Desaparición de una masa valvular aórtica con anticoagulación / Aortic valvular mass disappearance with anticoagulation

Describimos el caso de una mujer joven seguida en la consulta de Neurología por episodios de vértigo, pérdida de campo visual y síncopes. La batería de pruebas analíticas solicitada resultó anodina, descartándose un substrato trombofílico. Las pruebas de imagen pusieron de manifiesto la presencia de lesiones isquémicas occipitales de probable origen microembólico o vasculítico. Ante la repetición de nuevos episodios neurológicos focales se practicó una ecocardiografía transtorácica seguida de un ETE. Esta última constató la presencia de una masa valvular aórtica asociada a regurgitación significativa. Analizando las características ecocardiográficas de la masa, así como el contexto clínico de la paciente, se llegó al diagnóstico de probable fibroelastoma papilar aórtico y se pautó anticoagulación oral. Un año más tarde hemos comprobado la desaparición de la masa valvular aórtica así como la disminución del grado de regurgitación (AU)

[A right aorto-atrial fistula as a complication of early prosthetic endocarditis]. / Fístula aorta-aurícula derecha como complicación de endocarditis protésica precoz.

Early infectious endocarditis occurs in 3% of prostheses in the first 12 months after valvular surgery and is more aggressive than late prosthetic endocarditis. Mortality remains high, especially in early cases, despite combined medical and surgical treatment. Clinical manifestations of early cases are due to both bacteremia and prosthetic malfunction, and is mainly caused by staphylococci. We present a case report of early prosthetic endocarditis in aortic prostheses complicated with severe aortic regurgitation and right atria-aortic root fistula with auriculoventricular and intraventricular disturbance in electrocardiogram.

Clinical value of parameters derived by the application of the proximal isovelocity surface area method in the assessment of mitral regurgitation.

UNLABELLED: To determine the clinical value of several parameters derived by application of the proximal isovelocity surface area method in the assessment of mitral regurgitation (MR), 28 consecutive patients with angiographic diagnosis of MR underwent color Doppler echocardiography within 48 h of cardiac catheterization. Aliasing velocities (V(N)) were baseline-shifted to 25 cm/s and the maximal radius (R) was measured from the first aliasing boundary to the tips of the mitral valve. By continuity, the regurgitant orifice area (ROA) and regurgitant stroke volume (RSV(PISA)) were obtained. We have related them to the angiographic grade, and with determination of the regurgitant stroke volume (RSV(DE)) and the regurgitant fraction (RF), we calculated the volume of the transmitral flow according to Fisher's method. RESULTS: RSV(DE) correlated well with RSV(PISA) (r = 0.98). A clear relation existed between the isovelocity radius and the RSV(DE) and RF (r = 0.95 and 0.88, respectively). A radius of 8 mm or more was identified well with an RSV(DE) of 40 cm3 or more (sensitivity: 100%, specificity: 95%) and an RF of 35% or more (sensitivity: 88%, specificity: 94%). The ROA was closely related to the RSV(DE) and RF, with r = 0.92 and 0.88, respectively. An ROA of 20 mm2 or more identified well patients with RSV(DE) values of 40 cm3 or more and RF values of 35% or more. The radius, RSV(PISA) and ROA were closely related to the angiographic grade of MR (r = 0.91, 0.83 and 0.92, respectively). A radius of 7 mm or more identified patients with grade III or IV of regurgitation (sensitivity: 82%, specificity: 94%), while an ROA of 15 mm2 or more discriminated well significant regurgitation (sensitivity: 91%, specificity: 94%). CONCLUSIONS: Parameters derived by application of the proximal isovelocity surface area method provide quantitative information that can be helpful in predicting the severity of mitral regurgitation noninvasively.

[Transesophageal echocardiography diagnosis of perforation of the mitral valve secondary to infective endocarditis]. / Diagnóstico por ecocardiografía transesofágica de perforación de la válvula mitral secundaria a endocarditis infecciosa.

We report on a patient with infective endocarditis and severe mitral regurgitation secondary to perforation in the base of the posterior mitral leaflet. Transthoracic echocardiography was inconclusive. Only transesophageal echocardiography could confirm the presence of vegetations, their characteristics and the existence of valvular perforation. We also review the literature on the contribution of transesophageal echocardiography to the diagnosis of infective endocarditis and its complications.

[Isosorbide 5-mononitrate (delayed release) in stable effort angina]. / 5-mononitrato de isosorbida (liberación lenta) en la angina de esfuerzo estable.

This work has been carried out to evaluate over a short and medium space of time (100 days) the efficacy, tolerance and haemodynamic repercussion of 50 mg of sustained release Isosorbide 5-Mononitrate administered once day to patients with stable effort angina in a random and prospective study, which was double blind crossover and placebo-controlled. In this study we included 10 patients who showed positive exercise test using clinical (angina) and electrocardiographic (ischemic drop of the ST greater than 1 mm) criteria. The assessment was done with cycloergometry starting with 30W and increasing by 20W every 2 minutes until angina appeared accompanied by an ischemic drop of the ST. The effort tests were done basally and at intervals of 4, 12 and 24 hours after the dose. The parameters studied were obtained on the 1st, 25th and 100th days of the study and were compared with those of the placebo. The time taken for the ST to 1 mm to fall (seconds) increased when evaluated after 4 and 12 hours on the 1st, 25th and 100th days in comparison with placebo (p < 0.05). The time taken for angina (seconds) to appear lengthened considerably when evaluated 4 and 12 hours after the dose not only on the 1st day but also on the 25th and 100th days in comparison with placebo (p < 0.05). The duration of the effort (seconds) was significantly greater after 4 and 12 hours on the 1st, 25th and 100th days when compared to that of the placebo (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Combination of rubidazone and cytosine arabinoside in the treatment of first relapse in acute myelocytic leukemia.

This study tested the efficacy of rubidazone and cytosine arabinoside in 35 patients (13 children and 22 adults) with acute myelocytic leukemia in first relapse. Induction consisted of 1-2 courses of rubidazone 200 mg/m2 days x 4 days plus cytosine arabinoside 100 mg/m2 x 7 days in CI followed by 2 consolidation courses of 3 days and 5 days. Nineteen patients (54%) achieved complete remission, 8 failed to respond, and 8 died. Twelve patients relapsed after 1 to 9 months, at a median of 4 months, 1 patient died of cardiac failure and 1 remains in complete remission at 12 months. Five patients underwent bone marrow transplantation, 3 of them autologous, 1 was still in complete remission at 29 months, 1 relapsed, and 1 died of sepsis. Two received allogeneic marrow transplants and died at 3 and 4 months afterwards of VOD and graft failure. The main toxicity was severe and prolonged myelosuppression.

[Improvement of the preoperative localization technique in the surgery of hyperparathyroidism (author's transl)]. / Verbesserung der präoperativen Lokalisationstechnik in der Chirurgie des Hyperparathyroidismus.

The possibility of preoperatively localizing overactive parathyroid adenoma by measuring the difference in parathormone levels in selective blood samples from the thyroid venous plexus and from the periphery (large veins) by radioimmunoassay has brought a decisive advance in parathyroid surgery. We report our experience with this preoperative localization technique, which we have used in 10 patients.