A Tako-Tsubo syndrome case managed with robotic telechocardiography during the containment due to the covid-19 pandemic

Hedreville, M.; Hedreville, S.; Nupert, F.; Forbin, A.; Chabus, S.; Gabriel, J.

Introduction This clinical case reports a Tako-Tsubo syndrome, in a 48-year-old single woman without cardiovascular history, without COVID symptoms, admitted with acute heart failure to the emergency room of the hospital of Marie-Galante (CHSM), an island of the Guadeloupe archipelago, confined due to the COVID-19 pandemic. The treatment of the congestive phase then the background outpatient treatment of the heart failure were initiated, on the spot thanks to cardiological teleconsultation (TLC) and robotized telechocardiography (TER). Method The TER device (Melody ®) is a non-invasive remote cardiac imaging technique, configured as follows: the expert site (CHU Guadeloupe), the patient site (CHSM). The articulated arm of the robot, equipped with the echocardiography probe on its outside, is positioned on the patient's thorax by the tele-assistant nurse. The cardiologist takes the dummy probe in hand and remotely controls the robot, which reproduces the movements of his or her hand precisely and synchronously. The digital control unit and the reading of the echographic image allow him to parameterize the echocardiography in real time. The videoconference (Courbaril ®) allows the dialogue between the cardiologist and the patient or the tele-assistant nurse (Fig. 1). Results The first TER mainly showed a dilated cardiomyopathy, a LV severely hypokinetic, the LV ejection fraction was estimated to 15–20%, with a moderate intra LV contrast, and high LV filling pressures. The RV was dilated, moderately hypokinetic. A PAH at 76mmHg. A moderate pericardial and bilateral pleural effusion. Few pulmonary comet tails. The second TER, performed 6 weeks later showed a normalization of the LV size with improved ejection fraction to 58%. Conclusion Six TLC using 2 TER enabled the patient to be managed without medical evacuation to the CHU Guadeloupe during the containment due to COVID-19 pandemic. The TER system (robotized Tele echocarcardiography)