[The imaging diagnosis of pericardial agenesis]. / Diagnóstico de imagen de la agenesia de pericardio.

Pericardial agenesis is a rare anomaly, difficult to diagnose. Its evolution is usually benign. However, on rare occasions, partial defects have been the cause of sudden death. Therefore, surgical treatment has sometimes been indicated, even though in the cases were asymptomatic. We report the case of a 50 year-old woman with partial pericardial agenesis and herniation of left atrial appendage trough. The defect was discovered by a routine chest x-ray and treated in a conservative way. Current diagnostic and therapeutic techniques are reviewed.

[Diagnostic criteria of infective endocarditis: from Von Reyn to Duke. Transthoracic and transesophageal echocardiography]. / Criterios diagnósticos de endocarditis infecciosa de Von Reyn a Duke. Ecocardiografía transtorácica y transesofágica.

The Von Reyn criteria determine only a small number of definitive diagnoses of infectious endocarditis, while it is mainly diagnosed by histopathological confirmation in surgery or autopsy. This necessitates carrying out a new diagnostic scheme with accurate sensitivity and specificity based on rigorous clinical support. This scheme is provided by the Duke University criteria, which enhance the role of conventional and transesophageal echocardiography, in the diagnosis of infectious endocarditis. Echocardiography is the only accurate procedure for a non invasive diagnosis of vegetation, the main lesion in this pathology. Often, tissue destruction causes regurgitation, which is responsible for hemodynamic impairment or allows the spread of the infectious process to perivalvular tissue and can form an abscess. These complications and many others, which are difficult to treat, require an early diagnosis of this disease. Sensitivity of transesophageal technique to detect vegetations and complications is higher than that observed in conventional echocardiography, above all in patients with prosthetic valves. If the transesophageal study is negative, the existence of an infectious endocarditis is quite unlikely. Nevertheless, we need to consider clinical features, as the specificity of this technique is moderate.

[Diastolic dysfunction, left ventricular hypertrophy, and microalbuminuria in mild to moderate essential arterial hypertension]. / Disfunción diastólica, hipertrofia ventricular izquierda y microalbuminuria en la hipertensión arterial esencial ligera-moderada.

INTRODUCTION: It is known, that there is a high prevalence of left ventricular diastolic disfunction, which precedes left ventricular hypertrophy in hypertensive people, but there is little published in literature about the relationship between these findings and the presence of microalbuminuria. OBJECTIVE: In our study, we pretend to evaluate prevalence and eventual relation among microalbuminuria, diastolic disfunction and left ventricular hypertrophy, in young mild to moderate hypertensive patients, non diabetic and without previous treatment. MATERIAL AND METHODS: We studied prospectively 80 untreated hypertensive patients, with normal serum creatinine, and non diabetic (52.5% women and 47.5% men, mean age 41.4 +/- 9.6 years). We evaluated filling indexes by Doppler Echocardiography: Ratio of early to late diastolic peak filling velocity and early filling deceleration time. Left ventricular hypertrophy was defined by Devereux's criteria. Microalbuminuria in twenty four hours was measured by radioimmunoassay in hypertensive patients (microalbuminuria: 30-300 mg/24 hours). RESULTS: Microalbuminuria occurred in 23.7%, left ventricular hypertrophy 40%, and diastolic disfunction 48.8%, no significant correlation existed between the same. Only 29.5% had no cardiac or renal disease. Statistically significant differences were found in ratio of early to late diastolic peak filling velocity and microalbuminuria, between the two study populations, but multiple regression analysis didn't prove such correlation. Ratio of early to late diastolic peak filling velocity was independently related to age and diastolic blood pressure. CONCLUSIONS: There is a high prevalence of cardiac and/or renal disease in mild hypertensive patients, only 29.5% of these patients are free of disease. We don't find relation between lesions in these organs.

[Asymptomatic aortic dissection in a patient with aortic valve prosthesis]. / Disección aórtica asintomática en paciente con prótesis valvular aórtica.

The occurrence of iatrogenic aortic dissection after aortic valve replacement is uncommon, usually late, and exceptionally asymptomatic. We present here a case of dissecting aneurysm suspected by excessive mediastinal dilatation observed in the routine annual roentgenogram exam of a patient who has had an aortic valve prosthesis for thirteen years. The confirmation with other diagnostic methods and its successful surgical treatment are also described.

[Acute myocardial infarction in young adults. Analysis of risk factors and coronary angiography]. / Infarto agudo del miocardio en jóvenes. Análisis de factores de riesgo y angiografía coronaria.

Eighty patients aged under forty, survivors of an episode of acute myocardial infarction (AMI), were studied by means of angiography. Thirty five had anterior wall infarction, 26 diaphragmatic wall, 9 lateral side and 10 non Q AMI. Tobacco addiction (92% vs 71.9%) and hyperlipemia (34% vs 18.8% were higher (p less than 0.01) that in the total AMI population. They presented an average ejection fraction of 0.56 +/- 0.15 and only in three patients was under 0.30. One, 2 and 3 vessels disease respectively of 43%, 22% and 16%, similar to another series published. A 19% of patients with normal angiography coronaries was seen significantly higher (p less than 0.01) than the observed in AMI in older patients. In conclusion in spite of the good prognosis of this group of patients, is necessary to insist in primary preventive campaigns, mainly against tobacco addiction and hyperlipemia, in order to reduce the frequency of AMI in young people.