Edgar Lira-Filho

Importance of adequately performed Valsalva maneuver to detect patent foramen ovale during transesophageal echocardiography.

BACKGROUND Transesophageal echocardiography (TEE) plays an important role in evaluating cardioembolic sources of emboli. The identification of a patent foramen ovale (PFO) is reportedly improved with TEE compared with transthoracic echocardiography (TTE), but the Valsalva maneuver during TEE may be difficult or suboptimal. The aim of this study was to assess the efficacy of the Valsalva maneuver for PFO diagnosis using TEE compared with TTE by evaluating patients with ischemic stroke referred for echocardiography. METHODS Only patients able to perform the Valsalva maneuver during TTE were included; efficacy was defined by a 20 cm/sec decrease in transmitral E velocity. A PFO was judged present when microbubbles of agitated intravenous saline were seen in the left chambers within three cycles after right atrial opacification. RESULTS Of 108 patients (mean age, 55 ± 15 years; 61 men), 48 (44%) were judged to have PFOs by TEE and/or TTE. In 36 patients (33% of the total, 75% of those with PFOs), microbubbles were observed both by TEE and TTE, in seven patients only during TTE, and in five patients only during TEE. In patients able to satisfactorily perform the Valsalva maneuver during TEE, 22 PFOs were found, and two shunts (9%) were missed, whereas in patients unable to perform this maneuver, 26 PFOs were observed, with five shunts missed (19%) (P < .05). When a PFO was missed by TTE, either the echocardiographic window was suboptimal or the shunt was small. CONCLUSIONS An adequate Valsalva maneuver is crucial for diagnosis of PFO; most patients with stroke may be screened using TTE with contrast and the Valsalva maneuver, with TEE indicated in case of suboptimal transthoracic images.

Calcificação caseosa do anel mitral: relato de caso

ABSTRACT We present a rare case of probable caseous calcification of the mitral. This pathology is more frequently detected in asymptomatic women older than 70 years. To recognize this image is important because echocardiography is the easiest way to elucidate this diagnosis, and more importantly because this structure could be easily misdiagnosed as tumors, thrombus and vegetations, which are much more common. Normally, it has a benign evolution, and the correct diagnosis is crucial to avoid unnecessary surgical interventions.

Echocardiography Services: An Overview

Introduction: Due to an increasing growth in the number of echocardiographists in Brazil, as well as in echocardiography services, it has become paramount understanding the status quo of this practice in our country. Objective: Perceive an accurate profile of echocardiographic services offered in Brazil. Methods: A survey was carried out through the Internet with members from the Departament of Cardiovascular Imaging. They answered specific questions about infrastructure, services provided, number of tests, training and professional qualification. Results: Among the 429 participating centers, only those that answered the whole questionnaire were taken into account (n = 157). Of these 157 centers, 55 offer specialized training in echocardiography, and most of them is located in the Brazilian southeastern region. It was observed that 146 services (93%) have at least one professional certified in echocardiography by the Departament of Cardiovascular Imaging of the Brazilian Society of Cardiology. Conclusion: Most echocardiography centers in Brazil have professionals qualified and trained to perform the method. (Arq Bras Cardiol: Imagem cardiovasc. 2015;28(2):67-72)

Analysis of Diastolic Function and Atrial Function in High Performance Cyclists through Three-Dimensional Echocardiography

Results: The individuals of both groups had similar anthropometric variables. The following was observed in the cyclist group as for the controls: lower A’ wave velocity (5.9 cm/s ± 2.2 versus 7.6 ± 2.3 cm/s, with P = 0.03), smaller atrial contraction force (4.7 ± 1,4Kdyn vs. 6.2 ± 2.1Kdyn, P = 0.02) and greater passive emptying fraction (43.8% ± 12.8 versus 34.8 ± 10.4% with P = 0.03). A linear correlation was found between A’ wave velocity and atrial contraction force in the cyclists group (r = 0.65, P <0.05), between atrial contraction force and passive emptying fraction (r = 0.80, P <0.05) and between atrial contraction and volume before contraction (r = 0.65, P < 0.05). Conclusion: The cyclists group showed an increase in the passive component to the detriment of a reduction in the active component in total atrial emptying, which was showed to be correlated with supernormal diastolic activity in this group. (Arq Bras Cardiol: Imagem cardiovasc. 2014;27(4):235-242)

Impact of Fentanyl Associated with Midazolam in Sedation for Transesophageal Echocardiography

Introducao: O ecocardiograma transesofagico e atualmente uma das principais ferramentas no diagnostico de diversas alteracoes cardiacas. Para uma maior seguranca e conforto na sua realizacao, o exame tem sido realizado sob sedacao consciente moderada, sendo os benzodiazepinicos os agentes de escolha. Nessa classe de medicamentos, o midazolam e o mais utilizado, todavia nao esta isento de possiveis complicacoes relacionadas ao seu uso, como hipoxia, hipotensao, entre outras. Sabemos que grau de sedacao e dose-dependente, portanto, quanto menor a dose utilizada, sera menor o risco de complicacoes do procedimento.