Insuficiencia cardíaca de alto débito secundaria a una fístula arteriovenosa congénita. Síndrome de Parkes Weber / High-output cardiac failure due to congenital arteriovenous fistula. Parkes Weber syndrome

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The fully automatic external cardioverter defibrillator: reality of a new meaningful scenario for in-hospital cardiac arrests.

Sudden cardiac death is an unresolved problem which causes significant mortality and morbidity in both the community and in-hospital setting. Cardiac arrest is often caused by ventricular tachyarrhythmias which may be mostly interrupted by cardioversion or defibrillation. The single most critical factor for survival is the response time. Over the last 30 years, there have been virtually no procedural changes in the way hospitals address in-hospital resuscitation. A unique device has been developed that eliminates human intervention and assures defibrillation therapy is administered in seconds. This is accomplished with a fully automatic, external bedside monitor defibrillator designed to be prophylactically attached to hospitalized patients at risk of ventricular tachyarrhythmia. The safety and efficacy of the device has been demonstrated in multicenter US and European trials. Thus, this device allows a new scenario which may increase survival and enables meaningful redistribution of health resources.

[Morphologic study of the pulmonary veins by magnetic resonance angiography]. / Estudio morfológico de las venas pulmonares por angiorresonancia magnética.

Accurate knowledge of the anatomy of the pulmonary veins is important in clinical electrophysiology. In order to evaluate the usefulness of magnetic resonance angiography for this purpose, we studied 17 unselected patients. All the pulmonary veins were visualized in each individual. The diameters of the ostia ranged between 9 mm and 22 mm. The cross-section of the ostium was elliptical in 35% of cases. In 14 patients (82%), the 4 veins each had independent drainage. In 2 patients (12%), there was an additional intermediate right vein and, in 1 patient (6%), both left veins had a common ostium. In 74% of patients, the right pulmonary veins had a short common trunk with early branching. This pattern was seen in only 10% of left veins. Magnetic resonance angiography using a contrast medium is an excellent technique for studying the anatomy of the pulmonary veins and for identifying variants. The resulting information is potentially useful for electrophysiologists.

Estudio morfológico de las venas pulmonares por angiorresonancia magnética / Morphologic study of the pulmonary veins by magnetic resonance angiography

El desarrollo de la electrofisiología clínica ha potenciado el interés por el conocimiento de la anatomía de las venas pulmonares. Con el objetivo de valorar la utilidad de la angiografía por resonancia magnética para este fin se estudió a 17 pacientes no seleccionados, en los que se visualizó la totalidad de las venas en cada paciente. El diámetro máximo de los ostium osciló entre 9 y 22 mm y su morfología era oval en el 35% de casos. En 14 casos (82%) se observó una desembocadura independiente de las 4 venas. En 2 (12%) había una vena media derecha independiente y 1 (6%) presentaba un ostium común para las venas izquierdas. Las venas derechas mostraron ramificación precoz en un 74% de los casos, frente a un 10% de las izquierdas. La angiorresonancia magnética con contraste permite estudiar, de manera adecuada, la morfología de las venas pulmonares y sus variantes anatómicas, información potencialmente útil para el electrofisiólogo

Accurate knowledge of the anatomy of the pulmonary veins is important in clinical electrophysiology. In order to evaluate the usefulness of magnetic resonance angiography for this purpose, we studied 17 unselected patients. All the pulmonary veins were visualized in each individual. The diameters of the ostia ranged between 9 mm and 22 mm. The cross-section of the ostium was elliptical in 35% of cases. In 14 patients (82%), the 4 veins each had independent drainage. In 2 patients (12%), there was an additional intermediate right vein and, in 1 patient (6%), both left veins had a common ostium. In 74% of patients, the right pulmonary veins had a short common trunk with early branching. This pattern was seen in only 10% of left veins. Magnetic resonance angiography using a contrast medium is an excellent technique for studying the anatomy of the pulmonary veins and for identifying variants. The resulting information is potentially useful for electrophysiologists

[Clinical value of cardiovascular magnetic resonance imaging in the diagnostic work-up of patients with suspected arrhythmogenic right ventricular dysplasia]. / Utilidad clínica de la cardiorresonancia magnética para el diagnóstico de pacientes con sospecha de displasia arritmogénica ventricular derecha.

INTRODUCTION AND OBJECTIVES: To analyze retrospectively the usefulness of cardiovascular magnetic resonance imaging in the assessment of patients with clinically suspected arrhythmogenic right ventricular dysplasia. MATERIAL AND METHOD: We reviewed retrospectively findings from 46 consecutive patients (mean age, 42+/-19 years; 25 male) who were referred for investigation to rule out right ventricular dysplasia. Abnormal findings were classified according to the general diagnostic criteria established by the European Society of Cardiology. RESULTS: Evaluable images were available for all patients. Abnormal right ventricular findings were reported in 24 patients (52%), but only 5 were given a definite diagnosis of right ventricular dysplasia. Fatty infiltration was observed in 9 patients; it was an isolated finding in 6 but was associated with right ventricular contractile dysfunction in 3. These latter patients belonged to the group with confirmed dysplasia. None of the 22 patients (48%) with normal findings on magnetic resonance imaging was given a diagnosis of dysplasia. CONCLUSIONS: Cardiovascular magnetic resonance imaging enabled the right ventricle to be assessed in all patients. In those with clinically suspected dysplasia, normal findings ruled out the diagnosis. However, only 21% of those with abnormal findings on magnetic resonance imaging were finally given a confirmed diagnosis of dysplasia. Fatty infiltration of the right ventricular wall does not imply dysplasia unless it is associated with other abnormalities in right ventricular morphology or contractility. Cardiovascular magnetic resonance imaging is useful in the work-up of patients with clinically suspected arrhythmogenic right ventricular dysplasia.

Utilidad clínica de la cardiorresonancia magnética para el diagnóstico de pacientes con sospecha de displasia arritmogénica ventricular derecha / Clinical value of cardiovascular magnetic resonance imaging in the diagnostic work-up of patients with suspected arrhythmogenic right ventricular dysplasia

Introducción y objetivos. Revisar la utilidad práctica de la cardiorresonancia magnética en la evaluación de pacientes con sospecha clínica de displasia arritmogénica ventricular derecha. Material y método. Revisamos retrospectivamente los estudios de 46 pacientes (edad: 42 ± 19 años, 25 varones) remitidos a nuestro centro con diagnóstico de sospecha de displasia ventricular derecha. Clasificamos las alteraciones observadas según los criterios diagnósticos generales, mayores y menores, establecidos por la Sociedad Europea de Cardiología. Resultados. Obtuvimos imágenes valorables en el 100% de los casos. Detectamos afección de ventrículo derecho en 24 pacientes (52%), entre los que sólo 5 cumplieron criterios de displasia. Nueve pacientes mostraron infiltración grasa, 6 como único hallazgo y en 3 pacientes en asociación con alteraciones de la contractilidad; estos últimos pertenecían al grupo con criterios diagnósticos de displasia. Ninguno de los 22 pacientes con cardiorresonancia normal (48%) fue diagnosticado de displasia. Conclusiones. La cardiorresonancia magnética permitió estudiar el ventrículo derecho en el 100% de los casos. En la población evaluada, un estudio normal permitió descartar el diagnóstico de displasia. Entre el 52% de los estudios con hallazgos patológicos, el diagnóstico se confirmó en una pequeña proporción (5/24). La presencia de infiltración grasa no implicó el diagnóstico de displasia si no se acompañaba de otras alteraciones, morfológicas o de la contractilidad, del ventrículo derecho. La cardiorresonancia magnética es una técnica útil, en la práctica clínica, para el estudio de pacientes con sospecha de displasia arritmogénica ventricular derecha (AU)

Introduction and objectives. To analyze retrospectively the usefulness of cardiovascular magnetic resonance imaging in the assessment of patients with clinically suspected arrhythmogenic right ventricular dysplasia. Matherial and method. We reviewed retrospectively findings from 46 consecutive patients (mean age, 42±19 years; 25 male) who were referred for investigation to rule out right ventricular dysplasia. Abnormal findings were classified according to the general diagnostic criteria established by the European Society of Cardiology. Results. Evaluable images were available for all patients. Abnormal right ventricular findings were reported in 24 patients (52%), but only 5 were given a definite diagnosis of right ventricular dysplasia. Fatty infiltration was observed in 9 patients; it was an isolated finding in 6 but was associated with right ventricular contractile dysfunction in 3. These latter patients belonged to the group with confirmed dysplasia. None of the 22 patients (48%) with normal findings on magnetic resonance imaging was given a diagnosis of dysplasia. Conclusions. Cardiovascular magnetic resonance imaging enabled the right ventricle to be assessed in all patients. In those with clinically suspected dysplasia, normal findings ruled out the diagnosis. However, only 21% of those with abnormal findings on magnetic resonance imaging were finally given a confirmed diagnosis of dysplasia. Fatty infiltration of the right ventricular wall does not imply dysplasia unless it is associated with other abnormalities in right ventricular morphology or contractility. Cardiovascular magnetic resonance imaging is useful in the work-up of patients with clinically suspected arrhythmogenic right ventricular dysplasia (AU)

[Irreversible acute heart failure caused by cardiac hemochromatosis secondary to multiple transfusions]. / Insuficiencia cardíaca aguda irreversible debido a hemocromatosis cardíaca secundaria a transfusiones múltiples.

We report a 64 years old male, admitted for dyspnea and edema of two weeks duration. A sideroblastic anemia, requiring multiple transfusions, was diagnosed four years earlier. The chest X-ray showed an enlarged heart and right pleural effusion. A low left ejection fraction was evidenced by echocardiogram. Doppler analysis of the mitral flow revealed a restrictive hemodynamic pattern. A diagnosis of secondary cardiac hemochromatosis deposit was made. Nine days after admission the patient died due to heart failure. The clinical presentation of cardiac hemochromatosis as a sudden and irreversible heart failure, as well as the importance of early diagnosis and surveillance of high-risk patients is emphasized.