[Structural and functional changes in the of heart of high-performance (canoeing) athletes]. / Cambios estructurales y funcionales en el corazón del atleta (canotaje) de alto rendimento.

We studied two groups of healthy subjects: Group I was integrated by 13 high-performance sportsmen (10 men and 3 women), devoted to the discipline of the rowing. Group II was integrated by 16 sedentary healthy subjects. All of them were studied with a two-dimensional echocardiogram, in order to study the anatomical and functional characteristics of the heart. Both groups had similar characteristics in regard of total body area, heart rate and blood pressure, the only difference was in age. The ventricular mass and the diastolic volume were greater in athletes in spite of the fact that the dimensions and transverse thicknesses were similar, this imply a longitudinal increase of the heart size. It is possible that this form of ventricular remodeling has functional advantages. On the other hand, it was demonstrated the existence of physiological hypertrophy without disorders in diastolic function.

[The thickness/radius ratio (h/r) of the left ventricle in pure mitral insufficiency]. / La relación grosor/radio (h/r) del ventrículo izquierdo en la insuficiencia mitral pura.

We studied 11 patients with severe mitral regurgitation (MR). With 2-D echocardiogram we could obtain the septal and posterior wall thickness, left ventricular internal dimensions and ventricular function. With parasternal short axis view we calculate the h/r ratio (left ventricular thickness/radius). The results were compared with normal values: we found important left atrial and ventricle dilatation with significative difference from the normal values (P < 0.001), the diastolic and systolic h/r ratio was significative lower than the normal values (P < 0.005): the systolic wall stress was significative higher in relation to normal values (P < 0.001). We conclude that patients with severe (MR) initially have an important ventricular dilatation but no hypertrophy despite volume overload. The possible explanation is that in early stages of the disease, the afterload of the left ventricle is low and does not trigger the development of hypertrophy. The hypertrophy appears only when the systolic stress is high secondary to myocardial failure. The excessive dilatation of the left ventricle probably damages the myocardial fibers by excessive stretch. This mechanism probably explains the poor late surgical evolution of patients with mitral prosthesis. This we propose that the optimal surgical timing for such patients is when the systolic wall stress elevates over the normal limits, because this is an early sign of myocardial failure.

[Myocardial hypertrophy in aortic insufficiency as a compensation mechanism. Implications for surgical indication]. / La hipertrofia miocárdica en la insuficiencia aórtica como mecanismo de compensación. Implicaciones para la indicación quirúrgica.

We studied 24 patients with pure and severe aortic regurgitation. Using 2-D Echocardiography we obtained parasternal short axis view and calculate the thickness/radio (H/r) ratio and with apical four chambers and two chambers view the ejection fraction (E.F.) with biplanar Simpson technic. The patients were divided in three groups: I) those (12) with E.F. and H/r ratio within normal limits; II) those (6) with low H/r ratio and normal E.F. and the third group III) was formed with 6 patients whom had low H/r ratio and E.F. Three patients from group I had surgical treatment without mortality; all but one (bacterial endocarditis) are alive after two years; five patients from group II had surgical treatment and everyone is alive in functional class I in the same period. All patients of the third group III but one (that had surgical treatment) are death in spite of medical treatment. We conclude that the optimal moment for surgical procedure in severe aortic regurgitation can be determined when the hypertrophy does not compensate the hemodynamic overload (decreases H/r) but the cardiac performance (E.F.) is normal. In this moment the surgical mortality is low and the procedure can change the natural history of the disease.

[Rheumatic carditis in the adult. Anatomoclinical correlation]. / Carditis reumática del adulto. Correlación anatomoclínica.

The histologic findings of 325 necropsies of rheumatic patients at the National Institute of Cardiology in Mexico, between 1980-1985 were studied forty five of them had Aschoff nodules plus valvular inflammation-Out of these 45 cases two groups were formed: children-adolescent group (24 cases) and an adult group (21 cases). The clinical, histologic and laboratory findings were compared. Clinical records were reviewed searching for history of rheumatic fever. Active rheumatic fever was suspected in 16 patients in the younger group (67%) and only in 3 adults (14.2%). As far as Jones' criteria is concerned, the most common finding was carditis, principally in the younger group (83%). In the adult group, it appeared in 50% of the patients. All other criteria were only occasionally seen or could not be identified during the patients lifetime. The most common laboratory finding which could suggest active rheumatic fever were: a high levels of anti-streptolysin in younger patients (95%) and elevation of erythro-sedimentation in adults (83%). We conclude that in active rheumatic fever of the adult; Jones criteria are not met, so the illness is difficult to recognize, and there is clinical-histologic discrepancy. In this context the disease has a "silent" evolution.

[The thickness/radius ratio of the left ventricle in aortic stenosis. Prognostic and therapeutic implications]. / La relacion grosor/radio (h/r) del ventriculo izquierdo en la estenosis aortica. Implicaciones pronosticas y terapeuticas.

Using two-D echocardiography and cardiac catheterization we studied the performance of left ventricle in severe aortic stenosis with normal ventricular function (10 patients), and with heart failure (11 patients). With appropriate hypertrophy increased ventricular function, is found resulting in systolic wall stress normalization. When hypertrophic mechanism is unable to normalize the systolic wall stress; afterload increases with ensuing heart failure (inadequate hypertrophy). Surgical treatment in those cases reduces the afterload and increases de ventricular function. Normalization of systolic wall stress in patients with severe aortic stenosis and heart failure means irreversible myocardial damage.

[The thickness/radius ratio (t/r) in patients with dilated and hypertrophic cardiomyopathy]. / La relación grosor/radio (h/r) en las miocardiopatías hipertrófica y dilatada.

We studied 17 patients with cardiomyopathy (10 hypertrophic and 7 dilated). With two-dimensional echocardiography, we obtained a short axis view at the level of papillary muscle. We calculated the ratio between thickness (h), of ventricular wall and cavity's radius (r) in diastole and systole (h/r ratio). Hypertrophic cardiomyopathy has a high h/r ratio in diastole (inappropriate hypertrophy), hypercontractility and low and systolic wall stress. Dilated cardiomyopathy has a low diastolic h/r ratio (inadequate hypertrophy) with low contractility and elevated end-systolic, wall stress. We discuss the mechanisms and consequences of different patterns of hypertrophy on the ventricular performance.

[Study of ventricular function by means of echocardiographic quantification of the thickness/radius (h/r) ratio of the left ventricle in healthy subjects]. / Estudio de la función ventricular mediante la cuantificación ecocardiográfica de la relación grosor/radio (h/r) del ventriculo izquierdo en sujetos sanos.

We studied 72 healthy subjects; 31 of them were adults and 41 children. By means of two-dimensional echocardiography we obtained a short axis view at the papillary muscle level of the ratio of the thickness (h) of the ventricular wall and the radius (r) of the cavity. We analysed ventricular performance determinants (pre-load, after-load and contractility). This non-invasive method gives information similar to pressure-volume curves. Thus, we propose it for the study of left ventricular overloads.

[Natural history of rheumatic carditis. A follow-up of more than 20 years]. / Historia natural de la carditis reumática. Seguimiento por más de veinte años.

In this retrospective study of 43 patients of the National Institute of Cardiology of Mexico, 20 to 35 years after the first attack of rheumatic carditis shows that the prognosis of the heart valve disease is directly influenced by the number of attacks of rheumatic fever. In fact, when patients had only one rheumatic attack the secuelae was mild mitral regurgitation (19%), without hemodynamic significance, with less proportion of mitral stenosis (15%), or aortic regurgitation (7.6%), less plurivalvular lesions (16%), or required heart surgery (15%). In the other hand, when the patients suffered three rheumatic attacks had more proportion of mitral stenosis (33%), aortic regurgitation (41%), pluryvalvular lesions (38%) and required more heart (50%). We conclude that prophylactic treatment is important in patients with chronic rheumatic heart disease.

[Echocardiographic diagnosis of the right tri-atrial heart]. / Diagnóstico ecocardiográfico del corazón triatrial derecho.

In this report we describe the two-dimensional echocardiographic features of a case of cor triatriatum dexter. In this situation the right atrium is divided by a membrane in two chambers. Considering the anatomic characteristics of this case we added a new type in the classical classification proposed by Doucette et al.

[Calcified aortic stenosis. Semiology and non-invasive diagnostic aspects in the elderly]. / Estenosis aórtica calcificada. Semiología y aspectos diagnósticos no invasivos en el anciano.

Aortic stenosis (AoS) is a relatively common condition in elderly patients. It has different clinical manifestations from AoS seen in young individuals. We examined the manifestations of AoS in the elderly with emphasis on the findings that noninvasive techniques provide. Our study involved a retrospective analysis of 23 patients over 60 years old with diagnosis of calcified AoS established by hemodynamic studies. Calcification of the aortic valve on chest X-ray, left ventricular ejection time (LVET), from of the carotid pulse and thickness of ventricular walls by echocardiography proved to be useful variables for qualitative evaluation. The presence of syncope, murmur in mid-and end-systole and paradoxical splitting of the second sound as well as a LVET of more than 110% indicate a transaortic gradient greater than 50 mmHg. We conclude that evaluation by cardiac catheterization is required only in selected cases.

Echocardiography in infective endocarditis.

Echocardiography may detect the presence of vegetative lesions in between 55 and 80% of patients with the clinical syndrome of bacterial endocarditis. While the mere presence of vegetations does not alone warrant surgical intervention in patients with this disorder those patients with echocardiographically documented large left sided lesions are more prone to embolic events and patients with multiple valve involvement do have a tendency for progressive valvular deterioration. Serial echocardiography is of help in identifying patients with certain complications such as leaflet disruption, abscess or fistula formation and ventricular compromise. Vegetative lesions do not regress in size with antibiotic treatment and may remain for years. Major criteria for surgical intervention continued to be clinical presence of refractory congestive heart failure, repeated embolic events or persistent septicemia. When surgical intervention is decided on clinical grounds, cardiac catheterization is rarely required in patients with adequate echocardiographic studies.

[Hypertensive cardiopathy. Phonomechanocardiographic study and review of its physiopathological mechanisms]. / Cardiopatía hipertensiva. Estudio Fonomecanocardiográfico y revision de sus mecanismos fisiopatológicos.

Sixty four patients with essential hypertension were studied by phonocardiographic systolic time intervals. Prolongation of the pre-ejection period (PEP) at expense of the isovolume contraction time and of the true isovolume contraction time, which suggests myocardial contractile depression due to the increase in after-load. The significant increase, in rise of mean velocity of ventricular pressure suggests that the Anrep phemomena is used by the human heart as a compensatory mechanism in systemic hypertension. Ejection fraction in hypertensives was significantly lower (P less than 0.001) than that of normal controls, which indicates subclinical depression of ventricular function in the former. Myocardial hypertrophy can be considered as a compensatory mechanism which appears late in systemic hypertension and helps normalize ventricular performance and MVO2. It is clinically detected by an s-4 (registered by phonocardiographic tracings) and by an increase in the "A" index and the apexcardiogram (14.5 +/- 8%). The authors conclude that hypertensive heart disease can be identified early through the functional adaptations wich produce detrimental physiopathological reactions to the heart compensated initially by homeometric autorregulation and latter by myocardial hypertrophy.

[The heart in scleroderma. Phonoechocardiographic study]. / El corazón en la esclerodermia. Estudio fono-ecocardiográfico.

We performed phono-ecocardiograms in 11 normotensive patients with scleroderma, all of them below age 50. We compared the parameters measured with a control group of normal subjects. In 18% of the patients studied we found S-3, in 55% S-4. The following abnormalities were significant in the soleroderma group: prolongation of the prejection period (p less than 0.05) decrease of mean velocity of introventricular pressure (p less than 0.01) and also decrease of the contractility index. On the other hand the "A" index of the apexcardiogram was increased (p less than 0.005). In the echocardiogram we found diminished septal and posterior wall thickness (p less than 0.05 and 0.01 respectively). Perirardial effusion was evident in 2 patients. One had mitral disease that resembled rheumatic heart disease. One had calcification of the mitral ring. Two patients had signs of pulmonary hypertensión. We concluded that scleroderma heart disease shows initially decrease compliance, later on it affects systolic function and only in the advanced stages can be manifested as either congestive or restrictive myocardiopathy.

[Echocardiographic study of different forms of pulmonary atresia]. / Estudio ecocardiográfico de las differentes formas de atresia pulmonar.

Echocardiographic recognition of pulmonary atresia with either ventricular septal defect or intact ventricular septum is of great value in the differential diagnosis with other forms of right ventricular outflow tract obstruction or hypoplasia of the right ventricle. We studied nine patients with pulmonary atresia seven with ventricular septal defect and two with intact ventricular septum. It was not possible in either group of these patients to register systolic opening and diastolic closure movements of the pulmonary valve. In the group with ventricular septal defect, aortic straddling was present in all cases. In one patient it was possible to register the echoes of an imperforated pulmonary valve. In the remaining patients, the differential diagnosis with persistent truncus arteriosus was not possible. M-mode and Two-dimensional echocardiographic features of pulmonary atresia with intact ventricular septum are specific of this malformation and can differentiate it from other forms of hypoplasia of the right ventricle.

[Echocardiographic signs of congenital absence of the pulmonary semilunar cusps]. / Signos ecocardiográficos de la ausencia congénita de las sigmoideas pulmonares.

Five patients with congenital absence of the pulmonary valve leaflets were studied with M-mode and two-dimensional echocardiography. In addition to previously reported findings in this heart malformation, we found the presence of a narrow valvular ring that obstructs the outflow tract of the right ventricle, and a to-and-fro movement of the contrast bubbles from the right ventricle to the pulmonary artery suggesting pulmonary regurgitation. These features along with the volume overload data of the right ventricle suggests the diagnosis of congenital absence of the pulmonary valve leaflets.