Rev Esp Cardiol
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Review
[Special anesthesia care in heart transplantation. The management of right ventricular failure].
Right ventricular dysfunction is a common clinical event after heart transplantation. The major cause is the failure of right ventricle (RV) to adapt to the pulmonary hypertension (PH) secondary to chronic heart failure. ⋯ Once this occurs, the treatment is complex. The available therapeutic measures include the use of vasodilators such as prostaglandin E1 and nitric oxide.
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It's well known the utility of transesophageal echocardiography in the evaluation of cardiological patients that are critically ill. However, there is less experience about this usefulness in non-cardiological critically ill patients. ⋯ Transesophageal echocardiography can be safely performed and has a definite role in the diagnosis (showing sometimes non-suspected abnormalities) and management of non-cardiological critically ill patients.
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Brain death causes myocardial impairment by some mechanisms not yet well understood. The aim of this work was to assess the echocardiographic features found in these patients and their implication in donor selection for heart transplantation. ⋯ Brain death commonly causes alterations of left ventricular function, and this impairment is severe in almost 20% of cases. These echocardiographic features must be known when selection of donors for heart transplantation is concerned.
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Comparative Study
[The evaluation of the mechanism of mitral bioprosthesis malfunction by transesophageal echocardiography].
The aim of this study was to assess the usefulness of transesophageal echocardiography for detection of the mechanism of dysfunction in bioprosthetic valves in the mitral position. ⋯ Transesophageal echocardiography is suited for the assessment of mechanism of mitral regurgitation and for the diagnosis of vegetations in most of patients with bioprosthetic mitral valves. Transesophageal echocardiography adds little information to the transthoracic study in the evaluation of patients with stenotic bioprosthetic mitral valves, particularly in calcified degeneration.
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"Penetrating aortic ulcer", an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina and allows haematoma formation within the aortic wall, is rarely considered in the differential diagnosis of patients with sudden onset of severe chest or back pain. It has been suggested that it is a pathologic process that involves elderly hypertensive patients with severe atherosclerosis and rarely has been observed in the ascending aorta. ⋯ Penetrating aortic ulcer can also affect middle age patients without severe atherosclerosis and is frequently observed in the ascending aorta. Its form of presentation and clinical characteristics are similar to classic aortic dissection. The lack of angiographic confirmatory evidence of dissection with suggestive clinical history, should raise the possibility of penetrating aortic ulcer.