ECOCARDIOGRAFIA TRANSESOFÁGICA ECOCARDIOGRAMA EN EL QUE LAS IMÁGENES SE OBTIENEN DE UN TRASDUCTOR SITUADO EN EL ESÓFAGO The development of tissue Doppler imaging has enabled the quantification of mitral annular ……..systolic and …..early …….and……late diastolic velocities

ETE VENTAJAS Comparado con el ETT Comparado con RM and TC Proximidad (estructuras posteriores) Resolución de las imágenes Multi-plano Comparado con RM and TC se puede llevar a la cabecera del enfermo Resolución temporal Información funcional The development of tissue Doppler imaging has enabled the quantification of mitral annular ……..systolic and …..early …….and……late diastolic velocities

EQUIPO Sonda Transductor Ecocardiografo The development of tissue Doppler imaging has enabled the quantification of mitral annular ……..systolic and …..early …….and……late diastolic velocities

SONDA Cuerpo Transductor Mango The development of tissue Doppler imaging has enabled the quantification of mitral annular ……..systolic and …..early …….and……late diastolic velocities Mango

REALIZACIÓN DEL ETE Personal Preparación del paciente Sedación Intubación Obtención de las imágenes The development of tissue Doppler imaging has enabled the quantification of mitral annular ……..systolic and …..early …….and……late diastolic velocities

PREPARACIÓN Historia del paciente Consentimiento informado disfagia / anormalidades esofágicas Consentimiento informado riesgos, beneficios y alternativas Ayunas > 4hrs The development of tissue Doppler imaging has enabled the quantification of mitral annular ……..systolic and …..early …….and……late diastolic velocities

COMPLICACIONES Hipoxia Hipotension Hipertension Arritmia Hematemnesis Laringospasmo Úlcera esofágica Muerte 0.6% 0.5% 0.2% 0.3% 0.1% <0.02% <0.01% We therefore designed this study to compare tissue Doppler velocities at different margins of the mitral valve annulus…….. And to determine the effect this has on estimates of LV filling pressure

PREPARACIÓN Acceso venoso Profilaxis antibiótica Sedacion contraste salino Profilaxis antibiótica en general no se requiere. The development of tissue Doppler imaging has enabled the quantification of mitral annular ……..systolic and …..early …….and……late diastolic velocities

Anetesia tópica Lidocaina gel Lidocaina spray The development of tissue Doppler imaging has enabled the quantification of mitral annular ……..systolic and …..early …….and……late diastolic velocities

SEDACIÓN Efectos ansiolíticos y amnésicos Ambiente tranquilo y poca luz Fármacos Midazolam 1-10mg ev. The development of tissue Doppler imaging has enabled the quantification of mitral annular ……..systolic and …..early …….and……late diastolic velocities

MONITORIZACIÓN Ritmo cardiaco Presión arterial Saturación Aspiración de secreciones The development of tissue Doppler imaging has enabled the quantification of mitral annular ……..systolic and …..early …….and……late diastolic velocities

INTUBACIÓN Posición del paciente Tragar decúbito lateral izquierdo Flexión del cuello Tragar relajación del musculo cricofaríngeo

INTUBACIÓN

RECUPERACIÓN Vigilancia hasta que el efecto de la anestesia ha desaparecido Evitar comida y bebida hasta que el efecto de la anestesia tópica haya desaparecido No conducir en unas 12hrs

ESTUDIO CON CONTRASTE Se utiliza suero salino agitado, las burbujas de suero con ecodensas, se utilizan fundamentalmente para el diagnóstico de cortocircuitos derecha izquierda que no se visualizan rutinariamente (foramen oval permeable) The development of tissue Doppler imaging has enabled the quantification of mitral annular ……..systolic and …..early …….and……late diastolic velocities

VENTANAS basal cuatro camaras transgástrico apex nivel musculo papilar profundo apex Mitral annular diastolic velocities provide useful information about LV diastolic function In particular the early diastolic velocity is inversely related to the time constant of LV pressure decay and thus acts as an index of LV relaxation The early diastolic velocity has also been shown to be relatively preload independent and is useful in differentiating pseudonormal from normal LV filling paterns

PLANOS Eje largo Eje corto Cuatro camaras The development of tissue Doppler imaging has enabled the quantification of mitral annular ……..systolic and …..early …….and……late diastolic velocities

PLANOS (2) Eje largo horizontal (4C) 0o Eje largo vertical (2C) 90o Eje largo (3C) 120o Eje corto (TG) 0o Mitral annular diastolic velocities provide useful information about LV diastolic function In particular the early diastolic velocity is inversely related to the time constant of LV pressure decay and thus acts as an index of LV relaxation The early diastolic velocity has also been shown to be relatively preload independent and is useful in differentiating pseudonormal from normal LV filling paterns

CUATRO CAMARAS Mitral annular diastolic velocities provide useful information about LV diastolic function In particular the early diastolic velocity is inversely related to the time constant of LV pressure decay and thus acts as an index of LV relaxation The early diastolic velocity has also been shown to be relatively preload independent and is useful in differentiating pseudonormal from normal LV filling paterns

PLANO SUPERIOR 00 45-600 30-600 1200 45-600 Mitral annular diastolic velocities provide useful information about LV diastolic function In particular the early diastolic velocity is inversely related to the time constant of LV pressure decay and thus acts as an index of LV relaxation The early diastolic velocity has also been shown to be relatively preload independent and is useful in differentiating pseudonormal from normal LV filling paterns

PLANO TRASNGÁSTRICO 00 00 900 Mitral annular diastolic velocities provide useful information about LV diastolic function In particular the early diastolic velocity is inversely related to the time constant of LV pressure decay and thus acts as an index of LV relaxation The early diastolic velocity has also been shown to be relatively preload independent and is useful in differentiating pseudonormal from normal LV filling paterns 00

INDICACIONES Foco embolígeno Enfermedad Valvular Endocarditis Pre-cardioversión Aorta enfermedades congénitas Masas Intracardiacas Embolismo pulmonar 42% 14% 11% 6% 5% 2% 1% We therefore designed this study to compare tissue Doppler velocities at different margins of the mitral valve annulus…….. And to determine the effect this has on estimates of LV filling pressure

Cuatro camaras, vegetacion en valvula mitral We therefore designed this study to compare tissue Doppler velocities at different margins of the mitral valve annulus…….. And to determine the effect this has on estimates of LV filling pressure

Tracto de salida de ventrículo izquierdo, raíz aórtica We therefore designed this study to compare tissue Doppler velocities at different margins of the mitral valve annulus…….. And to determine the effect this has on estimates of LV filling pressure

Válvula aórtica trivalva (normal) We therefore designed this study to compare tissue Doppler velocities at different margins of the mitral valve annulus…….. And to determine the effect this has on estimates of LV filling pressure

Cuatro camaras, vegetacion en valvula mitral We therefore designed this study to compare tissue Doppler velocities at different margins of the mitral valve annulus…….. And to determine the effect this has on estimates of LV filling pressure

Orejuela izquierda con trombo We therefore designed this study to compare tissue Doppler velocities at different margins of the mitral valve annulus…….. And to determine the effect this has on estimates of LV filling pressure

Orejuela izquierda con trombo y ecocontraste espontáneo We therefore designed this study to compare tissue Doppler velocities at different margins of the mitral valve annulus…….. And to determine the effect this has on estimates of LV filling pressure