Detection of transplant heart rejection by analysis of endomyocardial voltage.

These studies seek an alternative method with myocardial biopsy for rejection diagnosis. A pacemaker (Biotronik model Logos) was implanted into 16 patients to detect intramyocardial voltage. The recordings were classified in two groups according to results of myocardial biopsy. The results of the biopsy were classified according to the recommendations of the International Society for Heart and Lung Transplantation: namely, Group I: rejection < 2 (52 recordings) and Group II: rejection > or = 2 (9 recordings). The sensitive parameter for rejection detection was Tslew, which was deduced from the paced intracardial potential in the monopolar mode. The results were significant in both groups; the medium value of Tslew in group I was 96.7%, and the value for group II was 87.13% (P=.022). The sensitivity value in our patient group for detection of treatedable rejection was 78%; the negative predictive value was 95%. In conclusion the method is useful for rejection detection, but is necessary to make several recordings for the same patients during the first month post transplant, to obtain an individual baseline value.

[Embolism in the right heart chambers: the diagnostic and therapeutic aspects]. / Embolia en cavidades cardiacas derechas: aspectos diagnósticos y terapéuticos.

Deep venus thrombosis may result in pulmonary embolism. In rare instances, embolization has occurred, not directly to the pulmonary arterial tree, but to the right heart chambers. Although the value of echocardiography in the diagnosis is well recognised, their is no consensus for the appropriate treatment. We report herein six cases of floating right atrial thrombi, diagnosed by echocardiography, in patients with pulmonary embolism, or unexplained shock or syncope. Surgical embolectomy was carried out in 4 patients, and thrombolytic therapy in 2, without in-hospital mortality. The high mortality associated to this entity may be improved by rapid echocardiographic recognition and emergency treatment with thrombolysis or surgery. Our data suggest the possible use of thrombolysis as a first-choice therapy in selected patients.

[Isolated left ventricular myxoma discovered incidentally by echocardiography]. / Mixoma ventricular izquierdo aislado descubierto casualmente por ecocardiografía.

We describe the case of a young patient in whom two-dimensional echocardiography, performed because of episodes of palpitations, discovered the presence of a small mass in the left ventricle, attached to the posterior wall. Transesophageal echocardiography was performed to further assess the mass's attachments and to verify the lack of involvement of the mitral valve and its associated structures. The patient had a cardiopulmonary bypass, surgery and the mass was removed approaching into the left ventricular cavity through the atrial septum via a right atriotomy, without any complication during the postoperative period. In the histologic study the mass appeared to be a typical myxoma. This case has a great interest because the ventricular location of the myxoma is unusual; and because the use of two-dimensional echocardiography, even in the absence of significant symptoms and/or signs, avoided dangerous embolic complications, which often represent the first sign of this neoplastic pathology.

[Abscess of the mitral-aortic confluence and perforation of the mitral valve in a patient with Brucella endocarditis]. / Absceso de la confluencia mitroaórtica y perforación de la válvula mitral en un paciente con endocarditis por Brucella.

We report a case of Brucella aortic valve endocarditis in a 36 year-old patient with no underlying heart disease who required urgent surgery. In the postoperative follow-up, he suffered from congestive heart failure due to an anterior mitral valve rupture. In the echocardiogram, a periprosthetic abscess was seen and a second intervention was necessary. This report suggests that treating Brucella endocarditis requires a combined medical and surgical approach.

[A comparison of bezafibrate and lovastatin treatment at the usual doses in post-heart transplant hyperlipemia]. / Comparación del tratamiento con bezafibrato y lovastatina a dosis habituales en la hiperlipemia postrasplante cardíaco.

INTRODUCTION: Coronary artery disease is a major limiting factor for long-term survival after heart transplantation. Hyperlipidemia is a probable risk factor for coronary artery disease in this kind of patient. Bezafibrate and lovastatin have proved to be effective in lowering total and low density lipoprotein cholesterol. The present study tested the safety and efficacy of both drugs on lipid levels in 21 patients with post-heart transplantation hyperlipidemia. PATIENTS AND METHODS: Patients maintained the same diet for three months. Then, they were randomized to lovastatin (20 mg/day) or bezafibrate (400 mg/day) for 8 weeks, and then, crossovered to an additional 8 weeks of bezafibrate or lovastatin. RESULTS: Both drugs were effective in lowering total and low density lipoprotein cholesterol and apoprotein B concentrations, but the effect of lovastatin was significantly greater. Only bezafibrate produced a significant reduction in total triglycerides and a significant rise in high density lipoprotein cholesterol and apoprotein AI. The total cholesterol/high density lipoprotein cholesterol and low density lipoprotein cholesterol/high density lipoprotein cholesterol ratios were decreased under both treatments. CONCLUSION: Both drugs, bezafibrate and lovastatin appear to be safe, effective and well-tolerated therapies for hyperlipidemia in cardiac transplant recipients.