Análise do processo de manutenção e de vida útil dos equipamentos médicos ecocardiógrafos: a experiência de um hospital de ensino / Analysis of the maintenance process and useful life of echocardiography equipment: An experience in a teaching hospital

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)

Utilidad de la ecocardiografía transesofágica en la cirugía de válvula mitral / Usefulness of transesophageal echocardiography in mitral valve surgery / Utilidade do ecocardiograma transesofágico na cirurgia da válvula mitral

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.

Produção Científica Sobre Ecocardiografia Transesofágica por Países Ibero-Americanos / Scientific Output on Transesophageal Echocardiography from Iberoamerican Countries

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.

Interventricular septal hydatid cyst: Transesophageal echocardiography as a therapeutic tool during bypass.

Cystic echinococcosis (hydatid disease) arising from infestation with a larval or adult form of the Echinococcus granulosus tapeworm is endemic in certain states of India, but affecting interventricular septum (IVS) solitarily is a scarce phenomenon. We present a rare case of transesophageal echocardiography guided management of IVS hydatid cyst even during cardiopulmonary bypass, which presented with a rather unusual complaint of repeated syncope.

Transesophageal echocardiography in surgical management of pseudoaneurysm of mitral-aortic intervalvular fibrosa with aneurysms of right sinus of Valsalva and left main coronary artery.

Pseudoaneurysm of mitral-aortic intervalvular fibrosa (MAIVF) is a rare complication associated with aortic and/or mitral valve surgery complicated by infective endocarditis. We report pseudoaneurysm of MAIVF in a young adult without overt cardiac disease or previous cardiac surgery. The patient had a rare combination of pseudoaneurysm of MAIVF impinging on anterior mitral leaflet causing moderate mitral regurgitation, right sinus of Valsalva aneurysm extending into interventricular septum, and left main coronary artery aneurysm. Transesophageal echocardiography helped in confirming the lesions, delineating the anatomy of all the lesions, and assessing the adequacy of surgical repair.

Early diagnosis of multilevel aortic dissection in accident and emergency department can save life case report

Acute aortic dissection is the most common catastrophe of the aorta and is associated with high morbidity and mortality. The 2-week mortality rate approaches 75% in patients with undiagnosed ascending aortic dissection. Despite advances in diagnostics and medical and surgical techniques, as well as the emergence of an endovascular management approach, the overall mortality associated with aortic dissection is 27%. An aortic dissection lesion begins with a tear that is typically transverse and does not involve the entire circumference of the vessel. The tear in the aortic intima and media allows for the blood to surge into the aortic wall. A 56-year-old Egyptian male patient known ischemic heart disease, heavy smoker presents to the Emergency Department with a history of sudden onset of constricting epigastric pain and right loin pain with radiation to the back and parasternal area, with normal blood pressure ,equal pulse. ECG showed incomplete RBBB, T wave inversion from V2 to V6. Bedside echocardiography showed good LVEF, good kinesis of LV wall, widened Aortic root [43mm]. TEE has proven extensive partially thrombosed aortic dissection starting 1 cm above the root of the aortic valve and Involving all the visible thoracic aorta communication between real lumen and false lumen was seen at the level of 25 cm of descending aorta. Spiral CT for chest and abdomen showed extensive Aortic dissection involving anterolateral aspect of ascending, descending thoracic aorta and posterolateral aspect of abdominal aorta. Right renal artery was involved as well, with multiple right renal infarctions, angiography was done and revealed occluded right renal artery and dilated ascending aorta, LAD had a 70% lesion near the apex, LCX had a 30% osteal lesion. Aortic angiogram showed grossly dilated ascending and arch of aorta. Aortic branches are not compromised. Patient was treated with nitroglycerin infusion, sodium nitroprusside infusion, labetalol and sedation. Was stabilized, then surgical repair of ascending Aorta with reposition of the Aortic valve was done. Eariy diagnosis of aortic dissection can speed up the process of management medically or surgically, and can increase the survival rate for such patients. Once you suspect aortic dissection you should proceed to more investigations with out excluding the clinical presentation from the picture

Comparing transesophageal echocardiography and transthoracic echocardiography for diagnosis of infectious endocarditis

Infectious endocarditis [IE] is caused by a variety of microbial agents and poses severe complications such as embolic and septic events. This condition is aggravated among elderly patients and is associated with a high morbidity rate. Recent advances in diagnostic modalities, especially transesophageal echocardiography [TEE] have revolutionalized early diagnosis, prediction of emboli, treatment and evaluating the outcomes of interventions. In this article, we explain our experience with 4 cases of infectious endocarditis. Having had the clinical suspicions to IE, patient underwent routine diagnostic procedures including transthoracic echocadiography [TTE] and blood culture. Surprisingly, TTE was negative for all patients; however, the clinical symptoms and the presence of complications were favoring IE, therefore, all were subjected for TEE. TEE confirmed the diagnosis of IE in all 4 cases. There were mitral valve vegetations measured 0.5-3cm in three cases, whereas the other one presented with aortic valve vegetation measured 1cm. Three patients had blood culture positive for staphylococcus aureus and one patient with aortic valve vegetations had enterococcus positive blood culture. All patients had developed various complications and one had splinter hemorrhage. Two patients underwent surgical valvuloplasty, however, one of them was re-operated for splenectomy due to splenic abscess. All patients received an appropriate antibiotic regimen including vancomycine and cefteriaxon and were discharged in satisfactory state. Patients were routinely admitted for follow up TEE, while none developed symptoms or complications compatible with IE. Our results revealed that TEE is significantly superior to TTE for diagnosis and follow up of IE

Placas protruyentes de la aorta torácica en el ecocardiograma transesofágico: características clínicas y ecográficas / Protruding plaques of the thoracic aorta in the transesophageal echocardiography: clinical and echographic features

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

Endocarditis infecciosa / Infective endocarditis

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