[Persistent left superior vena cava. Implications in central venous catheterisation]. / Vena cava superior izquierda persistente. Implicaciones en la cateterización venosa central.

The placement of central catheters through the subclavian and jugular venous path can be complicated by the cannulation of an artery or an aberrant venous path. The most frequent anomaly of the embryological development of the caval vein is the persistence of the left superior vena cava (LSVC). The implantation of catheters in the LSVC can be suspected by its anomalous route in thorax radiography. Gasometry and the pressure curve of the vessel make it possible to rule out an arterial catheterisation. Diagnostic confirmation is obtained through angiography, echocardiography, computerised tomography or cardiac resonance. The doctor who regularly implants central venous catheters must be familiar with the anatomy of the venous system and its variants and anomalies, since their presence might influence the handling of the patient.

Vena cava superior izquierda persistente. Implicaciones en la cateterización venosa central / Persistent left superior vena cava. Implications in central venous catheterisation

La colocación de catéteres centrales por vía venosasubclavia y yugular se puede complicar con la canalizaciónde una arteria o de una vía venosa aberrante.La anomalía más frecuente del desarrollo embriológicode la vena cava es la persistencia de la vena cava superiorizquierda (VCSI). La implantación de catéteres enla VCSI se puede sospechar por el recorrido anómalodel mismo en la radiografía de tórax. La gasometría y lacurva de presión del vaso permiten descartar una cateterizaciónarterial. La confirmación diagnóstica se obtienemediante angiografía, ecocardiografía, tomografíacomputerizada o cardio-resonancia.El médico que implanta habitualmente catéteresvenosos centrales, debe estar familiarizado con la anatomíadel sistema venoso, sus variantes y sus anomalías,ya que su presencia puede influir en el manejo delpaciente(AU)

The placement of central catheters through thesubclavian and jugular venous path can be complicatedby the cannulation of an artery or an aberrant venouspath. The most frequent anomaly of the embryologicaldevelopment of the caval vein is the persistence of theleft superior vena cava (LSVC). The implantation of cathetersin the LSVC can be suspected by its anomalousroute in thorax radiography. Gasometry and the pressurecurve of the vessel make it possible to rule out anarterial catheterisation. Diagnostic confirmation is obtainedthrough angiography, echocardiography, computerisedtomography or cardiac resonance.The doctor who regularly implants central venouscatheters must be familiar with the anatomy of the venoussystem and its variants and anomalies, since theirpresence might influence the handling of the patient(AU)

[Sudden death in a normal heart. Idiopathic ventricular fibrillation. Review of the literature concerning one case]. / Muerte súbita en un corazón normal. Fibrilación ventricular idiopática. Revisión de la literatura a propósito de un caso.

Idiopathic ventricular fibrillation is that which is produced in the absence of structural cardiac disease and of other identifiable causes of ventricular fibrillation such as cardiotoxicity, electrolytical alterations or hereditary predisposition. The case of a healthy male, aged 37, who was asymptomatic until the day he was admitted to hospital where he showed numerous episodes of ventricular fibrillation without any previous triggering, is discussed. In the examination no cause was found to explain this, and an automatic defibrillator was implanted. The requirements for its diagnosis, risk stratification and the usefulness of the tests employed, as well as the treatments proposed are discussed.

Muerte súbita en un corazón normal. Fibrilación ventricular idiopática. Revisión de la literatura a propósito de un caso / Sudden death in a normal heart. Idiopathic ventricular fibrillation. Review of the literature concerning one case

La fibrilación ventricular idiopática es aquella que se produce en ausencia de enfermedad cardíaca estructural y de otras causas identificables de fibrilación ventricular como cardiotoxicidad, alteraciones electrolíticas o predisposición hereditaria. Comentamos el caso de un varón sano de 37 años de edad asintomático hasta el día de su ingreso en el cual presentó múltiples episodios de fibrilación ventricular sin ningún desencadenante previo, no encontrándose en el estudio ninguna causa que lo justificase, implantándose finalmente un desfibrilador automático implantable. Comentamos los requisitos para su diagnóstico, la estratificación de riesgo y la utilidad de las pruebas utilizadas, así como los tratamientos propuestos (AU)

Idiopathic ventricular fibrillation is that which is produced in the absence of structural cardiac disease and of other identifiable causes of ventricular fibrillation such as cardiotoxicity, electrolytical alterations or hereditary predisposition. The case of a healthy male, aged 37, who was asymptomatic until the day he was admitted to hospital where he showed numerous episodes of ventricular fibrillation without any previous triggering, is discussed. In the examination no cause was found to explain this, and an automatic defibrillator was implanted. The requirements for its diagnosis, risk stratification and the usefulness of the tests employed, as well as the treatments proposed are discussed (AU)

Mechanisms of sustained ventricular tachycardia in myotonic dystrophy: implications for catheter ablation.

BACKGROUND: Ventricular arrhythmias have been documented and linked to the high incidence of sudden death seen in patients with myotonic dystrophy. However, their precise mechanism is unknown, and their definitive therapy remains to be established. METHODS AND RESULTS: We studied 6 consecutive patients with myotonic dystrophy and sustained ventricular tachycardia by means of cardiac electrophysiological testing. Particular attention was paid to establish whether bundle-branch reentry was the tachycardia mechanism, and when such was the case, radiofrequency catheter ablation of either the right or left bundle branch was performed. Clinical tachycardia was inducible in all patients and had a bundle-branch reentrant mechanism. In 1 patient, 2 other morphologies of sustained tachycardia were also inducible, neither of which had ever been clinically documented, and both had a bundle-branch reentrant mechanism. Ventricular tachycardia was no longer inducible after bundle-branch ablation, except for a nonclinically documented and nonsustained ventricular tachycardia in the only patient who had apparent structural heart disease. CONCLUSIONS: A high clinical suspicion of bundle-branch reentrant tachycardia is justified in patients with myotonic dystrophy who exhibit wide QRS complex tachycardia or tachycardia-related symptoms. Because catheter ablation will easily and effectively abolish bundle-branch reentrant tachycardia, myotonic dystrophy should always be considered in patients with sustained ventricular tachycardia. This is especially true if no apparent heart disease is found.

[Retrospective analysis of a large number of patients over 70 years old, subject to percutaneous coronary angioplasty or to surgery]. / Análisis retrospectivo de una cohorte de pacientes mayores de 70 años sometidos a angioplastia coronaria percutánea o a cirugía.

INTRODUCTION: The number of patients of advanced age with symptomatic coronary illness that need surgical or percutaneous revascularisation is increasing. The aim of the present paper is to gain knowledge of the evolution of patients over 70 years of age subjected to myocardial revascularisation. MATERIAL AND METHODS: We compare two groups of patients, in a non-aleatory manner, subjected to angioplasty (N=65) and to surgery (N=75). The average age was 74.12 +/- 3.5 (70-85) and 71.97 +/- 1.9 (70-79) years respectively. The number of unhealthy vessels was greater in the surgical group (1.84 +/- 0.8 vs 2.65 +/- 0.8). RESULTS: The number revascularised vessels is greater and revascularisation more complete in the surgical group (1.14 +/- 0.4 vs 2.59 +/- 0.9) and (76% vs 49%). There is no difference in mortality in both groups. The functional degree during the evolution is worse for the angioplasty group and besides more antianginous medicines are used in treatment (1.92 +/- 1.2 vs 1.26 +/- 0.8) and they are subjected more frequently to a new revascularisation. CONCLUSIONS: Both the sick rate and the mortality of the procedure was similar in both groups. Both procedures are valid therapeutic alternatives and are acceptably safe with these patients. Surgery is more complete and is carried out on a group of patients with greater coronary distress. There are no differences in life expectancy amongst the patients treated with either of the techniques. During the follow-up period the functional degree of the surgical group is better and there are more patients treated with monotherapy.