Cuantificación de la relación entre el gradiente transmitral y la duración de los ciclos cardíacos en pacientes con estenosis mitral y fibrilación auricular utilizando la técnica doppler / Quantification of the relationship between transmital gradient and cardiac cycle lenght in patients with mitral stenosis and atrial fibrillation using the doppler technique

Fundamento. En pacientes con estenosis mitral (EM) y fibrilación auricular (FA) se analiza y cuantifica la influencia del ciclo cardíaco (RR) sobre los gradientes transmitrales. Métodos. En 58 pacientes con EM pura y FA se obtienen mediante ecocardiografía-Doppler los gradientes transmitrales telediastólico (GTD) y medio (GM) y se relacionan con los intervalos RR, agrupando a los pacientes según el área valvular mitral: A=EM grave (área1,5 cm2).Resultados. La relación entre el GTD y los intervalos RR ha sido significativa e inversa en todos los casos.Considerando globalmente a todos los pacientes de cada grupo las rectas de regresión obtenidas han sido las siguientes: grupo A) GTD=27,3-0,021RR; n=608; p<0,0001; grupo B) GTD=16,8-0,013RR; n=878; p<0,0001; grupo C) GTD=11,2-0,009RR; n=472; p<0,0001. El mismo tipo de relación se ha observado al considerar la relación entre los GM y los intervalos RR. Conclusiones. En los pacientes con EM y FA existe una relación significativa e inversa entre los gradientes transmitrales y la duración de los ciclos cardíacos. La estimación de los gradientes transmitrales según la duración de los ciclos utilizando las funciones propuestas permite cuantificar las repercusiones hemodinámicas del control inadecuado de la frecuencia cardíaca en este tipo de pacientes (AU)

[The effect of the duration of the cardiac cycles on determining mitral valve area by means of pressure half-time]. / Influencia de la duración de los ciclos cardíacos en la determinación del área valvular mitral mediante el tiempo de hemipresión.

INTRODUCTION AND AIMS: To analyze the influence of variations in the length of cardiac cycle length of calculating mitral valve area by means of the pressure half time in patients with mitral valve stenosis and atrial fibrillation. METHODS: Fifty-nine patients with pure mitral valve stenosis and atrial fibrillation were subjected to transmitral flow measurements by continuous Doppler monitoring from the apical window. In each patient the pressure half time was quantified, corresponding to a minimum of 30 consecutive cycles. RESULTS: Considering all the measurements made in each patient, the correlation between pressure half time and cardiac cycle was significant in 20 cases (34%). The pressure half time variation coefficients were significantly greater when including the values corresponding to the shortest cycles. Thus, for cycle duration of > or = 800, 700, 600, 500 and 400 ms, the mean values were 0.096 +/- 0.041, 0.106 +/- 0.042 (NS), 0.128 +/- 0.032 (p < 0.05), 0.167 +/- 0.048 (p < 0.001) and 0.231 +/- 0.057 (p < 0.0001), respectively. Upon analyzing the relation between pressure half time and cardiac cycle with progressive exclusion of the longer cycles > or = 800, 700 and 600 ms the number of patients with significant correlation coefficients increased to 19/37 (51%), 12/23 (52%) and 4/6 (67%) on respectively excluding. CONCLUSIONS: Patients with mitral valve stenosis and atrial fibrillation show a variation in pressure half time that may complicate calculation of the mitral valve area. Variability is inherent to the measurement method, and is furthermore dependent upon cardiac cycle duration. This may be resolved by limiting determinations to cycles longer than 800 ms.

[Cardiac cysts. A case of isolated cardiac hydatidosis]. / Quistes cardíacos. Un caso de hidatidosis cardíaca aislada.

In the presence of cardiac cysts we must discard a hydatid disease, even if there is no involvement of other organs. Imaging techniques are useful for guiding the initial diagnosis. The presence of daughter vesicles or multiple cysts is very characteristic. We present a patient affected by cardiac hydatid disease, in the form of multiple cardiac cysts, without extracardiac affectation, who presented pericardial chest pain. The patient was dealt with surgery to avoid the risks of a cyst rupture.

[Left ventricular pseudoaneurysm. The dynamics and flow patterns analyzed by Doppler echocardiography]. / Seudoaneurisma ventricular izquierdo. Dinámica y patrones de flujo analizados mediante ecocardiografía-Doppler.

A patient with antecedents of ischemic cardiopathy is presented. Echocardiographic exploration revealed the presence of an accessory cavity in connection with the left ventricle behind the basal segment of the posterior left ventricular wall, the characteristics of which were compatible with a ventricular pseudoaneurysm. The Doppler study (both conventional and color coded) allowed us to determine the multiphasic characteristics of the flow between both cavities, and its relation with the variations of volume of the same, as well as with the transmitral and aortic flows. The filling of the pseudoaneurysm was observed to begin before initiation of the ejection through the aorta. Initiation of emptying towards the left ventricular cavity took place in the late systole, and there was a new flow inversion towards the pseudoaneurysm in the early diastole coinciding with the rapid ventricular filling, and therefore before producing the atrial contraction.