Role of real-time three-dimensional transoesophageal echocardiography for guiding transcatheter patent foramen ovale closure.

Patent foramen ovale (PFO) is a relatively common congenital condition which has been implicated in cryptogenic stroke as a result of paradoxical thromboembolism by right-to-left shunting. Many studies have demonstrated that transcatheter PFO closure significantly reduced the incidence of recurrent strokes in a small group of high-risk patients with PFO and atrial septal aneurysm compared with antithrombotic drugs. Two-dimensional transoesophageal echocardiography (2D TEE) has become the election technique for guiding patent foramen ovale closure. Real-time Three-dimensional transoesophageal echocardiography (3D TEE) may be potentially superior to 2D TEE in the accurate assessment of the morphology and efficacy of transcatheter closure devices because of a better spacial orientation.

[Clinical characteristics, epidemiology and prognosis of acute coronary syndrome without ST-segment elevation and angiographically normal coronary arteries]. / Características clínicas, epidemiología y pronóstico del síndrome coronario agudo sin elevación del segmento ST con coronarias sanas.

BACKGROUND AND OBJECTIVE: It has been estimated that up to 12% of patients with acute myocardial infarction do not present coronary atherosclerotic disease demonstrable with angiographic studies. We assessed the clinical characteristics and prognosis of acute coronary syndrome without ST-segment elevation with angiographically normal coronary arteries. PATIENTS AND METHOD: Comparative retrospective analysis of 58 consecutive patients with this diagnosis and a sample (n = 59) with lesions in angiographic studies, analyzing demographic characteristics, analytical parameters, electrocardiogram, ventricular function and prognosis. RESULTS: The group represented 19% of the totality of acute coronary syndromes, showing a lower prevalence rates of hypercholesterolemia, diabetes mellitus and no record of ischemic heart disease (p = 0.043 to p = 0.005). The presence of regional wall motion abnormalities was significantly higher in the group with angiographic lesions (76.3% vs 41.4%; p < 0.01). In-hospital mortality rate showed a non significant trend toward to be lower in the group with normal angiogram (1.7% vs 8.4%). CONCLUSIONS: The absence of significant coronary artery disease in acute coronary syndrome without ST-segment elevation is not infrequent and was related to a lower cardiovascular risk profile and the absence of regional wall motion abnormalities showing a trend toward better in-hospital prognosis.

Características clínicas, epidemiología y pronóstico del síndrome coronario agudo sin elevación del segmento ST con coronarias sanas / Clinical characteristics, epidemiology and prognosis of acute coronary syndrome without ST-segment elevation and angiographically normal coronary arteries

FUNDAMENTO Y OBJETIVO: Se ha estimado que hasta el 12%de los pacientes con infarto de miocardio no presentaenfermedad arteriosclerótica demostrable mediante coronariografía.El objetivo de este estudio ha sido analizarlas características clínicas y el pronóstico de los pacientescon síndrome coronario agudo sin elevación del segmentoST que no presentan lesiones coronarias.PACIENTES Y MÉTODO: Se ha realizado un análisis retrospectivode 58 pacientes consecutivos con este diagnóstico,a quienes se comparó con una muestra (n = 59) quepresentaba lesiones angiográficas. Se valoraron las característicasdemográficas, parámetros analíticos, electrocardiograma,función ventricular y pronóstico.RESULTADOS: El grupo estudiado representó el 19% de loscasos de síndrome coronario y mostró una prevalenciamenor de dislipemia, diabetes e historia de cardiopatíaisquémica (p = 0,043 a p = 0,005). La presencia de alteracionessegmentarias de la contractilidad fue mayoren el grupo de pacientes con lesiones coronarias (un76,3 frente a un 41,4%; p < 0,01). La mortalidad intrahospitalariamostró una tendencia no significativa a sermenor en el grupo sin lesiones (el 1,7 frente al 8,4%).CONCLUSIONES: La ausencia de lesiones coronarias significativasen el síndrome coronario agudo sin elevación delsegmento ST no es infrecuente. Se relaciona con un perfilde riesgo cardiovascular menor y con la ausencia dealteraciones segmentarias de la contractilidad, y muestrauna tendencia a un mejor pronóstico intrahospitalario

BACKGROUND AND OBJECTIVE: It has been estimated that upto 12% of patients with acute myocardial infarction donot present coronary atherosclerotic disease demonstrablewith angiographic studies. We assessed the clinicalcharacteristics and prognosis of acute coronary syndromewithout ST-segment elevation with angiographicallynormal coronary arteries.PATIENTS AND METHOD: Comparative retrospective analysisof 58 consecutive patients with this diagnosis and a sample(n = 59) with lesions in angiographic studies, analyzingdemographic characteristics, analytical parameters,electrocardiogram, ventricular function and prognosis.RESULTS: The group represented 19% of the totality ofacute coronary syndromes, showing a lower prevalencerates of hypercholesterolemia, diabetes mellitus andno record of ischemic heart disease (p = 0.043 top = 0.005). The presence of regional wall motion abnormalitieswas significantly higher in the group with angiographiclesions (76.3% vs 41.4%; p < 0.01). In-hospital mortalityrate showed a non significant trend toward to belower in the group with normal angiogram (1.7% vs 8.4%).CONCLUSIONS: The absence of significant coronary arterydisease in acute coronary syndrome without ST-segmentelevation is not infrequent and was related to a lowercardiovascular risk profile and the absence of regionalwall motion abnormalities showing a trend toward betterin-hospital prognosis

Trombosis subaguda de stents farmacoactivos en paciente protador de prótesis mecánica: importancia de la doble antiagregación / Subacute thrombosis of drug-eluting-stents in a patient with a mechanical aortic prosthesis: the importance of dual antiplatelet therapy

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