[Goldenhar syndrome in adults]. / Sindromul Goldenhar la adult.

The paper presents the case of a 43 year old female patient with multi-malformations syndrome (facio-auriculo-vertebral syndrome), distinguished by alterations of the skeleton, face, sensorial organs and the heart. The syndrome is dominant at young ages and scarce at adults, and the explanation of the favorable evolution could be the lack of severe visceral or central nervous system involvement. The peculiar anomalies of this case are: asymmetric face, epibulbar dermoid, dysplastic ears, auricular tags, conductive and sensorineural deafness, fusion of vertebrae, hemivertebrae, ventricular septal defect.

[The etiological spectrum of pure and isolated chronic mitral insufficiency]. / Spectrul etiologic al insuficientei mitrale cronice pure si izolate.

The 78 patients with mitral insufficiency studied in the present paper were chosen taking into consideration the following: regurgitant apex holosystolic or mesotelesystolic murmur, noise 3 and the dilation of the left atrium and/or left ventricle at Echo-20. The patients were investigated clinically, ECG, phonocardiographically and echographically (2D). The etiology was established in 75 patients; non rheumatic causes were present in 70% of the cases. The echographic study, besides the other methods, is very important in diagnosing the mitral insufficiency, in etiology, severity and the degree of deterioration of the pump function of the left ventricle. The Eco-2D examination, a noninvasive method, allows reaching therapeutic medical and surgical decisions at the best moment and helps in assessing the results.

[An echocardiographic evaluation of pure and isolated mitral stenosis. Comparisons with other noninvasive methods]. / Evaluarea ecocardiografica a stenozei mitrale pure si izolate. Confruntari cu alte metode neinvazive.

In 94/116 (81%) cases of pure and isolated mitral stenosis (MS), ECO-2D permitted the correct determination of the surface of the mitral opening (SMO). The cases were divided in terms of the SMO size into: extended MS (SMO greater than 2 cm2, n = 28), moderate MS (SMO between 1.1 and 2 cm2, n = 54), and narrow MS (SMO less than or equal to 1 cm2, n = 12). The SMO size influenced significantly the values of several noninvasive indices of the MS severity: the Wells index, the 2-C1DM noise interval, the NYHA class, the cardiothoracic index (expressed as an average, the +/- standard deviation for each group), and also the incidence of the atrial fibrillation, AQRS greater than or equal to 70 degrees, of the radiographic aspect of the pulmonary stasis or of the right cardiac failure (given in percent for each group). Anyhow, none of these parameters, taken alone, permitted the correct assessment of the MS severity. The sensibility, specificity and predictive value of the above-mentioned criteria were not sufficient for the detection of the narrow MS (SMO less than or equal to 1 cm2). ECO-2D is the most exact noninvasive method for appreciating the anatomical state of the mitral valvular apparatus in MS and for selecting the patients for the surgical correction.

[Right ventricular infarct--a rarely diagnosed site]. / Infarctul ventricular drept--o localizare rar diagnosticata.

RVI is usually associated to a left ventricular (postero-inferior) myocardial infarction. Its occurrence as an isolated entity is extremely infrequent. Clinical signs suggesting the diagnosis are: predominance of right ventricular failure, Kussmaul's sign and rupture of the interventricular septum. The most sensitive diagnostic method is 2D-ECHO (51% sensitivity), followed by nuclear angiocardiography (37%) and right heart catheterization (26%). Electrocardiographic evidence of RVI is obtained only by routine recording of right precordial leads in patients with transmural postero-inferior left ventricular infarctions. Specific therapeutic measures include use of plasma expanders in order to achieve an increase of cardiac output. Agents that augment left ventricular emptying, as sodium nitroprusside dopamine or dobutamine are useful in cases with coexisting left ventricular disfunction. Avoidance of diuretics administration, in spite of evidence of right ventricular failure is essential to the preservation of a normal cardiac output.