RESUMO
La ecocardiografía transesofágica (ETE) es una herramienta fundamental en el intraoperatorio y postoperatorio de cirugía cardiaca con una gran difusión en los últimos años. El objetivo de este trabajo es conocer la situación actual de la ETE en el ámbito de la anestesiología en cirugía cardiaca en España a través de una encuesta nacional que explora la disponibilidad de equipos, indicación y utilización de dicha técnica, así como la formación y acreditación de los profesionales responsables. Los hallazgos muestran que en España la ETE intraoperatoria es parte integral de los procedimientos cardiovasculares hoy en día y en la mayor parte de los centros es realizada por anestesiólogos altamente involucrados en este tipo de cirugías. A pesar de la ausencia de formación estructurada en el currículum formativo de nuestra especialidad, los anestesiólogos adquieren las competencias mediante rotaciones específicas de corta duración y un alto porcentaje de ellos ha obtenido la acreditación oficial
Transesophageal echocardiography (TEE) is an essential tool in the intraoperative and postoperative period of cardiac surgery with recently wide diffusion. We aimed to know the current situation of TEE in the field of cardiovascular anesthesiology in Spain through a national survey that explores the availability of equipment, indication and use of this technique as well as the training and accreditation of professionals involved. The findings show that in Spain intraoperative TEE is an integral part of cardiovascular procedures today and in most centers it is performed by anesthesiologists highly involved in this type of surgery. Despite the absence of structured training in the curriculum of our specialty, anesthesiologists acquire the skills through specific short-term rotations and a high percentage of them have obtained official accreditation
Assuntos
Humanos , Monitorização Intraoperatória/métodos , Procedimentos Cirúrgicos Cardíacos , Pesquisas sobre Atenção à Saúde , Período Intraoperatório , Ecocardiografia , EspanhaRESUMO
Transesophageal echocardiography (TEE) is an essential tool in the intraoperative and postoperative period of cardiac surgery with recently wide diffusion. We aimed to know the current situation of TEE in the field of cardiovascular anesthesiology in Spain through a national survey that explores the availability of equipment, indication and use of this technique as well as the training and accreditation of professionals involved. The findings show that in Spain intraoperative TEE is an integral part of cardiovascular procedures today and in most centers it is performed by anesthesiologists highly involved in this type of surgery. Despite the absence of structured training in the curriculum of our specialty, anesthesiologists acquire the skills through specific short-term rotations and a high percentage of them have obtained official accreditation.
RESUMO
La ecocardiografía transesfofágica es una técnica semiinvasiva que permite una evaluación de la morfología y función cardiaca a tiempo real y que constituye, a día de hoy, un estándar de calidad en las intervenciones de cirugía cardiovascular. Se ha convertido en una herramienta fundamental tanto de monitorización como de diagnóstico en el perioperatorio que permite la correcta planificación quirúrgica y manejo farmacológico dirigido. El objetivo de este documento es dar respuesta de forma consensuada y avalada por la evidencia científica de cuándo y cómo debe hacerse la ecocardiografía transesfofágica intraoperatoria en cirugía cardiovascular, qué aplicaciones tiene en el intraoperatorio, quién debe realizarla y cómo debe transmitirse la información obtenida durante el estudio. Los autores han hecho una revisión sistemática de las guías internacionales, artículos de revisión y ensayos clínicos para dar respuesta a estas preguntas
Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions
Assuntos
Humanos , Ecocardiografia Transesofagiana/métodos , Procedimentos Cirúrgicos Cardiovasculares/métodos , Monitorização Intraoperatória/métodos , Monitorização Hemodinâmica/métodos , ConsensoRESUMO
Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions.
RESUMO
A 71-year-old man presented stable angina due to severe coronariophaty and chronic atrial fibrillation. A radial approach for atrial fibrillation and three coronary artery bypass grafts were performed without cardiopulmonary bypass. The procedure for the arrhythmia ablation was done epicardially with a multipolar radiofrequency catheter. Intraoperatively, the patient regained normal sinus rhythm, with an uneventful postoperative course. Postoperative echocardiography demonstrated the presence of an atrial A wave.
Assuntos
Fibrilação Atrial/cirurgia , Ponte de Artéria Coronária/métodos , Isquemia Miocárdica/cirurgia , Idoso , Cardioversão Elétrica , Circulação Extracorpórea , Humanos , MasculinoRESUMO
BACKGROUND: Atrial fibrillation is frequently observed under conditions associated with atrial dilatation. Atrial size is a factor related to the genesis and maintenance of atrial fibrillation. Predictive parameters of persistence of atrial fibrillation after maze procedure are atrial size and long duration of atrial fibrillation. The aim of this study was to investigate the effects of surgical left atrial reduction in chronic atrial fibrillation by mitral valvulopathy. PATIENTS AND METHOD: nineteen patients with chronic atrial fibrillation and dilated left atrium undergoing mitral valve procedures were included in this prospective study: group I with left atrial reduction (10 patients) and group II including control (9 patients). Both groups were with similar preoperative characteristics. RESULTS: At the mean follow-up of 12 months, all the patients in group II had chronic atrial fibrillation, and 7 patients in group I showed in atrial rhythm (p < 0.003). The patients in whom atrial fibrillation continued after surgery showed left atrial area of 33.8 +/- 12.3 cm2 and a volume of 98.5 +/- 53.9 ml; and the patients with normal rhythm had a left atrial area of 24.5 +/- 5.3 cm2 and a volume 60.3 +/- 21.2 ml. CONCLUSIONS: Preliminary results indicate that surgical left atrial reduction in patients with chronic atrial fibrillation may be a mechanism implicated in the elimination of arrhythmia after surgery.
Assuntos
Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Insuficiência da Valva Mitral/complicações , Adulto , Idoso , Fibrilação Atrial/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Prosthetic valve endocarditis remains as one of the most life-threatening complication of valve replacement surgery. Homografts are the valve of choice with a lower early risk of endocarditis than other valve substitutes, however they are not always available. Recently a new prosthesis has been introduced with a silver-coated sewing cuff (St. Jude Medical with Silzone coating). Silver is an antimicrobial agent that has been proven to reduce bacterial colonization. We present the case of a 48-year-old man with an early prosthetic valve endocarditis which affected an aortic stentless prosthesis. He was successfully treated with a silver-coated prosthesis. Indications for surgery and the use of this prosthesis as a valuable option in this disease entity are discussed. Although the present patient is an isolated case, the interest of this article is the encouraging result obtained with this new prosthesis for this serious complication. Moreover, the clinical experience is reduced with only a few reports in the literature.
Assuntos
Anti-Infecciosos , Valva Aórtica , Materiais Revestidos Biocompatíveis , Endocardite Bacteriana/etiologia , Próteses Valvulares Cardíacas , Infecções Relacionadas à Prótese/etiologia , Prata , Endocardite Bacteriana/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Infecções Relacionadas à Prótese/cirurgiaRESUMO
Cardiac tamponade is a life-threatening complication after cardiac surgery which may develop in the early or late postoperative period. The latest have been defined arbitrarily as the ones occurring after the 7th postoperative day. They are less common than the early ones and most of the cases have been reported up to six months after the operation. They usually determine diagnostic difficulties that can negatively influence the prognosis. Because of its atypical late appearance, a case of a 65 year old man is presented who developed a postpericardiotomy syndrome and subsequently a pericardial clot nearly two years after aortocoronary bypass grafting.
