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RESUMEN Introducción y objetivos: La Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) y el Grupo de Trabajo de Hemodinámica de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (GTH-SECPCC) presentan su informe anual de actividad hemodinámica en cardiopatías congénitas correspondiente al año 2022. Métodos: Se invitó a participar a los centros españoles con laboratorio de hemodinámica y actividad intervencionista en cardiopatías congénitas. La recogida de datos se realizó mediante un cuestionario telemático. Una empresa externa analizó los resultados, que fueron revisados por miembros de la ACI-SEC y el GTH-SECPCC. Resultados: Participaron en el registro 22 centros (19 públicos y 3 privados). Se incorporaron al análisis los datos de intervencionismo en cardiopatías congénitas del adulto aportados por otros 99 hospitales al Registro de Hemodinámica y Cardiología Intervencionista de la ACI-SEC del año 2022. Se registraron 1.141 estudios diagnósticos (un 4,3% más que en 2021) y 2.508 cateterismos intervencionistas (un 61,5% más que en 2021). Las técnicas con mayor casuística fueron el cierre de defectos interauriculares (1.135 casos), el cierre de ductus arterioso (262 casos) y la angioplastia de ramas pulmonares (234 casos). El incremento más significativo se comunicó en la valvuloplastia aórtica (48,9%), el cierre de defectos interauriculares (45,2%) y el cierre de comunicación interventricular (40,7%). La tasa de éxito en los procedimientos intervencionistas fue del 97,6%, con una tasa de complicaciones mayores del 1,4 % y una mortalidad intrahospitalaria del 0,2%. Conclusiones: El presente trabajo es la tercera publicación del Registro Español de Intervencionismo en Cardiopatías Congénitas. Se ha comunicado un aumento muy significativo de la mayoría de los procedimientos terapéuticos, destacando el incremento de la valvuloplastia aórtica, del cierre de defectos interauriculares y del cierre de comunicación interventricular. Todas las técnicas intervencionistas han comunicado excelentes datos de seguridad y eficacia.

RESUMEN Introducción y objetivos: A pesar de que el cateterismo cardiaco (CC) se ha convertido en una práctica habitual en el trasplante cardiaco (TxC) pediátrico, hay escasez de protocolos globales y de evidencia robusta sobre los procedimientos requeridos y el impacto que tienen en la evolución del propio trasplante y los futuros CC. Este estudio tiene como objetivo analizar la actividad de CC en niños receptores de trasplante cardiaco en un centro terciario y describir los factores de riesgo para un mayor número de procedimientos. Métodos: Estudio retrospectivo con datos obtenidos de los informes médicos y los archivos de hemodinámica. La muestra se dividió en miocardiopatías y cardiopatías congénitas (CAC). El análisis de los factores de riesgo para CC se calculó con regresión lineal y ANOVA. Resultados: Conformaron la muestra 61 niños (36,07% CAC). Las CAC muestran una mayor media de CC antes del TC. Los cateterismos diagnósticos son la actividad más frecuente previa al TxC, seguidos por las biopsias endomiocárdicas en las miocardiopatías y el cierre de colaterales aortopulmonares en las CAC. Hubo 389 CC tras el TC (608 procedimientos), la mayoría (92,75%) por vigilancia del rechazo. El subgrupo de CAC univentriculares tuvo significativamente un mayor número de CC tras el TxC...

Abnormalities in the tricuspid valve have a lower incidence than defects in the rest of the heart valves and may be due to primary or secondary causes. Recently, its pathophysiology and importance in morbidity and mortality due to cardiac causes have been widely studied. Open tricuspid valve surgery has a high rate of morbidity and mortality, and even more so when it comes to reoperation. For this reason, it is important to carry out these procedures endovascularly via a transcatheter catheter and some cases of exacerbations by this method have recently been published throughout the world, by means of percutaneous valve-in-valve implantation in the tricuspid position. We present the first reported case of this procedure in Colombia in a pediatric patient, whose procedure was uneventful and a significant improvement in valve function was impaired, as an initial step to continue developing the technique and performing the procedure in this country. [ABSTRACT FROM AUTHOR]

RESUMEN Introducción y objetivos: La Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) y el Grupo de Trabajo de Hemodinámica de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (GTH-SECPCC) presentan su informe anual de actividad hemodinámica en cardiopatías congénitas correspondiente al año 2021. Métodos: Se invitó a participar a los centros españoles con laboratorio de hemodinámica y actividad intervencionista en cardiopatías congénitas. La recogida de datos fue telemática y su análisis lo efectuó una empresa externa junto con miembros de la ACI-SEC y el GTH-SECPCC. Resultados: Participaron 16 centros (15 públicos y 1 privado) que acumulan 34 salas de hemodinámica con actividad en cardiopatías congénitas, 7 (20,5%) de ellas con dedicación exclusiva a pacientes pediátricos. Se registraron 1.094 estudios diagnósticos (5,1% más que en 2020) y 1.553 cateterismos intervencionistas (6,4% más que en 2020). Las técnicas más frecuentes fueron el cierre de comunicación interauricular (336 casos), la angioplastia de ramas pulmonares (231 casos) y el cierre de ductus (228 casos). Respecto al año anterior se incrementaron significativamente las técnicas de implantación de válvulas percutáneas (29,3%), cierre de ductus (20,6%) y angioplastia aórtica (12,8%). La tasa de éxito en los procedimientos intervencionistas fue del 95%, con una tasa de complicaciones mayores del 2,7% y una mortalidad intrahospitalaria del 0,2%. Conclusiones: Este trabajo es la segunda publicación del Registro Español de Intervencionismo en Cardiopatías Congénitas. Se ha constatado un aumento significativo de los procedimientos diagnósticos y terapéuticos, destacando el incremento en la implantación de válvulas percutáneas, el cierre de ductus y la angioplastia aórtica. La mayoría de las técnicas intervencionistas siguen demostrando excelentes datos de seguridad y eficacia.

Objetivo: identificar o conhecimento e sentimentos de pessoas sobre o cateterismo cardíaco. Método: estudo descritivo, abordagem qualitativa, realizado com 12 pacientes em hospital referência em cardiologia, no município de João Pessoa, no período de novembro a dezembro de 2021. Os dados foram coletados através de entrevista gravada e semiestruturada, os dados analisados pela Análise de Conteúdo de Bardin. Resultados: a partir das entrevistas foram construídas três categorias temáticas: C1 - Conhecimento do procedimento de cateterismo cardíaco, C2 - Falta de orientação dos cuidados que envolvem o cateterismo cardíaco e C3 - Sentimentos à realização do cateterismo cardíaco. Os dados evidenciam um conhecimento insuficiente e limitado que podem se relacionar com o surgimento de sentimentos negativos. Considerações finais: Percebe-se a necessidade de orientações e informações, bem como o planejamento e construção de tecnologias educativas para as pessoas que irão realizar o cateterismo cardíaco, com a finalidade de promover um pré, intra e pós-exame seguro.

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: demographic transition is an epidemiological change from which Colombia is not exempt, cardiovascular disease continues to be the most frequent cause of mortality. The increase in the older adult population and the characteristics of aging lead to approach their pathologies from a different perspective. This population is usually excluded from clinical studies, which is why a descriptive study of the clinical and epidemiological characteristics of this age group was carried out. Objective: To carry out a descriptive study of the clinical and epidemiological characteristics of older adults hospitalized with acute coronary syndrome. Materials and method: The medical record of 92 patients older than 80 years was reviewed. Results: A mean age of 83 years was found, 55.4% of the patients were men, invasive management was decided in 51%, the main risk factors were arterial hypertension and diabetes mellitus; the main clinical history found was that of established coronary disease. It was found that both the incidence of complications and mortality was higher in the group not taken to invasive management, probably secondary to the number of their comorbidities and their previous complications, annexed to this it was evidenced that the state of frailty was not a described variable in most patients belonging to this age group. It was found that pharmacological management did not differ from that of younger people according to the literature. Conclusions: Patients taken to medical management had more complications possibly secondary to their underlying comorbidities; the patients taken to catheterization had favorable results in terms of morbidity and mortality compared to the group that only received medical management. The comprehensive assessment of the elderly is important since its functional and mental evaluation allows decision-making in the treatment of acute coronary syndrome. [ABSTRACT FROM AUTHOR]

Resumo Objetivo Analisar a aceitabilidade de pessoas submetidas ao cateterismo cardíaco não programado acerca de uma intervenção complexa (IC) de enfermagem para reduzir a ansiedade. Métodos Estudo qualitativo e avaliativo da aceitabilidade de 15 participantes submetidos ao cateterismo cardíaco acerca de uma IC de enfermagem. A coleta de dados foi realizada na unidade de emergência de um hospital de alta complexidade da cidade de São Paulo, especializado em cardiologia. Os participantes tinham diagnóstico de Síndrome Coronariana Aguda e receberam a IC, constituída por componente musical e educativo, denominada Education and Music Intervention to Reduce Anxiety (EMIRA). Os dados foram coletados no período de setembro a outubro de 2021, e os participantes foram submetidos à entrevista semiestruturada. As perguntas norteadoras da entrevista foram elaboradas com base em Kazdin. As entrevistas foram gravadas e transcritas para análise de conteúdo de Bardin. Para analisar a aceitabilidade dos participantes da EMIRA, utilizou-se o aporte teórico das Representações Cotidianas. Resultados A análise da aceitabilidade em relação à EMIRA permitiu a identificação de três categorias: Intervenção complexa EMIRA: nova experiência que ajuda a entender o cateterismo cardíaco; Intervenção complexa EMIRA: uma experiência que gera satisfação; e Intervenção complexa EMIRA: uma experiência que alivia a ansiedade. Os participantes relataram sensações de calma, alívio, tranquilidade, satisfação, e recomendaram o uso da EMIRA. Conclusão A experiência dos participantes com a EMIRA foi positiva, sugerindo boa aceitabilidade da IC por pessoas aguardando a realização do cateterismo não programado na unidade de emergência.

RESUMEN Introducción y objetivos: La Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) y el Grupo de Trabajo de Hemodinámica de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (GTH-SECPCC) presentan el informe de actividad hemodinámica en cardiopatías congénitas de 2020, año de inicio de la pandemia de la enfermedad coronavírica de 2019 (COVID-19). Métodos: Se invitó a participar a los centros españoles con laboratorio de hemodinámica y actividad intervencionista en cardiopatías congénitas. La recogida de datos se realizó telemáticamente; una empresa externa, junto con miembros de la ACI-SEC y el GTH-SECPCC, los analizó. Resultados: Participaron 16 centros (todos públicos), que acumulan 30 salas de hemodinámica con actividad en cardiopatías congénitas, 7 (23,3%) de ellas con dedicación exclusiva a pacientes pediátricos. Se registraron 1.046 estudios diagnósticos y 1.468 cateterismos intervencionistas. Los procedimientos terapéuticos fueron exitosos en el 94,9%, con una tasa de complicaciones mayores del 2% y una mortalidad del 0,1%. Las técnicas más frecuentes fueron el cierre de comunicación interauricular (377 casos), la angioplastia pulmonar (244 casos) y el cierre de ductus arterioso (199 casos). Conclusiones: El presente trabajo representa la primera publicación del Registro Español de Intervencionismo en Cardiopatías Congénitas. La casuística registrada está condicionada por la pandemia de la COVID-19. Los cateterismos diagnósticos siguen teniendo un papel relevante en esta actividad. Para la mayoría de las técnicas intervencionistas se han reportado excelentes datos de seguridad y eficacia.

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermería en Cardiologia is the property of Asociacion Espanola de Enfermeria en Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Ischaemic stroke is the most common neurological complication of cardiac catheterisation. This study aims to analyse the clinical and prognostic differences between post-catheterisation stroke code (SC) and all other in-hospital and prehospital SC. Methods: We prospectively recorded SC activation at our centre between March 2011 and April 2016. Patients were grouped according to whether SC was activated post-catheterisation, in-hospital but not post-catheterisation, or before arrival at hospital; groups were compared in terms of clinical and radiological characteristics, therapeutic approach, functional status, and three-month mortality. Results: The sample included 2224 patients, of whom 31 presented stroke post-catheterisation. Baseline National Institutes of Health Stroke Scale score was lower for post-catheterisation SC than for other in-hospital SC and pre-hospital SC (5, 10, and 7, respectively; P = .02), and SC was activated sooner (50, 100, and 125 minutes, respectively; P

Resumo Fundamento A nefropatia induzida por contraste (NIC) é definida como deterioração da função renal, representada por um aumento da creatinina sérica ≥25% ou ≥0,5 mg/dL até 72 horas após a exposição ao meio de contraste iodado (MCI). A medida preventiva mais eficaz até o momento é a hidratação venosa (HV). Pouco se sabe sobre a eficácia da hidratação oral (HO) ambulatorial. Objetivo Investigar se a HO ambulatorial com água é tão eficaz quanto a HV com solução salina a 0,9% na prevenção de NIC em procedimentos coronarianos eletivos. Métodos Neste estudo observacional retrospectivo, foram analisados prontuários médicos e dados laboratoriais para coletar dados de indivíduos submetidos a procedimentos coronarianos percutâneos com MCI. Os dados coletados entre 2012 e 2015 avaliaram indivíduos que foram submetidos à HV e entre 2016 e 2020 (após a implementação de um protocolo de HO), os indivíduos que foram submetidos à HO em casa antes e depois de procedimentos coronarianos, conforme orientação da equipe de enfermagem. A significância estatística adotada foi de α=0,05. Resultados No total, 116 pacientes foram incluídos neste estudo, 58 no grupo HV e 58 no grupo HO. Observou-se incidência de NIC de 15% (9/58) no grupo que recebeu HV e 12% (7/58) no grupo que recebeu HO (p=0,68). Conclusão O protocolo de HO realizado pelo paciente parece ser tão eficaz quanto o protocolo de HV hospitalar na proteção renal de indivíduos suscetíveis a desenvolver NIC em intervenções coronarianas eletivas. Essas descobertas devem ser testadas em ensaios mais abrangentes.

Copyright of Enfermería en Cardiologia is the property of Asociacion Espanola de Enfermeria en Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Patent ductus arteriosus, a persistent communication between the descending thoracic aorta and the pulmonary artery, is one of the most common congenital heart defects. Transcatheter occlusion is an effective alternative to surgery and is currently standard of care for most patients. The authors present the results from a single center after twelve years of experience using this technique. Methods: Retrospective analysis of medical records from all patients referred to a tertiary center for percutaneous ductus closure between January 2006 and September 2018. Results: A total of 221 patients were referred, with a mean age of 5.5 years-old (16 patients were infants, with the youngest aged four months). A Nit-Occlud® coil was used 139 times (62.9%), an Amplatzer™ duct occluder 79 times (35.7%), and vascular plugs were used three times. Percutaneous closure was achieved in every treated patient, with 1.4% maintaining residual shunting. Although higher overall coil device implantation was noted, duct occluder usage has been greater since 2011. Of all the coils, 55% were either 4x4 or 5x4 mm, and 73% of all Amplatzer duct occluders were either 6x4 or 8x6 mm, which correlates to the majority of patients having a small to moderately sized ductus. No complications were noted during the procedure, with a 1.8% post-procedure complication rate (one device embolization after 48 hours and three cases of loss of arterial pulse). Conclusions: Percutaneous patent ductus arteriosus closure was safe and effective in this setting, with a low global complication rate and similar outcomes to most equivalent centers. Resumo: Introdução: A persistência de canal arterial, uma comunicação entre a aorta descendente torácica e a artéria pulmonar, é uma das cardiopatias congénitas mais comuns. O encerramento percutâneo, uma alternativa eficaz à cirurgia, corresponde atualmente ao tratamento de eleição na maioria dos doentes. Os autores apresentam os resultados de um centro de referência após doze anos de experiência com esta técnica. Métodos: Análise retrospetiva dos registos eletrónicos de todos os doentes orientados para encerramento percutâneo num centro de referência entre janeiro de 2006 e setembro de 2018. Resultados: Foram referenciados 221 doentes, com média de 5,5 anos (16 lactentes, o mais novo com quatro meses de idade). Globalmente, 139 pacientes foram tratados com coil Nit-Occlud® (62.9%), 79 pacientes foram tratados com Amplatzer duct occluders (35,7%) e plugs vasculares foram utilizados três vezes. O encerramento percutâneo foi conseguido em todos os doentes tratados, com shunt residual em 1,4% dos casos. De todos os coils, 55% eram 4x4 ou 5x4 mm e 73% de todos os Amplatzer duct occluders eram 6x4 mm ou 8x6 mm, refletindo o facto de a maioria dos doentes apresentar canais arteriais de pequena-média dimensão. Não foram descritas complicações durante o procedimento, reportando-se uma taxa de complicações pós-procedimento de 1,8% (uma embolização de dispositivo após 48 horas e três casos de perda de pulso arterial). Conclusão: O encerramento percutâneo da persistência de canal arterial demonstrou ser seguro e eficaz neste contexto, com uma baixa taxa de complicações e resultados semelhantes a outros centros equivalentes.

Objective: To determine the clinical adverse events related to the use of femoral and radial artery access in patients who underwent interventional cardiology procedures in the Hospital Nacional Hipólito Unanue from 2015 to 2017. Materials and methods: A comparative, retrospective, observational and analytical study was conducted with a total of 151 medical records of patients who had clinical adverse events. Medical record review was used as data collection technique, and a data collection sheet designed by the researcher was used as instrument. The R software was used for the analysis. Results: Out of 151 cardiac catheterizations, 51.66 % were performed by a femoral artery access and 48.34 % by a radial artery access. The average age of the patients was 59.6 ± 11.3 years, out of which 39.73 % ranged between 60 and 70 years, and 73.50 % of the patients were males. The most frequent comorbidities were arterial hypertension Horiz Med (Lima) 2022; 22(1): e1719 and diabetes mellitus. Non-serious clinical adverse events occurred as a result of both vascular access procedures; however, their incidence was high. Fifty percent (50%) of the patients who underwent a femoral artery access procedure showed the following adverse events: hematoma (25.60 %), bleeding (9 %), ischemia (1.30 %), vagal response (1.30 %), pseudoaneurysm (1.30 %), a rare skin rash that looked like a burn (1.30 %) and pain (10.20 %). In contrast, 19.14 % of the patients who underwent a radial artery access procedure presented hematoma (8.21 %), bleeding (2.73 %), radial artery spasm (1.40 %) and pain (6.80 %). Conclusions: After determining the clinical adverse events, it was concluded that radial artery access is better than femoral artery access for interventional cardiology procedures. [ABSTRACT FROM AUTHOR]

Objective: To characterize the hemodynamic classification of pulmonary hypertension in a series of patients undergoing to right cardiac catheterization. Methods: This is a retrospective study, we analyze the records of all right heart catheterizations performed between January 2017 and December 2018, all patient older than 18 years were included and those with incomplete or inconclusive data were excluded. We identify three hemodynamic profiles according to the result of right heart catheterization. Results: 92 subjects were included and pulmonary hypertension was ruled out in 4 of them; 26.1% were classified as precapillary, 31.8% postcapillary and 42% as combined pulmonary hypertesion. There were no differences between the 3 groups in age or sex, pulmonary pressures were higher in the precapillary pulmonary hypertension group, right catheterization reclassified 35% of the patients in a hemodynamic group in a different from that expected. Precapillary PH was suspected in most of these cases, but the hemodynamic profiles found in cardiac catheterization corresponded to post-capillary or combined pulmonay hypertension. Conclusion: Right heart catheterization is necessary for the hemodynamic classification of pulmonary hypertension, which is important not only for diagnosis but also for evaluating the etiology of the disease. [ABSTRACT FROM AUTHOR]

Copyright of Enfermería en Cardiologia is the property of Asociacion Espanola de Enfermeria en Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermería en Cardiologia is the property of Asociacion Espanola de Enfermeria en Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Se presenta el caso de una paciente con antecedente de ventrículo único por atresia tricuspídea, doble vía de salida del ventrículo izquierdo e hipoplasia del anillo de la arteria pulmonar. La paciente fue tratada con cirugía de Glenn a los 7 años de vida y, a los 16, se le realizó cirugía de Fontan extracardíaco fenestrado. Luego de 1 mes de realizada la cirugía presentó hemoptisis severa sin adecuada respuesta al manejo médico. Se realizó cierre percutáneo de las fístulas aortopulmonares con coils, con evolución favorable, sin presentar recurrencias de hemoptisis.

Background: Several interventional cardiology procedures are required in neonates with congenital heart disease. Interventional cardiology procedures have a higher risk of cardiac arrest compared to other interventions. At present, there is great heterogeneity in the perioperative management of congenital heart disease neonates undergoing diagnostic cardiac catheterization or therapeutic cardiac catheterization. Study objectives: Primary aim: Provide a systematic review of the most effective and/or safe anesthetic and perioperative management in neonates with congenital heart disease who undergo diagnostic cardiac catheterization or therapeutic cardiac catheterization. Secondary aim: Identify the medications, monitoring parameters and airway management used in the same population. Design: Systematic literature review. Setting: Catheterization laboratory. Methods: Literature was searched (December 2017) in electronic databases Medline, EMBASE, ScienceDirect, BIREME-Lilacs-Biblioteca Virtual de la Salud, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment Database. Main results: From 130 records identified, four studies met inclusion criteria and quality assessment. None of the studies were relevant to the primary objective. Regarding the secondary objectives, one study compared the efficacy and adverse effects of racemic ketamine and its S(+) ketamine enantiomer, one study reported the efficacy of subarachnoid anesthesia for high-risk children undergoing diagnostic cardiac catheterization, one study identified the factors associated to high severity adverse events related to sedation, anesthesia and airway, and one study retrospectively analyzed cardiac catheterization procedures in neonates weighing less than 2.5 kg. Conclusion: There are no evidence-based recommendations available for congenital heart disease neonates undergoing cardiac catheterization. More studies are required to evaluate the ideal anesthetic and perioperative management in this population. Resumo: Introdução: Vários procedimentos de cardiologia intervencionista são necessários em neonatos com doença cardíaca congênita. Os procedimentos de cardiologia intervencionista têm um risco maior de parada cardíaca em comparação com outras intervenções. Atualmente, há grande heterogeneidade no manejo perioperatório de neonatos com doença cardíaca congênita submetidos a cateterismo cardíaco diagnóstico ou cateterismo cardíaco terapêutico. Objetivo: Objetivo principal: fornecer uma revisão sistemática do manejo anestésico e perioperatório mais efetivo e/ou seguro em neonatos com doença cardíaca congênita submetidos à cateterismo cardíaco diagnóstico ou cateterismo cardíaco terapêutico. Objetivo secundário: Identificar os medicamentos usados, parâmetros monitorizados e manejo das vias aéreas utilizado na população estudada. Desenho: Revisão sistemática da literatura. Local: Laboratório de hemodinâmica e cateterismo cardíaco. Método: Foi realizada busca na literatura (Dezembro de 2017) nos seguintes bancos de dados eletrônicos: Medline, EMBASE, ScienceDirect, BIREME-Lilacs-Biblioteca Virtual de la Salud, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects e Health Technology Assessment Database. Resultados principais: Dos 130 registros identificados, quatro estudos obedeceram aos critérios de inclusão e de avaliação de qualidade. Nenhum dos estudos foi relevante para o objetivo principal. Em relação aos objetivos secundários, um estudo comparou a eficácia e os efeitos adversos da cetamina racêmica e seu enantiômero S(+) cetamina, um estudo relatou a eficácia da anestesia subaracnóidea em crianças de alto risco submetidas ao cateterismo cardíaco diagnóstico, um estudo identificou os fatores associados à maior gravidade de eventos adversos relacionados à sedação, anestesia e vias aéreas, e um estudo analisou retrospectivamente os procedimentos de cateterismo cardíaco em neonatos com peso inferior a 2,5 kg. Conclusão: Não há recomendações baseadas em evidências disponíveis para neonatos com doença cardíaca congênita submetidos a cateterismo cardíaco. Mais estudos são necessários para avaliar o manejo anestésico e perioperatório ideal nessa população.

Objetivo: avaliar o conhecimento dos pacientes sobre os exames Cateterismo Cardíaco e Angioplastia da Artéria Coronária. Método: trata-se de estudo descritivo, transversal, de abordagem quantitativa, desenvolvido no Setor de Hemodinâmica e Radiologia Intervencionista de um hospital do interior de São Paulo, com 30 pacientes. Para coleta de dados utilizou-se um questionário semiestruturado. Resultados: do total de participantes, 50% era do sexo feminino e 50% do sexo masculino, com idade entre 41 e 80 anos e 73,4% possuíam o 1° grau incompleto. Sobre acesso a informações, 43,4% usavam internet, 86,6% usavam celular, 53,4% não tinham internet em casa. Sobre aplicativos, 53,4% referiram usar o whatsapp, e 46,6% buscavam informações de saúde pela internet. No entanto, quando perguntados se sabiam alguma informação sobre ambos os procedimentos, ou se já tiveram a oportunidade de ler ou falar sobre o assunto com alguém, a maioria respondeu que não (63,6%). Conclusão: a maioria dos pacientes desconheciam as informações sobre os procedimentos, embora tivessem acesso à internet e celulares, fato este que pode gerar ansiedade e medo no momento do procedimento. Por isso, há necessidade de maiores informações e esclarecimento por parte da equipe de enfermagem a esses pacientes.

Introduction: Pulmonary hypertension (PH) is a serious disease that requires early diagnosis to achieve a better patient prognosis. Right heart catheterization (RHC) has become the main diagnostic test for this disease, measuring the pressures from the right heart chambers invasively, using a catheter placed through venous access. Nursing performance has an important role in RHC through peripheral venous access due to its well-done skills for canalization and knowledge about the management and care of these accesses. RHC performed through peripheral venous access provide advantages over those performed through central venous access., Objective: To analyze the benefits from RHC through peripheral venous access compared to those performed through central venous access, as well as highlighting the role of nursing during this type of procedures., Method: A retrospective, descriptive, and observational study was performed for patients who underwent RHC in our center between January 2019 to January 2023. We analyzed clinical characteristics, access, fluoroscopy parameters, periprocedural complications, and hospital admissions., Result: A total of 115 patients were included. The average age was 65±12 years, with 58.1% of females. Risk stratification of PH was the reason for conducting RHC in 82.9%. The anterocubital veins became the main approach (72.2%), performed by hemodynamics nurses, while the central venous ones composed the rest (27.8%), which were done by cardiology specialized doctors. We observed a significant reduction in radiation dose in RHC via anterocubital route compared to central venous access (4.4Gycm 2 vs 12.5Gycm 2 [IQR: 4.5]; P<.001), and it does also in fluoroscopy times (2.3minutes vs 4.6minutes [IQR: 2.6]; P<.001). No complications were recorded, independently of the approach. Patients who underwent a scheduled catheterization were discharged more frequently on the same day of the procedure whether a peripheral approach was performed (77.2%, 44 of 57 patients), in comparison with the central one (28.6%) (P=.001)., Conclusions: The RHC is an essential tool for the diagnosis of PH, achieving nursing such an important role for those performed by peripheral venous access. Peripheral venous access provides benefits and advantages like the reduction of radiation exposure and scan times, reduced hospital stay. All this could bring greater comfort, safety and better quality of care to the patient., (Copyright © 2024 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Congenital heart diseases are the most common congenital abnormalities in newborns with a prevalence of 1%. Therapeutic and diagnostic cardiac catheterization has revolutionized the treatment of these diseases; however, it can be associated with complications. Objective: To describe the incidence and type of complications associated with pediatric cardiac catheterization in a reference center for congenital heart defects. Methodology: Retrospective observational study, with analytical intention based on records of cardiac catheterization performed on patients with congenital and acquired heart disease. Results: 2,688 records were included for nine consecutive years. 53.9% were men, 21.3% with ages between 2 and 5 years and 20.3% between 6 months and 2 years. 63.5% of the procedures were elective. The prevalence of complications in the first 24 hours after catheterization was 6.7% (4.2% minor and 2.4% major). Early death occurred in 0.8% of the procedures. Factors associated with complications were age at catheterization <28 days (OR 2.18, 95% CI [1.28-3.70]), precatheter oxygen saturation <79% (OR 2.15, 95% CI [1.02-4.53]), use of pre-catheter inotropics (OR 3.00, 95% CI [1.68-5.33]). The variables included in the model explain 38% of the variance of post-cardiac catheterization complications in patients younger than 18 years. Discussion: Cardiac catheterization is associated with major and minor complications including death. The associated factors were less than 28 days, lower oxygen saturation and use of pre-catheter inotropics. [ABSTRACT FROM AUTHOR]

BACKGROUND: Takotsubo syndrome, also known as stress cardiomyopathy, is a condition triggered by emotional factors or intense physical stress; postmenopausal women are the predominant population. CLINICAL CASES: A series of cases is presented. In the first clinical case a primary takotsubo syndrome is exposed in a 60-year-old female patient with chest pain, accompanied by exaggerated neurovegetative response related to a previous emotional event. On the second case, a 69-year-old female patient suffered a fall in her own support plane, with direct contusion on the thorax, developing later a secondary takotsubo syndrome. In both cases an electrocardiogram with T-wave reversal and ST segment elevation, cardiac enzyme elevation, and a characteristic imaging study, showing no coronary artery injury, as well as a left ventricle with severe apical hypokinesia giving a characteristic image in the form of a vase of takotsubo. CONCLUSIONS: The diagnosis of takotsubo syndrome is challenging due to the similarity of the clinical picture to an acute coronary syndrome. Definitive diagnosis requires a ventriculography that shows the characteristic pattern in the shape of the vessel that gives to the syndrome its name. [ABSTRACT FROM AUTHOR]

Protein-losing enteropathy is one of the most feared complications of the Fontan circulation. The diagnosis of protein-losing enteropathy in this setting should prompt a thorough investigation for the presence of a treatable hemodynamic impairment. In this report, we describe a complete reversal of protein-losing enteropathy following percutaneous enlargement of a restrictive atrial septal defect in a patient with a fenestrated lateral tunnel Fontan and severe mitral stenosis. Resumo: A enteropatia por perda de proteínas é uma das complicações mais temidas da circulação de Fontan. O diagnóstico de enteropatia por perda de proteínas neste contexto deve suscitar uma avaliação exaustiva da eventual presença de uma alteraçao hemodinâmica tratável. Neste artigo, apresentamos uma completa regressão de enteropatia por perda de proteínas após dilatação percutânea de defeito restritivo do septo interauricular num doente com tunel lateral fenestrado de Fontan e estenose mitral grave.

Introdução: Com o aumento da expectativa de vida há também um consequente aumento das doenças cardiovasculares e de intervenções coronárias percutâneas. Objetivo: Avaliar obtenção de hemostasia após cateterizações arteriais percutâneas, por via radial, utilizando torniquete de compressão de artéria radial (TCAR). Métodos: Foi realizado um estudo observacional, transversal quantitativo, que avaliou 80 prontuários de pacientes submetidos consecutivamente a operações arteriais percutâneas (cateterismo cardíaco com ou sem necessidade de angioplastia) por acesso radial, que utilizaram TCAR da marca COMED®, como técnica para obtenção da hemostasia, baseando-se o protocolo institucional para manuseio e retirada do dispositivo. Resultados: Sessenta e cinco por cento dos pacientes eram do sexo masculino, com média de idade de 63 anos, peso médio de 76,5 Kg. Cinco mil unidades internacionais de heparina não fracionada foram administradas em todos os procedimentos, com doses adicionais em pacientes que foram submetidos à angioplastia. A maioria (88,7%) dos dispositivos foram insuflados com 15 ml de ar após o procedimento e a hemostasia foi obtida em 78,7% dos casos. Conclusão: A obtenção de hemostasia com compressão da artéria pelo TCAR COMED®, e com a técnica realizada seguindo o protocolo da instituição, mostrou-se efetiva, reduzindo o tempo de compressão sugerido pelo fabricante. Introduction: With the increase in life expectancy, there is also a consequent increase in cardiovascular diseases and percutaneous coronary interventions. Objective: To evaluate hemostasis after radial percutaneous arterial catheterization using the radial artery compression tourniquet (RACT). Methods: An observational, cross-sectional quantitative study was carried out to evaluate 80 medical records of patients consecutively submitted to percutaneous arterial surgeries (cardiac catheterization with or without angioplasty) by radial access using COMED® RACT as the technique to obtain hemostasis, based on the institutional protocol for device handling and removal. Results: Sixty-five percent of the patients were male, with a mean age of 63 years, mean weight of 76.5 kg. Five thousand international units of unfractionated heparin were administered in all procedures, with additional doses in patients who underwent angioplasty. Most (88.7%) devices were inflated with 15 ml of air after the procedure and hemostasis was obtained in 78.7% of cases. Conclusion: Obtaining hemostasis with compression of the artery by COMED® RACT, and with the technique performed following the protocol of the institution, was effective, reducing the time for compression suggested by the manufacturer.

RESUMEN Introducción y objetivos: Actualmente es cada vez más habitual realizar procedimientos sin retirar la anticoagulación oral (ACO), pero la necesidad o no de suspender la ACO antes del cateterismo cardiaco sigue siendo una cuestión controvertida. Se evalúan la eficacia y la seguridad de la realización de un cateterismo transradial en pacientes ambulatorios sin retirar los anticoagulantes orales de acción directa (ACOD). Métodos: Estudio observacional, prospectivo, que incluye 270 pacientes sometidos a cateterismo transradial electivo desde enero de 2013 hasta noviembre de 2017, divididos en 3 grupos de 90 pacientes: grupo A (sin ACO), grupo B (con antagonista de la vitamina K), grupo C (con ACOD), emparejados según la fecha de realización del cateterismo. No se suspendió la ACO antes del procedimiento. Se evalúan las complicaciones del acceso radial en las primeras 24 h y un mes después del cateterismo. Resultados: Había más varones tratados con ACOD que con un antagonista de la vitamina K (71,1 frente a 47,8%; p = 0,01) y los pacientes eran más jóvenes en el grupo sin ACO (63,45 ± 11,47 frente a 70,22 ± 9,35 años; p = 0,03). En el grupo B hubo menos diabéticos (22,2 frente a 36,67% en el grupo C; p = 0,03). En el grupo A, los pacientes tenían más antecedentes de cardiopatía isquémica que los pacientes con anticoagulación (27,84 frente a 14,44% en el grupo C; p = 0,028), además de la toma concomitante de fármacos antiplaquetarios. El acceso fue radial en la mayoría de los pacientes (98,2%). No hubo diferencias significativas en las complicaciones del acceso vascular, con una tasa de hematoma o hemorragia al alta del 1,1% en el grupo con ACOD y tasas de oclusión arterial tanto al alta como al mes del 0-2,2%. Conclusiones: En nuestra experiencia, la realización de un cateterismo diagnóstico transradial sin interrupción de los ACOD es seguro, con tasas bajas de complicaciones trombóticas y hemorrágicas, sin diferencias respecto a los pacientes en tratamiento con un antagonista de la vitamina K o sin ACO.

Objetivo: Traçar o perfil clínico-epidemiológico de usuários submetidos ao cateterismo cardíaco; propor uma tecnologia gerencial para criar um banco de dados com informações de interesse epidemiológico. Método: Estudo quantitativo, retrospectivo de bases de dados e prontuários de 1890 usuários submetidos ao procedimento na unidade de hemodinâmica entre abril/2014 e abril/2016. Utilizou-se o software Microsoft Office Excel® para organização e análise dos dados. CAAE:55615616.0.0000.5282 Resultados: A idade média é de 61,45 anos. A maioria da população atendida é encaminhada pelo Sistema de Regulação (63%) e sua distribuição: (52,86%) masculino e (47,14%) feminino. Identificou-se que 79,5% dos usuários são hipertensos. Verificou-se que a atual estratégia para acompanhamento dos usuários atendidos apresenta falhas nas informações. Conclusão: A consulta de enfermagem com a obtenção de informações relevantes e determinantes para as condutas de enfermagem, contribui para a melhoria do Sistema Único de Saúde. Descritores: Cateterismo cardíaco; Enfermagem; Fatores de risco; Hemodinâmica; Perfil epidemiológico.

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Objective: To examine the accuracy of a pulmonary hypertension screening strategy based on a combination of echocardiographic data and tomographic measurements (pulmonary artery diameter and pulmonary artery diameter to ascending aorta diameter ratio) in patients with chronic lung disease referred for lung transplantation. Methods: A retrospective observational study with patients with pulmonary emphysema or fibrosis referred for transplantation between 2012 and 2016. Pulmonary hypertension was defined as mean pulmonary artery pressure ≥25mmHg, or between 21 and 24mmHg, with pulmonary vascular resistance >3 Wood units on right heart catheterization. Tomographic measurements were made by two independent radiologists. Results: This sample comprised 13 patients with emphysema and 19 patients with pulmonary fibrosis. Of these, 18 had pulmonary hypertension. The level of agreement in tomographic measurements made by radiologists was high (intraclass correlation coefficients 0.936 and 0.940, for pulmonary artery diameter and pulmonary artery diameter to ascending aorta diameter ratio, respectively). Areas under the ROC curves constructed for pulmonary artery diameter, pulmonary artery diameter to ascending aorta diameter ratio, and pulmonary artery systolic pressure as predictors of pulmonary hypertension were 0.540, 0.629 and 0.783, respectively. The sensitivity, specificity and negative predictive value of pulmonary artery systolic pressure ≥40mmHg were 67%, 79% and 65%, respectively. The combined criterion (pulmonary artery diameter to ascending aorta diameter ratio >1 and/or pulmonary artery systolic pressure ≥40mmHg) achieved sensitivity of 72%, specificity of 79%, and a negative predictive value of 69%. Conclusion: Measurements of pulmonary artery and ascending aorta diameter were highly reproducible. The association of pulmonary artery and aortic diameter >1 and/or pulmonary artery systolic pressure ≥40mmHg improved the sensitivity and the negative predictive value for pulmonary hypertension screening. This strategy demands prospective validation to assess safety and cost-effectiveness. [ABSTRACT FROM AUTHOR]

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Objetivo: El objetivo general del presente lineamiento es proponer una normativa para realización de cateterismos programados o de emergencia en pacientes pediátricos con COVID-19 confirmado o sospechoso. Pregunta de salud cubierta por la Guía: ¿Cómo deben ser atendidos los pacientes pediátricos con diagnóstico o sospecha de COVID-19 que requieren un cateterismo cardíaco programado o por emergencia? Población: La población objetivo es pacientes en edad pediátrica con enfermedades cardiovasculares que requieren cateterismo cardíaco programada o por emergencia y en quienes se sospecha el diagnóstico de COVID-19. Guías: se hacen recomendaciones de bioseguridad en la atención de este grupo específico de pacientes.

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Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Vários procedimentos de cardiologia intervencionista são necessários em neonatos com doença cardíaca congênita. Os procedimentos de cardiologia intervencionista têm um risco maior de parada cardíaca em comparação com outras intervenções. Atualmente, há grande heterogeneidade no manejo perioperatório de neonatos com doença cardíaca congênita submetidos a cateterismo cardíaco diagnóstico ou cateterismo cardíaco terapêutico. Objetivo principal: fornecer uma revisão sistemática do manejo anestésico e perioperatório mais efetivo e/ou seguro em neonatos com doença cardíaca congênita submetidos à cateterismo cardíaco diagnóstico ou cateterismo cardíaco terapêutico. Objetivo secundário: Identificar os medicamentos usados, parâmetros monitorizados e manejo das vias aéreas utilizado na população estudada. Revisão sistemática da literatura. Laboratório de hemodinâmica e cateterismo cardíaco. Foi realizada busca na literatura (Dezembro de 2017) nos seguintes bancos de dados eletrônicos: Medline, EMBASE, ScienceDirect, BIREME ‐Lilacs‐Biblioteca Virtual de la Salud , Cochrane Database of Systematic Reviews , Database of Abstracts of Reviews of Effects e Health Technology Assessment Database. Dos 130 registros identificados, quatro estudos obedeceram aos critérios de inclusão e de avaliação de qualidade. Nenhum dos estudos foi relevante para o objetivo principal. Em relação aos objetivos secundários, um estudo comparou a eficácia e os efeitos adversos da cetamina racêmica e seu enantiômero S(+) cetamina, um estudo relatou a eficácia da anestesia subaracnóidea em crianças de alto risco submetidas ao cateterismo cardíaco diagnóstico, um estudo identificou os fatores associados à maior gravidade de eventos adversos relacionados à sedação, anestesia e vias aéreas, e um estudo analisou retrospectivamente os procedimentos de cateterismo cardíaco em neonatos com peso inferior a 2,5 kg. Não há recomendações com base em evidências disponíveis para neonatos com doença cardíaca congênita submetidos a cateterismo cardíaco. Mais estudos são necessários para avaliar o manejo anestésico e perioperatório ideal nessa população. Several interventional cardiology procedures are required in neonates with congenital heart disease. Interventional cardiology procedures have a higher risk of cardiac arrest compared to other interventions. At present, there is great heterogeneity in the perioperative management of congenital heart disease neonates undergoing diagnostic cardiac catheterization or therapeutic cardiac catheterization. Primary aim: Provide a systematic review of the most effective and/or safe anesthetic and perioperative management in neonates with congenital heart disease who undergo diagnostic cardiac catheterization or therapeutic cardiac catheterization. Secondary aim: Identify the medications, monitoring parameters and airway management used in the same population. Systematic literature review. Catheterization laboratory. Literature was searched (December 2017) in electronic databases Medline, EMBASE, ScienceDirect, BIREME‐Lilacs‐Biblioteca Virtual de la Salud , Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment Database. From 130 records identified, four studies met inclusion criteria and quality assessment. None of the studies were relevant to the primary objective. Regarding the secondary objectives, one study compared the efficacy and adverse effects of racemic ketamine and its S(+) ketamine enantiomer, one study reported the efficacy of subarachnoid anesthesia for high‐risk children undergoing diagnostic cardiac catheterization, one study identified the factors associated to high severity adverse events related to sedation, anesthesia and airway, and one study retrospectively analyzed cardiac catheterization procedures in neonates weighing less than 2.5 kg. There are no evidence‐based recommendations available for congenital heart disease neonates undergoing cardiac catheterization. More studies are required to evaluate the ideal anesthetic and perioperative management in this population. [ABSTRACT FROM AUTHOR]

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Background: In patients with ST elevation myocardial infarction (STEMI) thrombolytic therapy is the optimal reperfusion strategy when primary percutaneous intervention is not available. Objective: To determine the clinical characteristics and hospital evolution of patients with STEMI who were treated with thrombolytic therapy in the Emergency department. Method: Retrospective and transversal study; we included all patients who were diagnosed with STEMI in the Emergency department of the Hospital General Regional No. 46 and received thrombolytic therapy, within a 12 month period. Results: We analyzed 59 cases, with a mean age of 62.2 years old, 70% were male sex; the average age for men was 60 years (range 38-84) and for women was 71 years (range 43-87); according to the initial electrocardiogram the most common myocardial affected regions were inferior (43.8%) and extense anterior (43.8%); tenecteplase was the most used thrombolytic therapy (93%), with an average door in-needle time of 82 minutes (range 10-360 min), 52.6% met clinical criteria for reperfusion; in 49 cases a cardiac catheterism was performed in subsequent days, 49% of them was naria percutánea de rescate; la mortalidad intrahospitalaria fue del 28%. Conclusiones: La fibrinólisis en los pacientes con IAMCEST es efectiva e incrementa las probabilidades de preservar tejido miocárdico. En nuestro centro son necesarias mayor disponibilidad y amplia aplicación de la terapia fibrinolítica, en consideración de los tiempos de traslado al tercer nivel. [ABSTRACT FROM AUTHOR]

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Copyright of Ciencia, Cuidado e Saude is the property of Universidade Estadual de Maringa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

La definición universalmente aceptada de hipertensión pulmonar corresponde a todos los pacientes con presión arterial pulmonar media igual o mayor a 25 mm Hg en reposo, medida por cateterismo cardíaco derecho, sin olvidar que la presión promedio normal de la arteria pulmonar es de máximo 20 mm Hg, lo cual obliga a seguir a los pacientes con presión arterial pulmonar media entre 20 y 24 mm Hg. También cabe recordar ser claros al diferenciar entre hipertensión pulmonar e hipertensión arterial pulmonar. La hipertensión pulmonar incluye cinco grupos, entre los cuales la hipertensión arterial pulmonar constituye el grupo 1. El concepto de hipertensión arterial pulmonar inducida por el ejercicio puede definirse como todos los pacientes con presión arterial pulmonar por encima de los 30 mm Hg a un gasto cardíaco menor de 10 l, o una resistencia pulmonar total de más de 3 unidades Wood. La hipertensión pulmonar inducida por el ejercicio es un campo de investigación hasta ahora poco explorado. La clasificación continúa con los cinco grupos, y es dinámica de acuerdo con el progreso en entender la fisiopatología de cada enfermedad.

La hipertensión arterial pulmonar es una entidad patológica propia de la circulación pulmonar, poco frecuente, definida como la elevación de la PAPm ≥ 25 mm Hg con cuña ≤ 15 mm Hg y RVP >3 unidades Wood, determinadas en reposo y mediante cateterismo cardiaco derecho1. La hipertensión arterial pulmonar pertenece al grupo 1 de la clasificación de hipertensión pulmonar, un grupo constituido por entidades consideradas “raras”, y su diagnóstico requiere descartar la presencia de otras causas de hipertensión pulmonar2. La complejidad de la enfermedad y el uso de procedimientos altamente especializados para el diagnóstico, hace necesaria y deseable la remisión a centros de experiencia o referencia en el manejo de la patología1,2. Sin embargo, existen aproximaciones diagnósticas iniciales que pueden adelantarse en centros de atención primaria y acelerar así el proceso de diagnóstico.