Transesophageal echocardiography: TEE instrumentation.

7/25/2019 Transesophageal echocardiography: TEE instrumentation.

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MASTER EN ECOCRDIOGRF

TRNSESOFAGIC

TEM 2. INSTRUMENTCIN EN ETE.ORGNIZCIN DEL LBORTORIO PR

L PRACTIC DE ETE

Ricardo Po!da "ara#i$$oF!$$o% &!'(!'iaCardioa'c)$ar

U&i!r'idad CES


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G!&!ra$idad!'

Moda$idad d! i#a*!& cardioa'c)$ar

cr+(ica#!&(! i#,or(a&(! La ,ro-i#idad d!$ !'/a*o a$ cora0&

1 *ra&d!' a'o' $a ac! )&a

!-c!$!&(! !&(a&a


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I&dicacio&!'

or(a3 L3 4$)$a' &a(ia' 1,ro(5'ica'.

Ea$)aci& d!!'(r)c()ra 1 /)&ci&

Toda cir)*+a a cora0& a6i!r(oTEE i&(rao,!ra(orio

Ci!rr! CI3 ci!rr! L3 ,roc!di#i!&(o'a$)$ar!' (ra&'ca(5(!r

G)+a d!,roc!di#i!&(o'

(ra&'ca(5(!r ETT &o dia*&'(ica 1 $o' a$$a0*o' !& $a

ETE ,)!d!& a$(!rar !$ #a&!7o d!$,aci!&(!.

Paci!&(!'cr+(ica#!&(!

!&/!r#o'


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S!*)ridad

La seguridad de laETE se ha

documentado enmltiples estudios


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Co#,$icaci& Dia*&o'(ic TEEIntraoperative

TEE

Ta'a *$o6a$ d!co#,$icacio&!'

8.9:;23:< =r!/' 2>32?@ 832< =r!/ @

Mor(a$idad8.89;8.82< =r!/'

2>32?32@8< =r!/ @

Mor6i$idad #a1or 8.2< =r!/ 2@ 8;9.2< =r!/' 32:32@

!#orra*ia #a1or 8.89< =r!/ 2>@ 8.8;8.:< =r!/' 32:@

P!r/oraci& !'o/4*ica 8.89 =r!/ 2>@ 8;8.< =r!/' 32:32@

Fa$$a card+aca 8.8?< =r!/ 2:@

rri(#ia 8.8;8.< =r!/' 32:38@

I&()6aci& (ra)!a$ 8.82< =r!/ 8@

Ma$a ,o'ici& d!$ ()6o!&do(ra)!a$

8.8< =r!/ @

Lari&*o!',a'#o 8.9>< =r!/ 2@Bro&co!',a'#o 8.8;8.8< =r!/' 2>38@

Di'/a*ia 9.: < =r!/ 9@

!#orra*ia /ar+&*!a#!&or

8.89;8.2< =r!/'2>32?32@

8.89< =r!/ @

Odi&o/a*ia '!!ra 8.9< =r!/ @


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Co&(rai&dicacio&!'

6'o$)(a'

H+'c!ra ,!r/oradaE'(!&o'i' !'o/4*icaT)#or d! !'/a*o

P!r/oraci& !'o/4*icaLac!raci& !'o/4*icaDi!r(+c)$o

Sa&*rado *a'(roi&(!'(i&a$ '),!rior ac(io

R!$a(ia'

i'(oria d! radiaci& !& !$ c)!$$o 1 !$ #!dia'(i&oi'(oria d! cir)*+a *a'(roi&(!'(i&a$

Sa&*rado *a'(roi&(!'(i&a$ '),!rior r!ci!&(! E'/a*o d! Barr!((

i'(oria d! di'/a*ia

R!'(ricci& d! $a #oi$idad d!$ c)!$$o!r&ia ia(a$ 'i&(o#4(ica

Haric!' !'o/4*ica'Coa*)$o,a(+a

Tro#6oci(o,!&iaE'o/a*i(i' ac(ia

J$c!ra ,5,(ica ac(ia


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Conocimientos requeridos para la competencia en ecocardiografatranstorcica

I&dicacio&!' a,ro,iada'3 co&(rai&dicacio&!' 1 ri!'*o' d! $a ETE.

Dia*&'(ico di/!r!&cia$ d! $a' di'(i&(a' !&/!r#!dad!' 1 '+&dro#!'cardioa'c)$ar!'.

M!dida' d! co&(ro$ d! $a i&/!cci& 1 a',!c(o' d! '!*)ridad !$5c(rica r!$acio&ado'co& !$ ,roc!di#i!&(o.

Ma&!7o d! $a '!daci&3 i&c$)1!&do acci&3 !/!c(o' '!c)&dario' 1 ri!'*o' d! $o'#!dica#!&(o' )(i$i0ado'3 a'+Kco#o d! $a #o&i(ori0aci& cardiorr!',ira(oria.

&a(o#+a cardioa'c)$ar !& ') i'i& (o#o*r4ca3 (a$ co#o '! ! !& ETE.

&a(o#+a d!$ (rac(o *a'(roi&(!'(i&a$ '),!rior3 co& !',!cia$ 5&/a'i' !& $o' ,ro6$!#a'r!$acio&ado' co& $a i&()6aci& !'o/4*ica.

$(!racio&!' co&*5&i(a' 1 ad)irida' d! $a a&a(o#+a cardioa'c)$ar 1 ') a',!c(o !&ETE.

Co#,o&!&(!' (5c&ico' ,ara ETT 1 ETE.Ca,acidad ,ara di'(i&*)ir )& !'()dio ad!c)ado d! )&o i&ad!c)ado.

O(ro' #5(odo' dia*&'(ico' )! '! ,)!da& corr!$acio&ar co& $o' a$$a0*o' d! $aETE.

Ca,acidad d! co#)&icaci& d! $o' r!')$(ado' d!$ !-a#!& a$ ,aci!&(! a o(ro',ro/!'io&a$!' o ') ,)6$icaci& 1 r!*i'(ro.


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a6i$idad!' (5c&ica'

Ca,aci(aci& !& !cocardio*ra/+a (ra&'(or4cica.

Ca,aci(aci& ,ara !$ )'o d! $a '!daci& d! /or#a '!*)ra 1 !/!c(ia.Co#,!(!&cia ,ara r!a$i0ar )&a i'(oria d! $a' !&/!r#!dad!' *a'(roi&(!'(i&a$!'d!$ ,aci!&(!.

Ca,aci(aci& !& (5c&ica' d! r!a&i#aci& cardio,)$#o&ar.

Co#,!(!&cia !& $a i&(rod)cci& '!*)ra d! $a 'o&da d! ETE !& !$ !'/a*o 1 !$!'(#a*o 1 !& ') a7)'(! ,ara $a o6(!&ci& d! $a' di/!r!&(!' i#4*!&!'

(o#o*r4ca' 1 Do,,$!r.Co#,!(!&cia !& !$ #a&!7o corr!c(o d!$ !)i,o d! )$(ra'o&ido' 1 d! $o'co&(ro$!' )! a/!c(a& a $a ca$idad d! $a i#a*!&.

Co#,!(!&cia !& !$ r!co&oci#i!&(o d! $a' a&o#a$+a' d! $a !'(r)c()ra 1 $a /)&ci&cardiaca' d!(!c(ada' a (ra5' d! $a !&(a&a (ra&'!'/a*ica 1 (ra&'*4'(rica3 1 d!$o' ,o'i6$!' ar(!/ac(o'.

Co#,!(!&cia !& $a r!a$i0aci& d!$ a&4$i'i' c)a$i(a(io 1 c)a&(i(a(io d! $o' da(o'!cocardio*r4co'.

Ca,aci(aci& ,ara $a r!a$i0aci& d! )& i&/or#! !'cri(o d! $o' a$$a0*o'!cocardio*r4co' 1 ')' i#,$icacio&!' c$+&ica'.

Co#,!(!&cia !& $o' 'i'(!#a' d! d!'i&/!cci& d! $a 'o&da3 !& $a d!(!cci& d!d!/!c(o' (5c&ico'3 !',!cia$#!&(! $o' r!$acio&ado' co& !$ ai'$a#i!&(o !$5c(rico.


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R!)!ri#i!&(o' ,ara !$ &i!$!'(4&dar d! $o' $a6ora(orio' d!

ETE

P!r'o&a$ d! staf

9. "!/! d! ETE d!'i*&ado.2. D!6! r!a$i0ar o '),!ri'ar a$ #!&o' ?8 ETEao.

. Or*a&i0aci&!)i,a#i!&(o

9. Pro(oco$o' !'(a6$!cido'.2. Co&'!&(i#i!&(o i&/or#ado !'cri(o.. E)i,o d! r!')ci(aci&.>. So&da #)$(i,$a&o.


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R!)!ri#i!&(o' ,ara !$ &i!$!'(4&dar d! $o' $a6ora(orio' d! ETE

U'o r)(i&ario d!9. O-+*!&o3 a',iraci& 1 ,)$'io-i#!(r+a.2. Mo&i(ori0aci& d! ,r!'i& ar(!ria$.

. Pr!,araci& d!$ ,aci!&(!.>. I&/or#aci& ,or !'cri(o.5. Checklist a&(!' d!$ ,roc!di#i!&(o.. For#aci& co&(i&)ada.

. Co&(ro$ d! ca$idad.:. U'o d! '!daci& co&/or#! a $a' *)+a'.. r#ario co& c!rrad)ra ,ara #!dicaci&.98. I&'(a$acio&!' ,ara $i#,i!0a 1 !'(!ri$i0aci& d!

'o&da'.


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R!)!ri#i!&(o' ,ara !$ &i!$aa&0ado d! $o' $a6ora(orio' d! ETE

"!/! d! ETE co& #4' d! ?8 !'()dio' ,or aor!a$i0ado' o '),!ri'ado'.

"!/! d! ETE co& acr!di(aci& d! EE o &acio&a$. P!r'o&a d!'i*&ada ,ara !$ #a&(!&i#i!&(o d! $a +a

a5r!a 1 $a r!c),!raci& d!$ ,aci!&(!. Ar!a d! r!c),!raci& =28 #2@. Li'(a d! i&dicacio&!' co&'!&')ada i&(!r&a#!&(!. Co&(ro$ d! ca$idad a (ra5' d! cir)*+a3 ,a(o$o*+a3

o(ra' #oda$idad!' d! i#a*!&. )di(or+a' !'(a6$!cida' d! /or#a r!*)$ar. Pro(oco$o' !'cri(o' d! $o' ,roc!di#i!&(o'. E-,!ri!&cia doc!&(!. $#ac!&a#i!&(o di*i(a$. Ecocardio*ra/+a i&(rao,!ra(oria.


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Ti,o' d! 'o&da'

Las que poseen un

mecanismorotacional en su

extremoLas matriciales


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T!c&o$o*+a d! #a(ri0

E$ a0 '! diri*! acia !$a0i#)( 1 !& !$!aci& a0

!& /or#a d! ,ir4#id!


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Co&(ro$!' 1 #a&!7o d! $a 'o&da

La 'o&da d! ETE (i!&! do' ,ar(!'9. E& !$ !-(r!#o di'(a$ !$ (ra&'d)c(or co&

$o' cri'(a$!' ,i!0o!$5c(rico'2. E& !-(r!#o ,ro-i#a$ )& #a&*o co& $o'

co&(ro$!' &!c!'ario' ,ara ') #a&!7o.. R)!da' d! #a1or (a#ao co&(ro$a $a

!-i& d!$ !-(r!#o d! $a 'o&da !&'!&(ido a&(!ro;,o'(!rior. Giro orario!-i& a&(!rior3 *iro a&(iorario !-i&,o'(!rior

. R)!da d! #!&or (a#ao =#4' !-(!r&a@co&(ro$a $a !-i& !& '!&(ido $a(!ra$. U&*iro orario d! $a #i'#a !-io&a $a'o&da acia $a i0)i!rda 1 !$ a&(iorarioa $a d!r!ca

. Pa$a&ca d! 6$o)!o co& (r!' ,o'icio&!'. Bo(o&!' d! ro(aci& a-ia$ co&(ro$a& !$

4&*)$o d! cor(! d!'d! 8Q a'(a 9:8Q.


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Pr!,araci& d!$ ,aci!&(!

H!&ir aco#,aado&o co&d)cir !+c)$o' E-,$icar co& (odo d!(a$$! !$ ,roc!di#i!&(o

1 o6(!&!r !$ co&'!&(i#i!&(o i&/or#ado. R!i'ar $a i'(oria c$+&ica d!$ ,aci!&(! !

i&(!rro*ar$! !& r!$aci& co& ,o'i6$!'

,a(o$o*+a' !'o/4*ica'3 !&/!r#!dad,)$#o&ar '!!ra 1 a$!r*ia'#!dica#!&(o'a' o i&(o$!ra&cia'

1)&o d! ora'


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S!daci&

S!daci& co&'ci!&(! =#od!rada@r!',)!'(a a !'(i#)$aci& !r6a$ o (4c(i$ co&!&(i$aci& !',o&(4&!a 'i& &!c!'idad d!

'o,or(! d! $a +a a5r!a. 1)&o #+&i#o ora' ,ara 6!6ida' 1

co#ida' =di/!r!&(!' a $+)ido' c$aro'@ L)!*o d!$ ,roc!di#i!&(o &o i&*!rir &ada

,or 9 ora. To#ar ')' #!dica#!&(o' ,or orario co&

,!)!o' 'or6o' d! a*)a.


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$dr!(! #odicado

Criterio a6i$idad P)&()aci&

c(iidad Ca,a0 d! #o!r'!o$)&(aria#!&(! o a&(! )&a ord!&

> !-(r!#idad!' 2

2 !-(r!#idad!' 9

8 !-(r!#idad!' 8

R!',iraci& Ca,a0 d! r!',irar 1 (o'!r$i6r!#!&(! 2

Di'&!a3 r!',iraci& '),!rcia$ o$i#i(ada 9

,&!ico 8

Circ)$aci& BP ;28 ##* &i!$ d!,r!'!&(aci& 2

BP ;28;?8 ##* d! &i!$,r!'!&(aci& 9

BP ;?8 ##* &i!$ ,r!'!&(aci& 8

E'(ado d! co&'ci!&cia Co#,$!(a#!&(! d!',i!r(o 2

D!',i!r(a a$ $$a#ado 9

No r!',o&d! 8


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L!#o&

Loo

Ea$)a(!

Ma$$a#,a(i

O6'(r)c(io&N!c #o6i$i(1


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S!daci&

&!'(5'ico(,icooro/ar+&*!oa&(!' d! $a'!daci&

=B!&0oca+&a3C!(acai&a o$idoca+&a@


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I&(o-icaci&,or

a&!'(5'ico'$oca$!'

E-ci(aci& SNCa*i(aci&3a&'i!dad3or#i*)!o

,!ri6)ca$3 do$ord! ca6!0a3

i,!r!'(!'ia3(!#6$or!'3

#ar!o'3

a$)ci&acio&!' 1co&)$'io&!'.

D!,r!'i& d!$SNC'o#&o$!&cia3

$!(ar*o3 dic)$(ad,ara a6$ar3

co&/)'i&3 ,5rdidad! $a co&ci!&cia3

d!,r!'i&r!',ira(oria.

CH i,o(!&'i&36radicardia3arri(#ia'3

a)#!&(o d!$)#6ra$

d!'6ri$ador3!d!#a3 1 o ,aro

card+aco

R!',ira(orio6ro&co!',a'#

o3 di'&!a3d!,r!'i&,aro

r!',ira(orio

GI 'a6or#!(4$ico3&4)'!a'3#i(o'

Pi!$ ,ica0&3d!',i*#!&(aci&3 !r),ci&c)(4&!a3

)r(icaria3 !d!#a

Sa&*r!

#!(a!#o;*$o6i&!#i

a

O+do'o7o'(i&i()'3

ardor $oca$3i,!r!#iaco&7)&(ia$3

di,$o,+a.


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T(o i&(o-icaci& ,or a&!'(5'ico'$oca$!'

28 < lipid emulsion Bo$o i&icia$ 93? #$*3 '!*)ido ,or

I&/)'i& 832? #$*#i& d)ra&(! 8;8 #i&)(o'

Bo$o ,odr+a r!,!(ir'! 9;2 !c!' '+ a1 a'i'(o$ia,!r'i'(!&(!. La !$ocidad d! i&/)'i& '! ,odr+a

a)#!&(ar 'i !$ BP di'#i&)1!.

((,%%%.$i,idr!'c)!.or*


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M!(a!#o*$o6i&!#ia

&(+do(o

So$)ci& d! a0)$ d! #!(i$!&o a$ 9< =98#*#$@ 9 a 2 #** ,or +ai&(ra!&o'a $!&(a#!&(! d)ra&(! ? #i&3'!*)ido ,or 'o$)ci& 'a$i&a &or#a$.


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S!daci&

Mida0o$a# !$!cci& ,ara '!daci&Ei(ar $a' BZD !& !$ !#6ara0o =,ri&ci,a$#!&(!

!& !$ I (ri#!'(r!@

&(+do(o )#a0!&i$ 8.2 #* c#i& a'(a r!!r(ir!$ !/!c(o

S! ,)!d!& adicio&ar o,ioid!' ,ara di'#i&)ir !$

di'co#/or( d! $a i&'!rci& 1 #a&i,)$aci& d! $a'o&da.&(+do(o &a$o-o&a 8.9 #*r c#i& a'(a FR

92


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Pr!,araci& d!$ ,aci!&(!

H+a !&o'a ,ara ad#i&i'(rar#!dicaci&3 ')!ro 'a$i&o o co&(ra'(!

'i !' &!c!'ario. Mo&i(ori0ar ,r!'i& ar(!ria$3

'a()raci& d! o-+*!&o 1 ECG. No )'o d! ,ro$a-i' ,ara !&docardi(i'

i&/!ccio'a


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Pro(oco$o d! i&()6aci&

&!'(!'ia oro/ar+&*!aV R!(irar $a' ,r(!'i' d!&(a$!'3 co$ocar a$ ,aci!&(!

!& d!cW6i(o $a(!ra$ i0)i!rdo3 co& !$ c)!$$o'!#i!-io&ado

X L)6ricar 'o&da co& *!$ $)6rica&(! d! *$ic!ri&a. E$*)arda6ocado' d!6! !'(ar co$ocado 1a !& $a'o&da

Y Li6!rar co&(ro$!' d! !-i& Ma&(!&!r $a 'o&da !& )&a 'i()aci& $o #4'

c!&(ra$ ,o'i6$!3 'i& r!a$i0ar #a&io6ra' 6r)'ca' oco& !-c!'ia /)!r0a ,ara !&c!r $a r!'i'(!&cia.


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[ S! i&'!r(a acia $a ,ar(!,o'(!rior d! $a /ari&*!3 '! $!,id! a$ ,aci!&(! )! d!*$)(a 1'! aa&0a $a 'o&da !&

,o'ici& &!)(ra acia !$!'/a*o.

\ S! ,)!d!& i&'!r(ar 9;2 d!do'!& $a 6oca ,ara *)iar $a 'o&da

] La ad)i'ici& d! $a i#a*!&'! $o*ra i!&do $a i#a*!& )!'! o6(i!&! a #!dida )! $a'o&da !' #a&i,)$ada


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^_)5 ac!r '+ '! a$$a

r!'i'(!&cia #i!&(ra' '!aa&0a !$ (ra&'d)c(or`

6or(ar


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E$ !)i,o

La #a1or+a d!$ !-a#!&!cocardio*r4co '! r!a$i0a #!dia&(!

)$(ra'o&ido !&(r! 3? 1 M0.Li#i(! d! ,!'o ,ara )(i$i0ar !$ !)i,o

ad)$(o 28*'

Li#i(! d! ,!'o ,ara )(i$i0ar !$ !)i,o,!di4(rico 9*


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^Por )5 &o )(i$i0ar $a 'o&da,!di4(rica !& (odo' $o'

,aci!&(!' ,ara di'#i&)ir !$ri!'*o d! $!'io&!' d!

!'/a*o`


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No d!'c)idar !$

c)idado d!$ ,aci!&(!,or $a /a'ci&aci&

a&(! $a i#a*!&


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C)idado3 #a&(!&i#i!&(o 1$i#,i!0a d! $a' 'o&da'


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G$)(ara$d!ido


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G$)(ara$d!ido

,!'ar )! $a i&cid!&cia d! $a

i&/!cci& !' #)1 6a7a =9 d! cada 93:#i$$o&!' d! ,roc!di#i!&(o'@3 $o' 6ro(!'&o'oco#ia$!' '! a& r!$acio&ado co&!&do'co,io' co&(a#i&ado' #4' )!co& &i&*)& o(ro di',o'i(io #5dico


43/47

G$)(ara$d!ido

c(iar $a 'o$)ci& #!dia&(! !$)'o d! a*!&(!' a$ca$i&i0a&(!' a, 3? a :3?

$)i$aci& d! *r),o'')$/idri$o3 idro-i$o3 car6o-i$o31 *r),o' a#i&o d! $o'#icroor*a&i'#o'

C i i$ $


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C#o a&i)i$a a$a&i)i$ador`

Bac(!ria'!*!(a(ia' 2#i&)(o'

M. ()6!rc)$o'i'3o&*o' 1 ir)'98 #i&)(o'

E',ora' d!

Baci$$)' 1C$o'(ridi)# ora'


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G$)(ara$d!ido

98?;9898)&idad!' /or#adora' d! co$o&ia' =UFC@#$ C)$(iar )&a !0 a$ #!' !$ a*)a )(i$i0ada ,ara !$ !&7)a*)!

&a$ !& $a $i#,i!0a d! $a 'o&da

E$ #a$!(+& )(i$i0ado ,ara !$ (ra&',or(! d! $a 'o&da &o d!6!'!r )(i$i0ado ,ara a$#ac!&ar )& !&do'co,io o ,ara(ra&',or(ar !$ i&'(r)#!&(o d!&(ro d!$ c!&(ro #!dico.

E$ *$)(ara$d!+do &o !' corro'io a$ #!(a$3 $!&(!'3 ca)co o,$4'(ico.

E-,o'ici& d!r#a(i(i'3 irri(aci& d! #)co'a' =o7o'3 &ari036oca@ o '+&(o#a' ,)$#o&ar!'3 !,i'(a-i' 3 a'#a3 1 ri&i(i'.

Di',o'ici& a (ra5' d! a$ca&(ari$$ado o 6i')$/a(o d! 'odio.


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C)idado3 #a&(!&i#i!&(o 1 $i#,i!0ad! $a' 'o&da'

Li#,i!0a7a6&d!'i&/!c(a&

(!!',!c+coco& )& ,

&!)(ro 28 #i&)(o'!& )&

r!ci,i!&(!co& )&a

'o$)ci& d!/or#a$d!+do a 28bC

Li#,i!0aco& a*)ad!'(i$ada

!'(5ri$

$#ac!&a#i!&(o !& ,o'ici&

!r(ica$

R!i'io&!'!$5c(rica',!ridica'

co&car4c(!r

,r!!&(io.

U'o


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La#or! i&c! '!#,r!

Gra0i!

Transesophageal echocardiography: TEE instrumentation.

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Transcript of Transesophageal echocardiography: TEE instrumentation.