Dia: 31 de julho de 2013

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?!?!?!?

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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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…

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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