Publication: Proyección ecocardiográfica transesternal en la edad pediátrica
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2017-02-21
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Universidad Complutense de Madrid
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Abstract
En ecocardiografía transtorácica el ultrasonido penetra en el organismo a través de la pared torácica anterolateral hasta llegar al mediastino medio, lugar en el que se ubica el corazón. Las características de las estructuras anatómicas que debe atravesar condicionan la calidad con que se visualizan las distintas estructuras cardiovasculares. En la edad pediátrica se dan unas circunstancias especiales que permiten ventanas ultrasónicas excelentes. Sin embargo, las ventanas que se emplean en ecocardiografía pediátrica son básicamente las mismas que en la edad adulta. La válvula pulmonar se visualiza habitualmente en ecocardiografía transtorácica bidimensional en su eje longitudinal, proyección que no permite definir con precisión su morfología. El eje corto o transversal de la válvula pulmonar nos proporcionaría una imagen similar a la que se obtiene de la válvula aórtica a cualquier edad desde la proyección paraesternal eje corto, pero la posición anatómica de la válvula pulmonar respecto a las proyecciones habituales hace que sea difícil conseguirlo en condiciones normales. Dado que en neonatos y lactantes el esternón y las costillas son estructuras predominantemente cartilaginosas que transmiten bien el ultrasonido, habitualmente se puede acceder al corazón desde una proyección transesternal. Además, el timo, localizado en el mediastino anterosuperior, facilita la visualización de las estructuras cardiovasculares...
Transthoracic echocardiographic ultrasound equipment transmits waveform into the body through the anterolateral thoracic wall till it reaches the medium mediastinum, place where the heart is located. The characteristics of the anatomic structures that the ultrasounds needs to go through determine the quality with which the different vascular structures are visualized. In the pediatric age there are several special circumstances that allow an excellent ultrasound window. Some of these are no more present when the child becomes older. However, the transthoracic views used in pediatric echocardiography are basically the same as in adults. The pulmonary valve is visualized normally in the bidimensional transthoracic echocardiography in its longitudinal axis, projection that does not allow to define with accuracy its morphology and functionality. The short or transversal axis view of the pulmonary valve would provide us with a similar image than the one of the aortic valve at any age from the parasternal short axis view. However, the anatomical position of the pulmonary valve compared with the usual projections makes it difficult to achieve under normal conditions. The sternum and the ribs in newborns and infants are mainly formed by cartilage, which transmits perfectly well the ultrasound, and you can usually access the heart from a transsternal projection. Besides, the thymus, located in the anterosuperior mediastinum, facilitates the visualization of cardiovascular structures...
Transthoracic echocardiographic ultrasound equipment transmits waveform into the body through the anterolateral thoracic wall till it reaches the medium mediastinum, place where the heart is located. The characteristics of the anatomic structures that the ultrasounds needs to go through determine the quality with which the different vascular structures are visualized. In the pediatric age there are several special circumstances that allow an excellent ultrasound window. Some of these are no more present when the child becomes older. However, the transthoracic views used in pediatric echocardiography are basically the same as in adults. The pulmonary valve is visualized normally in the bidimensional transthoracic echocardiography in its longitudinal axis, projection that does not allow to define with accuracy its morphology and functionality. The short or transversal axis view of the pulmonary valve would provide us with a similar image than the one of the aortic valve at any age from the parasternal short axis view. However, the anatomical position of the pulmonary valve compared with the usual projections makes it difficult to achieve under normal conditions. The sternum and the ribs in newborns and infants are mainly formed by cartilage, which transmits perfectly well the ultrasound, and you can usually access the heart from a transsternal projection. Besides, the thymus, located in the anterosuperior mediastinum, facilitates the visualization of cardiovascular structures...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Pediatría, leída el 04/02/2016