[The radiofrequency ablation of a left lateral accessory pathway during pre-excitation atrial fibrillation]. / Ablación con radiofrequencia de una vía accesoria lateral izquierda durante fibrilación auricular pre-excitada.

The occurrence of atrial fibrillation during an electrophysiologic study in patients with Wolff-Parkinson-White syndrome is a common problem and it is time-consuming to terminate it either with the use of drugs or by electrical cardioversion. The purpose of this report is to assess the feasibility of successful radiofrequency catheter ablation of and mapping for overt left-sided accessory pathway during atrial fibrillation. During an electrophysiologic study, pre-excitation was lost and the patient developed sustained atrial fibrillation either spontaneously or during catheter manipulation. We decided to map during this arrhythmia because we noted that the patient had maximally pre-excited beats which might increase the possibility of accessory pathway potential recording and a successful ablation site. With the ablation catheter in the left-lateral region we recorded an early ventricular electrogram and a rapid deflection preceding the onset of ventricular activation that was not observed in non pre-excited beats and we considered it the Kent potential. At this site we applied one pulse of radiofrequency current with temperature control at 70 degrees C and eliminated anterograde conduction over the accessory pathway during the first 3 seconds and continue the radiofrequency current for a total of 2 minutes. The procedure time was 60 minutes. We conclude that mapping and radiofrequency catheter ablation can be successfully performed during pre-excited atrial fibrillation and this could shorten the procedure and obviate the need for several electrical cardioversions.

Crossed atrioventricular connections.

Four cases of crossed atrioventricular connections are described. All of them were diagnosed at cardiac catheterization by angiocardiography and one was examined pathologically. Two possessed situs solitus, one with concordant connections and the other with discordant connections; the other had two situs inversus, both of them with concordant connections. Two had double-outlet right ventricle, one had transposition of the great arteries, and the other had normally related and connected great arteries. These cases have been interpreted as representing abnormal rotation of the ventricles following sepatation. A review of 36 cases previously reported on and our own cases, suggests that most patients have concordant atrioventricular connections. There are many types of ventriculo-arterial connections, the most frequent being transposition of the great arteries. There has not been any case reported with persistent truncus arteriosus. On the basis of atrioventriculo-arterial connections, we propose a classification for this malformation. We discuss the importance of the bulboventricular loop in the type of atrioventricular connections, some clinical implications for the diagnosis, and analyze the value of the rules to localize the ventricles by means of the position of the great arteries.

[Quantification of ventricular volume. Comparative study of 2 angiographic methods]. / "Cuantificación de los volúmenes ventriculares: estudio comparativo de 2 métodos angiográficos".

The left ventricular volumes and the ejection fraction were measured in 78 patients who had different cardiopathies, in more than 50% the diagnosis of ischaemic heart disease of coronary origin was made. Every cineangiocardiogram was carefully observed to find those who had normal and abnormal ventricular contraction. The ventricular volumes were calculated by the Green method and afterwards the results were compared with the values obtained by the Sandler and Dodge method. A very good correlation was found between the two methods and we got the conclusion that although it is preferable to calculate ventricular volumes and the ejection fraction with biplane method or with Saudler and Dodge's monoplane, the results of the present work permit the use of Green's method in calculating ventricular volumes and obtaining confident results, independently of the ventricular contraction type with the exception of those who have large ventricular aneurisms.

[Pulmonary thromboembolism in heart disease]. / La tromboembolia pulmonar en el cardiópata. Parte I.

In heart disease (HD) pulmonary emboli (PE) is seen with same frequency at necropsy as in the general hospital population. There is more mortality in patients with HD than in those without it. The patient with HD rarely is asymptomatic during the pulmonary embolization. Symptoms, signs and laboratory abnormalities occurs with the same frequency in both groups of patients with PE, but some symptoms and clinical signs, and also laboratory abnormalities could pre exist in the patients with HD, situation that dificulties the clinical diagnosis of PE. Particular value should be given to the symptoms and signs for the diagnosis in the patients with HD when they progress. In patients with HD the arrithmias were more common and also the pulmonary infection, for these reasons monitorization and the use on antibiotics should be routenely.