Clinical, histochemical, and ultrastructural correlation in septal endomyocardial biopsies from chronic chagasic patients: detection of early myocardial damage.

In order to recognize early signs of myocardial damage, histologic, histochemical, and ultrastructural studies were performed on septal endomyocardial biopsy tissue obtained from 79 chronic chagasic patients and from 18 patients with atypical chest pain (control group). Abnormal biopsy findings were recognized in 9 of 16 (60%) chagasic patients with no clinical evidence of myocardial damage. In cases of segmental asynergy only, biopsies were abnormal in 18 of 19 patients. When signs of advanced myocardial damage were evidenced by clinical examination or ECGs, all biopsies were abnormal. Mitochondrial, nuclear, and cell membrane irregularities were consistent findings. A peculiar dilatation and filling of the T tubule system with a glycoprotein-like substance and a remarkable increase in monoamine oxidase activity were observed early in the disease and progressed in magnitude and frequency as myocardial damage became more evident by other diagnostic methods. Septal endomyocardial biopsy is a sensitive method for detection of early myocardial damage in chronic chagasic patients. Based on these findings, a modification of the currently used classification is proposed.

[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.

[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.

[Value of the indices of myocardial contraction rate in patients with chronic mitral insufficiency]. / Utilidad de los indices de velocidad de la contraccion miocárdica en pacientes con insuficiencia mitral crónica

Determinations of dp/dt max, Vec and Vmax were made in 20 patients with chronic mitral regurgitation of several degrees. Each of these results was correlated with the corresponding ejection fraction. Only dp/dt max showed adequated correlation and few scattering of individual results, demonstrating its true dependence on the intrinsec contractile state of the left ventricule. Vec. and Vmax. determinations also reflected contractility changes, but their variability and difficult clinical applicability does not allow to recommend its routine utilization in a clinical setting. We could not demonstrate any influence of the valvular lesion on the results of the measured contractility indicators.