Mitral and aortic valve aneurysms secondary to infective endocarditis: impressive images of a rare echocardiographic finding.

Mitral and aortic valve aneurysms are uncommon, but the coexistence of both mitral and aortic valve aneurysms in the same patient is a rather unusual finding in the literature. We report a rare clinical case of a patient with both mitral and aortic valve aneurysms and a rupture of the mitral valve aneurysm, as the main echocardiographic manifestations of infective endocarditis. This clinical case emphasizes infective endocarditis as the most frequent cause of valve aneurysms, reminding that this diagnosis should be suspected even in the absence of vegetations. This case demonstrates that transoesophageal echocardiography plays a major role on diagnosis of valve aneurysms, revealing the rupture of the mitral valve aneurysm and defining this rupture as the main mechanism of mitral valve regurgitation. This case also underlines the role of transoesophageal echocardiography on management decisions, allowing a morphological evaluation of the mitral valve and selection of the appropriate surgical strategy.

Validação da escala Nurse-Parent Support Tool para a cultura portuguesa: Confiabilidade e validade / Validation of the Nurse-Parent Support Tool scale for Portuguese culture: Reliability and validity / Validación de la escala Nurse-Parent Support Tool para la cultura portuguesa: Fiabilidad y validez

Resumo Enquadramento: A avaliação da perceção dos pais de crianças hospitalizadas sobre o apoio dos enfermeiros constitui um contributo para aferir a qualidade dos cuidados de enfermagem pediátricos. Objetivo: Concluir o processo de Adaptação Cultural e Validação da Nurse-Parent Support Tool (NPST) para a realidade portuguesa, avaliando a confiabilidade e validade. Metodologia: Estudo metodológico quantitativo, com uma amostra de 291 pais de crianças hospitalizadas. As propriedades psicométricas do instrumento foram aferidas, avaliando a confiabilidade, através do cálculo do coeficiente do alfa de Crohnbach, e a validade de construto, pela análise fatorial exploratória, com rotação Varimax. Resultados: A NPST apresenta características psicométricas apropriadas à população portuguesa, de pais de crianças hospitalizadas (alfa de Cronhbach 0,925), garantindo-lhe a confiabilidade e validade para medir o apoio dado pelos enfermeiros. Conclusão: Os resultados demonstraram que a Escala de Apoio dos Enfermeiros aos Pais (EAEP), versão portuguesa da NPST, é um instrumento fiável e válido para avaliar o apoio dos enfermeiros, aos pais da criança hospitalizada e apresenta muito boa consistência interna.

Abstract Background: Assessing the perceptions of parents of hospitalized children about the support provided by nurses can contribute to assessing the quality of pediatric nursing care. Objective: To complete the cultural adaptation and validation of the Nurse-Parent Support Tool (NPST) for the Portuguese population by assessing its reliability and validity. Methodology: Quantitative methodological study, with a sample of 291 parents of hospitalized children. The psychometric properties of the instrument were measured by assessing its reliability using Cronbach's alpha coefficient and its construct validity through exploratory factor analysis with Varimax rotation. Results: The psychometric characteristics of the NPST show that it is appropriate to the Portuguese population of parents of hospitalized children (Cronbach's alpha of 0.925), as well as a reliable and valid tool to measure the support provided by nurses to these parents. Conclusion: The European Portuguese version of the NPST - Escala de Apoio dos Enfermeiros aos Pais (EAEP) - is a reliable and valid instrument with very good internal consistency to assess the support provided by nurses to parents during a child's hospitalization.

Resumen Marco contextual: La evaluación de la percepción de los padres de niños hospitalizados sobre el apoyo de los enfermeros es una contribución para evaluar la calidad de la atención de enfermería pediátrica. Objetivo: Completar el proceso de Adaptación Cultural y Validación del Nurse-Parent Support Tool (NPST) para la realidad portuguesa, evaluando fiabilidad y validez. Metodología: Estudio metodológico cuantitativo, con una muestra de 291 padres de niños hospitalizados. Se midieron las propiedades psicométricas del instrumento, evaluando la fiabilidad mediante el cálculo del coeficiente alfa de Crohnbach y la validez de constructo mediante análisis factorial exploratorio, con rotación Varimax. Resultados: El NPST presenta características psicométricas apropiadas para la población portuguesa de padres de niños hospitalizados (alfa de Cronhbach 0,925), garantizando su fiabilidad y validez para medir el apoyo dado por los enfermeiros. Conclusión: Los resultados mostraron que la Escala de Apoio dos Enfermeiros aos Pais (EAEP), versión portuguesa de NPST, es un instrumento confiable y válido para evaluar el apoyo de las enfermeras, a los padres, durante la hospitalización del niño y tiene muy buena consistencia interna.

Consensus document on transthoracic echocardiography in Portugal. / Documento de Consenso e Recomendações para a realização de Ecocardiografia Transtorácica em Portugal.

Echocardiography is the most widely used imaging technique in modern cardiological clinical practice, since it is readily available, portable and safe, and provides a comprehensive morphological and functional assessment at low cost compared to other imaging modalities. Recent technological advances have introduced new echocardiographic techniques and widened the clinical applications of echocardiography. However, these developments have also led to an increase in information, rendering interpretation of the data provided by the exam more complex; this may result in assessment errors by less experienced operators. Standardization of procedures and training in echocardiography is therefore essential to ensure quality and safety for patients. The present document aims to contribute to this end, recommending quality requirements for operators and echocardiography laboratories in Portugal.

Cirrhotic cardiomyopathy: Isn't stress evaluation always required for the diagnosis?

AIM: To describe the proportion of patients with cirrhotic cardiomyopathy (CCM) evaluated by stress echocardiography and investigating its association with the severity of liver disease. METHODS: A cross-sectional study was conducted. Cirrhotic patients without risk factors for cardiovascular disease were included. Data regarding etiology and severity of liver disease (Child-Pugh score and model for end-stage liver disease), presence of ascites and gastroesophageal varices, pro-brain natriuretic peptide (pro-BNP) and corrected QT (QTc) interval were collected. Dobutamine stress echocardiography (conventional and tissue Doppler imaging) was performed. CCM was considered present when diastolic and/or systolic dysfunction was diagnosed at rest or after pharmacological stress. Therapy interfering with cardiovascular system was suspended 24 h before the examination. RESULTS: Twenty-six patients were analyzed, 17 (65.4%) Child-Pugh A, mean model for end-stage liver disease (MELD) score of 8.7. The global proportion of patients with CCM was 61.5%. At rest, only 2 (7.7%) patients had diastolic dysfunction and none of the patients had systolic dysfunction. Dobutamine stress echocardiography revealed the presence of diastolic dysfunction in more 6 (23.1%) patients and of systolic dysfunction in 10 (38.5%) patients. QTc interval prolongation was observed in 68.8% of the patients and increased pro-BNP levels in 31.2% of them. There was no association between the presence of CCM and liver impairment assessed by Child-Pugh score or MELD (P = 0.775, P = 0.532, respectively). Patients with QTc interval prolongation had a significant higher rate of gastroesophageal varices comparing with those without QTc interval prolongation (95.0% vs 50.0%, P = 0.028). CONCLUSION: CCM is a frequent complication of cirrhosis that is independent of liver impairment. Stress evaluation should always be performed, otherwise it will remain an underdiagnosed condition.

Prosthetic aortic valve: a bone in the system.

We report a case of a 73-year-old female patient admitted to the surgical department for a splenic abscess. She had a history of a mechanical aortic valve implanted two years earlier. During the diagnostic work-up, the patient underwent a transesophageal echocardiogram that revealed the presence of multiple paravalvular abscesses, establishing the diagnosis of prosthetic valve endocarditis. A few days later, the echocardiogram was repeated due to a new-onset systolic-diastolic murmur. A large pseudoaneurysm and significant periprosthetic regurgitation were now noted and the patient was referred for cardiac surgery. The microbiologic exam revealed the presence of Streptococcus milleri, usually found in the gastrointestinal flora and a known pathogenic agent of endocarditis. Interestingly, the patient had had a foreign body (bone fragment) removed from her esophagus a few weeks earlier, which was the probable portal of entry for this infective endocarditis.

Clinical trial of a self-etching adhesive for sealant application: success at 24 months with Prompt L-Pop.

PURPOSE: To evaluate the 2-year clinical sealant success when using Prompt L-Pop (3M-ESPE), the first self-etching adhesive, as the sole etching and adhesive step prior to sealant placement. METHODS: Patients ages 7-13 years with matched pairs of permanent molars needing sealants were enrolled into an ongoing clinical study of sealant success. First and/or second permanent molars were randomly assigned to control (sealant only after phosphoric acid etch) or Prompt plus sealant groups in a split-mouth, matched pair study design. Standard methods were used for sealant (Delton, Dentsply) placement, except for the Prompt group in which the self-etching adhesive was brushed on the surface, air thinned, followed by immediate placement of the sealant and polymerization. All sealants were placed using appropriate cotton-roll isolation and a dental assistant. Sealant scoring was done at 24 months using strict clinical criteria for failure, previously published, and photos of the sealed surfaces were archived on video. RESULTS: Percentages of sealants scored as successful (no significant loss of material or need for repair) through 24 months were: (a) Occlusal sealants: Control = 61%, versus Prompt = 61%; (b) Bu/Lingual sealants: Control = 54%, versus Prompt = 62%; McNemar's Chi Square tests indicate no difference in success between the Prompt sealants and their matched controls (P > 0.80). Time of placement for sealants, timed from start of the etch step through polymerization, averaged 3.1 minutes for Control and 1.8 minutes for Prompt. We conclude that Prompt L-Pop self-etching adhesive is effective in bonding sealant to enamel and that the simplified method dramatically shortens treatment time and treatment complexity.

Use of an implantable loop recorder: initial experience.

OBJECTIVE: Retrospective analysis of the initial experience at our department with an implantable loop recorder (ILR) for the evaluation of patients with recurrent syncope, palpitations or dizziness. METHODS: We studied ten patients aged 31-65 (52.3) years referred to our center after an inconclusive evaluation that included ECG, Holter monitoring, events recorder, stress test, echocardiogram and electrophysiological study. Seven patients had structural heart disease. We used a Reveal Plus (Medtronic, USA) ILR, which allows up to 41 minutes of electrocardiographic recording, over a period of 24 months, patient or device activated, according to the programmed parameters. Follow-up was scheduled every three months or after every event activated by the patient. Symptoms and recorded events were analyzed. RESULTS: Eight patients activated events, out of a total of 45 episodes, and five patients reported two or more symptoms. Dizziness was reported by five patients (24 episodes), palpitations by three (seven episodes), syncope by three (seven episodes) and nonspecific symptoms by five patients (seven episodes). The first symptom occurred between the twelfth day and the sixth month after implantation. Four episodes (three syncope and one dizziness) occurred with significant AV conduction disturbance (complete or high grade AV block) and in 41 episodes no rhythm or AV disturbance was recorded. Thirty events were automatically activated. There were no device-related complications. None of the patients died during follow-up.