[Echocardiographic indicators of electric cardioversion in patients with atrial fibrillation]. / Indicadores ecocardiográficos de cardioversión eléctrica en pacientes con fibrilación auricular.

We studied 80 patients to evaluate the safety of the transesophageal echocardiography (TEE) as a guidance to identify spontaneous echo contrast or atrial thrombosis in patients with atrial fibrillation (AF). 34 out of these patients were men and 46 women, with a mean age of 61 +/- 12 years. Five were not candidates due to the presence of risk factors. 75 patients have undergone electric cardioversion. The duration of AF was < 2 weeks in 61 > or = 2 and < 6 weeks 13, and > or = 6 weeks and < 1 year 6; 24 patients received previous anticoagulant therapy. The echocardiographic findings revealed left atrial dimension 45 +/- 8.4 mm ejection fraction of left ventricle 61 +/- 7.5%, SEC absent in the left atrium of 35, mild in 40 and severe in 5 patients, flow in left atrial appendage in 78 patients, thrombi in 2. EC was performed with 200 Joules in all patients and it was successful in 74. The study lasted 8.7 +/- 5.7 months; 11 patients were recurrent. The predictors were: left atrial dimension > 50 mm (p > 0.05), > 2 EC performed (p = 0.02), > 200 Joules (p = 0.05) and in patients with AF < or = 2 weeks. We concluded that the TEE is beneficial to detect risk factors in patients with AF, and it helps when deciding to perform the EC early and safely without previous anticoagulation.

[Dilated cardiomyopathy induced by ectopic atrial tachycardia]. / Cardiomiopatía dilatada inducida por taquicardia auricular ectópica.

The deleterious effect of chronic or incessant supraventricular tachycardia on ventricular function is well-known and it has been demonstrated than can ultimately lead to dilated cardiomyopathy if unrecognized. Any variety of supraventricular tachycardia with chronic evolution may lead to left ventricular dysfunction, ectopic atrial tachycardia because of its persistent nature, often incessant and poorly responsive to antiarrhythmic drugs is a frequent cause of reversible congestive heart failure in patients without other demonstrable organic heart disease. Five patients (aged 14 to 52 years) were referred with symptoms of heart failure, NYHA functional class II (one patient), class III (one patient) and class IV (3 patients) associated with an incessant ectopic atrial tachycardia. Four patients underwent radiofrequency catheter ablation of the ectopic focus and one patient was treated with amiodarone. All patients were successfully treated and the echocardiographic assessment of left ventricular function indicated regression of the cardiomyopathy picture with recovery of systolic function, (mean left ventricular ejection fraction 39.2 +/- 6.1% before vs mean 62.4 +/- 4.8% after (p < 0.01). The clinical and echocardiographic picture of cardiomyopathy induced by incessant ectopic atrial tachycardia is reversible after successful treatment. This stresses the necessity of recognizing such arrhythmia as cause of primary heart failure.

[Medical-surgical management of left heart valve prosthesis dysfunction due to obstruction. Eleven year's experience]. / Manejo médico-quirúrgico en la disfunción de prótesis valvular mecánica cardiaca izquierda por obstrucción. Once años de experiencia.

UNLABELLED: We report the surgical-medical experience in left side mechanic prosthesis cardiac valve dysfunction. From January 1986 to June 1997 we included 108 consecutive patients (pts), 24 were men and 84 women, mean age 45 years, they underwent 114 surgical procedures, 104 in mitral and 10 in aortic position. RESULTS: The dysfunction was due to obstruction in fixed disc in 107 pts and intermitent in 7 pts. The pathological findings were thrombosis in 92 pts, pannus in 9 pts and both in 13 pts. The time interval between valve replacement and dysfunction was from 1 to 247 months, mean 53.8 +/- 56.7. Seventy five percent of patients received inadequate anticoagulant therapy, the mean INR was 2.06 +/- 0.79. In 76% of patients the functional class was III or IV NYHA. The diagnosis was made by clinical and echocardiographic findings in 96% of patients. The surgical procedures included valve replacement in 103, and toilette in 11 pts. The time of extracorporeal circulation in patients who died us survival patients were (159.9 +/- 108.95 vs 87.32 +/- 27.53 min) and aortic cross-clamp (64.8 +/- 20.69 vs 48.28 +/- 23.71 min) respectively (p < 0.001). The overall mortality was 12 pts (10.5%), all in functional class III or IV NYHA (p < 0.05), five patients died during surgical procedure. In conclusion the diagnosis must be established clinically as well as by echocardiography. The risk factors associated with mortality were pulmonary edema, shock, delayed surgery, surgical time prolonged and functional class III or IV NYHA.

[A papillary fibroelastoma of the left ventricule in the presence of a mitral valve prosthesis. A case report and review of the literature]. / Fibroelastoma papilar del ventrículo izquierdo en presencia de prótesis valvular mitral. Reporte de un caso y revisión de la literatura.

Papillary fibroelastoma is a rare, benign cardiac tumor. Before echocardiogram came into existence, it was diagnosed only by necropsy or incidentally at surgery. This kind of tumor may appear on the endocardial surface or in any of the valves. Although it is usually small in size, it is associated to embolic phenomena, thoracic pain and sudden death. This report presents the first case of papillary fibroelastoma in the presence of a mechanical valvular prosthesis in mitral position. In a patient 55 years old, presenting inactive rheumatic heart disease. The tumor was detected by means of transthoracic and transesophageal echocardiogram.

[Thrombolysis in unstable angina. A perspective before and after TIMI IIIB]. / Trombolisis en angina inestable. Una perspectiva antes y después del TIMI IIIB.

To identify the utility and security of thrombolytic therapy in unstable angina, we performed: a) retrospective analysis of controlled trials through computers system and cross references; b) analysis of TIMI IIIB trial to identify variables that explain, why thrombolytic therapy was unsuccessful; c) analysis of our clinical experience. For the three models of research, variables of primary and secondary effectivity were designed. Twenty two controlled trials with 3,544 patients were analyzed, the variables of primary effectivity suggest that in patients with unstable angina with sustained and recurrent clinical and electrocardiographic manifestations of acute ischemia, the use thrombolytic therapy could produce benefit, if the main mechanism is an intracoronary thrombus and if it is associated with maximum pharmacologic treatment and anticoagulation in acute phase. In the TIMI IIIB trial, variables that explain unsuccessful thrombolytic therapy were identified. The clinical experience in 17 patients with high risk unstable angina that received streptokinase in accelerated and standard infusion, proved success in 100% of the cases by improvement of ischemia, avoidance of infarction and recurrence, without hemorrhagic complications, without mortality. The results suggest, that in unstable angina with high clinical suspicion of disruption and thrombogenesis, refractory acute ischemia, jeopardized myocardium, and hemodynamic unstability, thrombolytic therapy could be an alternative that eliminates acute ischemia, as a bridge to the use in a second time of a definitive therapy. These data require in our environment revalidation with controlled trials and inclusion of more patients.