Hospital de Santa Marta (Portuguese pronunciation: [ɔʃ.piˈtaɫ dɨ ˈsɐ̃.tɐ ˈmaɾtɐ], "Saint Martha's Hospital") is a public Central Hospital serving the Greater Lisbon area as part of the Central Lisbon University Hospital Centre (CHULC), a state-owned enterprise.Originally a Poor Clares nunnery, it became one of the country's main schools of Internal Medicine during most of the 20th century; more recently, it became especially differentiated in Cardiology and Cardiothoracic Surgery: it is one of the main reference centres on the diagnosis and treatment of cardiovascular disease in Portugal.
Ultrasound has become indispensable in the management of patients supported with extracorporeal membrane oxygenation (ECMO), enabling rapid diagnosis, procedural guidance, physiologic monitoring, and informed decision-making across the entire ECMO continuum. This review, conducted under the auspices of the Extracorporeal Life Support Organization (ELSO), provides evidence-based recommendations for the use of ultrasound in adult, pediatric, and neonatal ECMO patients. An international, multidisciplinary panel of experts with dual expertise in ECMO and ultrasound, representing all ELSO chapters, convened to define the scope and structure of the review. A comprehensive literature review identified 133 relevant publications informing recommendations. The review addresses training and competency requirements, choice of ultrasound modalities, and the role of ultrasound before ECMO initiation, during cannulation, throughout ECMO support, for troubleshooting complications, and during ECMO weaning and post-decannulation care. Pre-ECMO ultrasound is emphasized for assessment of cardiopulmonary function, vascular anatomy, and identification of contraindications or reversible conditions. Real-time ultrasound guidance is recommended for cannulation to reduce complications and confirm optimal cannula positioning. During ECMO, echocardiography and extracardiac ultrasound are central to monitoring cardiac function, cannula position, ventricular loading conditions, pulmonary pathology, neurological complications, and vascular integrity. Ultrasound-based strategies for diagnosing hypoxemia, recirculation, tamponade, ventricular distension, and limb ischemia are detailed. Finally, ultrasound plays a critical role in assessing readiness for ECMO liberation and identifying post-ECMO complications. This review highlights the pervasive role of ultrasound as a core competency in ECMO care and provides a practical framework to support safe, effective, and standardized ultrasound use across diverse ECMO programs worldwide.
INTRODUCTION: Subintimal angioplasty is an endovascular technique used to recanalize occluded segments in the arterial bed that cannot be crossed via an intraluminal path. However, there is still limited data regarding the clinical outcome of subintimal angioplasty. The aim of this study is to evaluate the impact of subintimal angioplasty in femoro-popliteal lesions. METHODS: This is a retrospective, single-centre, comparative study. From January 2023 to February 2025, all patients with chronic lower limb ischemia due to femoro-popliteal arterial lesions who underwent endovascular treatment as a first revascularisation procedure were considered. Patients were grouped according to the cross-lesion pathway: the subintimal cross-lesion group (S group) and the intraluminal cross-lesion group (L group). Both groups were compared with respect to the atherosclerotic disease pattern, and the primary endpoints were the rates of reintervention and amputation. RESULTS: The study included 95 patients, of whom 10% (n = 9) presented with intermittent claudication and 90% (n = 85) with chronic limb-threatening ischaemia. The median follow-up time was nine months. The S group included 30% (n = 28) of the patients and L group included 70% (n = 67). The median femoro-popliteal GLASS classification was 4 in both groups, but this GLASS stage was more common in S group (p = 0.004). Severe calcification (p < 0.001) and bailout stenting (p < 0.001) were more common in the S group. Regarding the primary endpoints, no statistically significant differences were found between groups in rates of reintervention (p = 0.95) and amputation (p = 0.26) at 12 months of follow-up. CONCLUSION: Our results suggest that the clinical outcomes of subintimal angioplasty are similar to those of intraluminal angioplasty, with comparable limb outcomes in patients with femoro-popliteal lesions. These findings may support adopting a lower threshold for subintimal crossing in calcified and complex lesions, as it can achieve good results with comparable outcomes to the intraluminal angioplasty.
Abstract Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe and potentially curable subtype of pulmonary hypertension (PH), causing by persistent pulmonary vascular obstruction by organized thromboembolic material. Tertiary referral centers play a crucial role in advanced diagnostic evaluation and selection of targeted therapeutic strategies. Aim To describe the clinical profile and therapeutic management of patients with CTEPH followed at a tertiary referral center. Methods Retrospective analysis of consecutive patients with established CTEPH under regular follow-up at a specialized PH center. Demographic characteristics, risk factors for chronic thromboembolic disease, NT-proBNP, hemodynamic parameters, and imaging findings were collected. Pharmacological therapy, interventional procedures such as balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) were evaluated. Results Fifty patients were evaluated, of which 68% were female. The mean age was 66.7 ± 13.9 years. Five patients died (mean age 69.6 ± 8.4 years), with one death related to a PEA complication. Acute PE was the most prevalent risk factor (78%), followed by deep vein thrombosis (DVT) (32%) and 26% of patients had a history of both. Other prevalent risk factors were cancer (18%) and coagulopathy (18%), with the antiphospholipid syndrome (APS) being the most frequent coagulopathy. 64% of patients were on medical therapy (MT): 34% on single MT, 26% on double MT and 2% under triple MT. Riociguat was the most used. 34% underwent BPA and 40% underwent PEA. Five patients underwent to both PEA and BPA and were also underTM. At baseline, most patients presented with elevated NT-proBNP, evidence of right ventricular (RV) overload – 51% RV dilatation, 38% D-shape left, ventricle, mean VD-AD 53±28.7 cm2 - and elevated pulmonary pressures - mean PSAP 57.3±29.9 mmHg, mean mPAP 41.2±13.6 mmHg. During follow-up, significant improvements were observed in all echocardiographic and invasive hemodynamic parameters previous mentioned, with statistical significance (p< 0.05). Conclusion Patients with CTEPH at a tertiary referral center frequently present with advanced disease, requiring comprehensive assessment and access to specialized therapeutic options. These findings highlight the importance of early diagnosis and referral to experienced CTEPH centers to optimize outcomes.For image description, please refer to the figure legend and surrounding text.
