Trombose de prótese: Diagnóstico ao Eco e terapia clínica.

Valvular Heart Disease
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Thrombolytic Therapy for the Treatment of Prosthetic Heart Valve Thrombosis in Pregnancy With Low-Dose, Slow Infusion of Tissue-Type Plasminogen Activator
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Methods and Results—Between 2004 and 2012, tissue-type plasminogen activator was administered to 24 consecutive women in 25 pregnancies with 28 prosthetic valve thrombosis episodes (obstructive, n=15; nonobstructive, n=13). Mean age of the patients was 29±6 years. Thrombolytic therapy sessions were performed under transesophageal echocardiography guidance. The mean dose of tissue-type plasminogen activator used was 48.7±29.5 mg (range, 25–100mg). All episodes resulted in complete thrombus lysis after thrombolytic therapy. One patient had placental hemorrhage with preterm live birth at the 30th week, and 1 patient had minor bleeding.
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Conclusions—Low-dose, slow infusion of tissue-type plasminogen activator with repeated doses as needed is an effective therapy with an excellent thrombolytic success rate for the treatment of prosthetic valve thrombosis in pregnant women. This protocol also seems to be safer than cardiac surgery or any alternative medical strategies published to date. Thrombolytic therapy should be considered first-line therapy in pregnant patients with prosthetic valve thrombosis.
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Infelizmente casos de trombose de próteses acontecem. O ecocardiografista é chamado para definir. Com um exame anterior no prontuário, fica mais fácil. Registre o gradiente máximo de todos os ângulos, pelo menos 5 fotos! Já vi questionamento do laudo do Eco no intraoperatório. Mas o paciente foi anti-coagulado para a cirurgia, não foi?!?!?!?

US Coronárias com microbolhas: Pega ?

Aqui completo
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Detection of Luminal-Intimal Border and Coronary Wall Enhancement in Intravascular Ultrasound Imaging After Injection of Microbubbles and Simultaneous Sonication With Transthoracic Echocardiography
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We performed continuous intracoronary ultrasound recordings (EndoSonics; 20 MHz) in the proximal left anterior descending coronary artery before (Figure 1, A), during (Figure 1, B) and after injection (Figure 1, C) of 4 mL of SonoVue (ultrasound contrast agent with lyophilized capsule filled with sulfurhexafluoride). Simultaneously with contrast injection, ultrasound acoustic power of 0.6 mechanical index was delivered via a transthoracic transducer (2.5 MHz) toward the left main to sonicate the delivered microbubbles. Immediately after the passage of the microbubble contrast agent, which was clearly detected by the intracoronary ultrasound probe, an enhancement of the entire plaque and adventitia was seen. The luminal-intimal boundary appeared to show a ring-like enhancement, which clearly defined the inner borders of the coronary arterial wall.
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Notem que foram usados 2 US para obter a imagem. Mais um uso inexplorado das finadas microbolhas
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Vórtices com contraste de microbolhas: Pega?

Aqui livre
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Conclusions It was feasible to quantify LV vorticity arrangement by CE using particle image velocimetry in normal subjects and those with LV systolic dysfunction, and the vorticity imaging by CE may serve as a novel approach to depict vortex, the principal quantity to assess the flow structure.
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Encontraram mais um uso para o finado contraste. Para medir os vórtices. Agora vai…

Tamponamento : Bela dica

Displaying images over the respiratory cycle, not just over the cardiac cycle, may aid in the detection of hemodynamic effects of pericardial disease.
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Respiratory-Mode Display of Echocardiographic Images Highlights Effects of Pericardial Disease ONLINE FIRST
Michael V. McConnell, MD, MSEE; Holden H. Wu, PhD
J Am Coll Cardiol Img. 2013;():. doi:10.1016/j.jcmg.2012.12.013
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Aqui
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Transesofágico intraoperatório: 3 motivos para fazer.


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Procedimento muito útil mas subutilizado por dificuldades técnicas e financeiras, o ecocardiograma transesofágico pode ser uma saída para quem faz rotina em hospital e pode dar uma passadinha ou várias passadinhas no centro cirúrgico.
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Ecoestresse discordante do Cateterismo pode muito bem ser concordante com a verdadeira anatomia.

Coronary Artery Disease
Assessment of Coronary Artery Stenosis by Coronary Angiography
A Head-to-Head Comparison With Pathological Coronary Artery Anatomy.
.AQUI LIVRE.

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Between July 2004 and December 2011, 97 patients underwent CCA within 15 days before heart transplantation in Fuwai hospital. A head-to-head comparison study was performed to examine the diagnostic accuracy of CCA as compared with that of pathological coronary artery anatomy.
Per-segment evaluation found CCA was more accurate for detecting ≥50% and ≥75% stenosis in proximal and middle segments than in distal segments, and the diagnosis ability decreased in more severe stenosis segments and more complex lesions.
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Conclusions—The accuracy of CCA is quite high in detecting coronary artery stenosis in patients- and vessels-based levels. However, the diagnosis ability decreased in more severe and complex lesions, especially for distal segments.
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Estudo inteligente e bem executado mostra que o Cateterismo é muito fraco como método para afastar isquemia. Muitos ecostresses positivos que foram confrontados com cateterismos “normais” podem ter até 50% de chance de ser uma lesão distal mal avaliada pelo exame de coronariografia.

Dilatação da aorta em bivalvulados

Aqui artigo completo livre.
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Aortic Dilation in Bicuspid Aortic Valve Disease
Flow Pattern Is a Major Contributor and Differs With Valve Fusion Type
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Conclusions—Flow abnormalities may be a major contributor to aortic dilation in BAV. Fusion type affects the severity of flow abnormalities and may allow better risk prediction and selection of patients for earlier surgical intervention.
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Artigo muito bonito, com belas imagens. Mas as velocidades eram diferentes. Geram gradientes diferentes e fenômenos de Bernoulli muito diferentes. Não seria isso?
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