Diagnóstico de infarto miocárdico perioperatorio dentro de las primeras 72 horas posteriores a la cirugía cardiaca / Diagnosis of perioperative myocardial infarction within the first seventy-two hours after cardiac surgery

One of the most frequent complications of cardiac surgery is the perioperative myocardial infarction (PMI). Incidence of PMI shows a wide variation because an accurate detection of this complication is difficult in the early postoperative stage. The objectives of the present study were to determine in our population of patients the incidence of PMI during the first seventy two hours after cardiac surgery as well as associations among the accepted criteria to diagnose this complication. PATIENTS AND METHODS: One hundred sixty four adults patients undergoing elective cardiac surgery were studied. With baselines preoperative studies, serial electrocardiographic, enzymatic [(determination of serum creatine kinase isoenzyme (CK-MB)] and echocardiographic studies were performed during the first 72 hours after cardiac surgery. Diagnosis of PMI was established with two or all the three positive criteria [electrocardiographic (ECG), enzymatic (CK-MB) and echocardiographic (ECHO)]. RESULTS: In 24 (15%) patients PMI was diagnosed. In this group 13 (54%) all the three criteria were positive. In 8 (33%) patients CK-MB and ECHO were positive. In 3 (13%) patients CK-MB and ECG were positive. CONCLUSIONS: In our population the incidence of PMI (15%) is agree with the reported in previous studies. In most of cases of PMI all the three diagnostic criteria are positive. When diagnosis is established only with two criteria, in most of cases these are CK-MB and ECHO.

Correlación entre el índice de pérdida de trabajo-latido ventricular izquierdo y el área valvular aórtica en pacientes con estenosis aórtica / Correlation between left ventricular stroke work loss index and aortic valve area in patients with aortic stenosis

In echocardiographic evaluation of patients with aortic stenosis (AS), prospective studies have demonstrated that left ventricular stoke work loss index (LVSWLI) provide a more clinical efficacy than calculate of aortic valve area (AVA) by continuity equation to estimate severity of stenosis. The aim of this study was assess in our population of patients with AS the correlation between LVSWLI and AVA in regard to severity. MATERIAL AND METHODS: Forty nine patients with moderate and severe AS were evaluated by transthoracic echocardiography. Grades of AS were assessed by transaortic flow velocity (Vmax) and mean aortic transvalvular gradient (deltaP). AVA and LVSWLI were calculated and Pearson's and Spearman's correlation coefficients between both methods were assessed. Significance level was set at <0.05. RESULTS: The age of the patients was 66 +/- 13 (31-84 years). Thirty four (69%) patients had severe AS and 15 (31%) moderate AS. The Pearson's correlation coefficient between LVSWLI and AVA was 0.79 (p<0.04) and between LVSWLI and deltaP was 0.90 (p<0.03). The Spearman's correlation coefficient between LVSWLI and symptomatic status was 0.70 (rho = 0.70, p < 0.003). CONCLUSIONS: In patients with moderate and severe AS, the correlation between LVSWLI and deltaP is higher than correlation between LVSWLI and AVA. Moreover LVSWLI has a higher correlation with presence of symptoms than AVA.

La ecocardiografía en la remodelación cardíaca después del infarto agudo de miocardio / The echocardiography in cardiac remodeling after acute myocardial infarction

OBJECTIVES: The goal of this study was to assess the impact of left ventricular diastolic filling on remodeling and survival after acute myocardial infarction. METHODS: We studied 36 patients with first acute myocardial treated with thrombolytic agents. A Doppler echocardiography was performed at 24 hours, 30 and 90 days after infarction. It measured the relation between E and A waves peak velocities (E/A ratio) and of the E deceleration time (EDT, ms), as well as the flow propagation velocity using color mode M and the E'-wave by tissular Doppler at the lateral mitral ring. RESULTS: Patients were divided into three groups. Group I, restrctive filling (deceleration time < 140 ms, E/FPV > or = 2, E/A> 2 and E/E' > 15). Group II, elevated filling pressure (deceleration time > or = 140 ms, E/FVP > or = 2, E/A 1,2 and E/E' < or = 15). Group III, normal filling pressure (deceleration time > or = 140 ms, E/FVP < 2, E/A < 1 and E/E' < 15). The E/FPV showed a better correlation in the group with restrictive filling and left ventricular filling pressure was significantly greater than in the group with normal filling pressure at 90 days (2.18 +/- 0.90 vs. 1.5 +/- 0.35; r = 0.99; P = .0001). The end diastolic volume (EDV) was similar in the three groups 24 hours after infarction. EDV varied at 90 days after infarction in those patients that underwent successful coronary angioplasty. Group I, 142.48 +/- 32 vs. 112.48 +/- 32, r = 573; P < .0001). CONCLUSIONS: E/FVP, using color M-mode Doppler echocardiography, estimates left ventricular filling pressure and predicts left ventricular dilation after acute myocardial infarction.

Correlación entre la radiografía de tórax y el ecocardiograma para la valoración de cardiomegalia en pacientes con hipertensión arterial sistémica / Correlation between chest radiography and the echocardiogram to evaluate cardiomegaly in patients with systemic arterial hypertension

The chest radiography is used routinely by the clinician as a tool in the scan of patients with systemic arterial hypertension (SAH) to evaluate the dimensions of the heart. However the highest reported sensitivity for the evaluation of heart growth with this method is 77.3% in contrast to the transthoracic echocardiogram (TTE) that reaches between 90 to 100%. The aim of this study was assess in our population of patients with SAH, the correlation between chest radiography and the TTE in regard to cardiomegaly. PATIENTS AND METHODS: Seventy two patients with SAH and radiological cardiomegaly, graded by measuring the cardiothoracic ratio (CTR), were evaluated by transthoracic echocardiography. The Pearson's and Spearman's correlation coefficients between both methods were assessed. Significance level was set at < 0.05. RESULTS: Forty one (56.9%) patients were women and 31 (43.1%) were men. The age was 62.4 +/- 10 years (43-83 years). Left ventricular concentric hypertrophy (LVCH) was found in 56 (77.8%) patients. In 13 (18%) patients the left ventricular end diastolic diameter (LVEDD) was higher than the normal value. The correlation coefficient between the diastolic ventricular septal thickness (DST) and CTR was 0.285 (p < 0.05) and between the LVEDD and radiological cardiomegaly was 0.203 (p = NS). CONCLUSIONS: In patients with SAH, the radiological evidence of cardiomegaly keeps a correlation with ventricular hypertrophy, but not with ventricular dilation.

Taponamiento cardíaco recidivante secundario a síndrome postpericardiotomía / Recidivant cardiac tamponade secondary to postpericadrdiotomy syndrome

Mujer de 22 años de edad, con diagnóstico de comunicación interauricular ostium secundum sometida a corrección quirúrgica. Treinta y cinco días después reingresa con síntomas de congestión venosa sistémica y pulmonar, fiebre y dolor precordial. Por ecocardiografía se demostraron derrame pericárdico de aproximadamente 3500 cc y datos de taponamiento cardíaco, por lo que requirió pericardiocentesis. Se diagnosticó como síndrome postpericardiotomía y se manejó con prednisona 10 mg cada 24 horas con evolución satisfactoria. Dos semanas después reingresó por presentar disnea y nuevo derrame pericárdico con taponamiento incipiente demostrado por ecocardiografía. Se incremento la dosis de prednisona hasta 40 mg al día. El control ecocardiográfico 10 días después reportó derrame de 600 cc, con notable mejoría clínica. A los tres meses estuvo asintomática y ecocardiográficamente sin datos de derrame pericárdico