in patients with Chagas' cardiomyopathy and to determine the relationship of these thrombi with left ventricular systolic function and with the presence of stroke. BACKGROUND: Thromboembolic events are a serious complication of Chagas' cardiomyopathy. Because most data come from autopsy studies, the prevalence of cardiac thrombi for patients who are clinically stable is unknown. METHODS: A total of 75 patients (52 men; mean age 48 +/- 13 years) with Chagas' cardiomyopathy were prospectively studied by transthoracic and transesophageal echocardiography and followed for 24 +/- 10 months. RESULTS: In all, 14 patients (19%) had a history of stroke at the time of enrollment and two had this complication at follow-up. Most patients (88%) were in New York Heart Association (NYHA) functional classes I and II and 9 (12%) were in classes III and IV. Mean ejection fraction was 40 +/- 13%. A total of 17 patients (23%) had left ventricular thrombus on transthoracic echocardiography and this finding was associated with a history of stroke ( P = .01). Apical aneurysm occurred in 35 patients (47%) and it was associated both with thrombus and stroke ( P = .04). Strokes were more frequent ( P = .04) among patients with mild systolic dysfunction (57% of patients with strokes were in NYHA I). Four patients (5%) had thrombi at the left atrial appendage, and one (1%) at the right atrial appendage. A total of 13 patients (17%) died at follow-up. CONCLUSIONS: Stroke was frequent in Chagas' cardiomyopathy and associated with mild systolic dysfunction and with intracardiac thrombi. These occurred mainly in the typical apical aneurysm of Chagas' disease.
Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Cardiomiopatia Chagásica/epidemiologia , Embolia Intracraniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Trombose/epidemiologia , Disfunção Ventricular Esquerda/epidemiologia , Brasil/epidemiologia , Comorbidade , Ecocardiografia/estatística & dados numéricos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Feminino , Humanos , Incidência , Embolia Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Medição de Risco/métodos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Trombose/diagnóstico , Disfunção Ventricular Esquerda/diagnósticoRESUMO
OBJECTIVE: To study the diagnostic contribution of repeated transthoracic (TTE) and transoesophageal echocardiography (TOE) among patients with suspected infective endocarditis. METHODS: 262 patients with 266 episodes of suspected infective endocarditis were referred for TTE and TOE over three years in a 423 bed university cardiology hospital. Patients were a mean (SD) of 47.6 (17.9) years old. 139 (52.3%) episodes occurred in men and 127 (47.7%) in women. The diagnostic information obtained from repeated TTE and TOE examinations was evaluated relative to the diagnosis of endocarditis. RESULTS: TTE examinations were repeated in 192 (72.2%) and TOE examinations were repeated in 49 (18.4%) of 266 episodes. A mean of 2.4 TTE and 1.2 TOE examinations were performed for each episode of suspected endocarditis. The second and third TTEs added diagnostic information in 34 (26.7%) and the second and third TOEs added diagnostic information in 25 (19.7%) of 127 episodes with definite endocarditis. After the third TTE or TOE no additional diagnostic information was obtained. CONCLUSIONS: The diagnostic contribution of repeated TTE or TOE for the diagnosis of endocarditis decreased as the number of repetitions increased. In this setting, the data do not substantiate more than three TTE or TOE examinations as an efficient strategy to increase the diagnostic yield for all but selected patients with suspected endocarditis.
Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Adulto , Estudos de Coortes , Ecocardiografia/estatística & dados numéricos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Transesophageal echocardiography has a better sensitivity than conventional echocardiography for the detection of protruding atheroesclerotic plaques of the thoracic aorta. Clinical histories of 308 patients subjected to transesophageal echocardiography were reviewed. Subjects with protruding aortic plaques >0,5 cm were selected. Fifteen patients had protruding aortic plaques on transesophageal echocardiography and none of these were detected with conventional echocardiography. All these patients were in sinus rhythm and had high blood pressure. Ten subjects (67 percent) had a history of ischemic cerebrovascular or peripheral artery diseases (compared to 31 percent of subjects without protruding plaques) and in 7, the plaque was the only embolic source. Six patients (40 percent), smoked and 4 (27 percent) had coronary artery disease. One patient was diabetic and one had hypercholesterolemia. In conclusion, transesophageal echocardiography allows the detection of protruding aortic plaques that are potential embolic sources in patients with vascular diseases
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Aterosclerose , Aorta Torácica , Ecocardiografia/estatística & dados numéricos , Embolia , Isquemia , Ecocardiografia Transesofagiana/estatística & dados numéricosRESUMO
UNLABELLED: Severe mitral regurgitation is accompanied by increment of left atrial pressure. The objective of this work was to compare Doppler parameters related to transvalvular peak-pressure gradient in patients with normally functioning and patients with malfunctioning mitral prosthetic valve, secondary to insufficiency, in order to analyze if the presence of high protodiastolic pressure gradient and normal prosthetic valve area could correlate with severe mitral regurgitation (MR). Fourty-two patients were studied. Group I: twenty-two normally functioning prosthesis (15 mechanical, 7 biological). Group II: twenty malfunctioning mitral prosthetic valves secondary to severe insufficiency (11 mechanical and 9 biological), 12 patients with acute MR and 8 with chronic MR. All of the patients were evaluated though transthoracic (TTE) and transesophageal (TEE) Doppler-echocardiography. Diastolic peak velocity prosthetic flow (DVP), protodiastolic gradient (PDG), mean gradient (MG) and prosthetic area (PA) by pressure halftime (PHT) were measured. DVP in Group I was 1.56 +/- 0.29 m/s and 2.49 +/- 0.30 m/s in Group II (p = 0.001). PGD measured 10.36 +/- 3.79 mmHg in Group I and 15.95 +/- 7.48 mmHg in Group II (p = 0.001). MG 4.86 +/- 1.90 mmHg in Group I and 10.38 +/- 4.8 mmHg in Group II (p = 0.001). PA was 2.01 +/- 0.54 cm2 in Group I and 2.10 +/- 0.43 cm2 in Group II (NS). PHT was 115.59 +/- 31.99 mseg in Group I and 108.3 +/- 19.1 mseg in Group II (NS). CONCLUSION: In patients with high PDG (greater than 20 mmHg) and normal prosthetic mitral area assessed by TTE could be suspicious of malfunctioning prosthesis secondary to severe insufficiency. Due to the higher sensitivity and specificity in the diagnosis of malfunctioning mitral prosthesis and the ability to determine the magnitude and severity of prosthetic regurgitation assessment should be completed with TTE.
Assuntos
Bioprótese , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/diagnóstico por imagem , Bioprótese/estatística & dados numéricos , Distribuição de Qui-Quadrado , Diástole , Ecocardiografia Doppler/estatística & dados numéricos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Próteses Valvulares Cardíacas/estatística & dados numéricos , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/fisiopatologia , Falha de Prótese , Sensibilidade e EspecificidadeRESUMO
47 transesophageal echocardiograms (TEE) were performed on 43 patients (27 men and 20 women) in 30 months. The average age was 52.1 +/- 24.3 years. The most frequent indications for the procedure were: search for the source of emboli in 15 patients, suspected endocarditis and valvulopathies in 11. The main findings were intracavitary thrombi in 9 and vegetations in 8. The findings on TEE changed the medical management in 22 patients, confirmed suspected diagnosis in 15, and added nothing new in 10. Hypotension occurred in only one patient and resolved when the transducer was withdrawn. Comparing their results with those found in the literature the authors found that the indications were similar. TEE is an easy, safe and trustworthy study in selected patients.
Assuntos
Ecocardiografia Transesofagiana/estatística & dados numéricos , Cardiopatias/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PanamáRESUMO
Cuando se compara con la caracterización de la EI en los 70 y a principios de los 80, parece que es más probable que en los 90 la EI se presente en forma aguda y asociada con menos estigmas clásicos y también es más probable que el agente etiológico sea S. aureus. Si esto representa un verdadero cambio clínico y microbiológico en el espectro de la enfermedad o es el resultado de informes con un efecto de sesgo, en este momento resulta poco claro. La posibilidad para designar un caso definitivamente como EI desde un punto de vista clínico ha mejorado con la utilización de nuevos criterios diagnósticos, entre ellos los hallazgos de la ecocardiografía bidimensional en el esquema de clasificación. Estos nuevos criterios han sido confirmados en poblaciones seleccionadas de pacientes, no obstante habría que confirmarlos en otros grupos de pacientes en riesgo de padecer EI (v.g. receptores de válvulas protésicas). La ecocardiografía bidimensional es la técnica no invasiva de elección para la EI vegetante definida. La ETE es significativamente más sensible para poder identificar vegetaciones valvulares que la ETT y también representa el método de elección para detectar complicaciones perianulares en la EI. Queda todavía ser aclarado cuál es el papel de la evaluación del flujo Doppler en la insuficiencia valvular de la EI. Los esquemas con cursos cortos (2 semanas) de un ß-lactámico más un aminoglucósido, parecen ser altamente efectivos en el tratamiento de la EI derecha por S. aureus. El empleo de vancomicina para el tratamiento de la EI por S. aureus continúa siendo cuestionada debido a informes que hablan de una respuesta lenta y subóptima en los resultados al tratamiento (AU)
Assuntos
Humanos , Endocardite Bacteriana/etiologia , Endocardite Bacteriana Subaguda/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Reservatórios de Doenças , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana Subaguda/diagnóstico , Endocardite Bacteriana Subaguda/tratamento farmacológico , Ecocardiografia Transesofagiana/estatística & dados numéricos , Ecocardiografia/estatística & dados numéricos , Ecocardiografia/métodos , Ecocardiografia/estatística & dados numéricos , Sensibilidade e EspecificidadeRESUMO
Cuando se compara con la caracterización de la EI en los '70 y a principios de los '80, parece que es más probable que en los '90 la EI se presente en forma aguda y asociada con menos estigmas clásicos y también es más probable que el agente etiológico sea S. aureus. Si esto representa un verdadero cambio clínico y microbiológico en el espectro de la enfermedad o es el resultado de informes con un efecto de sesgo, en este momento resulta poco claro. La posibilidad para designar un caso definitivamente como EI desde un punto de vista clínico ha mejorado con la utilización de nuevos criterios diagnósticos, entre ellos los hallazgos de la ecocardiografía bidimensional en el esquema de clasificación. Estos nuevos criterios han sido confirmados en poblaciones seleccionadas de pacientes, no obstante habría que confirmarlos en otros grupos de pacientes en riesgo de padecer EI (v.g. receptores de válvulas protésicas). La ecocardiografía bidimensional es la técnica no invasiva de elección para la EI vegetante definida. La ETE es significativamente más sensible para poder identificar vegetaciones valvulares que la ETT y también representa el método de elección para detectar complicaciones perianulares en la EI. Queda todavía ser aclarado cuál es el papel de la evaluación del flujo Doppler en la insuficiencia valvular de la EI. Los esquemas con cursos cortos (2 semanas) de un ß-lactámico más un aminoglucósido, parecen ser altamente efectivos en el tratamiento de la EI derecha por S. aureus. El empleo de vancomicina para el tratamiento de la EI por S. aureus continúa siendo cuestionada debido a informes que hablan de una respuesta lenta y subóptima en los resultados al tratamiento
Assuntos
Humanos , Reservatórios de Doenças , Endocardite Bacteriana/etiologia , Endocardite Bacteriana Subaguda/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Ecocardiografia , Ecocardiografia/estatística & dados numéricos , Ecocardiografia/estatística & dados numéricos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Endocardite Bacteriana , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana Subaguda/diagnóstico , Endocardite Bacteriana Subaguda/tratamento farmacológico , Sensibilidade e EspecificidadeRESUMO
We studied 18 patients with suspected intrathoracic mass from january 1990 to august 1993. In all patients electrocardiogram, X-ray, transthoracic and transesophageal echocardiography were performed. Accordingly, the patients were divided into two groups: I) 8 patients with intracardiac myxoma, and II) 10 patients with no myxomatous tumor. The histopathologic identification of the intracardiac or extracardiac tumor was corroborated in all patients of group I and in only 8 patients of group II. In group I the mean age was 39 years and the female sex was more frequently (75%); with transthoracic and transesophageal approaches the myxoma was found in right atrium in four patients, in left atrium in three, and in the last patient the four chambers were occupied. In group II the mean age was 36 years, and the male sex was predominant (60%). In three patients cardiac tumors were detected by echocardiography, two of them were found in the right cavities (leiomyoma and leiomyosarcoma), in the rest the histologic lineage of the left atrial tumors was not possible to recognize. In the other seven patients with mediastinal tumor the heart was not infiltrated. On the basis of the obtained results we conclude that transthoracic echocardiography permits the identification of the intracardiac tumor; in these patients transesophageal studies give us an additional valuable information about the valves, the site of tumoral implantation and the wall infiltration. Transesophageal approach provides more information about its potential cardiac compression.