Actualización en cardiopatía isquémica

This article contains a review of the main developments reported in 2011 on the pathophysiology, prevention, prognosis and treatment of chronic coronary artery disease and acute coronary syndrome, with or without ST-segment elevation. It also discusses the recommendations of the latest clinical practice guidelines.     

Actualización en cardiopatía isquémica

This article contains a review of the main developments reported in 2010 concerning the pathophysiology, prevention, prognosis and treatment of ST-segment elevation and non-ST-segment elevation acute coronary syndromes, and of recommendations made by the most recent clinical practice guidelines.     

Técnicas de imagen en infección musculoesquelética

Imaging techniques are routinely used to evaluate patients with suspected musculoskeletal infection. Although radiographs will not establish the diagnosis, they should always be performed when infection is suspected because of their utility in differential diagnosis and follow-up. Radiographs provide an overview of the anatomical region of interest and of previous alterations that can influence the selection and interpretation of subsequently used techniques. Magnetic resonance imaging is the most sensitive examination, does not irradiate, and provides excellent anatomic detail and rapid results. This technique is especially valuable in spondylodiscitis, osteomyelitis, and diabetic foot infections. Its main limitations are the false-positives caused by nonspecific bone edema and poor reliability in the assessment of short-term therapeutic response. Among nuclear medicine procedures, the 3-phase bone scan is widely available and highly accurate in previously healthy bone. Labeled leukocyte scintigraphy should be used in complicated osteomyelitis, such as prosthetic infection, although it is also useful to exclude infection in diabetic foot and neuropathic joints. Ga-67 scintigraphy is useful in spinal infections. In these infections, positron emission tomography can also be a useful alternative. Finally, it is important to remember atypical radiological presentations in distinct locations and particular clinical situations, as well as certain conditions that can mimic infection.     

Técnicas de fusión de imagen en los procedimientos intervencionistas

The field of percutaneous structural heart interventions has grown tremendously in recent years. This growth has fueled the development of new imaging protocols and technologies in parallel to help facilitate these minimally-invasive procedures. Fusion imaging is an exciting new technology that combines the strength of 2 imaging modalities and has the potential to improve procedural planning and the safety of many commonly performed transcatheter procedures. In this review we discuss the basic concepts of fusion imaging along with the relative strengths and weaknesses of static vs dynamic fusion imaging modalities. This review will focus primarily on echocardiographic-fluoroscopic fusion imaging and its application in commonly performed transcatheter structural heart procedures.     

Actualización en cardiología pediátrica y cardiopatías congénitas: técnicas de imagen,hipertensión arterial pulmonar,tratamientos híbridos y quirúrgicos

This article contains a review of the most significant contributions to pediatric cardiology and congenital heart disease reported in publications between September 2009 and August 2010. The review focuses on imaging techniques, new treatment for pulmonary arterial hypertension in pediatric patients, and therapy in general (e.g. hybrid treatment and surgical treatment). With regard to imaging techniques, the review highlights the increasing application of congenital heart disease diagnosis during fetal life, the introduction of new echocardiographic techniques (e.g. tissue Doppler imaging, two-dimensional speckle-tracking imaging and three-dimensional echocardiography) into routine clinical practice, and the growing use of cardiac CT and magnetic resonance imaging in diagnosis and the assessment of cardiac function, respectively. The role played by cardiac interventions continues to increase and cardiac surgery is becoming more advanced and has, in some cases, been combined with hybrid techniques. However, there are still a number of controversial issues in cardiac surgery that have not yet been resolved, such as whether or not fenestration should be used with Fontan surgery, the optimum type of correction for hypoplastic left heart syndrome, and the best conduit for pulmonary artery replacement.     

Situación actual: lo nuevo en técnicas de imagen cardiaca

Cardiac imaging continues to reveal new anatomical and functional insights into heart disease. In echocardiography, both transesophageal and transthoracic three-dimensional imaging have been fully developed and optimized, and the value of the techniques that have increased our understanding of cardiac mechanics and ventricular function is well established. At the same time, the healthcare industry has released new devices onto the market which, although they are easier to use, have limitations that restrict their use for routine assessment. Tomography's diagnostic and prognostic value in coronary artery disease continues to increase while radiation exposure becomes progressively lower. With cardiac magnetic resonance imaging, myocardial injury and recovery in ischemic heart disease and following acute coronary syndrome can be monitored in exquisite detail. The emergence of new combined tomographic and gamma camera techniques, exclusively developed for nuclear cardiology, have improved the quality of investigations and reduced radiation exposure. The hybrid or fusion images produced by combining different techniques, such as nuclear cardiology techniques and tomography, promise an exciting future.