Dia: 31 de outubro de 2014

As diferentes dilatações da raiz da aorta: Lições para a ecocardiografia

Beto Matos-Souza
    • Valvular Heart Disease

Aortic Valve Adaptation to Aortic Root Dilatation

Insights Into the Mechanism of Functional Aortic Regurgitation From 3-Dimensional Cardiac Computed Tomography

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http://circimaging.ahajournals.org/content/7/5/828.abstract

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Conclusions—Aortic cusp enlargement occurs in ARD, but cusp adaptation and distensibility become limited in prominent, asymmetrical ARD, leading to AR. Optimal AR repair tailored to individual patient anatomy can benefit from appreciating valve adaptation and 3-dimensional relationships; understanding cusp adaptation mechanisms may ultimately provide therapeutic opportunities to improve such compensation.

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“Specialized 3-dimensional software measured individual cusp surface areas relative to maximal mid-sinus cross-sectional area and minimal 3-dimensional annular area, coaptation area fraction, and asymmetry of sinus volumes and intercommissural distances”.

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As medidas acima podem ser realizadas ao ecocardiograma 3D e deveriam ser avaliadas em seguimento.

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” Cusp distensibility (closed diastolic versus open area) decreased from 20% in controls and AR-negative patients to 5% in AR-positive patients (P<0.001).”

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Parece que a capacidade de distensão da válvula semilunar determina o refluxo.

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“Total open cusp surface area increased (P<0.001) from 7.6±1.4 cm2/m2 in normals to 12.9±2.2 cm2/m2 in AR-negative and 15.2±3.3 cm2/m2 in AR-positive patients”.

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Vejam que a área quase dobra mas ainda não temos refluxo. A pequena mudança de área de aproximadamente 3 cm² /m² determina o vazamento.

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Tudo isso está acessível ao ecocardiografista. Mais uma demonstração da necessidade do 3D em nossa linha de frente de ecocardiografia.

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Epidemia de TC de Coronária

Beto Matos-Souza

Repeat Coronary Computed Tomographic Angiography in Patients With a Prior Scan Excluding Significant Stenosis

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http://circimaging.ahajournals.org/content/7/5/788.abstract

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Conclusions—Nondiabetic patients with a prior CCTA <3 years showing no or ≤25% stenosis had a <5% prevalence of significant stenosis. The value of repeat CCTA in this group is likely small, especially when the prior CCTA demonstrated normal coronaries, even if the clinical scenario considered a CCTA appropriate.

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Antes de repetir um Tomo de Coronárias, algo que acontece em ritmo alucinante, vale a pena refletir sobre a necessidade e a probabilidade baixa de encontrar doença significativa.

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