Utility of Ultraportable Echocardiography in the Preoperative Evaluation of Noncardiac Surgery / Utilidade do Ecocardiograma Ultraportátil Direcionado na Avaliação Pré-Operatória de Cirurgia Não Cardíaca

Abstract Background: The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries. Objectives: To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk. Methods: A total of 211 patients referred for elective surgeries, without suspicion of previous heart diseases, were included in the study. Assessment of patients was conducted by conventional echocardiogram using the ultraportable V Scan (GE) device right after the pre-anesthetic clinical evaluation. We assessed the clinical impact of echocardiography results by using a questionnaire addressed to the anesthetist. Results: Mean age of patients was 68.9 ± 7.0 years, 154 were women. The most frequent surgeries were: a) facectomy - cataract - 18; b) inguinal hernia surgery - 18; c) Cholecystectomy - 16. We found 58 normal tests (27.5%), 70 (33.2%) with mild valve reflux, and 83 (39.3%) with relevant abnormality, such as increase in heart chamber size, global and/or segmental contractile dysfunction, significant valve dysfunction or other unspecified. Test results caused delay of surgical procedure for a more detailed cardiac evaluation in 20 (9.5%) patients, and change in anesthetic management in 7 (3.3%). Conclusion: There was a considerable clinical impact with the use of the ultraportable echocardiography, since one out of every ten patients evaluated had their clinical management changed due to the detection of previously unsuspected, significant heart diseases, with the potential for severe complications.

Resumo Fundamento: O ecocardiógrafo ultraportátil, com importante mobilidade e facilidade diagnóstica em mãos experientes pode contribuir para a segurança na avaliação pré-operatória em cirurgias não cardíacas. Objetivo: Avaliar os parâmetros de função cardíaca nos pacientes com mais de 60 anos de idade, candidatos a cirurgias não-cardíacas eletivas, classificados como ASA 1 ou ASA 2 na classificação de risco cirúrgico. Métodos: Foram incluídos 211 pacientes direcionados para cirurgias eletivas diversas e sem suspeita prévia de cardiopatia. Os pacientes foram avaliados por técnica ecocardiográfica convencional, usando o aparelho ultraportátil V Scan (GE) logo após a avaliação clínica pré-anestésica. Avaliamos o impacto clínico dos resultados da ecocardiografia por um questionário dirigido ao anestesista. Resultados: A idade média dos pacientes foi 68,9 ± 7,0 anos, 154 do sexo feminino. As cirurgias mais frequentes foram: a) Facectomia-catarata - 18; b) Herniorrafia inguinal - 18; c) Colecistectomia - 16. No total, foram observados 58 exames normais (27,5%), 70 (33,2%) exames que apresentavam leves refluxos valvares e 83 (39,3%) exames com alguma anormalidade relevante, como aumento de câmara cardíaca, disfunção contrátil global e/ou segmentar, disfunção valvar mais significativa ou outra não especificada. Os resultados determinaram que 20 (9,5%) pacientes tivessem seus procedimentos cirúrgicos adiados até avaliação cardiológica mais detalhada e em 7 (3,3%) houve mudança na conduta anestésica. Conclusão: Houve um impacto clínico considerável com o uso da ecocardiografia ultraportátil, pois um em cada dez pacientes avaliados sofreu modificação na conduta clínica, em função da detecção de cardiopatias significativas, não suspeitadas previamente, e com potencial para complicações graves.

Rotação ventricular esquerda anormal em mulher com talassemia / Abnormal left ventricular torsion in woman with thalassemia

Introdução: Cardiomiopatia induzida pelo ferro é bem documentada em pacientes com talassemia. A ecocardiografia convencional associada a novas tecnologias pode detectar, precocemente, alterações na função ventricular esquerda nesses pacientes. Relato do caso: Mulher, 50 anos, assintomática, com diagnóstico de talassemia, mostra parâmetros ecocardiográficos convencionais e Doppler tecidual normais com alteração na torção e rotação ao speckle tracking. Comentários:A detecção precoce de alterações da função cardíaca por meio de novas tecnologias, em pacientes com talassemia, tem demonstrado importância prognóstica.

Introduction: Iron induced cardiomyophathy is well documented in patients with thalassemia. Conventional echocardiogram associated with new technologies has provided parameters for early detection of changes in left ventricular function. Case report: Woman, 50 years old, asymptomatic, diagnosed with thalassemia, shows normal conventional echocardiogram and tissue Doppler parameters but altered torsion and rotation parameters using speckle tracking. Comments: Early echocardiographic findings using speckle tracking in patients with thalassemia is important and may improve prognosis in these patients.

Eficácia e segurança com diferentes associações medicamentosas na cardiomiopatia periparto / Efficiency and safety of different drug combinations in peripartum cardiomyopathy

Relata-se o caso de uma paciente de 38 anos, com quadro de insuficiência cardíaca (IC) 30 dias após o parto, tratada de forma convencional. Houve necessidade de mudanças na terapia medicamentosa devido a efeitos colaterais e resposta inadequada da pressão arterial. Discutiram-se, à luz da medicina baseada em evidências, as diversas associações medicamentosas e sua segurança, nos casos de cardiomiopatia periparto (CMPP).

This case study addresses a 38-year-old patient who developed heart failure thirty days after delivery. She received conventional treatment, but changeswere required due to adverse effects and inadequate blood pressure response. In the light of evidencebasedmedicine, various drug combinations andtheir safety are discussed, for cases of peripartum cardiomyopathy.

Avaliaçäo ecodopplercardiográfica em pacientes HIV positivos em diferentes estágios da doença / Doppler echocardiographic evaluation of HIV-positive patients in different stages of the disease

Objective - To evaluate by Doppler echocardiography (DE) early abnormalities of ventricular function in HIV-positive patients, as well as other cardiac abnormalities that can be detected by this method, with special emphasis on mitral valve flow: Methods - 84 HIV - positive patients, 59 with CD4 cell count>500/mm3 (Group A) and 25 with CD4 cell count<500/mm3 (Group B), were analyzed. CD4 cells were counted and matched with structural data and systolic and diastolic function of the left ventricle (LV), as analyzed by DE. The results were compared with those obtained in 47 healthy individuals (Group C). Reuslts - 8 per cent of patients in Group B had mild pericardial effusion; 31.5 per cent showed decreased systolic function of the LV, and 12 per cent had moderate mitral regurgitation. A wave velocity from the mitral inflow was different among the 3 groups, being higher in Group B, where the deceleration time of the the E wave of the mitral inflow and the E/A ratio were significantly lower with a normal value of the isovolumic ralaxation time (IVRT). Conclusion --HIV - positive patients with a CD4 cell count > 500/mm3 had no abnormalities by DE. Patients with a more advanced infection (those with a CD4 cell count <500/mm3), had a significantly abnormal LV systolic function and a higher incidence of pericardial effusion and mitral regurgitation. Mitral valve inflow by doppler did not indicate diastolic dysfunction.