Successful Percutaneous Intervention of Contained Coronary Artery Rupture: The Role of Intracoronary Imaging.

A 66-year-old male presented with ST-segment-elevation myocardial infarction. Percutaneous coronary intervention (PCI) of the culprit right coronary artery lesion was performed, during which a small wire-related perforation was noted. The perforation was no longer visible post procedure and we opted for conservative management. One month later, coronary angiography before intervention of the left anterior descending and circumflex lesions revealed a focal dilation at the site of the earlier wire perforation. Further imaging with intravascular ultrasound and optical coherence tomography visualized the defect and guided treatment options.

[Peripartum cardiomyopathy with biventricular thrombi]. / Miocardiopatía periparto con trombosis biventricular.

Peripartum cardiomyopathy is a rare cause of congestive heart failure which develops in the last month of pregnancy or during five months postpartum in women without previously known cardiac disease. Intraventricular thrombi are no unusual and can be identified by echocardiography. We report the case of a woman with peripartum cardiomyopathy whose echocardiographic study showed the presence of biventricular thrombi. This is a quite rare finding with only two cases reported in the literature. Diagnosis, treatment and special situations that could predispose to intracardiac thrombi formation are discussed.

[Therapeutic options in cardiogenic shock]. / Opciones terapéuticas en el shock cardiogénico.

Cardiogenic shock continues to be a clinical situation which is related with high mortality. Although its etiology is varied, the most frequent cause is an acute myocardial infarction. The poor prognosis of cardiogenic shock can be favourably modified with the diagnosis of the underlying cause followed by the stabilization of the patient and early revascularization. Early treatment with inotropic or vasopressor drugs improves the condition of most patients and the use of circulatory assistance, such as the intraaortic balloon, lead to an acceptable hemodynamic situation in 80% of cases. However, they do not significantly modify the mortality rates. In addition, thrombolytic therapy does not appear to be effective for this kind of patients. Only revascularization methods have proved to be effective; surgery is the only option where ventricular septal, free wall, or papillary muscle rupture occurs, resulting in survival rates of between 50 and 60% with coronary artery by-pass surgery. Angioplasty is frequently successful in reperfusion of the infarct-related artery; the survival rate in these cases is approximately 70%, according to the different series published. As the mortality rate is exceedingly high (70-90%) when conventional therapy is used; when appropriate diagnostic and therapeutic means are available and when the patient's condition is recoverable, the attitude should be aggressive and coronary angiography and angioplasty applied as soon as possible. In centers where these means are not available, once measures have been taken to achieve the stabilization of the patient, the most suitable procedure is to transfer him or her to a hospital in which qualified staff and such treatment methods are available.

[Usefulness of exercise echocardiography for the diagnosis of ischemic heart disease]. / Utilidad de la ecocardiografía de esfuerzo en el diagnóstico de la cardiopatía isquémica.

INTRODUCTION AND PURPOSE: The purpose was assessing the usefulness of exercise digitalized echocardiography for the diagnosis of ischemic heart disease. PATIENTS AND METHODS: Eighty-eight patients, with suspected artery coronary disease, underwent both a exercise echocardiography with treadmill Bruce protocol and a coronary arteriography, within a period less than 2 months, without changes in their clinical evolution. Fifty-eight patients shown significant coronary lesions (> or = 50%). RESULTS: The exercise echocardiography showed a high sensitivity (74%), significantly greater (p < 0.01) than exercise electrocardiography alone. The sensitivity was fixed by the level of exercise done, reaching 91% when submaximal exercise was achieved, and by the severity and extension of coronary disease, being of 68.5% for a single-vessel, 80% for two-vessel and 100% for three-vessel. The specificity was 87%, considering the lesions lesser than 50% as not significant, and it was 100% when the coronary arteries without disease were taken into account. CONCLUSIONS: Exercise echocardiography can be a rutinary method for the diagnosis of ischemic heart disease, and it shows a high sensitivity and specificity, greater than exercise electrocardiography alone.

[Coronary ostial stenosis after an aortic valve replacement diagnosed by transesophageal echocardiography]. / Estenosis de ostium coronario tras recambio valvular aórtico diagnosticado mediante ecocardiografía transesofágica.

We submit the case of a 75-year-old man that underwent aortic valve replacement whose preoperative coronary angiography showed lesion-free coronaries. Two months after surgery he began to feel rapidly progressing effort angina pectoris. Transesophageal echocardiography showed prosthetic normal function while allowing the study of the great coronary trunks. We observed the presence of a 50% stenosis at the ostium of the left coronary artery trunk due to the use of selective coronary cannulation to supply cardioplegia solution during valve replacement. A second coronary angiography confirmed this finding. Transesophageal echocardiography may be used as an initial diagnostic method when coronary ostial stenosis is suspected after aortic valve replacement.