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.

Síndrome de QT largo congénito y su manejo con marcapaso permanente / Congenital long QT syndrome and its management with permanent pacemaker

Dos pacientes con síndrome de QT largo congénito y taquicardias ventriculares polimorfas recurrentes rebeldes a bloqueadores beta adrenérgicos, fueron tratados adecuadamente con terapia eléctrica con marcapaso permanente. Se discute el papel de la estimulación cardiaca con marcapaso, en el contexto de otras modalidades terapéuticas, a la luz de los recientes conocimientos de las alteraciones cromosómicas y de los canales iónicos

Alternancia eléctrica total y cambios en la repolarización auricular en un recién nacido / Total electrical alternans with atrial repolarization changes in a newborn

Se presenta el caso de una recién nacida de 34 semanas de gestación y tres días de nacida, quien presentó bloqueo auriculo-ventricular 2:1, anormalidades progresivas de la repolarización auricular y alternancia eléctrica total. Múltiples alteraciones metabólicas y electrolíticas fueron documentadas, pero destacan la hipoxia, hipotermia y el alargamiento del intervalo QT, en un corazón inmaduro

Aneurisma subvalvular mitral de probable etiología chagásica / Subvalvular aneurysm of chagasic etiology

Se informa el caso de una mujer de 45 años de edad proveniente de una zona rural del Distrito Federal, portadora de aneurisma subvalvular mitral de probable origen chagásico, en quien la manifestación clínica predominante fue la presencia de arritmias ventriculares refractarias al tratamiento médico. El diagnóstico se realizó mediante comprobación serológica, ecocardiografía, cineventriculografía y biopsia endocárdica. El tratamiento fue la resección quirúrgica del aneurisma con evolución postoperatoria exitosa