RESUMO
SUMMARY: Thorough knowledge and understanding of coronary arteries and their anatomy is essential when performing cardiac surgery such as a coronary bypass. Coronary angiography is a minimally invasive method used to evaluate the anatomy and obtain different measurements of the coronary arteries. This study was designed to evaluate the endoluminal diameter, trunk length and anatomical distribution of coronary arteries in Chilean subjects without apparent angiographic lesions. Measurements were carried out by 3 trained examiners using Leonardo® software program in 238 Chilean subjects of both sexes with an age-range of 45 to 78 years. Ostium and the distal luminal segments diameters were measured, as well as trunk length of both right and left coronary arteries. Ostium of the anterior interventricular artery, dominance and tortuosity were also registered. In the right coronary artery, the diameters (3.8 ± 1.2 mm and 3.6 ± 1.0 mm) differed according to sex and dominance, and the length (35.2 ± 12.5 mm) differed according to age. In the left coronary artery, the diameters (4.9 ± 1.1 mm and 4.7 ± 1.0 mm) were greater in males than in females. The left coronary artery showed greater diameters and length than the right coronary artery. The prevalence of right arterial dominance was 88.0 %. Patients with right arterial dominance presented greater distal caliber in the right coronary artery than those with left arterial dominance (p<0.05), especially in older patients. Significant arterial tortuosity was observed in seven subjects.
RESUMEN: Un factor clave durante los procedimientos quirúrgicos cardiacos tal como el bypass coronario, es el conocimiento exhaustivo de las arterias coronarias y su anatomía. La angiografía coronaria es un método mínimamente invasivo que se utiliza para evaluar la anatomía y obtener diferentes medidas. El presente estudio fue diseñado para evaluar el diámetro endoluminal, la longitud del tronco y la distribución anatómica de las arterias coronarias en sujetos chilenos sin lesiones angiográficas significativas. Las mediciones fueron realizadas en 238 sujetos chilenos de ambos sexos con un rango etario entre 45 a 78 años. Tres examinadores preparados llevaron a cabo las mediciones utilizando el software Leonardo®. Se midieron los ostios y los diámetros luminales distales de los troncos coronarios derecho e izquierdo, como también las longitudes del tronco de las arterias coronarias derecha e izquierda. Además, se identificaron los ostios de la arteria interventricular anterior, dominancia y tortuosidad. En la arteria coronaria derecha, los diámetros (3,8 ± 1,2 mm y 3,6 ± 1,0 mm) se observaron variaciones según el sexo y la dominancia, y la longitud (35,2 ± 12,5 mm) difirió según la edad. En la arteria coronaria izquierda, los diámetros (4,9 ± 1,1 mm y 4,7 ± 1,0 mm) fueron mayores en los hombres que en las mujeres. La arteria coronaria izquierda mostró mayor diámetro y longitud que la arteria coronaria derecha. La prevalencia de dominancia arterial derecha fue del 88,0 %. Los pacientes con dominancia arterial derecha presentaron mayor calibre distal en la arteria coronaria derecha que aquellos con dominancia arterial izquierda (p <0,05), especialmente en pacientes mayores. En siete sujetos se observó una tortuosidad arterial significativa.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Angiografia Coronária/métodos , Vasos Coronários/anatomia & histologia , Vasos Coronários/diagnóstico por imagem , Chile , Estudos RetrospectivosRESUMO
In health sciences and medicine, collaborative learning has an important role in the development of competences to solve clinical situations. Adequate cooperation, coordination and communication skills have a direct effect on patient safety. Computer Supported Collaborative Learning (CSCL) and Clinical Simulation (CS), separately, are effective and efficient educational methods to develop competences in undergraduate medical students. To our knowledge, educational models that combine both teaching methods, including a personalized attention of the student, educational infrastructure, materials, teaching techniques and assessment competencies, have not been proposed previously. This article describes the application of a combined model of CSCL and CS for teaching clinical competences to medical students. Since 2015, the collaborative clinical simulation model is part of the training agenda of the Universidad de Talca Medical School in Chile. During 2016 and 2017 it was also applied on students of the Universidad de Barcelona Faculty of Medicine in Spain. According to the experience acquired, implementation of this method is feasible with commonly used resources, although its real efficacy remains to be evaluated.
Assuntos
Humanos , Ensino , Instrução por Computador/métodos , Competência Clínica , Modelos Educacionais , Educação de Graduação em Medicina/métodos , Satisfação Pessoal , EspanhaRESUMO
Se presenta el caso de una paciente de 64 años que tras sufrir un IAM, sufre un proceso de remodelación ventricular en un período menor 7 meses que la conduce a una insuficiencia cardíaca severa.