Plasma norepinephrine, myocardial damage and left ventricular systolic function in Chagas' heart disease.

The functional status of the sympathetic nervous system in Chagas' heart disease is still the subject of intense controversy. To determine the nature of the abnormalities of the sympathetic nervous system, we measured the plasma norepinephrine concentration of chagasic patients with varying degrees of myocardial damage. Thirty-six patients with positive serology for Chagas' disease were studied. Twenty patients were in Functional Class I (New York Heart Association), 10 were in Functional Class II and six were in Functional Classes III-IV. Cardiac catheterization was performed in 24 patients. The asymptomatic patients had a plasma norepinephrine concentration (121 +/- 37 pg/ml, mean +/- S.D.) not different from normal controls (103 +/- 59 pg/ml). The symptomatic patients, however, had a significantly elevated plasma norepinephrine concentration (665 +/- 354 pg/ml, P < 0.001). The baseline heart rate of the asymptomatic and symptomatic patients directly correlated with the plasma norepinephrine concentration (r = 0.69, P < 0.0001). The symptomatic patients had larger ventricular volumes, higher left ventricular end-diastolic pressures and lower ejection fractions than the asymptomatic patients and normal controls. The plasma norepinephrine concentration correlated linearly with the left ventricular end-diastolic volume (r = 0.77, P < 0.0001), and non-linearly with the ejection fraction (r = -0.70, P < 0.0001) and the left ventricular end-diastolic pressure (r = 0.53, P < 0.007). These results indicate that, in Chagas' heart disease as in most other cardiac diseases, sympathetic nervous system activation is a late and compensatory phenomenon. In other words, sympathetic activation is very likely related to the progressive impairment of left ventricular function.

[Percutaneous pulmonary valvuloplasty at the cardiovascular center of the Universidad de Los Andes]. / Valvuloplastia pulmonar percutánea en el Centro Cardiovascular de la Universidad de Los Andes.

PURPOSE: To compare balloon valvuloplasty and surgical valvulotomy in the management of pulmonary valvar stenosis. PATIENTS AND METHODS: Balloon pulmonary valvuloplasty was performed in 10 consecutive patients, 6 girls and 4 boys, age ranges 3 to 19 years (mean 11), between April 1987 to November 1988. RESULTS: Immediate hemodynamic and angiographic changes consisted in reduction of the peak transvalvular gradient from 93 +/- 42 mmHg to 39 +/- 26 (p less than 0.01), the right ventricular systolic pressure from 108 +/- 16 mmHg to 58 +/- 27 mmHg (p less than 0.01) and in increasing of the pulmonary valve diameter from 9.59 +/- 3.28 mm to 19.55 +/- 6.16 mm (p less than 0.01) and the systolic pulmonary artery pressure from 15.15 +/- 3.28 mmHg to 18.4 +/- 6 (NS). No relationship between right ventricular systolic pressure and transpulmonary valvular gradient could be found. We only observed one case of mild pulmonary insufficiency as a complication of the procedure. The intermediate follow up (7 to 14 months), in 4 of 10 patients showed maintenance of the initial finding. CONCLUSION: The results of the percutaneous pulmonary valve valvuloplasty are as good as those obtained by the surgical valvulotomy.

[Extraction of foreign bodies (catheters) from the right atrium and the abdominal aorta by the percutaneous route. Report of 2 cases and review of the literature]. / Extracción de cuerpos extraños (catéteres) de la auricula derecha y aorta abdominal por via percutanea. Informe de dos casos y revisión de la literatura.

Two cases of catheter-fragment embolism from a peripherical vein into the cardiac cavities and their extraction by means of a modified technique are presented. In the first case, the foreign body was located in the right cavities of the heart and it was extracted employing a modified technique by means of a Pigtail catheter and a Bioptom sequentially introduced percutaneously. In the second case, the embolus was located in the abdominal aorta and was extracted percutaneously with a Fogarty catheter. A review of the literature is made and, owing to the increasing frequency of the use of intravascular catheters, some recommendations are made in order to avoid this kind of complications.

Extraccion de cuerpos extranos (cateteres) de la auricula derecha u aorta abdominal por via percutanea: informe de dos casos y revision de la literatura / Extraction of foreign bodies (catheters) from the right atrium and abdominal aorta by percutaneos way: report of 2 cases and review of the literature

Se presentan dos casos de emvolizacion de cuerpos extranos (cateteres) y su extraccion con tecnicas modificadas. En el primero de los casos, el cuerpo extrano estaba ubicado en las cavidades derechas del corazon y se logro su captura mediante una tecnica modificada que utiliza in cateter Pigtail y un bioptomo introducidos secuencialmente por via percutanea. En el segundo de los casos, el cuerpo extrano estaba localizado en la aorta abdominal y se logro su extraccion por via percutanea con la ayuda de un cateter Fogarty. Se revisa la literatura sobre el tema y dada la frecuencia cada vez mayor del uso de cateteres intravasculares, se dan recomendaciones para evitar este tipo de complicación

[Study of left ventricular mass in pure mitral stenosis]. / Estudio de la masa ventricular ezquierda en la estenosis mitral pura.

We studied 19 patients (13 women and 6 men), with pure mitral stenosis by cineangiocardiograms taken in the right anterior 30 degrees oblique projection. Seven patients were also studied by single element M mode echocardiography in monoplane projection. We observed a significative diminution in the wall thickness and mass of the left ventricle in those patients in which the mitral valvular area was less than 1 cm2/m2. These results were interpreted as due to a global diminution in the cardiac mass induced by a reduction in the wall thickness of the left ventricle in all segments. When the patients with diminished mass were grouped by age, no correlation between chronicity and diminished mass was observed. We concluded that the diminution of the left ventricular mass in pure, severe mitral stenosis has a multifactorial etiology; the prolonged immobility of some myocardial segments could play a role, but the fibrosis secondary to acute or chronic myocarditis could be more important.

Estudio de la masa ventricular izquierda en la estenosis mitral pura. / Study of the left ventricular mass in pure mitral stenosis

Se estudio la masa y el espesor ventriculares izquierdos por cineangiocardiograma en oblicua derecha anterior a 30 grados en 19 pacientes, 13 mujeres y 6 hombres portadores de estenosis mitral pura y por ecocardiograma monoplano, modo M, en 7 de estos pacientes.Se observo una disminucion estadisticamente significativa del espesor y masa ventriculares izquierdos en pacientes con area valvular mitral menor de 1 cm2/m2. Se interpreto el hecho como una disminucion universal de la masa cardiaca debida a una disminucion del espesor de la pared ventricular en todos sus segmentos. Al comparar los resultados obtenidos en los pacientes con masa disminuida, por grupos etarios, con el fin de ver la influencia de la cronicidad, no se observo diferencia significativa entre los grupos. Se sugiere que la disminucion de la masa ventricular izquierda en la estenosis mitral pura severa es un problema multifactorial, donde podria influir la inmovilidad del miocardio en algunos segmentos, pero quizas sea mas importante la presencia de miocarditis aguda o cronica que haya conducido a fibrosis

[Thromboembolism of the lung and lower extremities in patients with chronic global congestive heart failure]. / Enfermedad tromboembólica pulmonar y de los miembros inferiores en pacientes con insuficiencia cardíaca congestiva global crónica.

The results of a prospective study on the incidence of pulmonary thromboembolism and deep leg veins phlebitis in patients with congestive heart failure are presented. Pulmonary thromboembolism was diagnosed by means of pulmonary isotopic scanning and angiography; deep leg veins were studied using conventional and isotopic phlebography. A total incident of 60% for pulmonary thromboembolism and 92% for deep leg veins phlebitis was found, being of little significance the results suggested by clinical signs. ECG, chest X rays and laboratory tests such as arterial PO2, transaminase and lactic dehidrogenases. Among patients with pulmonary thromboembolism, the hospitalization periods were longer and more frequent, the incidence of deep leg veins phlebitis was 100%, mortality was slightly higher and the degree of hemodynamic derrangement was more advanced in patients without pulmonary thromboembolism. The rutinary use of pulmonary scanning and isotopic phlebography for detection of these complications in patients with congestive heart failure is recommended, emphasizing the need for prophylactic anticoagulant treatment in most of these patients.