ABSTRACT
Resumen La telemedicina es una herramienta subutilizada en nuestros sistemas de atención sanitaria. Se trata de un recurso tecnológico que optimiza los servicios de salud, ahorra recursos, expande la capacidad de atención especializada a lugares remotos, descongestiona servicios médicos tradicionales y es un instrumento invaluable de enseñanza e investigación. La pandemia por COVID-19 nos obliga a extender su uso y supone una oportunidad para diseñar una adecuada implementación.
Abstract Telemedicine is an underused instrument along our healthcare systems. It´s a technological tool that optimizes resources, save money, expands our capacities, decongests our traditional medical services and is an invaluable help for teaching and research. The COVID-19 pandemic is forcing us to expand its use and it gives us the opportunity to design an appropriate implementation.
Subject(s)
Humans , Pneumonia, Viral/epidemiology , Cardiovascular Diseases/therapy , Telemedicine/methods , Coronavirus Infections/epidemiology , Cardiology/methods , Pandemics , COVID-19ABSTRACT
Resumen La evolución en el intervencionismo estructural percutáneo ha generado un desarrollo paralelo en las técnicas de imagen avanzada. Teniendo en cuenta que este tipo de procedimientos requiere un entendimiento total de la anatomía cardiaca y con el fin de garantizar los mejores resultados y seguridad para el paciente durante procedimientos complejos, se desarrolló un software capaz de fusionar la fluoroscopia y la ecocardiografía 3 D en una sola imagen. La tecnología del Echonavigator® integra dos técnicas de imágenes dinámicas de un corazón en movimiento; el adecuado co-registro y visualización de fluoroscopia y ecocardiografía transesofágica 2D/3D es la clave en la obtención de resultados óptimos. La fusión de dos imágenes dinámicas en tiempo real es una herramienta factible y segura en los procedimientos de intervencionismo estructural del corazón; los estudios iniciales han logrado disminuir el tiempo de realización de los procedimientos y las dosis de radiación al paciente. El futuro es prometedor y su progresiva expansión de uso teniendo en cuenta su reciente aparición, aportará más datos en el crecimiento de esta tecnología.
Abstract The evolution of percutaneous structural interventionism has led to the simultaneous development of advanced imaging techniques. Taking into account that these types of procedures require a full understanding of cardiac anatomy, and with the aim of ensuring the best results and patient safety during complex procedures, a software program was developed that was capable of fusing and 3D-echocardiography into a single image. The Echonavigator® technology combines two dynamic imaging techniques of a heart in movement. The appropriate co-recording and visualising of fluoroscopy and 2D/3D transoesophageal echocardiography is essential for obtaining optimal results. The fusion of two images in real-time is a feasible and safe tool in structural heart interventionist procedures. Initial studies have managed to decrease the time of performing the procedures, as well as the dose of radiation to the patient. The future is promising, and its gradual expansion of use, taking into account its recent appearance, will provide more data on the growth of this technology.
Subject(s)
Fluoroscopy , Echocardiography, Transesophageal , Radiology, Interventional , Echocardiography, Three-Dimensional , Patient Safety , Heart DiseasesSubject(s)
Cardiology , Scientific and Technical Publications , Periodicals as Topic/trends , Latin America , SpainSubject(s)
Cardiology , International Cooperation , Periodicals as Topic , Publishing , Latin America , SpainABSTRACT
La ecocardiografía es una técnica casi imprescindible para hacer una adecuada valoración de los pacientes hipertensos. Es útil a nivel diagnóstico, pronóstico y terapéutico. En el presente artículo, trataremos de resumir la importancia de esta técnica en este tipo de pacientes de una forma breve pero útil.
Echocardiography is considered an indispensable tool for the adequate evaluation of hypertensive patients. It is usefulfor diagnosis, prognosis and therapeutic management. In the present article, we try to summarize the importance of this technique in such patients in a brief but useful way.
Subject(s)
Humans , Male , Female , Echocardiography/methods , Hypertension/pathology , Hypertrophy, Left Ventricular/physiopathology , Blood Pressure , Cardiovascular Physiological PhenomenaABSTRACT
INTRODUCTION AND OBJECTIVES: Echocardiography is considered a basic tool in the diagnosis and management of infective endocarditis. Transesophageal echocardiography is more sensitive than transthoracic echocardiography. Our aim was to describe which factors are related to the ability of transthoracic echocardiography to establish the diagnosis of infective endocarditis. The presence of this factors in a patient with a normal transthoracic echocardiography would make unnecessary to perform a transesophageal echocardiography and would suggest to seek for other diagnostic possibilities. METHODS: 127 consecutive patients admitted to our hospital with the diagnosis of infective endocarditis and a complete transthoracic echocardiography and transesophageal echocardiography comprised our study group. Predisposing factors and clinical, echocardiographic and microbiological variables were studied. RESULTS: The presence of a cardiac murmur, the presence of an optimal acoustic window, degenerative valvular disease as the predisposing factor for infective endocarditis and positive blood cultures were related to the ability of transthoracic echocardiography to diagnose the existence of signs of infective endocarditis on its own. Nevertheless, only the presence of a cardiac murmur (RR 2.724; 95% CI 1.071-6.926; p 0,035) and the presence of an optimal acoustic window (RR 5.538; 95% IC 2.75-11.15; p < 0.001) were found as independent factors to detect those patients in which transthoracic echocardiography is able to diagnose signs of infective endocarditis on its own. CONCLUSIONS: The diagnostic accuracy of transthoracic echocardiography to detect echocardiographic signs of infective endocarditis is high in those patients with cardiac murmur and optimal acoustic window. In those patients with these characteristics, without prosthetic heart valves and a negative transthoracic echocardiography for infective endocarditis other diagnostic possibilities should be ruled out before performing of a transesophageal echocardiography.
Subject(s)
Female , Humans , Male , Middle Aged , Endocarditis, Bacterial , Sensitivity and SpecificityABSTRACT
Hasta el momento, la valoración de la severidad de la estenosis miral reumática ha estado basado en métodos Doppler, muy influenciares por las condiciones hemodinámicas del paciente y en métodos de planimetría valvular obtenida a partir de imágenes bidimensionales. La ecocardiografia 3D en tiempo real ha hecho su aparición en la rutina clínica diaria, proporcionando imágenes de alta calidad en tres dimensiones y requiriendo un muy corto período de tiempo para su adquisición. En el presente trabajo tratamos de realizar una puesta al día de la utilidad de esta técnica en la valoración de la severidad de la estenosis mitral reumática. Estos hallazgos están basados en la experiencia de nuestra Unidad de Imagen Cardiovascular del Hospital Clínico San Carlos de Madrid.
To date, the assessment of rheumatic mitral stenosis has been based on Doppler methods, which have a high dependence on the hemodinamic conditions and on the planimetry obtained from 2D echo images. Real Time 3D echocardiography has been implemented in the daily clinical practice. It provides high quality 3D images and the acquisition time is very short. In the present work, we try to show the "state of the art" of Real Time 3D echocardiography in the assessment of rheumatic mitral stenosis. These findings are based on the experience of our "Unidad de Imagen Cardiovascular" at the Hospital Clínico San Carlos de Madrid. (Arch Cardiol Mex 2005; 75:210-221).
Subject(s)
Female , Humans , Male , Middle Aged , Echocardiography, Three-Dimensional/methods , Mitral Valve Stenosis , Rheumatic Heart Disease , Echocardiography, Doppler , Evaluation Studies as Topic , Mitral ValveABSTRACT
The prevalence of cardiac tumors is 1% among non selected population. Three quarters of them are myxomas. Before 1951, diagnosis of cardiac tumors was only possible after the patient had died. Nowadays, echocardiogram has become the election method for diagnosis and follow up of patients with cardiac masses. Nevertheless, nowadays we have new diagnostic methods. Transesophageal echocardiogram has high sensitivity and specificity to establish its diagnosis and to provide other information as the location of the attachment point and the presence of associated lesions. There are other diagnostic tools: echo contrasts and magnetic resonance. Nevertheless, no one has demonstrated a diagnostic accuracy as high as the transesophageal echocardiogram. Nowadays, real-time threedimensional echocardiogram is being used. It is helpful when planning the surgical management.
Los tumores cardíacos tienen una incidencia del 1% en la población general, tres cuartas parte de ellos son de tipo benigno y cerca de la mitad de éstos, mixomas. Hasta 1951 el diagnóstico de estos tumores sólo se hacía post mortem. Sin embargo, en la actualidad se dispone de nuevas herramientas diagnósticas. El ecocardiograma transesofágico ha demostrado tener muy buena sensibilidad y especificidad para establecer su diagnóstico, además de aportar datos adicionales, como la ubicación exacta de la implantación del tumor, así como lesiones asociadas. Existen otras técnicas diagnósticas para su estudio como el empleo de ecopotenciadores y la resonancia magnética. Sin embargo, ninguna demostró tener tanta precisión diagnóstica como el estudio transesofágico. Actualmente se está empezando a utilizar el ecocardiograma tridimensional en tiempo real, de gran utilidad a la hora de plantear el manejo quirúrgico.