The Use of Pulmonary Artery Catheters and Echocardiography in the Cardiac Surgery Setting: A Nationwide Italian Survey.

OBJECTIVE: Wide variations exist in the use of pulmonary artery catheters (PACs) and echocardiography in the field of cardiac surgery. DESIGN: A national survey promoted by the Italian Association of Cardio-Thoracic Anesthesiologists and Intensive Care was conducted. SETTING: The study occurred in Italian cardiac surgery centers (n = 71). PARTICIPANTS: Anesthesiologists-intensivists were enrolled. INTERVENTIONS: Anonymous questionnaires were used to investigate the use of PACs and echocardiography in the operating room (OR) and intensive care unit (ICU). MEASUREMENTS AND MAIN RESULTS: A total of 257 respondents (32.2% response rate) from 59 centers (83.1% response rate) participated. Use of PACs seems less common in ORs (median insertion in 20% [5-70] of patients), with slightly higher use in ICUs; in about half of cases, it was the continuous cardiac output monitoring system of choice. Almost two-thirds of respondents recently inserted at least one PAC within a few hours of ICU admission, despite its need being largely preoperatively predictable. Protocols regulating PAC insertion were reported by 25.3% and 28% of respondents (OR and ICU, respectively). Transesophageal echocardiography (TEE) was performed intraoperatively in >75% of patients by 86.4% of respondents; only 23.7% stated that intraoperative TEE relied on anesthesiologists. Tissue Doppler and/or 3D imaging were widely available (87.4% and 82%, respectively), but only 37.8% and 24.3% of respondents self-declared skills in these modalities, respectively; 77.1% of respondents had no echocardiography certification, nor were pursuing certification (various reasons); 40.9% had not attended recent echocardiography courses. Lower PAC use was associated with university hospitals (OR: p = 0.014, ICU: p = 0.032) and with lower interventions/year (OR: p = 0.023). Higher independence in performing TEE was reported in university hospitals (OR: p < 0.001; ICU: p = 0.006), centers with higher interventions/year (OR: p = 0.019), and by respondents with less experience in cardiology (ICU: p = 0.046). CONCLUSION: Variability in the use of PACs and echocardiography was found. Protocols regulating the use of PACs seem infrequent. University centers use PACs less and have greater skills in TEE. Training and certifications in echocardiography should be encouraged.

Use of Transesophageal Echocardiography for Liver Transplantation: A Global Comparison of Practice From the ILTS, SATA, and LICAGE.

BACKGROUND: Anesthesiologists frequently use intraoperative transesophageal echocardiography (TEE) to aid in the diagnosis and management of hemodynamic problems during liver transplantation (LT). Although the use of TEE in US centers continues to increase, data regarding international use are lacking. METHODS: This prospective, global, survey-based study evaluates international experience with TEE for LT. Responses from 252 LT (105 US and 147 non-US) centers representing 1789 anesthesiologists were analyzed. RESULTS: Routine use of TEE in the United States has increased in the last 5 y (from 37% to 47%), but only 21% of non-US LT anesthesiologists use TEE routinely. Lack of training (44% US versus 70% non-US) and equipment (9% non-US versus 34% US) were cited as obstacles. Most survey participants preferred not to perform a complete cardiac examination but rather use only 6 of 11 basic views. Although non-US LT anesthesiologists more frequently had additional clinical training than their US counterparts, they had less TEE experience (13% versus 44%) and less frequently, TEE certification (22% versus 35%). Most LT anesthesiologists agreed that TEE certification is essential for proficiency. Of all respondents, 89% agreed or strongly agreed that TEE provides valuable information needed for immediate clinical decision-making, and >86% agreed or strongly agreed that that information could not be derived from other sources. CONCLUSIONS: The use of TEE for LT surgery in the US LT centers is currently higher compared with non-US LT centers. This may become a standard monitoring modality during LT in the near future.

Análise do processo de manutenção e de vida útil dos equipamentos médicos ecocardiógrafos: a experiência de um hospital de ensino / Analysis of the maintenance process and useful life of echocardiography equipment: An experience in a teaching hospital

Introdução: A ecocardiografia é uma ferramenta diagnóstica de crescente utilização na prática clínica, aplicada a diversos cenários médicos. Os cuidados e os processos de manutenção preventiva ou corretiva dos equipamentos são ainda pouco padronizados. O objetivo do presente estudo foi descrever o processo de manutenção atualmente aplicado a equipamentos ecocardiográficos em um laboratório. Descrever o processo inclui a caracterização de danos e aplicações de manutenção preventiva ou corretiva. Métodos: Estudo observacional descritivo e exploratório realizado em centro único. As informações de dados do processo de manutenção de equipamentos ecocardiográficos foram obtidas de arquivos eletrônicos do sistema de gestão de equipamentos de um laboratório de médio porte de um hospital público de nível terciário com características de ensino, no período de 2003 a 2018. Resultados: Foram identificados dez tipos de avarias mais comuns, como dano a programas (23,8%), peças (23,1%) e relacionadas à queda de energia e de acessórios (13,8%). Após a implementação do processo de manutenção preventiva, houve significativa redução dos custos de manutenções (US$ 44.472,10 versus US$ 25.807,59; p= 0,029). Mesmo após a manutenção preventiva, os custos de manutenção corretiva em equipamentos aplicados à ecocardiografia transesofágica (US$ 7.789,17) foram maiores que aqueles a equipamentos aplicados a outras modalidades (US$ 3.184,37 em ecocardiografia transtorácica e US$1.813,00 em estresse). Conclusão: O processo de manutenção de equipamentos ecocardiográficos foi descrito. Danos a equipamentos ecocardiográficos estão relacionados a altos custos, principalmente naqueles aplicados a modalidades especiais, como ecocardiografia transesofágica. As manutenções preventivas reduziram significativamente os custos de manutenção. (AU)

Introduction: Echocardiography is a diagnostic tool that is increasingly used in clinical practice in different medical scenarios; however, the preventive (PM) or corrective maintenance (CM) care and processes for this equipment are still poorly standardized. To describe the maintenance process currently implemented for echocardiographic equipment (ECHO) in a medium-sized laboratory in a tertiary-level public teaching hospital. The description of the process includes damage characterization and MP and MC implementation. Methods: This was a descriptive and exploratory single-center observational study. Data on the maintenance process of echocardiographic equipment were obtained from electronic files from the hospital's equipment management system between 2003 and 2018. Results: Together with the description of the equipment maintenance process, the ten most common types of malfunctions were identified, including software (23.8%), parts (23.1%), and power outage and accessory damage (13.8%). The implementation of the PM process significantly decreased the maintenance costs (USD 44,472.10 vs USD 25,807.59, p = 0.029). Even after the MP, the CM costs related to transesophageal echocardiography equipment (TEE) (USD 7,789.17) were higher than those with other equipment modalities (USD 3,184.37 for transthoracic echocardiography equipment (TTE) and USD 1,813.00 for stress testing). Conclusion: The maintenance process for ECHO equipment was described. ECHO equipment damage has high costs, especially in special modalities such as TEE. PM significantly reduced maintenance costs. (AU)

Utilidad de la ecocardiografía transesofágica en la cirugía de válvula mitral / Usefulness of transesophageal echocardiography in mitral valve surgery / Utilidade do ecocardiograma transesofágico na cirurgia da válvula mitral

El siguiente trabajo detalla un enfoque integral para la evaluación y el manejo intraoperatorio de la cirugía en la válvula mitral. Los avances tecnológicos han hecho de esta técnica un instrumento fundamental en el manejo intraoperatorio de estos pacientes. Las nuevas técnicas quirúrgicas de reparación de la válvula mitocondrial han determinado que el abordaje ecotransesofágico bi-dimensional se ha convertido en un examen de rutina, sin embargo, el advenimiento del ultrasonido tridimensional (3D) nos ha permitido aprender más sobre la anatomía funcional de la regurgitación de la válvula mitral, el mecanismo fisiopatológico predominante, y realizar evaluaciones en tiempo real de los resultados de una reparación o reemplazo quirúrgico. Estas contribuciones han contribuido a la capacidad de toma de decisiones de los equipos quirúrgicos, resultando en una mayor tasa de éxito para la reparación de la válvula mitral y una reducción de las complicaciones quirúrgicas.

The following work details an integral approach to the evaluation and intraoperative management of surgery on the mitral valve. Advances in technology have made this technique a fundamental instrument in the intraoperative management of these patients. The new surgical techniques of mitochondrial valve repair have determined that the bi-dimensional ecotransesophageal approach has become a routine examination, however, the advent of three-dimensional ultrasound (3D) has allowed us to learn more about the functional anatomy of the mitral valve's regurgitation, the predominant pathophysiological mechanism, and to conduct real-time evaluations of the results of a surgical repair or replacement. These contributions have contributed to surgical teams' decision-making capabilities, resulting in a greater success rate for mitral valve repair and a reduction of surgical complications.

O seguinte trabalho, faz uma abordagem integral da avaliação e manipulação intraoperatória da cirurgia na valva mitral. Os avanços na tecnologia tem feito dessa técnica um instrumento fundamental na manipulação intraoperatória desses pacientes. As novas técnicas cirúrgicas de reparação valvar mitral determinaram que a ecocardiografía transesofágica bidimensional tornou se um exame de rotina, no entanto o ultrassom tridimensional (3d) nos permitiu saber mais sobre a anatomia funcional da valva mitral, o mecanismo fisiopatológico predominante, assim como a avaliação em tempo real dos resultados da reparação ou substituição cirúrgica. Essas contribuições tem contribuído para a toma de decisões da equipe cirúrgica resultando numa maior taxa de sucesso de plastias da válvula mitral, assim como uma redução nas complicações cirúrgicas.

Produção Científica Sobre Ecocardiografia Transesofágica por Países Ibero-Americanos / Scientific Output on Transesophageal Echocardiography from Iberoamerican Countries

Fundamento: A ecocardiografia transesofágica (ETE) tem atraído grande atenção e está se tornando um campo científico importante e rapidamente crescente. Objetivo: Analisar a contribuição e as características das publicações científicas sobre ETE na Ibero-América. Métodos: Uma pesquisa bibliográfica foi realizada no PubMed (US National Library of Medicine National Institutes of Health) para identificar publicações científicas sobre ETE indexadas até 1º de maio de 2015. Os termos utilizados na pesquisa bibliográfica incluíram "ecocardiografia transesofágica", "ecocardiograma transesofágico", ecocardiografia transesofágica 3D" e "ecocardiografia tridimensional". Esses termos foram vinculados a cada país ibero-americano. Dados adicionais sobre as revistas de cada publicação científica foram obtidos a partir do SCImago Journal & Country Rank. Resultados: A Ibero-América originou 4% de todas as publicações sobre ETE. O número de publicações da Ibero-América aumentou de zero antes de 1990 a 60 em 2015. A Espanha, o México e o Brasil originaram 75% de todas as publicações da região. Cerca de 30% dos textos completos eram de acesso livre. A maioria das publicações científicas era em inglês. Cerca de 90% das publicações eram relatos de casos ou séries de casos sobre endocardite infecciosa, tumores ou massas cardíacas, doença cardíaca congênita, fontes cardioembólicas de acidente vascular cerebral e cardiologia intervencionista invasiva. A Espanha e a Argentina foram os países que originaram manuscritos com maior probabilidade de serem publicados em revistas estrangeiras. Cerca de 40% das publicações ibero-americanas foram em revistas classificadas no quartil superior das revistas científicas em seu respectivo campo. Conclusões: A produção científica sobre ETE na Ibero-América é limitada, mas vem aumentando. O número e as características das publicações sobre ETE mostram diferenças notáveis entre os países ibero-americanos. (Int J Cardiovasc Sci. 2016;29(6):422-430)

Transesophageal echocardiography (TEE) has attracted great attention and is becoming an important, rapid­progressing scientific field. Objective: To analyse the contribution and characteristics of scientific publications on TEE from Iberoamerica. Methods: A literature search was conducted in PubMed (US National Library of Medicine National Institutes of Health) to identify scientific publications on TEE indexed before May 1, 2015. Terms used for the literature search included "transesophageal echocardiography", "transesophageal echocardiogram", "3D transesophageal echocardiography", and "three­dimensional echocardiography". These terms were combined with each Iberoamerican country. Additional data from the journal of each scientific publication were obtained from the SCImago Journal & Country Rank. Results: Iberoamerica originated 4% of all publications on TEE. The number of publications from Iberoamerica increased from zero before 1990 to 60 in 2015. Spain, Mexico, and Brazil originated 75% of all publications from the region. About 30% of full­texts were freely available. Most of the scientific publications were in English. About 90% of the publications were case reports or case series about infectious endocarditis, tumors or cardiac masses, congenital heart disease, cardioembolic sources of stroke, and invasive interventional cardiology. Spain and Argentina were the countries that originated manuscripts with a higher likelihood of being published in foreign journals. About 40% of Iberoamerican publications were in journals ranked in the top 25% of scientific journals in their field. Conclusions: The scientific production on TEE from Iberoamerica is limited, but is increasing. The number and characteristics of publications on TEE show notable differences between Iberoamerican countries.

Placas protruyentes de la aorta torácica en el ecocardiograma transesofágico: características clínicas y ecográficas / Protruding plaques of the thoracic aorta in the transesophageal echocardiography: clinical and echographic features

Transesophageal echocardiography has a better sensitivity than conventional echocardiography for the detection of protruding atheroesclerotic plaques of the thoracic aorta. Clinical histories of 308 patients subjected to transesophageal echocardiography were reviewed. Subjects with protruding aortic plaques >0,5 cm were selected. Fifteen patients had protruding aortic plaques on transesophageal echocardiography and none of these were detected with conventional echocardiography. All these patients were in sinus rhythm and had high blood pressure. Ten subjects (67 percent) had a history of ischemic cerebrovascular or peripheral artery diseases (compared to 31 percent of subjects without protruding plaques) and in 7, the plaque was the only embolic source. Six patients (40 percent), smoked and 4 (27 percent) had coronary artery disease. One patient was diabetic and one had hypercholesterolemia. In conclusion, transesophageal echocardiography allows the detection of protruding aortic plaques that are potential embolic sources in patients with vascular diseases

Endocarditis infecciosa / Infective endocarditis

Cuando se compara con la caracterización de la EI en los '70 y a principios de los '80, parece que es más probable que en los '90 la EI se presente en forma aguda y asociada con menos estigmas clásicos y también es más probable que el agente etiológico sea S. aureus. Si esto representa un verdadero cambio clínico y microbiológico en el espectro de la enfermedad o es el resultado de informes con un efecto de sesgo, en este momento resulta poco claro. La posibilidad para designar un caso definitivamente como EI desde un punto de vista clínico ha mejorado con la utilización de nuevos criterios diagnósticos, entre ellos los hallazgos de la ecocardiografía bidimensional en el esquema de clasificación. Estos nuevos criterios han sido confirmados en poblaciones seleccionadas de pacientes, no obstante habría que confirmarlos en otros grupos de pacientes en riesgo de padecer EI (v.g. receptores de válvulas protésicas). La ecocardiografía bidimensional es la técnica no invasiva de elección para la EI vegetante definida. La ETE es significativamente más sensible para poder identificar vegetaciones valvulares que la ETT y también representa el método de elección para detectar complicaciones perianulares en la EI. Queda todavía ser aclarado cuál es el papel de la evaluación del flujo Doppler en la insuficiencia valvular de la EI. Los esquemas con cursos cortos (2 semanas) de un ß-lactámico más un aminoglucósido, parecen ser altamente efectivos en el tratamiento de la EI derecha por S. aureus. El empleo de vancomicina para el tratamiento de la EI por S. aureus continúa siendo cuestionada debido a informes que hablan de una respuesta lenta y subóptima en los resultados al tratamiento