Carrera de Grado Acadmico

UNIVERSIDAD NACIONAL DE LA PLATA

FACULTAD DE CIENCIAS MEDICAS
DEPARTAMENTO DE POSTGRADO
Directores
Prof. Dr. Eduardo Escudero
Prof. Dr. Ricardo Ronderos
Coordinador
Dr. Dimedes Corneli
Duracin: 2 aos con presentacin de Tesis Final
Fecha de iniciacin: Abril 2006
Inscripcion: Octubre 2005
Facultad de Ciencias Mdicas
Departamento de Postgrado
Calle 60 y 120 (1900) La Plata
Tel/Fax 54-221-489 1265
magistercardio@netverk.com.ar
Acreditada CONEAU 99
Categoria Bn 99
ECOCARDIOGRAFIA
TRANSESOFAGICA
ENF DE LA AORTA
Dr Ricardo E Ronderos
Jefe Dto de Imagenes cardiovasculares ICBA
Director Instituto de Cardiologia La Plata
Profesor libre de cardiologia de Postgrado
Director Master Ultrasonido en Cardiologia
Universidad Nacional de La Plata
Argentina
MARFAN SYNDROME
AORTIC DISSECTION
AORTIC MURAL HEMATOMA
AORTIC ULCER AND PERFORATION
AORTIC LUMINAL THROMBOSIS
AORTIC ANEURYSM AND RUPTURE
AORTIC TRAUMA
AORTIC MYCOTIC ANEURYSM AND
SEUDOANEURYSM
ACUTE AORTIC
SYNDROME
1/ 10.000 ADMISSIONS IN GENERAL
HOSPITALS
1/ 363 AUTOPSIES
10 CASES/ MILLON/ YEAR
OVER 2.000 CASES/ YEAR
AORTIC DISSECTION
INCIDENCE AND PREVALENCE
0 20 40 60 80 100
15 MIN
6 HS
24 HS
48 HS
7 DAYS
14 DAYS
30 DAYS
90 DAYS
Anagnostopoulos, Am.H.Journal 1972.
%
AORTIC DISSECTION
MORTALITY
AORTIC DISSECTION
DEBAKEY AND STANFORD
CLASSIFICATION
35%
17%
48%
TYPE I
TYPE II
TYPE III
European Counci l Echocardi ography 1993
AORTIC DISSECTION
PREVALENCE ACCORDING TO
DEBAKEY CLASSIFICATION
N =128
AORTIC DISSECTION
INTIMAL TEARS
AORTIC DISSECTION
COMPLICATIONS
ECO TRANSESOFAGICO
MULTIPLANO
DISECCION AORTICA
AORTIC DISSECTION
INTIMAL TEARS
AORTIC DISSECTION
PROXIMAL DISECTION
AORTIC DISSECTION
DISECCION AORTICA
DESGARROS INTIMAL
DESCENDING AORTA
AORTIC DISSECTION
INTIMAL TEARS
AORTIC ARCH
Afectacin de ramas arteriales
Gentileza del Dr G Avegliano
AORTIC DISSECTION
INTIMAL TEARS
Hemorragia Periartica
Gentileza del Dr G Avegliano
TRANSESOPHAGEAL ECHO
FALSE LUMEN SPONTANEOUS
CONTRAST EFECT
TRANSESOPHAGEAL ECHO
TRUE LUMEN COAPTATION
CT
SCAN
NMR. ANGIO
RX
TEE
INTIMAL FLAP DIAGNOSIS +++ +++ +++ +++
INTIMAL TEARS ENTRY AND
REENTRY
0 ++ +++ +++
DIAGNOSIS TRUE AND
FALSE LUMEN
++ +++ +++ +++
FLOW PROFILES 0 ++ ++ +++
FALSE LUMEN THROMBOSIS ++ +++ ++ +++
AORTIC MAIN BRANCHES + +++ +++ +
AORTIC REGURGITATION 0 ++ +++ +++
HAEMOPERICARDIUM +++ +++ 0 +++

AORTIC DISSECTION
DIAGNOSTIC TECHNIQUES
AORTIC DISSECTION
DIAGNOSTIC TECHNIQUES
SENSITIVITY SPECIFICITY ADVANTAGES DISADVANTAGES
ANGIO
CT SCAN
MSLICE
CT SCAN
MRI
TEE
80-90 %
65-85 %
80-100 %
95-100 %
85-95 % 95-100 %
95-100 %
95-100 %
90-95 %
AORTIC
BRANCHES
AORTIC
BRANCHES
FLOW
FAST
WIDELY
AVAILABLE
FAST
IN SITU
REAL TIME
FLOW
INVASIVE
NON DIAGNOSTIC
MURAL HEMATOMA
NON DIAGNOSTIC
AORTIC
BRANCHES
PT TRANSFER
LONG TIME STUDY
SEMI-INVASIVE
BAD AORTIC
BRANCHES
AORTIC DISSECTION
OBSTRUCTION CORONARY
ARTERIES
ECO TRANSESOFAGICO
ARTERIAS CORONARIAS
AO AO
TC MULTISLICE Y RMN
ARTERIAS CORONARIAS
PDA
P
AV artery
PDA
PL
PL
RCA
Gated Sequential Acquisition
Off-line 3D
Image Processing and
Reconstruction
Aortic aneurysm
3DE reconstruction
Aortic aneurysm
3D reconstruction
41
Live 3D TEE
Live 3D TEE provides
visualization of cardiac
function never seen before
TACy RMN son superiores a ETE para
evaluar dimensiones aorticas
TYPE III Non communicant:
Mural haematoma distal to left subclavian artery,
without comunicacin between true lumen and lesion
TYPE III Communicant:
Distal to left subclavian artery, with comunication
between true and false lumen Antegrade dissection.
TYPE III Retrograde:
Distal to left subclavian artery, communication
between true and false lumen with retrograde
disection.
AORTIC DISSECTION
EUROPEAN COUNCIL OF
ECHOCARDIOGRAPHY
AORTIC HAEMATOMA
FOLLOW UP
62 y/o female back pain ct scan with mural
haematoma
AORTIC HAEMATOMA
FOLLOW UP
62 y/o female back pain ct scan with mural haematoma
TC
HEMATOMA INTRAMURAL
ANGIO
RM ETE
Gentileza del Dr G Avegliano
AORTIC HAEMATOMA
FOLLOW UP
62 y/o female back pain ct scan with mural
haematoma
AORTIC DISSECTION
INTRAMURAL HEMATOMA
TRANSESOPHAGEAL ECHO
AORTIC HEMATOMA
TRANSESOPHAGEAL ECHO
AORTIC HEMATOMA
AORTIC ULCERS
INTIMAL LESSIONS
AORTIC PLAQUES
INTIMAL LESSIONS
Ulceras articas. Diagnstico etiolgico
AORTIC HAEMATOMA
INTIMAL LESSIONS
Ulcera penetrante artica
TRANSESOPHAGEAL ECHO
AORTIC PLAQUES AND TROMBUS
AORTIC TRAUMA
FIXED
FIXED
TRAUMA
RUPTURE
RUPTURE
AORTIC PATHOLOGY
DIAGNOSTIC
TECHNIQUES
AORTIC TRANSSECTION
TRANSESOPHAGEAL ECHO
AORTIC TRANSSECTION
TRANSESOPHAGEAL ECHO
AORTIC TRANSSECTION
PROXIMAL DISTAL
TRANSESOPHAGEAL ECHO
AORTIC RUPTURE
AO
RUPTURE
AO
PSEUDOAN
TRANSESOPHAGEAL ECHO
AORTITIS AND SEUDOANEURISM
AO
PSEUDOAN
RUPTURE
PSEUDOAN
TRANSESOPHAGEAL ECHO
AORTITIS AND SEUDOANEURYSM
ROLE OF TEE
IN
AORTIC PATHOLOGY
CONCLUSIONS
TEE IS ACCURATE, FAST AND GIVES ALMOST COMPLETE
DIAGNOSIS IN ACUTE THORACIC AORTIC DISEASES
MULTIPLANE PROBES ARE NECESSARY TO REDUCE
RISK OF AORTIC DISRUPTION
MRI GIVES BETTER UNDERSTANDING OF ANATOMY AND
MORPHOLOGY, BUT LESS INFORMATION ABOUT FLOW
PROFILES IN RETROGRADE DISECTION
MULTIPLANE TEE IS ELECTIVE IN ACUTE SCENARIOS
AND MRI IS EXCELLENT FOR CHRONIC FOLLOW UP
DIAGNOSTICO EN SOSPECHA DE
SINDROME AORTICO AGUDO
Dolor toracico o dorsal
Baja probabilidad
clinica
Alta probabilidad
clinica
TAC helicoidal
Con contraste
NORMAL
HEMATOMA DESCENDENTE
DISECCION
ETE
ETE
TIPO A
CIRUGIA
TIPO B
CONTROL ETE Y POST RMN
TIPO A
TIPO B
CIRUGIA
CONTROL ETE Y POST RMN
CONTROL ETE Y POST RMN