Les animaux de compagnie présentent un intérêt majeur dans les études cardiovasculaires soit comme modèles expérimentales soit comme modèles spontanées. De plus, le développement de méthodes d'exploration non invasives en médecine vétérinaire est devenu une nécessité à cause de régulations strictes concernant le bien être de l'animal. Un facteur limitant demeure l'exactitude et la fiabilité (répétabilité/reproductibilité) des techniques d'exploration pour leur utilisation répétitive chez des animaux vigiles. La mesure de la pression artérielle systémique (PA) non invasive et l'échocardiographie conventionnelle et avancée ont gagné de la place dans le domaine de recherche ; cependant, il n'existe pas de recommandations spécifiques sur la validation métrologique de méthodes quantitatives utilisées en recherche clinique ou fondamentale en médecine vétérinaire. Le présent travail a premièrement focalisé sur la validation métrologique de la mesure de la PA chez le chien et le chat en étudiant la répétabilité et la reproductibilité de la méthode Doppler (chez les deux espèces) et de la méthode oscillométrique (chez le chien) et en déterminant l'influence du niveau d'expérience de l'opérateur sur la variabilité intra- et inter-jour et le pourcentage de mesures réussies. Puis l'effet de la position de l'animal et du nombre de mesures répétées sur de variables sélectionnées d'échocardiographie bidimensionnelle (2D) et temps-mouvement (TM) a été évalué. De plus, la méthode de l'aire de la surface de l'isovélocité proximale (PISA) pour la quantification de la régurgitation mitrale (RM) ainsi que le strain (St) et strain rate (SR) dérivé du Doppler tissulaire ont été validé chez le chien par le calcul de la répétabilité et la reproductibilité des techniques. Dans un deuxième temps les techniques précédemment validées ont été appliquées chez des chiens sains, des chiens souffrant de maladie valvulaire mitrale dégénérative (MVD) spontanée et dans un modèle expérimental de myopathie centronucléaire (CNM) chez des Labradors retrievers. Toutes les études ont été réalisées à l'Unité de Cardiologie d'Alfort, à l'Ecole Nationale Vétérinaire d'Alfort. Pour les mesures de la PA, toutes les deux études ont montré que l'entrainement est important, notamment pour la mesure de la pression diastolique avec le Doppler, tandis que la répétabilité et reproductibilité sont bonnes pour un opérateur expérimenté. Concernant l'échocardiographie 2D et TM, la technique peut être réalisée chez des chiens couchés ou debout avec une répétabilité/reproductibilité similaire. La fraction régurgitée évaluée par la méthode PISA est une variable répétable et reproductible pour l'évaluation de la RM chez le chien souffrant de MVD. De façon similaire le St et SR peuvent être mesurés de manière fiable chez le chien vigile et leur utilisation combinée avec d'autres paramètres échocardiographiques offre une nouvelle approche à l'étude de la fonction systolique dans cette espèce et peut complémenter l'échocardiographie conventionnelle pour la mesure de la performance myocardique. L'intérêt de ces méthodes validées a été illustré dans des études avec des chiens souffrant de MVD de gravité variable et une différence significative des paramètres étudiés (PA et fraction régurgitée) a été retrouvée dépendant du stade de la maladie. Enfin dans le modèle de CNM, des altérations sous-cliniques ont été détectées et considérées comme significatives étant donnée les faible coefficients de variation de techniques utilisées. En conclusion, le présent travail a évalué la répétabilité et la reproductibilité de quelques techniques d'exploration cardiovasculaires et a démontré l'importance de la validation en les appliquant dans des circonstances cliniques. Cependant ces résultats ne sont valables que dans les conditions spécifiques utilisées dans ces études. / Small animais present a major interest in cardiovascular studies either as experimental or as spontaneous models. Additionally, the development of non-invasive exploration methods in veterinary medicine has been impeding since regulations applying to animais are getting stricter and animal welfare has been the subject of many debates recently. A limitation factor regarding noninvasive cardiovascular exploration by different methods remains the accuracy, and reliability of the different techniques, that is to say, if the methods are repeatable and reproducible, and able to be used in repeated manner in awake animais. Although non-invasive arterial blood pressure (ABP) measurement and conventional, as weil as, advanced echocardiographic techniques have gained place in the domain of veterinary research, there are no specifie guidelines on how to metrologically validate a quantitative imaging technique in veterinary medicine for use in clinical or fundamental research. The present work focused firstly on metrological validation of non-invasive ABP measurement in dogs and cats by assessment of repeatability and reproducibility of Doppler ultrasonography (DU, in both dogs and cats) and high definition oscillometry (in dogs) and by determination of the influence of the observer's level of experience on within-day and between-day variability and the percentage of successful measurements. Then, the effect of animal position and number of repeated measurements on selected 2-dimensional (20) and M-mode echocardiographic variables in heal~hy dogs was evaluated. Moreover, the proximal isoveJocity surface area (PISA) method for quantification of mitral regurgitation (MR) and the tissue Doppler-derived strain (St) and strain rate (SR) technique in the dog were validated by calculation of repeatability and reproducibility. In a second step, the previously validated techniques were applied to healthy dogs, dogs suffering from spontaneous mitral valve disease (MVD) and to an experimental model of centronudear myopathy (CNM) in labrador retrievers. A total of 7 studies were realized. Ali studies were conducted at the Cardiology Unit of Alfort, in the National Veterinary School of Alfort. For ABP measurements, bath studies showed that training is important especially for evaluation of diastolic ABP with DU, whereas repeatability and reproducibility are good for sufficiently experienced observers. Regarding transthoracic 20 and M-mode echocardiography, itcan be performed on dogs in both standing position and lateral recumbency, and the repeatability of measurements is similar. Regurgitant fraction assessed by the PISA method is a repeatable and reproducible variable for the non-invasive evaluation of MR in awake dogs with MVD. This Doppler index is reliable, and its assessment can therefore be recommended for use, in combination with evaluation of other Doppler echocardiographic variables, in longitudinal studies of mitral valve disease in dogs. SimilarJy, myocardial St and SR can be measured non-invasively and in real time from regional myocardial velocities by TOI with good repeatability and reproducibility in the awake dog. The combined use of. St and SR indices with other tissue Doppler parameter's offers a new ultrasound approach to the systolic function in this species and may complement conventional echocardiographic measure of myocardial performance. The interest of those validation methods was firstly iIIustrated in studies involving dogs suffering from MVD of differing severity, where a relevant difference of the evaluated parameters (ABP and regurgitant fraction) was found depending on the stage of the disease.

The purpose of this phenomenological study was to determine the meaning parents give to their family's experience when they have a child awaiting corrective heart surgery. A secondary purpose was to identify appropriate interventions for nurses who deal with families during the transition period, from initial diagnosis of congenital heart disease until admission to hospital for corrective heart surgery. A convenience sample of six couples were interviewed at various times during the identified transition period, for a total of 11 interviews. An interview guide of open-ended questions provided some loose structure for the initial interviews. Analysis of the verbatim transcriptions began concurrently with data collection and continued during the formal analytic phase with meaning units emerging from the data. The parents described four facets of the experience: diagnosis of congenital heart disease, adjusting to caring for child once home, living with a child with a chronic condition, and waiting for corrective heart surgery. Not only did parents talk about how they felt during the four facets but they also described the range of coping strategies they employed through their experience. In discussing these findings within the context of other chronic illness experiences it became evident that parents draw from a common pool of coping strategies whether the child is in a chronic or more acute phase of an illness. Most of the parents in discussing their overall impressions of the experience had not found their child's illness to be as disruptive to family life as they had first anticipated. Those families with the most symptomatic infants seemed to have a particular need for an alliance with one health care professional to support them through the transition period. Generally, parents did not spend a lot of time dwelling on the corrective surgery until close to the anticipated date for that event; instead they employed various coping strategies which allowed them to normalize their lives. Implications for nursing practice which arise from these conclusions are multiple. Overall, nurses must assess the meaning that individual families give to their experience, assist families to employ suitable coping strategies, and offer support as necessary. General implications for nursing research are in the realm of studies which will further nurses' understanding of the waiting period for corrective heart surgery both from the parents' and the siblings' perspective. / Applied Science, Faculty of / Nursing, School of / Graduate

Apresenta-se uma retrospectiva histórica do conhecimento e aplicação da engenharia biomédica/bioengenharia no Brasil; no período do século XX, enfocando a história da arte brasileira com relação à engenharia biomédica/bioengenharia, evidenciando perspectivas de desenvolvimento deste interessante campo de conhecimento. Por razões metodológicas e didáticas dividirão a engenharia biomédica/bioengenharia em áreas de aplicação: cardiologia, ortopedia, odontologia, oftalmologia, medicina regenerativa coadunando as áreas de ciências exatas e da terra onde, por exemplo, os conhecimentos das propriedades dos materiais utilizados, são evidenciados como composição química, estrutura, propriedades e aplicações, contextualmente definida como aplicação da engenharia biomédica/bioengenharia na medicina, de forma transitória ou permanente pelos diversos tecidos dos organismos dos seres vivos. Eles são utilizados como um todo ou parte de um biológico que trata, restaura ou substitui algum tecido, órgão ou função do corpo humano ou ainda como um material não viável utilizado em um dispositivo médico, com a intenção de interagir com o sistema biológico. A definição de bioengenharia foi encarada nessa dissertação de forma a direcionar a pesquisa de campo em empresas e núcleos que desenvolvem biomateriais, entrevistas com pessoas que vivenciaram o desenvolvimento da bioengenharia no Brasil, preparando um compêndio da história da bioengenharia no Brasil, no século XX / Show up a historical retrospective of knowledge and appliance of biomedic engineering in Brazil, on period of XX century, focus the history of brazilian art with relation of biomedic engineering, connecting perspective of development of this interesting knowledge filld. For methodological and didactic reasons biomedic engineering was divide in areas of appliance cardiologic, orthopedic, odontology, ophthalmology, regenerate medicine connecting areas of exact science and earth where, for example, the knowledge of property of material used, are evidence like chemistry composition, structure, properties and appliances contextualmente defined like appliance of biomedic engineering in medicine, on transitory or permanent form by several tissues of creature organisms. They are used as a whole or a part of a biological than treat, repair or replace some tissue, organ or function of human body or even like a material not possible to use in a medical gadget, with purpose of interragir with a biological system. The definition of bioengineering was look at in that dissertation so that direction to research field in enterprises and centers that development biomaterials, interview with peoples that live the development of bioengineering in Brazil, make compêndio of brazilian bioengineering history, on XX century

La cardiopathie rhumatismale (CR) demeure la première cause de cardiopathie acquise chez les enfants et les jeunes adultes à travers le Monde. L'essor de l'échographie cardiaque comme outils de dépistage dans les zones endémiques pose de nouvelles questions. Trois études indépendantes ont été menées en Nouvelle Calédonie dans le cadre de la thèse de 2011 à 2013: " L'étude de cohorte rétrospective en population a évalué une campagne de dépistage national de la CR par échocardiographie visant à inclure tous les enfants scolarisés en classe de CM1 sur l'île de 2008 à 2011. Les méthodes diagnostiques complexes utilisées en recherche ne peuvent être transposées en campagnes de dépistage écho-guidées à l'échelle nationale en raison du nombre élevé d'enfants (~25%) sans diagnostic final. Le pronostic de la CR asymptomatique dépistée par échographie est bénin à moyen terme, quoique les lésions échographiques persistent dans la majorité des cas. Environ 13% des enfants initialement sains présentent des anomalies échocardiographiques à 2 ans de suivi. " Une étude prospective en population a exploré des méthodes simplifiées de dépistage à l'aide de l'échoscopie cardiaque avec des appareils de poche par du personnel paramédical. La sensibilité et la spécificité de cette approche permet de dépister ~80% des cas, avec une sensibilité de ~90% dans le cadre de CR certaine, seul cas de figure où un traitement est nécessaire. " Une cohorte hospitalière contemporaine de patients admis à l'unique centre du pays a permis d'apporter des données épidémiologiques de la CR symptomatique, et d'identifier les facteurs associés à la survenue d'événements cardiovasculaires. Le diagnostic y est encore souvent porté à un stade tardif, révélé par des complications (~25%). Le taux de survie à 8 ans de la CR symptomatique sans complication initiale est élevé (~98%) mais l’incidence annuelle d’événements atteint 59‰ (95% CI 44.35-73.75). La sévérité de la CR au diagnostic (CR moyenne versus modérée HR 3.39 (0.95 – 12.12); CR sévère versus modérée HR 10.81 (3.11 – 37.62), p<0.001) et l’antibioprophylaxie (HR 0.27 (0.12-0.63), p=0.01) sont les deux facteurs associés à la survenue d’événements cardiovasculaires. / Rheumatic heart disease (RHD) remains the leading acquired heart disease in the young worldwide. The advent of echocardiography as a screening tool has raised new questions in the field. This thesis incorporated three studies to explore critical questions regarding the burden of asymptomatic and symptomatic RHD in New Caledonia (2011-2013): Retrospective population-based cohort study assessing the first nationwide echo-screening campaign targeting all children in 4th grade (2008-2011). Methods derived from research may not be applicable as a healthcare policy given the lack of completeness (~25%). Outcomes of children with asymptomatic RHD detected by echocardiography are benign although the majority of valve lesions persist with little clinical implications. RHD being a dynamic condition, 13% of children at high risk of RHD with normal baseline echocardiograms may present with mild echocardiographic lesions at 2 years follow-up. Prospective population-based study assessing sensitivity and specificity to detect asymptomatic RHD of a focused cardiac ultrasound (FCU) compared to echocardiography. FCU includes nurses after a short training scheme using pocket-echocardiographic machines and simplified criteria. Sensitivity and specificity for RHD detection was of ~80% and performed better (sensitivity ~90%) when restricted to definite RHD in which case treatment is recommended. Retrospective hospital-based cohort of patients admitted with symptomatic RHD. RHD remains prevalent and incident. Diagnosis if often made at an advanced stage (~25%). In patients with uncomplicated RHD, the survival rate was ~96% at 8 years with however an annual incidence of 59.05‰ (95% CI 44.35-73.75) major cardiovascular events. The severity of RHD at diagnosis (moderate vs. mild HR 3.39 (0.95 – 12.12); severe vs. mild RHD HR 10.81 (3.11 – 37.62), p<0.001), and ongoing secondary prophylaxis at follow-up (HR 0.27 (0.12-0.63), p=0.01) were the two most influential factors associated with major cardiovascular events.

<p>An abdominal aortic aneurysm (AAA), defined as a pathological expansion of the largest artery in the abdomen, is a relatively common disease that frequently leads to death if rupture occurs. Once diagnosed, clinicians often evaluate the rupture risk based on the maximum diameter of the aneurysm, a limited metric that is not accurate for all patients. In this study, we worked to provide additional distinguishing factors between growing and stable AAAs to aid in clinical rupture risk assessment. We utilized a relatively new murine model that uses surgical application of topical elastase to cause initial aortic expansion, and a lysyl oxidase inhibitor, β-aminopropionitrile (BAPN), in the drinking water to promote AAA growth. We further sought to develop and demonstrate applications of advanced imaging approaches, including four-dimensional ultrasound (4DUS), to obtain and evaluate alternative geometric and biomechanical parameters between 1) growing AAAs, 2) stable AAAs, and 3) non-aneurysmal control mice. Our study confirmed the reproducibility of the model and found reduced strain values, greater tortuosity, and decreased elastin health in mice with aneurysms. We also found expanding murine AAAs to have increased peak wall stress and surface area per length compared to stable aneurysms. The results from this work help provide a better understanding of the growth patterns associated with elastase-BAPN murine aneurysms and demonstrate the capabilities of high-frequency ultrasound. Eventually these data could help lay the groundwork for improving insight into clinical prediction of AAA expansion.</p>

This master´s thesis deals with the analysis of experimental telemetrical ECG records with intention to determine the long-term influence of anticancer drug sunitinib on the electrical activity of heart. A laboratory rat was chosen as a model organism for the experimental study carried out at the Department of Physiology at Faculty of Medicine, Masaryk university. The sunitinib was applied to the rats at an early age and the ECG was measured with a 20-week delay using the Stellar telemetry system. To measure the effect of sunitinib on the electrical activity of the heart chambers, an analysis of the duration of the RR and QT interval and the width of the QRS complex was chosen. These parameters were detected by the wavelet transform method. Statistical analysis was performed using nonparametric tests - the Wilcoxon signed rank test, the MannWhitney test and the Friedman Test. The obtained results suggest that the use of sunitinib has no long-term effect on the observed parameters for the chosen animal model. After extension of the study, the results obtained could contribute to assess the effect of drugs on electrical activity of the human heart several decades after sunitinib treatment termination.

El Programa de Prevención y Rehabilitación Cardiaca Integral: CARDIOMOVE ; es una empresa de salud con fines de lucro que busca rentabilidad económica y social, cuyo objetivo es mejorar clínicamente al paciente; tanto del punto de vista cardiológico, como psicológico a quienes han sufrido de una cardiopatía isquémica como ; infarto o ataque al corazón, sometidos a una intervención coronaria percutáneo , cirugía de revascularización, angina crónica estable, implantación de dispositivo, trasplante cardiaco, insuficiencia cardíaca, intervención sobre válvulas cardiacas, enfermedad arterial periférica, y pacientes sin ninguna cardiopatía pero con factor de riesgo cardiovascular (hipertensión, diabetes mellitus , obesidad y dislipidemias) El Programa de Prevención y Rehabilitación cardíaca Integral: CARDIOMOVE; está compuesto por pilares fundamentales como el control de los factores de riesgo, la mejoría de la capacidad física, optimización del tratamiento médico, la educación de hábitos de vida saludable, y el soporte psicológico y nutricional. Nuestro servicio va dirigido para el público mayor de 18 años con cardiopatía o sin ella, pero con factor cardiovascular pertenecientes al nivel socioeconómico B y C de Lima Metropolitana con posibilidad de pago de bolsillo. El Programa de Prevención y Rehabilitación Cardíaca Integral: CARDIOMOVE: tiene su sede central localizada en el distrito de Jesús María, debido a que es un lugar de fácil acceso geográfico desde los distintos distritos de Lima. La idea de negocio, nace ante la prevalencia de enfermedades cardiovasculares, el aumento de factores de riesgo y pobre fomentación de estilos de vida saludable, ausencia de programas de rehabilitación prevención cardiovascular, ausencia de programa de rehabilitación cardiaca como estrategia de prevención secundaria demostrada, la desinformación sobre los grandes beneficios de la rehabilitación cardiaca ; la escasa derivación de pacientes a dichos programas casi inexistentes y el crecimiento de las enfermedades no transmisibles. Nuestra propuesta de valor es mejorar la calidad de vida; reincorporándolo laboral y socialmente; evitando el deterioro psicológico, fortaleciendo la capacidad física; brindando una experiencia única y segura; mediante una atención multidisciplinaria y personalizada a las personas que requieran un programa de prevención y rehabilitación cardiaca Integral. Todo esto es posible con un equipo humano profesional de salud y administrativo, cuyos valores principales son: Hospitalidad, Respeto, Responsabilidad, Calidad y Espiritualidad. Respecto a la evaluación económica financiera; se ha estimado una inversión de S/427,369 nuevos soles, el cual se financia 30% por capital y 70% por deuda. Con un precio promedio de venta por paquete completo del programa de prevención y rehabilitación cardíaca integral de S/. 1440 nuevos soles, un costo mensual de S/ 480 nuevos soles y un costo variable unitario promedio de S/. 40 nuevos soles. Con un tiempo de retorno de la inversión del segundo semestre del 1 año. Obteniendo un valor actual neto económico de la empresa de aproximadamente S/1,067.984nuevos soles. Respecto a la Tasa Interna de Retorno de la empresa corresponde de 30.83 %. Después de lo expuesto según los datos de rentabilidad financiera y estudios de sensibilidad, se concluye que se trata de una inversión de moderado riesgo con una gran posibilidad de crecimiento en el tiempo aunado a un gran impacto de salud de las personas. / The Comprehensive Cardiac Prevention and Rehabilitation Program: CARDIOMOVE; is a for-profit health company that seeks economic and social profitability, whose objective is to improve the patient clinically; both from a cardiological and psychological point of view to those who have suffered from ischemic heart disease such as; infarction or heart attack, undergoing percutaneous coronary intervention, bypass surgery, chronic stable angina, device implantation, heart transplantation, heart failure, intervention on heart valves, peripheral arterial disease, and patients without any heart disease but with a risk factor cardiovascular (hypertension, diabetes mellitus, obesity and dyslipidemias) The Comprehensive Cardiac Prevention and Rehabilitation Program: CARDIOMOVE; It is made up of fundamental pillars such as control of risk factors, improvement of physical capacity, optimization of medical treatment, education of healthy lifestyle habits, and psychological and nutritional support. Our service is aimed at the public over 18 years of age with or without heart disease, but with cardiovascular factors belonging to socioeconomic status B and C of Metropolitan Lima with the possibility of paying out of pocket. The Comprehensive Cardiac Prevention and Rehabilitation Program: CARDIOMOVE: has its headquarters located in the Jesús María district, due to the fact that it is a place with easy geographic access from the different districts of Lima. The business idea was born due to the prevalence of cardiovascular diseases, the increase in risk factors and poor promotion of healthy lifestyles, absence of cardiovascular prevention rehabilitation programs, absence of a cardiac rehabilitation program as a proven secondary prevention strategy, misinformation about the great benefits of cardiac rehabilitation; the scarce referral of patients to these programs almost non-existent and the growth of non-communicable diseases Our value proposition is to improve the quality of life; reincorporating him to work and socially; avoiding psychological deterioration, strengthening physical capacity; providing a unique and safe experience; through multidisciplinary and personalized care for people who require a comprehensive cardiac prevention and rehabilitation program. All this is possible with a professional health and administrative human team, whose main values ​​are: Hospitality, Respect, Responsibility, Quality and Spirituality. Regarding the financial economic evaluation; An investment of S / 427,369 nuevos soles has been estimated, which is financed 30% by capital and 70% by debt. With an average sale price for a complete package of the comprehensive cardiac prevention and rehabilitation program of S /. 1,440 nuevos soles, a monthly cost of S / 480 nuevos soles and an average unit variable cost of S /. 40 new soles. With a return on investment of 1 years. Obtaining a net present economic value of the company of approximately S / 1,067.984 new soles. Regarding the Internal Rate of Return of the company it corresponds to 30.83%. After the above, according to the financial profitability data and sensitivity studies, it is concluded that it is a low risk investment with a great possibility of growth over time coupled with a great impact on people's health. / Trabajo de investigación

Additive Manufacturing (AM) is a fast-developing technology, that despite itspotential is yet to be applied by the mainstream healthcare market. Comparedto other clinical areas where AM is applied, cardiology has a negligible marketshare, why this thesis aimed at identifying barriers and facilitators for AMimplementation, as well as presenting a framework with factors to considerwhen attempting to implement AM. A literature review outlined aspects currently considered in literature, inrelation to the barriers and facilitators of implementing AM in cardiology. Toidentify barriers and facilitators to AM implementation in cardiology, and tocomplement the literature review, two exploratory case studies were carriedout, which had a comparative design. The case studies took place in Sweden,whereof one has already implemented AM in cardiology, and the other one hasnot. Purposive sampling was applied to choose the two involved hospitals, whileconvenience sampling and snowball sampling were used for selecting interviewparticipants. The findings were analyzed using a thematic analysis. Results show that barriers and facilitators can act on an individual,organizational, and industrial level. Barriers and facilitators were divided intothe themes Management, Technology, Network, Behavior, and Market. Aspectsfalling under the theme Management were mentioned most frequently amongthe respondents, suggesting that such barriers and facilitators play a significantrole in implementing AM, while findings placed in the Network and Behaviortheme respectively were not previously addressed in literature. Barriersinclude, among others, low involvement of leaders, little cross disciplinarycollaboration, and lack of innovation resources in health care. Facilitatorsinclude, among others, having an innovation culture that supports initiation ofprojects, providing an easy and intuitive system for ordering a 3D model, andpromoting the technology among potential users. Concluded is that AM implementation faces numerous barriers and facilitatorswhich should be considered before an implementation endeavor. Addressingthese on an individual, organizational, and industrial level most likely facilitatesthe process of AM implementation, leading to a successful and sustainablechange in the organization.

Abstract available through the Journal of the American College of Cardiology.

No description available.