[Study of calcification of the mitral annulus. Importance of echocardiographic analysis]. / Estudio de la calcificación del anillo mitral. Importancia del análisis ecocardiográfico.

Mitral annulus calcification is a common finding in old people. In order to know the association of mitral annulus calcification with other pathologic conditions, 25 patients were studied by echocardiography, 20 females and 5 males. No significant differences _ere observed with respect to sex. The average age was 67 +/- 15 years. Mitral annulus calcification was associated with aortic sclerosis in 100% of the cases, to arterial hypertension in 19 (76%), to obstructive pulmonary disease in 8 (32%), to diabetes mellitus in 5 (20%), and to peripheral arterial insufficiency in 5 (20%). Mitral regurgitation was found in 14 cases, atrial fibrillation in 2 (8%). Complete A-V block was not observed, but there was enlargement of the left ventricle in 23 (92%) and of the left atrium in 17 (68%). The chest X-ray showed mitral annulus calcification in 5 (20%) with a sensitivity of 25% and a specificity of 100%. The M-mode echocardiogram showed LA-Ao ratio of 1.4 +/- 0.3, the mitral valve D-E excursion was reduced 11.9 +/- 3.1 mm. and also the E-F slope 28.6 mm/seg +/- 16.7 with appearance of mitral stenosis, but the two-dimensional study demonstrated that this was false. In all patients the left ventricle was dilated and fractional shortening was diminished. Echocardiography not only is a good diagnostic method for mitral annulus calcification, it also allow us to evaluate the hemodynamic consequences of this pathology which occurs in older patients and is often associated with other common illnesses of advanced age. In our study 56% of mitral annulus calcification cases were associated with mitral regurgitation.

[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.

[Hypertensive retinopathy in patients with aortic coarctation]. / Retinopatía hipertensiva en pacientes con coartación aórtica.

In order to assess the incidence and the determinants of hypertensive vascular changes in the retina of patients with coarctation of the aorta, fifty (37 male and 13 female) were analyzed. The mean age of the group was 18.7 +/- 10.3 years. No one had evidence of nephropathy. Different degrees of hypertensive retinopathy (Puig-Solanes classification) were observed in 54%. Of the patients, no one had papilledema. Retinal vascular damage was not related to either age or sex. The group of patients with retinal vascular lesions had a mean level of systolic arterial pressure higher than the group with normal retinas. Multivariant statistical analysis of the results permitted the identification of systolic arterial pressure higher than 150 mm Hg, age greater than 15 years and cardiomegaly as the three variables more frequently associated with retinal vascular lesions. Surgical correction of the aortic malformation resulted in normalization of both systolic and diastolic arterial pressures in 98% of the total number of patients as determined one year postoperatively. It is concluded that, in coarctation of the aorta, vascular damage of the retina appears to have an incidence that is similar to that observed in patients with other forms of systemic arterial hypertension. The development of these retinal lesions in patients with coarctation of the aorta would seem to be determined by the severity and duration of the hypertensive process.

[Echocardiography and trivalvular infectious endocarditis in a heart without apparent previous cardiopathy]. / Ecocardiografía y endocarditis infecciosa trivalvular en corazón sin aparente cardiopatía previa.

The echocardiographic findings in a patient with infective endocarditis are reported. There was involvement the aortic, mitral, and tricuspid valves. The heart had no previous valvular disease. The M-Mode and two dimensional studies, showed presence of vegetations in the aortic, mitral, and tricuspid valves. We consider that the echocardiogram allows the detection of endocarditis in its early stage.