Search

Cardiac imaging continues to reveal new anatomical and functional insights into heart disease. In echocardiography, both transesophageal and transthoracic three-dimensional imaging have been fully developed and optimized, and the value of the techniques that have increased our understanding of cardiac mechanics and ventricular function is well established. At the same time, the healthcare industry has released new devices onto the market which, although they are easier to use, have limitations that restrict their use for routine assessment. Tomography's diagnostic and prognostic value in coronary artery disease continues to increase while radiation exposure becomes progressively lower. With cardiac magnetic resonance imaging, myocardial injury and recovery in ischemic heart disease and following acute coronary syndrome can be monitored in exquisite detail. The emergence of new combined tomographic and gamma camera techniques, exclusively developed for nuclear cardiology, have improved the quality of investigations and reduced radiation exposure. The hybrid or fusion images produced by combining different techniques, such as nuclear cardiology techniques and tomography, promise an exciting future.

Resumen La trombosis protesica grande, con trombo >5 mm o >0,8 cm2, tiene una elevada morbimortalidad. Presentamos una serie de 9 casos con trombosis protesica grande no oclusiva en posicion mitral. El tratamiento inicial fue anticoagulacion en 4 pacientes, fibrinolisis en 3 y cirugia en 2. Precisaron cirugia como tratamiento definitivo 8 de los 9 pacientes (89%). El tiempo medio hasta la intervencion quirurgica fue 6,7 dias en la cirugia del mismo ingreso y 70,2 en los pacientes con reingreso, con un aumento medio del Euroscore de 9,05% y una tasa de exito total de cirugia del 63%. La mortalidad total precoz fue del 33%, alcanzando el 55% en el seguimiento. La cirugia es posiblemente el tratamiento mas eficaz en la trombosis protesica mitral grande, y el retraso en la decision terapeutica puede determinar un aumento de mortalidad. Las terapias anticoagulante optima y fibrinolitica resultan a menudo no definitivas y no exentas de complicaciones.

The development of a noninvasive diagnostic test follows a typical timeline: description, enthusiasm, clinical assessment and application, and epidemiological study. However, for techniques such as echocardiography that are widely available, have no harmful effects and are inexpensive, clinical applications may become widespread before they have been evaluated. Real progress is being made with the use of new methodologies, such as myocardial deformation echocardiography and three-dimensional echocardiography. Three-dimensional transesophageal echocardiography has returned echocardiography to its place at the center of modern cardiac diagnosis after it had been displaced in recent years by cardiac multislice CT and cardiac magnetic resonance. However, the new radiological techniques that have helped to reduce radiation exposure to patients and that have improved image acquisition could restore CT to the heart of general cardiac diagnosis. At the moment, it is not possible to displace the echocardiography from its central role in cardiac imaging. This article contains a review of the most important publications on echocardiography, magnetic resonance imaging and cardiac CT that have appeared recently in cardiology journals, mainly during 2010.

Introduccion. Cada dia son mas los pacientes que sobreviven tras cirugia de reconstruccion de aorta ascendente. Estos pacientes requieren seguimiento para detectar factores pronosticos postoperatorios, como persistencia de flujo en falsa luz, roturas intimales o complicaciones del injerto. Hemos realizado un estudio utilizando la ecocardiografia transtoracica y transesofagica con el objeto de detectar anomalias residuales y establecer la utilidad de esta tecnica en un grupo de pacientes operados por patologia de aorta ascendente con intervencion de Bono-Bentall. Pacientes y metodo. Se estudian con ecocardiografia transtoracica y transesofagica 12 pacientes, 4 de ellos intervenidos por anulectasia aortica con insuficiencia aortica severa y 8 por diseccion aortica tipo A. La tecnica quirurgica fue la de Bono-Bentall en todos los pacientes y en tres de ellos se anadio la modificacion de Cabrol. Resultados. De los enfermos intervenidos por diseccion aortica, 7 de 8 (87%) presentaron anomalias residuales: 5 persistencia de diseccion distal, 1 seudoaneurisma y 1 hematoma peritubular. Solo en 1 de los 4 enfermos (25%) intervenidos por anulectasia se encontro lesion residual (seudoaneurisma). La fraccion de eyeccion era normal en los pacientes intervenidos por diseccion aortica y deprimida en los intervenidos por anulectasia aortica (60 ± 9 frente a 40 ± 10; p = 0,005). Conclusiones. En pacientes intervenidos con tecnica de Bono-Bentall existe una alta incidencia de anomalias residuales aorticas, especialmente cuando la indicacion quirurgica es la diseccion aortica. La ecocardiograf ia transesofagic a es un metodo diagnostico idoneo para la deteccion y seguimiento de anomalias residuales tras la cirugia de aorta ascendente. Creemos que esta tecnica debe formar parte del seguimiento periodico de estos pacientes. AMBULATORY FOLLOW-UP WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY OF PATIENTS WITH SURGICALLY TREATED ASCENDING AORTIC ANEURYSM OR DISSECTION

Introduccion Aunque se conoce que existe unaalta prevalencia de disfuncion diastolica del ventriculoizquierdo en los hipertensos que precede ala hipertrofia ventricular, se han comunicado pocosdatos en la bibliografia sobre la posible relacionentre tales hallazgos y la presencia de microalbuminuria. Objetivos Nuestro estudio realizado en sujetoscon hipertension ligera-moderada jovenes no diabeticosy sin tratamiento previo pretende evaluarla prevalencia y posible asociacion entre microalbuminuria,disfuncion diastolica e hipertrofia ventricularizquierda. Material y metodos Se estudiaron prospectivamente80 hipertensos no tratados, con creatinemianormal, no diabeticos (el 52,5% mujeres y el 47,5%varones, con una edad media de 41,4 ± 9,6 anos),a quienes se les realizo ecocardiografia-Doppler,cuantificandose los indices de llenado:relacion develocidad pico de llenado precoz/tardio y tiempo dedesaceleracion del llenado precoz. Se definio la hipertrofiaventricular izquierda segun criterios deDevereux. A los hipertensos se les determino la microalbuminuriamediante radioinmunoanalisis enorina de 24 h (microalbuminuria: 30–300 mg/24 h). Resultados Se detecto microalbuminuria en el23,7% de los sujetos, hipertrofia ventricular izquierdaen el 40% y el 48,8% presentaba disfunciondiastolica, sin asociacion estadisticamente significativaentre las mismas. Solo el 29,5% de los sujetosestaba libre de afectacion cardiorrenal. Hubodiferencias estadisticamente significativas entre larelacion de velocidad pico de llenado precoz/tardioy la microalbuminuria (p Conclusiones Existe una alta prevalencia deafectacion cardiaca y/o renal en pacientes con hipertensionligera, estando libre de ellas solo el29,5% de los sujetos. No encontramos asociacionentre dichas lesiones de organos.

Cardiovascular disease is the leading cause of death in most Western societies and it is increasing steadily in many developing countries. Aortic diseases constitute an emerging share of the burden. New diagnostic imaging modalities, longer life expectancy in general, longer exposure to elevated blood pressure, and the proliferation of modern noninvasive imaging modalities have all contributed to the growing awareness of acute and chronic aortic syndromes. Despite recent progress in recognition of both the epidemiological problem, diagnostic and therapeutic advances, the cardiology community and the medical community in general are far from comfortable in understanding the spectrum of aortic syndromes and defining an optimal pathway to manage aortic diseases.

The development of a noninvasive diagnostic test follows a typical timeline: description, enthusiasm, clinical assessment and application, and epidemiological study. However, for techniques such as echocardiography that are widely available, have no harmful effects and are inexpensive, clinical applications may become widespread before they have been evaluated. Real progress is being made with the use of new methodologies, such as myocardial deformation echocardiography and three-dimensional echocardiography. Three-dimensional transesophageal echocardiography has returned echocardiography to its place at the center of modern cardiac diagnosis after it had been displaced in recent years by cardiac multislice CT and cardiac magnetic resonance. However, the new radiological techniques that have helped to reduce radiation exposure to patients and that have improved image acquisition could restore CT to the heart of general cardiac diagnosis. At the moment, it is not possible to displace the echocardiography from its central role in cardiac imaging. This article contains a review of the most important publications on echocardiography, magnetic resonance imaging and cardiac CT that have appeared recently in cardiology journals, mainly during 2010.

This article contains a review of the most important contributions made by echocardiography, magnetic resonance imaging and computed tomography to the field of cardiology in 2009. During this period, we helped establish values for myocardial deformation parameters in a number of different clinical settings that have enabled us to achieve better understanding of systolic and diastolic function in both ventricles. Real-time three-dimensional echocardiography has provided new ways to improve the selection and monitoring of potential candidates for an increasing number of noncoronary interventions, such as percutaneous aortic valve implantation and percutaneous mitral valve repair. Magnetic resonance imaging has clearly become the technique of choice for studying a range of different conditions, such as myocarditis and various forms of cardiomyopathy, and is now established as the reference standard in clinical practice for determining the sizes of infarcts and myocardial areas at risk. The diagnostic potential of computed tomography for assessing heart disease has been confirmed in large multicenter trials.