Placas protruyentes de la aorta torácica en el ecocardiograma transesofágico: características clínicas y ecográficas / Protruding plaques of the thoracic aorta in the transesophageal echocardiography: clinical and echographic features

Transesophageal echocardiography has a better sensitivity than conventional echocardiography for the detection of protruding atheroesclerotic plaques of the thoracic aorta. Clinical histories of 308 patients subjected to transesophageal echocardiography were reviewed. Subjects with protruding aortic plaques >0,5 cm were selected. Fifteen patients had protruding aortic plaques on transesophageal echocardiography and none of these were detected with conventional echocardiography. All these patients were in sinus rhythm and had high blood pressure. Ten subjects (67 percent) had a history of ischemic cerebrovascular or peripheral artery diseases (compared to 31 percent of subjects without protruding plaques) and in 7, the plaque was the only embolic source. Six patients (40 percent), smoked and 4 (27 percent) had coronary artery disease. One patient was diabetic and one had hypercholesterolemia. In conclusion, transesophageal echocardiography allows the detection of protruding aortic plaques that are potential embolic sources in patients with vascular diseases

Taponamiento cardíaco hemorrágico sin rotura cardíaca en el curso de infarto del miocardio: caso clínico / Hemorrhagic cardiac tamponade without cardiac rupture during an evolving myocardial infarction: case report

Cardiac tamponade during acute myicardial infarction is a lif threatening complication that can be confounded with right ventricular infarction. The most frequent cause of this complication is cardiac rupture. We report here a patient with acute myocardial infarction that developed cardiac tamponade on day 7, after receiving late systemic thrombolysis. The diagnosis was suspected with echocardiography and confirmed with hemodynamic measurements. The tamponade was partially relieved with pericardiocentesis but afterwards required emergency surgery. No cardiac rupture was found but an hemorragic infarction. We conclude that in this case the hemorragic tamponade was probably related both to late thrombolysis and to post infarction pericarditis

Prolapso válvula mitral (PVM) / Mitral valve prolapse

El PVM está presente en alrededor del 4 al 6% de la población general (25,26). Su asociación con una variedad de síntomas aún es puesta en duda por algunos autores, pero es innegable su alta prevalencia como causa de insuficiencia mitral. Sus complicaciones, aunque poco frecuentes, constituyen alrededor del 90% de todas las causas de ruptura de cuerda tendínea (18), 40% de las crisis de isquemia transitoria en menores de 45 años (5) y probablemente 10-15% de los casos de endocarditis infecciosa. Es importante evitar sobrediagnosticar esta patología, para lo cual se han intentado establecer pautas diagnósticas basadas en criterios Mayores y Menores (3) cuyo valor predictivo deberá ser prospectivamente evaluado