{"id":4728,"date":"2015-09-28T13:53:15","date_gmt":"2015-09-28T13:53:15","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=4728"},"modified":"2016-07-01T14:08:07","modified_gmt":"2016-07-01T14:08:07","slug":"tele-ecocardiografia-viitor-sau-deja-realitate","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/tele-ecocardiografia-viitor-sau-deja-realitate\/","title":{"rendered":"Tele-ecocardiografia, viitor sau deja realitate?"},"content":{"rendered":"

\n

\"Gheorghe<\/a>
Gheorghe CERIN, MD, PhD, FESC, doctor \u00een \u015ftiin\u0163e medicale, medic primar cardiolog ecocardiografist \u015fi \u015feful Departamentului de Cardiologie \u015fi Medicin\u0103 Intern\u0103 Clinica San Gaudenzio Novara, Italia, cardiolog consultant la Cardiac Center, Spitalul Monza, Bucure\u015fti<\/em><\/figcaption><\/figure>\n

D-le dr Cerin, am v\u0103zut c\u0103, \u00een ultima vreme, sunte\u0163i din ce \u00een ce mai prezen\u0163i pe scena unor mari congrese de ecocardiografie, cu transmisii \u00een direct de eocardiografie intraoperatorie \u015fi de cardiochirurgie. Pute\u0163i s\u0103 ne spune\u0163i care este motiva\u0163ia Dumneavoastr\u0103 pentru aceste transmisii live? Cum a\u0163i ajuns la ele?\u00a0<\/strong><\/p>\n

Simplu! Este o problem\u0103 de experien\u0163\u0103. \u00een multe sensuri ale cuv\u00e2ntului. Mai \u00eent\u00e2i a\u015f aminti de experien\u0163a \u00a0Grupului Cardioteam de la Clinica San Gaudenzio din Novara, din ultimii 10-12 ani, cu transmisiile \u00een direct din sala operatorie. Cred c\u0103 de aici a plecat totul. Noi lucram \u00een nordul Italiei, \u00eentr-o re\u0163ea de 10 spitale private. At\u00e2t eu c\u00e2t \u015fi dr. Diena Marco – \u015feful de sec\u0163iei de chirurgie -, am \u00eenceput activitatea la San Gaudenzio, \u00een anul 2002. Aveam nevoie atunci s\u0103 facem cunoscut\u0103 colegilor din Piemonte valoarea grupul nostru profesional. Acesta a fost biletul nostru de vizit\u0103 \u015fi am ales, cum se vede, un bilet foarte special \u015fi transparent! Nu este timp acum s\u0103 abord\u0103m problema concuren\u0163ei din sistemele de s\u0103n\u0103tate, dar ea exist\u0103 \u015fi poate influen\u0163a felul nostru de a practica meseria. Reamintesc c\u0103 noi nu suntem un spital universitar, de\u015fi \u00een ultimii ani am devenit baza didactic\u0103 \u00een cardiologie pentru Universitatea din Pavia.<\/em><\/p>\n

A\u015fadar, din 2003 am organizat anual c\u00e2teva Cursuri ECM, recunoscute oficial de Ministerul S\u0103n\u0103t\u0103\u0163ii. La fiecare dintre ele, cu sprijinul economic al Grupului Policlinico di Monza, am inclus aproape totdeauna \u015fi leg\u0103turi \u00een direct cu sala operatorie. Fiind puternic orienta\u0163i spre chirurgia valvular\u0103 reparativ\u0103, nu putea lipsi ecocardiografia din aceast\u0103 \u201cre\u0163et\u0103\u201d. Nu se poate face chirurgie valvular\u0103 f\u0103r\u0103 ecografie \u00een sal\u0103, de\u015fi eco este esen\u0163ial \u00een cardiochirurgie nu doar pentru valve. Este util peste tot: \u00een sec\u0163ie, \u00een sal\u0103, \u00een ATI, hemodinamic\u0103 etc.<\/em><\/p>\n

\u00cencep\u00e2nd din 2003 deci, la Cursurile ECM am f\u0103cut opera\u0163ii \u015fi ecografii transesofagiene \u00een direct, transmise \u00een timp real din sala operatorie \u00een sala de congrese a Clinicii. De aici p\u00e2n\u0103 la transmisiile la distan\u0163\u0103 prin streaming nu a fost dec\u00e2t un singur pas. Asta se \u00eent\u00e2mpla acum 4\/5 ani.<\/em><\/p>\n

\u00cemi amintesc c\u0103 prima transmisie interna\u0163ional\u0103 \u00een streaming am f\u0103cut-o \u00een Rom\u00e2nia, la Sinaia. Eram cu dr. \u015eerban Mih\u0103ileanu \u00een prezidiu la CNC din 2011 \u015fi aveam sala plin\u0103! Am avut mari emo\u0163ii atunci pentru partea de internet\u2026 Am lucrat p\u00e2n\u0103\u00a0 noaptea t\u00e2rziu la set\u0103rile streamerului. Dar a ie\u015fit foarte bine! O mitral\u0103 operat\u0103 \u00een direct de dr. Diena, care a mers perfect! Calitatea imaginii \u00een streaming depinde mult de l\u0103rgimea de band\u0103 internet, iar la Sinaia, \u00een 2011, nu aveam o band\u0103 a\u015fa de larga atunci… Am f\u0103cut apoi \u015fi la Poiana Bra\u015fov o direct\u0103: by pass + plastie de mitral\u0103 la o cardiomiopatie dilatativ\u0103 sever\u0103. Mai toate cursurile ECM din San Gaudenzio sunt transmise \u00een streaming \u00een ultimii ani \u00een Rom\u00e2nia (Universitatea din Timi\u015foara, Sibiu, Oradea, Ia\u015fi, la Bucure\u015fti) \u00een Polonia, Moldova ori Georgia.<\/em><\/p>\n

\"*\"<\/a>
*<\/figcaption><\/figure>\n

Cum se face c\u0103 tocmai grupul Dumneavoastr\u0103 profesional, \u015fi nu altul din Italia\/Europa, a fost ales pentru acest tip de transmisii la EuroEcho 2013, EuroEcho 2014 sau World Echo 2014?<\/strong><\/p>\n

Greu de r\u0103spuns, dar acest background a contat mult\u2026 Cu mul\u0163i ani \u00eens\u0103 \u00eenainte de 2013, anul primei transmisii live la EuroEcho Imaging Istanbul -, am prezentat experien\u0163a \u00a0noastr\u0103 cu peste 30 de live session, \u015fi am propus Comitetului \u015etiin\u0163ific sesiuni similare \u00een cardul EuroEcho. Cum nu eram o clinic\u0103 universitar\u0103, a fost probabil nevoie de ceva mai mult timp p\u00e2n\u0103\u00a0 c\u00e2nd stafful \u015ftiin\u0163ific al EuroEcho a acceptat propunerea. Nu \u015ftiu s\u0103 fi existat \u015fi alte propuneri din alte centre europene \u00eens\u0103 pe acest profil… Pentru c\u0103 nu prea face nimeni a\u015fa ceva. Nici \u00een Italia nu sunt dec\u00e2t extrem de pu\u0163ine centre care fac transmisii live din sal\u0103. Dar nu fac \u015fi streaming.<\/em><\/p>\n

Plec\u00e2nd a\u015fadar de la o exigen\u0163\u0103 strict local\u0103, a noastr\u0103 ca grup profesional, f\u0103cut\u0103 cu pasiune, perseveren\u0163\u0103, \u015fi la un \u00eenalt nivel profesional, am ajuns ast\u0103zi s\u0103 fim prezen\u0163i la \u00eent\u00e2lniri de referin\u0163\u0103 la nivel mondial, ceea ce ne face evident pl\u0103cere \u015fi cu care ne m\u00e2ndrim.<\/em><\/p>\n

\u015ei ar mai fi poate un aspect. C\u00e2nd \u00a0cardiologul examineaz\u0103 un bolnav care urmeaz\u0103 s\u0103 mearg\u0103 \u00een sala operatorie, se expune totdeauna \u00een procent de 100%. Nu mai vorbim despre cazurile operate \u00een direct! \u00cenainte de a lucra \u00een chirurgie \u015fi eu am f\u0103cut ecografii \u00een ambulator mul\u0163i ani. F\u0103ceam eco \u015fi scriam concluziile. Dar \u00eemi lipsea un feed back, o confruntare \u015fi nu \u015ftiam c\u00e2nd gre\u015feam, pentru c\u0103 este normal s\u0103 gre\u015fe\u015fti\u2026 mai ales cu o \u0163int\u0103 anatomic\u0103 a\u015fa de complex\u0103 \u015fi care mai este \u015fi-n mi\u015fcare\u2026<\/em><\/p>\n

De fapt, aceast\u0103 confruntare zilnic\u0103 \u00eentre imaginea virtual\u0103 a ecranului \u015fi realitatea anatomic\u0103 din c\u00e2mpul operator, cu chirurgia \u00een sine, dar \u015fi cu alte metode de diagnostic, ne-a permis s\u0103 cre\u015ftem profesional \u015fi s\u0103 gre\u015fim din ce \u00een ce mai pu\u0163in. Am putea spune c\u0103, pentru noi, sala operatorie a fost ca un curs peren de ecocardiografie la 360\u02da, real \u015fi integral, pentru mul\u0163i ani. \u00cen cazul meu, pentru 23 de ani\u2026 Am ajuns astfel, cu timpul, s\u0103 primim la Novara cereri pentru training \u00een ecografie de la colegi din Italia, din Rom\u00e2nia, Moldova, Polonia, Georgia etc. Avem ast\u0103zi ecografi\u015fti, forma\u0163i la Novara, care fac eco \u00een diverse spitale din Rom\u00e2nia, la Bucure\u015fti \u00a0\u00een spitalele Universitar, Fundeni, Monza, Matei Bal\u015f etc., la T\u00e2rgu Mure\u015f, la Bra\u015fov, la Timi\u015foara ori \u00een Moldova, la Chi\u015fin\u0103u ori la Monte Carlo, la Var\u015fovia, \u00een Polonia, sau la Tbilisi \u00een Georgia.<\/em><\/p>\n

Cu siguran\u0163\u0103 c\u0103 procentajul de peste 99% de reparabilitate a mitralei, la care dr. Diena \u015fi colegii lui au ajuns \u00een ultimii ani, are la baz\u0103 o experien\u0163\u0103 chirurgicala incontestabil\u0103, dar \u015fi experien\u0163a \u015fi meritul unei echipe foarte solide de ecografi\u015fti care, la Novara, include \u00een afar\u0103 de mine, al\u0163i trei medici romani: dr. Diana Benea, dr. Bogdan Adrian Popa \u015fi dr. Diana Botezatu. Toate aceste transmisii \u00een direct, la congresele men\u0163ionate mai sus, nu se puteau face f\u0103r\u0103\u00a0 un operator expert \u00een ecocardiografia TEE \u00een sala operatorie.<\/em><\/p>\n

Reamintesc c\u0103 azi, at\u00e2t \u00een Europa c\u00e2t \u015fi \u00een SUA, \u00een medie doar 50% dintre bolnavii cu insuficien\u0163\u0103 mitral\u0103 \u00a0beneficiaz\u0103 de repararea valvei, restul fiind proteza\u0163i, cu dezavantajele de rigoare.\u00a0 Centrele dedicate, cum este \u015fi cel din Novara, au o rat\u0103 de succes de 90-95% \u015fi peste.<\/em><\/p>\n

\"mic<\/a>Ce rela\u0163ie este \u00eentre aceste transmisii \u00een direct \u015fi formarea profesional\u0103 medical\u0103? Se vorbe\u015fte azi de telemedicin\u0103 \u015fi de tele-learning. C\u00e2t de departe sau de aproape sunte\u0163i de aceste concepte?<\/strong><\/p>\n

Eu nu sunt informatician \u015fi a\u015f putea gre\u015fi. M-am uitat mai demult pe internet, \u00eencerc\u00e2nd s\u0103 \u00een\u0163eleg mai bine. Nu am g\u0103sit o defini\u0163ie foarte clar\u0103 \u00eentre e-Health, Cybermedicine, Telemedicine, m-Health (mobile health), e-learning etc. Sunt termeni \u015fi domenii noi, care introduc \u00een aceea\u015fi ecua\u0163ie bolnavul<\/strong> (diagnostic digital \u015fi mai ales monitorizarea telematic\u0103), meseria noastr\u0103<\/strong> \u015fi informatica<\/strong> (internet, re\u0163ele sau sisteme mobile GSM 3G\/4G, ca vector de transmisie a informa\u0163iei, biosenzori). Cred c\u0103, prin ceea ce facem, suntem foarte aproape de aceste concepte.<\/em><\/p>\n

Eu sunt ferm convins c\u0103 este extrem de important \u015fi didactic pentru un cardiolog s\u0103 vad\u0103 \u00een direct o interven\u0163ie pe cord deschis. Mai ales dac\u0103 el este ecografist, iar \u00een sal\u0103 se repar\u0103 o valv\u0103. Ca s\u0103 nu mai spunem c\u00e2t de important este pentru un chirurg! \u00cen ace\u015fti 10-12 ani am v\u0103zut c\u0103 imaginea ecocardiografic\u0103, dublat\u0103 de realitatea c\u00e2mpului operator, s-au dovedit a constitui o metod\u0103 extrem de eficient\u0103 pentru formarea profesional\u0103. Chinezii au un proverb care spune c\u0103 \u201eun desen este egal cu o mie de cuvinte\u201d. Evident, o imagine \u00een mi\u015fcare are valoare informa\u0163ional\u0103 cu mult mai mare dec\u00e2t acest \u201edesen\u201d metaforic al proverbului chinezesc! \u00cen plus, partea chirurgical\u0103 \u00eel face pe cardiolog s\u0103 \u00een\u0163eleag\u0103 cum se face opera\u0163ia la bolnavul pe care el \u00eel va trata dup\u0103 aceea\u00a0 \u015fi c\u0103ruia \u00eei va face ecografie dup\u0103 externare.\u00a0<\/em><\/p>\n

De aceea, a\u015f crede c\u0103 transmisiile \u00een streaming sunt mai aproape de termenul de tele-learning. S\u0103 nu uit\u0103m c\u0103 totul a \u00eenceput, \u00een fond, de la ni\u015fte Cursuri ECM de cardiologie\/cardiochirurgie\u2026<\/em><\/p>\n

De pu\u0163in\u0103 vreme facem \u00eens\u0103 \u015fi telemedicin\u0103, \u00een sensul diagnosticului telematic. De peste 20 de ani, \u00een cardiologie\u00a0 se folose\u015fte tele-electrocardiograma ca metod\u0103 de diagnostic. \u00cen ultima vreme, noi am \u00eenceput s\u0103 folosim \u00eens\u0103 tele-ecocardiografia \u00een sens diagnostic. Suntem la \u00eenceput \u015fi mai avem c\u00e2te ceva de perfec\u0163ionat \u00een sistem, dar metoda utilizat\u0103 ne permite s\u0103 vedem ecranul ecografului la distan\u0163\u0103 de locul la care este f\u0103cut examenul.<\/em><\/p>\n

Dar de ce este nevoie ca un cardiolog s\u0103 transmit\u0103 la distan\u0163\u0103 imaginile eco \u00een scop diagnostic? De ce nu face el singur diagnosticul dac\u0103 tot este acolo cu bolnavul?<\/strong><\/p>\n

\u00cen sistemul italian, ca \u015fi \u00een alte \u0163\u0103ri din Europa sau din Statele Unite, exist\u0103, cum \u015fti\u0163i probabil, tehnicieni de ecocardiografie – sonographer -, care \u015ftiu s\u0103 fac\u0103 (chiar foarte bine) examenul eco. Ei nu sunt \u00eens\u0103 abilita\u0163i s\u0103 elibereze un referat final, cu concluzii. De aceea, examenele (in format digital) sunt rev\u0103zute de un cardiolog, care trage concluziile \u015fi semneaz\u0103.<\/em><\/p>\n

Cardioteam Foundation are, de exemplu, un proiect de screening \u015fi diagnostic precoce \u00een bolile cardiovasculare, organizat \u00eentr-un camper itinerant, \u00een care avem un sonographer care face examenul eco. \u0162inta proiectului este anevrismul de aort\u0103 ascendent\u0103. Este o campanie \u00eenceput\u0103 de peste un an \u015fi am v\u0103zut p\u00e2n\u0103 acum peste 5000 persoane. De cur\u00e2nd, examenul eco f\u0103cut de sonographer \u00een camper este transmis printr-un sistem de internet mobil 3G\/4G, iar un cardiolog on call verific\u0103 examenul \u015fi il semneaz\u0103 telematic. \u00cen caz de neclarit\u0103\u0163i, examenul se poate repeta \u00een camper sau, eventual, \u00een spital.\u00a0<\/em><\/p>\n

Apari\u0163ia ecografelor portabile \u015fi sc\u0103derea pre\u0163ului de cost au determinat o foarte larg\u0103 r\u0103sp\u00e2ndire a ecografiei. Din ce \u00een ce mai mul\u0163i medici au cump\u0103rat \u015fi\/sau au acces la ma\u015fini de ecocardiografie portabile. Pentru moment, profesiunea de sonographer nu exist\u0103 \u00een Rom\u00e2nia. Cred c\u0103 este doar o problem\u0103 de timp p\u00e2n\u0103\u00a0 c\u00e2nd vor\u00a0 ap\u0103rea \u015fi la noi. Este, evident, obligatoriu ca formarea profesional\u0103 a acestor asisten\u0163i medicali \u015fi apoi certificarea lor s\u0103 fie f\u0103cut\u0103 la standarde de cea mai \u00eenalt\u0103 calitate, deoarece, a\u015fa cum \u015ftim, examenul ecocardiografic este metoda diagnostic\u0103 cea mai operator-dependent\u0103\u00a0 din c\u00e2te exist\u0103, pentru c\u0103 se lucreaz\u0103 pe o \u0163int\u0103 anatomic\u0103 foarte complex\u0103, \u00een mi\u015fcare. \u00cen Italia, doar tehnicienii de perfuzie miocardic\u0103 \u015fi cei de radiologie pot deveni sonographer, dup\u0103 un an de master f\u0103cut la universitate.<\/em><\/p>\n

\"mic<\/a>Cum vede\u0163i\/tr\u0103i\u0163i rela\u0163ia dintre cardiolog \u015fi sonographer?<\/strong><\/p>\n

Nu cred c\u0103 exist\u0103 incompatibilitate (sau egalitate) \u00eentre un ecografist cardiolog \u015fi un ecografist sonographer. Mai degrab\u0103 exista sinergie! \u015ei mai cred c\u0103 este p\u0103cat pentru un medic specialist ca, dup\u0103 zece ani de \u015fcoal\u0103, s\u0103 fie folosit de sistem\/grupul social pentru a face doar examene eco, cum se mai \u00eent\u00e2mpl\u0103 uneori\u2026 \u00cen\u0163eleg \u00een schimb existen\u0163a unui cardiolog dedicat cu prevalen\u0163\u0103 ecografiei \u00eentr-o sec\u0163ie de chirurgie cardiac\u0103. Este p\u0103cat \u00eens\u0103 de cardiolog s\u0103-\u015fi consume timpul f\u0103c\u00e2nd doar ecografii, dup\u0103 ce a studiat \u015fi a dat examene mul\u0163i ani ca s\u0103 ajung\u0103 la o viziune larg\u0103 asupra bolii \u015fi bolnavului \u015fi av\u00e2nd at\u00e2tea cuno\u015ftin\u0163e de medicin\u0103 \u00een general \u015fi de clinic\u0103… De aceea, eu v\u0103d o sinergie \u00eentre aceste dou\u0103 figuri profesionale \u015fi nu o contradic\u0163ie.<\/em><\/p>\n

De mai mul\u0163i ani lucra\u0163i at\u00e2t \u00een Rom\u00e2nia, la Centrul Cardiovascular Spitalul MONZA, Bucure\u015fti, cat \u015fi \u00een Italia. Care este diferen\u0163a \u00eentre cele dou\u0103 spitale apropo de telemedicin\u0103? \u00een ce m\u0103sur\u0103 folosi\u0163i la Bucure\u015fti telemedicina?<\/strong><\/p>\n

Statisticile din internet arat\u0103 c\u0103 telemedicina este cel mai folosit\u0103 \u00een specialit\u0103\u0163ile de radiologie \u015fi cardiologie, ca \u015fi \u00een medicina de urgen\u0163\u0103. Departamentul de Imagistic\u0103 a Spitalului Monza a fost g\u00e2ndit \u015fi implementat astfel \u00eenc\u00e2t examenele f\u0103cute la Bucure\u015fti s\u0103 poat\u0103 fi v\u0103zute \u015fi discutate \u00een Italia cu al\u0163i colegi, radiologi, cardiologi interven\u0163ioni\u015fti sau chirurgi cardiaci ori vasculari. Atunci c\u00e2nd avem de operat \u00een echipe mixte bolnavi complec\u015fi, colegii italieni pot discuta cazul \u015fi alege strategia operatorie \u00eenc\u0103 din Italia, cu toat\u0103 logistica pe care o implic\u0103 aceasta. Cum este, de exemplu, cazul bolnavilor cu cardiomiopatie hipertrofic\u0103 obstructiv\u0103 opera\u0163i de profesorul Paolo FERRAZZI, unul dintre cei mai renumi\u0163i cardiochirurgi \u015fi singurul care are la activ un num\u0103r de aproape 400 de cardiomiopatii hipertrofice operate, sau al profesorului Paolo ZANETTI, cu experien\u0163\u0103 de o via\u0163\u0103 \u00een chirurgia complex\u0103 a anevrismelor toraco-abdominale, mai ales la oameni tineri, cu sindrom Marfan. La fel face \u015fi dr. Marco DIENA c\u00e2nd are de operat cazuri dificile \u00een Rom\u00e2nia, pe care le discut\u0103 dinainte cu dr. Theo Cebotaru \u015fi dr. Flaviu Steiu. Sau dr. Tao ONORATO, care poate discuta \u015fi personaliza \u00eempreun\u0103 cu dr. \u015eerban B\u0103l\u0103nescu interven\u0163iile de \u00eenchideri percutane la copii cu cardiopatii congenitale sau cardiopatii structurale la adul\u0163i.<\/em><\/p>\n

Cred a\u015fadar c\u0103 telemedicina nu mai este doar proiectat\u0103 \u00een viitor sau un cuv\u00e2nt intuitiv \u015fi f\u0103r\u0103\u00a0 con\u0163inut concret. A\u015f zice c\u0103 a devenit deja realitate. Suntem desigur la \u00eenceput, dar apari\u0163ia nanosenzorilor va revolu\u0163iona cu siguran\u0163\u0103 \u00een c\u00e2\u0163iva ani felul nostru de a face medicin\u0103. Cred, \u00een plus c\u0103 nanosenzorii \u015fi smartphone-ul sunt pe cale de a deveni o combina\u0163ie revolu\u0163ionar\u0103 \u00een monitorizarea bolnavilor cronici la domiciliu. Este sau va fi \u00een cur\u00e2nd nevoie ca sistemul medical din Rom\u00e2nia (\u015fi nu numai) s\u0103 se adapteze \u015fi din punct de vedere formativ, dar \u015fi birocratic, la aceste schimb\u0103ri rapide. \u00cen plus, s\u0103 nu uitam c\u0103 rom\u00e2nii sunt lideri recunoscu\u0163i la inven\u0163ii \u015fi inova\u0163ii!<\/em><\/p>\n

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D-le dr Cerin, am v\u0103zut c\u0103, \u00een ultima vreme, sunte\u0163i din ce \u00een ce mai prezen\u0163i pe scena unor mari congrese de ecocardiografie, cu transmisii \u00een direct de eocardiografie intraoperatorie […]<\/p>\n","protected":false},"author":4,"featured_media":5873,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[276],"tags":[],"class_list":["post-4728","post","type-post","status-publish","format-standard","has-post-thumbnail","category-interviu"],"yoast_head":"\nTele-ecocardiografia<\/title>\n<meta name=\"description\" content=\"Tele-ecocardiografia, viitor sau deja realitate?\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/medici\/tele-ecocardiografia-viitor-sau-deja-realitate\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Tele-ecocardiografia\" \/>\n<meta property=\"og:description\" content=\"Tele-ecocardiografia, viitor sau deja realitate?\" \/>\n<meta property=\"og:url\" content=\"https:\/\/jurmed.ro\/medici\/tele-ecocardiografia-viitor-sau-deja-realitate\/\" \/>\n<meta property=\"og:site_name\" content=\"Jurmed - 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