[Independent predictive factors of acute and first year success after electrical cardioversion in patients with chronic atrial fibrillation]. / Factores predictores independientes del éxito agudo y al año de la cardioversión eléctrica en pacientes con fibrilación auricular crónica.

OBJECTIVES: We retrospectively analyzed the predictive factors of successfully electrical cardioversion in patients with chronic atrial fibrillation. METHODS: We included 118 patients, 68 men and 50 women, with a mean age of 65.1 years and a length of arrhythmia evolution of 83.3 days. These patients consecutively underwent electrical cardioversion in our Cardiology Department with a follow-up of one year to determine relapses. Structural cardiopathy was observed in 63.6% of the patients and 43.7% presented a left atrium between 4 and 5 cms. We analyzed the clinical and echocardiographic factors which predict the acute and first year success of electrical cardioversion. RESULTS: The cardioversion was effective in 73.7% (CI 95%, 64.6%-81.1%) of the patients and 35.6% (CI 95%, 25.8%-46.6%) had a relapse within the first year. The inexistence of cardiomyopathy and therapy with amiodarone were predictive of acute success (p < 0.04 and p < 0.03, respectively). The length of arrhythmia evolution did not predict acute success but did so when relapses were analyzed. The size of the left atrium is predictive of both acute and long term success (p < 0.02 and p < 0.001, respectively). Logistic regression showed that the size of the left atrium and the patient's age were the only predictive factors of acute and first year success. CONCLUSIONS: Electrical cardioversion is very efficient in the short-term, despite numerous relapses. Patient age and the size of left atrium are associated with acute and long-term success of cardioversion.

[Primary pericardial angiosarcoma with multiple lung and a solitary liver metastases: the clinical and anatomicopathological findings]. / Angiosarcoma pericárdico primario con metástasis pulmonares múltiples y hepática solitaria: hallazgos clínicos y anatomopatológicos.

A case of 66-year-old woman with cardiac tamponade and bilateral pulmonary infiltrates is reported. These infiltrates were "pseudonodulars" and confluent. We practice pericardiocentesis and a hemorrhagic fluid is pulled out. Its cytology shown not neoplastic cells. She died and the necropsy shown an angiosarcoma of pericardium with multiple pulmonary and alone hepatic metastases.

[Acute postpartal myocardial infarct: the role of methylergometrin in its etiopathogenesis]. / Infarto agudo de miocardio posparto: papel de la metilergometrina en su etiopatogenia.

We report a 28-year-old patient with an acute myocardial infarction, without previous symptomatology of ischemic heart disease, 5 hours after a delivery. We discuss the role of methylergometrine, used for avoid the bleeding postpartum, in its etiopathology and its specific therapy.

[Aortic insufficiency in an asymptomatic girl: valve prolapse as the only finding]. / Insuficiencia aórtica en niña asintomática: prolapso valvular como único hallazgo.

A case of an asymptomatic 9-year-old girl is reported. She was diagnosed of aortic regurgitation by valvular prolapse without other systemic or valvular pathology associated. We discuss her etiology and physiopathology.

[Swallowing syncope in a patient with diffuse esophageal spasm]. / Síncope deglutorio en paciente portador de un espasmo esofágico difuso.

We present a patient with swallowing syncope. The esophageal manometric examination showed a diffuse spasm. This induces a vagovagal reflex mediated by tensoreceptors from the esophageal wall, which block the AV and/or sinus nodes.

[Repeated cerebral embolism in a patient with papillary fibroelastoma of the mitral valve detected by two-dimensional echocardiography]. / Embolismo cerebral de repetición en una enferma portadora de fibroelastoma papilar de la válvula mitral, detectado mediante ecocardiografía bidimensional.

We report a 68 years-old woman with repeated cerebral embolism, secondary to a papillary fibroelastoma of mitral valve, located in its ventricular side. It was detected by two-dimensional echocardiography. Surgical treatment was satisfactory.

Noninvasive determination of pulmonary arterial systolic pressure by continuous wave Doppler.

We evaluated the accuracy of continuous wave Doppler for estimating pulmonary arterial systolic pressure in patients with tricuspid regurgitation. Of 44 patients with a variety of cardiac disorders, 39 (89%) had Doppler-detected tricuspid regurgitation. Adequate spectral profiles of the flow signals were obtained in 34 of them (87%), representing 77% of the entire group. Continuous wave Doppler ultrasound was used to measure the maximum velocity of the regurgitant jet, and by applying the modified Bernoulli equation, the systolic pressure gradient between the right ventricle and the right atrium was calculated. Pulmonary arterial systolic pressure was estimated by adding the transtricuspid gradient to the mean right atrial pressure, and correlated well with catheterization values (r = 0.96). The correlation coefficient was not significantly modified if mean right atrial pressures were excluded in the calculations (r = 0.91). Continuous wave Doppler constitutes a sensitive method for the detection of tricuspid regurgitation. The method using the tricuspid gradient provides an accurate estimation of pulmonary arterial systolic pressure. Combined with other available methods (pulsed wave Doppler), this noninvasive technique can yield information comparable with that obtained at catheterization.

Estudio evolutivo de 204 bioprotesis a largo plazo (8 años) / Long-term evolutive study of 204 bioprosthesis (8 years)

Presentamos los resultados obtenidos con 204 prótesis biológicas de Hancock, implantadas en nuestro Centro entre junio de 1974 y diciembre de 1975 y controladas posteriormente, con un seguimiento máximo de 8.5 años y mínimo de 5.8 años. La mortalidad quirúrgica-hospitalaria (QH) fué del 8.7% y la esperanza de sobrevida a los 8 años del 78.9%. Después de la intervención, del total de 171 enfermos intervenidos, 121 se hallaban en clase funcional I, y 123 presentaban cardiomegalia o esta era ligera. Al final del estudio el 95.3% de los enfermos con cambio mitral y el 95.8% con cambio aórtico estaban libres de endocarditis. La esperanza de ausencia de tromboembolismo a los 8 años fué del 92.1% para los enfermos con un cambio mitral y del 97.8% para la aórticos. A lo largo de la evolución se presentaron 49 disfunciones, de las cuales 16 fueron ligeras, no obligaron a valoración hemodinámica ni a cambio valvular. En un caso la disfunción se valoró como moderada y se indicó el estudio hemodinámico pero no la sustitución valvular. En 32 casos la disfunción fué grave y obligó a la reintervención inmediata. De las 36 prótesis explantadas, 22 presentaban signos de degeneración, 10 de endocarditis y 4 de deshiscencia periprotésica. Al final de los 8 años el 77.2% de los enfermos estaban libres de una disfunción severa. La mortalidad Q-H tras el segundo cambio fué del 9.4%

[Long-term (8 years) follow-up study of 204 bioprostheses]. / Estudio evolutivo de 204 bioprótesis a largo plazo (8 años).

From june 1974 to december 1975, 204 Hancock prosthetic valves were engrafted. The in-hospital mortality was 8.7%. The eight year survival rate was 78.9%. Of the 171 patients who had surgery, 121 reverted to functional class I, 123 had a mild or absent cardiomegaly. After 8 years of follow up 92% of the cases had not thromboembolic episodes. Ninety five percent of the patients with mitral valve replacement and 95% with aortic valve replacement were free of bacterial endocarditis. During the follow-up period; there were 49 valvular malfunctions, 16 of them mild that required no treatment. In 32 cases the alteration was severe and required surgical intervention. Thirty six prosthetic valves had to be removed; 22 of them had degenerative changes, 10 had bacterial endocarditis and in 4 the suture line broke down. After 8 years 77% of the valves were functioning well. The in-hospital mortality after the second valve replacement was 9.4%.