[Anesthesia in a patient with along-standing congenital heart malformation of the complete atrioventricular canal type for non-cardiac surgery]. / Anestesia en una paciente con malformación cardíaca congénita tipo canal auriculoventricular completo de larga evolución para cirugía no cardíaca.

Atrioventricular canal defects are a class of malformation attributable to anomalies in embryonic development of the anterior and posterior endocardial cushions. In the absence of surgical correction, death usually ensues in the first few years of life. Defects as severe as those observed in our patient are rare in adults. We describe the anesthetic management (epidural anesthesia with spontaneous ventilation by laryngeal mask) for a 46-year-old woman with this malformation who underwent emergency laparotomy.

[The effect of gallopamil and propranolol in patients with ischemic cardiopathy and moderate depression of ventricular function]. / Efecto del gallopamil y del propranolol en pacientes con cardiopatía isquémica y depresión moderada de la función ventricular.

BACKGROUND: Calcium channel blockers have been wide and successfully used in the treatment of coronary heart disease. Gallopamil, a metoxylic derivative of verapamil, has many of its properties and so, caution is recommended when given to patients with depressed left ventricular function. Clinical studies about this effect are scarce, and we have assessed it in patients with coronary heart disease and diminished left ventricular function. METHODS: We studied 20 patients in a cross-over, randomized, double-blind study during three weeks active periods with two intercalating washout placebo periods of one week. Patients had history of previous myocardial infarction, positive exercise stress test and ejection fraction ranging from 30% to 50% by echocardiography. RESULTS: There were no significant differences between each drug and corresponding placebo on either systolic or diastolic function. When we compared both drugs, patients showed a milder increase in area under E after propranolol than after gallopamil (p < 0.008). Clinical episodes of cardiac failure were not reported, and ejection fraction did not change. CONCLUSIONS: Both gallopamil and propranolol can be used in patients with coronary heart disease and moderately depressed left ventricular ejection fraction.