Primera resonancia magnética gestionada por cardiología en la red sanitaria pública española: experiencia y dificultades de un modelo innovador / First magnetic resonance managed by a cardiology department in the Spanish Public Healthcare System. Experience and difficulties of an innovative model

La resonancia magnética (RM) es la técnica considerada de referencia para evaluar la morfología, función, perfusión y viabilidad miocárdica, y su principal limitación es su escasa disponibilidad. En 2014 se implantó la primera RM gestionada por un servicio de cardiología de un hospital de la red sanitaria pública española con el objetivo de mejorar el proceso asistencial, formativo e investigador del servicio. En el periodo analizado, desde julio de 2014 a mayo de 2017, se realizaron 3.422 RM cardiacas (32 min/estudio, el 96% de buena calidad, el 75% con medio contraste). Las miocardiopatías (29%) y la cardiopatía isquémica (12%) fueron las indicaciones asistenciales más frecuentes. El 25% de los estudios correspondieron a protocolos de investigación. En los pacientes ambulatorios, predominaron los estudios de seguimiento, y en los ingresados, las valoraciones previas a intervención terapéutica. En el campo de la cardiopatía isquémica, la RM cardiaca modificó el diagnóstico de sospecha de hasta el 20% de los pacientes. La instalación y gestión del equipo de RM en un servicio de cardiología ha permitido integrar esta técnica en el día a día de los profesionales, modificar los protocolos asistenciales, optimizar la accesibilidad de esta tecnología para los pacientes cardiológicos, mejorar la formación y desarrollar la investigación

Magnetic resonance (MR) is considered the gold standard in the assessment of myocardial morphology, function, perfusion, and viability. However, its main limitation is its scarce availability. In 2014, we installed the first MR scanner exclusively managed by a cardiology department within the publicly-funded Spanish healthcare system with the aim of improving patient-care, training and research in the department. In the time interval analyzed, July 2014 to May 2017, 3422 cardiac MR scans were performed (32 minutes used per study; 96% with good quality; 75% with contrast media administration). The most prevalent clinical indications were cardiomyopathy (29%) and ischemic heart disease (12%). Twenty-five percent of studies were conducted in the context of research protocols. Follow-up studies predominated among outpatients, while pretherapeutic assessment was more common in hospitalized patients. The presumptive diagnosis was changed by cardiac MR scanning in up to 20% of patients investigated for ischemic heart disease. The installation and operative management of an MR scanner in our cardiology department has allowed us to integrate this technique into daily clinical practice, modify our clinical protocols, optimize access to this technology among cardiac patients, improve training, and conduct clinical research

First Magnetic Resonance Managed by a Cardiology Department in the Spanish Public Healthcare System. Experience and Difficulties of an Innovative Model.

Magnetic resonance (MR) is considered the gold standard in the assessment of myocardial morphology, function, perfusion, and viability. However, its main limitation is its scarce availability. In 2014, we installed the first MR scanner exclusively managed by a cardiology department within the publicly-funded Spanish healthcare system with the aim of improving patient-care, training and research in the department. In the time interval analyzed, July 2014 to May 2017, 3422 cardiac MR scans were performed (32minutes used per study; 96% with good quality; 75% with contrast media administration). The most prevalent clinical indications were cardiomyopathy (29%) and ischemic heart disease (12%). Twenty-five percent of studies were conducted in the context of research protocols. Follow-up studies predominated among outpatients, while pretherapeutic assessment was more common in hospitalized patients. The presumptive diagnosis was changed by cardiac MR scanning in up to 20% of patients investigated for ischemic heart disease. The installation and operative management of an MR scanner in our cardiology department has allowed us to integrate this technique into daily clinical practice, modify our clinical protocols, optimize access to this technology among cardiac patients, improve training, and conduct clinical research.

Postoperative recurrence of postinfarction true and false ventricular aneurysms.

Progressive dyspnea after myocardial infarction can suggests the presence of left ventricular (LV) dysfunction or a left ventricular aneurysm (LVA). Surgical treatment of LVA aims to reduce its volume and to restore the ventricle. Recurrence of LVA after previous repair is extremely rare and the occurrence of concomitant postoperative true and false aneurysms is extraordinary. Surgery is usually challenging because of LV dysfunction and cardiac adherences in reoperations. We describe the simultaneous occurrence in a patient of a recurrent true and false LVA after surgical repair of a postinfarction LVA. Five years postoperatively, the patient remains alive and healthy.

Utility of Real-Time 3-Dimensional Transesophageal Echocardiography in the Assessment of Mitral Paravalvular Leak.

BACKGROUND: Mitral paravalvular leak (PVL) is a potential complication of surgical valve replacement procedures. Real-time 3D transesophageal echocardiography (RT-3DTEE) has emerged as an efficient tool for providing essential information about the anatomy of mitral PVLs compared with 2DTEE findings. The purpose of this study was to evaluate the utility of RT-3DTEE in the assessment of mitral PVLs. METHODS AND RESULTS: The 3D characteristics of PVLs were recorded and compared with 2D findings. We included 34 consecutive patients with clinical suspicion of mitral PVL in the study. Mitral PVLs were detected in 26 patients (76%); 26 PVLs were identified by 2DTEE and 37 by RT-3DTEE. Moderate or severe mitral regurgitation was present in 23 patients (88%). The most common PVL locations were the septal and posterior regions. The median PVL size measured by RT-3DTEE was 7 mm long×4 mm wide. The median vena contracta of defect measured by 2DTEE and RT-3DTEE was 5 mm and 4 mm, respectively. The median effective regurgitant orifice area of defect measured by RT-3DTEE was 0.36 cm(2). The defect types were "oval" (54%), "round" (35%), "crescentic" (8%) and highly irregular (3%). CONCLUSIONS: Compared with 2DTEE, RT-3DTEE provided detailed descriptions of the number, location, size and morphology of PVLs, which is essential for planning and guiding the potential corrective techniques. (Circ J 2016; 80: 738-744).