Álvaro Beltrán

Clinical utility of low dose dobutamine echocardiography in regional myocardial viability detection before and after surgical revascularization.

Seventy‐eight consecutive patients (mean 63 ± 10 years, 79.5% men) with a history of myocardial infarction and indication of coronary artery bypass grafting (CABG) were studied with low dose dobutamine stress echocardiography (DSE) before (DSE 1) and at 3‐month follow‐up (DSE 2) to evaluate its clinical utility in the detection of viable myocardium. We determined the expected utilities of global patients (P; n = 67) and coronary territories (T; n = 126) with the classic strategy: DSE 1 and results of a rest follow‐up echocardiogram (REST 2) and applying them to a complementary strategy that submitted false positives (Fp) and false negatives (Fn) results to DSE 2. Assigned utilities in each node of the decision tree were maximal (1.0), submaximal (0.75), and intermedium (0.50) using the folding method as a mathematical model. Results: Global P and T expected utilities when performing DSE 1 were 0.84 and 0.89, respectively for positive viability; 0.85 and 0.82, respectively; and for negative viability 0.83 and 0.82, respectively. The expected utilities with the decision of performing a DSE 2 to Fp were 0.74 and 0.76, respectively (viability was detected in 66% of P and in 58% of T) and 0.47 and 0.45, respectively, as applied to Fn. Conclusions: Low dose DSE results in high clinical utility by finding viable or scar myocardium before CABG as well as when discordant results are found in follow‐up, particularly with Fp.

Guías de acreditación en ecocardiografía del adulto y del laboratorio de ecocardiografía de la Asociación de Ecocardiografía de la Sociedad Interamericana de Cardiología (ECOSIAC)

Grupo de Trabajo sobre Acreditacion de la Asociacion de Ecocardiografia dela Sociedad Interamericana de Cardiologia (ECOSIAC):(1) Departamento de Cardiologia No Invasiva. Clinica Medellin, Medellin,Colombia.(2) Cardiodiagnostico Investigaciones Medicas, Buenos Aires, Argentina.(3) Laboratorio de Ecocardiografia, Hospital Bernardette. Guadalajara, Jalisco, Mexico.(4) Hospital «Santa Cruz» CPS. «Diagnosis» Instituto de Medicina. Santa Cruz, Bolivia.(5) Instituto do Coracao, Universidade de Sao Paulo. Hospital Israelita AlbertEinstein. SP, Brasil.(6) Laboratorio de Ecocardiografia, Hospital Aeronautico Central. FuerzaAerea Argentina. Buenos Aires, Argentina.(7) Laboratorio de Cardiologia. Hospital Clinico. Pontificia UniversidadCatolica de Chile. Santiago, Chile.(8) Laboratorio de Ecocardiografia, Casa de Galicia. Servicio de Ecocardio-grafia Cardiaca. Montevideo, Uruguay.(9) Director Laboratorio de Ecocardiografia, Instituto Nacional de CirugiaCardiaca. Montevideo, Uruguay.(10) Clinica Limatambo. Lima, Peru.Correspondencia: Dr. Gustavo Restrepo Molina. Correo electronico:gustavorestrepomd@une.net.coRecibido: 04/05/2010. Aceptado: 25/08/2010..

Transesophageal Echocardiographic Diagnosis of a Congenital Circumflex Coronary Artery to Coronary Sinus Fistula in an Adult

We report a congenital circumflex coronary artery to coronary sinus arteriovenous fistula diagnosed by transesophageal echocardiography in a 38‐year‐old asymptomatic male. The coronary arteriovenous fistula was suggested by two‐dimensional transthoracic color Doppler. A first nondiagnostic angiography was performed, and it was during the second one, that the fistula could finally be visualized after a special dye technique was used. The high fistula flow rate prevented us from seeing it with regular dye concentration. Transesophageal echocardiography was precise in the anatomical and hemodynamic evaluation and it was essential in guiding the angiographic examination and surgical repair.