Mês: janeiro 2014

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AQUI no WikiEcho
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Possible pitfalls in pulse wave Doppler recordings of atrial and ventricular filling:[3][6]
Similar respiratory variation in mitral inflow velocity may occur in several clinical settings such as acute dilatation of the heart, pulmonary embolism, right ventricular infarct, conditions in which a dilated right ventricle helps in the differential diagnosis
Increased respiratory variation in mitral and tricuspid inflow velocities are seen in chronic obstructive lung disease without pericardial constriction due to respiratory changes in intrathoracic pressure. In this setting, E/A ratio is lower, EDT is more prolonged and there is a more pronounced respiratory variation in superior vena cava flow with increase in forward flow and systolic dominant flow with inspiration
Persistence of respiratory variation in mitral and tricuspid inflow velocities after pericardiectomy
Absence of respiratory variation in mitral inflow velocity in cases of markedly elevated left atrial pressure
Reduced respiratory variation in mitral inflow velocity in atrial fibrillation, with more pronounced respiratory change in D-wave velocity in this setting.
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Aqui, artigo original de 1997.
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Não esqueçam que o desvio é de +- 4mmhg!!!!
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Aqui livre
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Stress Testing
Assessing mitral gradients and pulmonary pressures during stress (preferably exercise or alternatively dobutamine infusion) 45 provides additional information in asymptomatic patients or in patients in whom the symptoms and MS severity do not seem to correlate. In addition, stress testing is very helpful in evaluating women with MS who are contemplating pregnancy. Pregnancy causes an obligatory increase in cardiac output (transmitral flow), heart rate (shorter diastolic filling time), and total blood volume, each of which increases the MV transvalvular gradient and thus left atrial pressure.

Consequently, many women with MS often present with symptoms for the first time during pregnancy due to the increase in pulmonary venous pressure (secondary to increased left atrial pressure). Exercise stress testing is a useful way to assess how well MS patients will tolerate pregnancy. It further helps identify which patients may benefit from no therapy, beta-blockade, or prophylactic PMBV or even surgery before becoming pregnant.
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Uso do ecoestresse de esforço embicicleta na Estenose Mitral. Fácil e rápido.
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Não ouvi pessoalmente mas uma fonte confiável afirmou:
– “A prova do título de especialista em ecocardiografia serve como reserva de mercado para os verdadeiros ecocardiografistas”.
Frase de um(a) presidente do DIC dita em público.
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Parece que não está funcionando, já que o mercado está muito concorrido na maioria do país, como mostra a pesquisa.
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Extrapolando a pesquisa e usando os novecentos e poucos titulados como amostra padrão, para três mil executantes de ecocardiografia, seria um titulado para cada dois sem título trabalhando no mercado.
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Então não serve para nada? Aí já é outra discussão…
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O importante da pesquisa é a mensagem:
– Vai sobreviver da ecocardiografia? Prepare-se para a concorrência acirrada.
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Aortic Valve Area, Stroke Volume, Left Ventricular Hypertrophy, Remodeling, and Fibrosis in Aortic Stenosis Assessed by Cardiac Magnetic Resonance Imaging
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By CMR, however, planimetric AVA(Valvar area) was larger in LF/LG (0.54±0.08 cm2/m2) and LG/NF (0.61±0.08 cm2/m2) than in HG/LF (0.46±0.07 cm2/m2; P<0.05) AS, and indexed LV mass was lower in LG/LF (75±12 g/m2) and LG/NF (81±18 g/m2) than in HG/LF (100±27 g/m2; P<0.05) AS
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CMR confirmed that classification of AS patterns by TTE was overall accurate. We observed a good correlation between measurements of LVOT, stroke volume, and aortic valve area between TTE and CMR.

Patients with paradoxical LG/LF and LG/NF AS had less severe AS severity, less hypertrophy and remodeling, and a similar amount of focal fibrosis compared with HG AS.
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E agora, senhores ecocardiografistas, como explicar os achados de área valvar superior na estenose aórtica com gradiente baixo????
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