Serviços de ecocardiografia no Brasil: uma visão geral / General profile of echocardiography services in Brazil

Introdução: Devido a um crescimento cada vez maior do número de ecocardiografistas no Brasil, assim como dos serviços de ecocardiografia, tornou-se importante compreender o status quo dessa área de atuação em nosso país.Objetivo: Visualizar um perfil acurado dos serviços ecocardiográficos oferecidos no Brasil.Métodos: Realizou-se por meio da internet uma pesquisa com os sócios ecocardiografistas do Departamento de Imagem Cardiovascular (DIC), respondendo questões específicas sobre infraestrutura, serviços disponibilizados, número de exames, treinamento e formação profissional.Resultados: Dentre os 429 centros participantes, foram computados apenas aqueles que responderam completamente ao questionário (n = 157). Desses, 55 são centros formadores em ecocardiografia e a maioria está localizada na Região Sudeste. Observou-se que 146 serviços (93%) possuem ao menos um profissional habilitado em ecocardiografia pelo Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia.Conclusão: A maioria dos centros de ecocardiografia do Brasil possui profissionais qualificados e habilitados para realização do método.

[Use of transesophageal echocardiography during implantation of aortic endoprosthesis (stent). Initial experience].

OBJECTIVE: To report the role played by transesophageal echocardiography during implantation of self-expanding aortic endoprostheses (stent) at a hemodynamics laboratory. METHODS: Thirteen patients underwent stent implantation in the descending thoracic aorta with the aid of transesophageal echocardiography during the entire procedure. Indications for stenting were as follows: 8 aortic dissections, 2 true aneurysms, 2 penetrating atherosclerotic ulcers, and 1 traumatic pseudoaneurysm. RESULTS: No complications resulting from the use of transesophageal echocardiography were observed. In 12 patients, the initial result was considered appropriate, with total or partial resolution of the major lesion confirmed by a posterior examination. In 1 patient, the procedure was suspended after transesophageal echocardiography and angiography showed that the proximal aortic diameter was inappropriate. Transesophageal echocardiography contributed to clarifying relevant points, such as aortic diameter, anatomic detail of the intimal lesion, and location and size of the communicating orifice. In addition, it facilitated placing the stent in the target lesion, reduced the time of exposure to radiation and the use of contrast medium, and provided rapid identification of intercurrent events, possibly reducing the total duration of the procedure. CONCLUSION: The use of transesophageal echocardiography during placement of aortic stents seems appropriate. The actual advantages of the procedure will be defined in a comparative prospective study.

Is the number of microembolic signals related to neurologic outcome in coronary bypass surgery?

Coronary artery bypass surgery (CABG) without cardiopulmonary bypass (CPB) may potentially reduce the number of microembolic signals (MES) associated with aortic manipulation or generated by the pump circuit, resulting in a better neurologic outcome after surgery. Our aim was to compare the frequency of MES and neurologic complications in CABG with and without CPB. Twenty patients eligible to routine CABG without CPB were randomized to surgery with CPB and without CPB and continuously monitored by transcranial Doppler. Neurologic examination was performed in all patients before and after surgery. The two groups were similar with respect to demographics, risk factors, grade of aortic atheromatous disease and number of grafts. The frequency of MES in the nonCPB group was considerably lower than in CPB patients, however, we did not observe any change in the neurologic examination during the early postoperative period. Neurologic complications after CABG may be related to the size and composition of MES rather than to their absolute numbers. A large prospective multicentric randomized trial may help to elucidate this complex issue.

[Quantification of mitral prosthesis failure by different methods of evaluation by transesophageal echocardiography]. / Quantificação de insuficiência protética mitral por diferentes métodos de avaliação pela ecocardiografia transesofágica.

PURPOSE: To evaluate the different methods for grading mitral regurgitation (MR) by transesophageal echocardiography (TEE) in patients with clinical suspicion of mitral prosthesis dysfunction. METHODS: Cardiac catheterization (Cath) was performed in 15 patients for grading the severity of prosthetic MR, divided in two groups based on the presence or absence of severe MR. Prosthetic MR was quantified by TEE using methods commonly used for MR of native valves: subjective assessment by color Doppler, objective assessment based on absolute jet area and on its relative area (jet area/left atrial area) and assessment based on the presence of systolic flow reversal in pulmonary vein. RESULTS: Prosthetic MR was mostly transprosthetic (14 patients) and eccentric (11 patients). There was significant correlation (p < 0.05) between Cath and TEE for identification of severe MR based on subjective assessment and on the presence of systolic flow reversal in pulmonary vein. Identification based on absolute (jet area > 7 cm2) and relative (jet area > 35% of left atrial area) jet areas did not reveal significant correlation with the angiographic grade and showed clear underestimation by TEE when the last method was used. However, there was good correlation (p < 0.05) if relative jet areas > 30% were considered as cut point. CONCLUSION: TEE correctly identified angiographic severe mitral prosthesis regurgitation, mainly by the presence of systolic flow reversal in pulmonary vein and subjective assessment. The estimation of severity of the prosthetic MR by absolute or relative jet area seems to be limited and should be used with caution due to eccentricity of the regurgitant jet, frequently seen in mitral prosthesis dysfunction.

Coração de atleta em desportistas deficientes de elite / Athlete's heart elite disable athletes

OBJETIVO - Verificar a prevalência de sinais de "coração de atleta" em desportistas deficientes para-olímpicos. MÉTODOS - Avaliação clínica, eletrocardiográfica, ecocardiográfica, vetocardiográfica, ergométrica em 75 atletas, 27ñ6,7 anos, 56 homens, várias modalidades; com deficiência física (47), visual (12) e paralisia cerebral (16). RESULTADOS - Sinais de coração de atleta ocorreram em 33 'por cento' dos exames clínicos (sopros e estalidos), em 55 'por cento' dos eletrocardiogramas (bradicardia, bloqueio incompleto de ramo direito, sobrecargas, alteraçöes de onda T), em 15 'por cento' dos vetocardiogramas (sobrecargas), em 5 'por cento' dos ecocardiogramas (dimensöes cavitárias acima do habitual). Os sinais ocorreram em 51 'por cento' dos atletas, sendo que em 46 'por cento' dos casos havia 2 ou mais sinais e, em 12 'por cento', 4 ou mais sinais. O TE foi normal em 77 'por cento' dos atletas; não houve ST isquêmico. Em 23 'por cento' dos casos houve bloqueio divisional direito. CONCLUSÄO - Foram encontrados dois ou mais sinais de coração de atleta em 46 'por cento' dos atletas deficientes para-olímpicos.

[Athlete's heart in elite disabled athletes]. / Coração de atleta em desportistas deficientes de elite.

PURPOSE: To assess the prevalence of the athlete's, heart syndrome in elite disabled Brazilians athletes. METHODS: Seventy-five athletes, age 27.8 +/- 6.7 years, 56 men, with various disabilities (47 physical, 12 visual and 16 cerebral paralysis) underwent clinical, electrocardiographic, vectorcardiographic, ergometric and echocardiographic evaluations. RESULTS: Athlete's heart signs occurred in 33% of the clinical evaluations, in 55% of the electrocardiograms, in 15% of the vectorcardiograms, and in 5% of the echocardiograms. At least one of these signs was presented in 51% of the athletes. There were 2 or more abnormalities in 46% of the athletes and 4 or more signs in 12%. Exercise test was considered not ischemic in 77% of the subjects. There was right bundle branch block in 23% of the tests. CONCLUSION: There were two or more athlete's heart syndrome signs in 46% of Brazilian disabled athletes.