[Results of myocardial scintigraphy with 99mTc-tetrofosmin and dipyridamole administration in patients diagnosed of microvascular angina]. / Resultados de la gammagrafía de perfusión miocárdica con 99mTc-tetrofosmina y estímulo con dipiridamol en pacientes diagnosticados de angina microvascular.

The objective of the study was to evaluate the results of the myocardial scintigraphy with 99mTc-tetrofosmin (Tc-Tf) and pharmacological stimulation with dipyridamole in patients diagnosed of microvascular angina. The study population is made up of 50 patients discharged with the diagnosis of microvascular angina who had undergone Tc-Tf-dipyridamole. Clinical and electrical positivity appeared in 40% and 12% of the patients, respectively. Myocardial perfusion defects were found in 35 patients (70%), and were reversible in 21 (60%), fixed in 11 (21%), and combined in 3 (9%). Abnormalities were inferior, anteroseptal and lateral in 21, 18, and 2 patients, respectively. Patients with a positive exercise treadmill test, compared with those with a negative one, had more frequent perfusion abnormalities (91% vs 50%, p = 0.0327) and myocardial ischemia (64% vs 20%, p = 0.392). Women, in comparison with men, had angina (56% vs 22%, p = 0.013), and anteroseptal perfusion abnormalities (26% vs 4%, p = 0.028) more frequently. On the contrary, men had inferior perfusion abnormalities more frequently (57% vs 30%, p = 0.057). Thus, Tc-Tf-dipyridamole shows perfusion abnormalities in 70% of patients with microvascular angina (91% in patients with a positive exercise treadmill test). Scintigraphic pattern may be partially conditioned by gender in these patients.

Resultados de la gammagrafía de perfusión miocárdica con 99mTc-tetrofosmina y estímulo con dipiridamol en pacientes diagnosticados de angina microvascular / Results of myocardial scintigraphy with 99m Tc-tetrofosmin and dypiridamole administration in patients diagnosed of microvascular angina

El objetivo del estudio fue analizar los resultados de la gammagrafía de perfusión miocárdica con 99m Tc-tetrofosmina (Tc-Tf) y estímulo con dipiridamol en pacientes diagnosticados de angina microvascular. La población de estudio está compuesta por 50 pacientes que habían sido dados de alta con el diagnóstico de angina microvascular y a los que se había realizado Tc-Tf-dipiridamol. La prueba fue clínica y eléctricamente positiva en el 40 por ciento y el 12 por ciento de los casos, respectivamente. Se encontraron defectos de perfusión en 35 pacientes (70 por ciento), que fueron reversibles en 21 (60 por ciento), fijos en 11 (21 por ciento), y mixtos en 3 (9 por ciento). En cuanto a la localización de los defectos de perfusión, ésta fue en el territorio de la coronaria derecha en 21 pacientes, de la descendente anterior en 18, y de la circunfleja en 2.Los pacientes que habían realizado una prueba de esfuerzo positiva, en comparación con los que habían realizado una ergometría negativa, presentaron más frecuentemente defectos de perfusión (91 por ciento vs 50 por ciento, p = 0,0327) e isquemia gammagráfica (64 por ciento vs 20 por ciento, p = 0,392). La aparición de angina fue más frecuente en mujeres que en varones (56 por ciento vs 22 por ciento, p = 0,013), así como la existencia de defectos de perfusión en el territorio de la arteria descendente anterior (26 por ciento vs 4 por ciento, p = 0,028). Los varones, por el contrario, mostraron más frecuentemente defectos de perfusión en la cara inferior (57 por ciento vs 30 por ciento, p = 0,057). En conclusión, el Tc-Tf-dipiridamol muestra alteraciones de la perfusión en el 70 por ciento de los pacientes diagnosticados de angina microvascular, siendo esta proporción del 91 por ciento en pacientes con ergometría positiva. El patrón gammagráfico en estos pacientes puede estar condicionado, en parte, por el sexo. (AU)

[Wiktor stent in de novo lesions: immediate results in 100 consecutive patients]. / Stent de Wiktor en lesiones de novo: resultados inmediatos en 100 pacientes consecutivos.

BACKGROUND: Randomized trials which compare different stents are lacking and the studies to test the behavior of the Wiktor stent in de novo lesions have not been substantiated by large numbers and with consistent results. METHODS: The lesions were predilated with a conventional balloon 1/2 mm smaller in diameter than the stent to be used. The overdilation was done with the same balloon in which the stent comes mounted. The quantitative coronary analysis was "off line" by the automatic edge detection method with the CMS system by Medis. The post implantation treatment was aspirin and ticlopidine in most of the patients and they were discharged 24-48 hours after the procedure. RESULTS: In one hundred consecutive patients 112 Wiktor stents were attempted to treat 106 de novo lesions. All stents but one were successfully implanted. The quantitative coronary analysis of the treated lesions showed a pre-procedure minimal luminal diameter of 0.85 +/- 0.65 mm for a reference diameter of 3.18 +/- 0.49 mm. The minimal luminal diameter after stent implantation was 2.97 +/- 0.39 mm for a reference diameter of 3.42 +/- 0.46 mm. The diameter stenosis changed from 73 +/- 18% pre-procedure to 13 +/- 9% after stent implantation. One patient was sent to emergency surgery. Another patient was referred for a semiselective bypass surgery. There was no mortality. One patient suffered a non Q wave myocardial infarction. There were no important bleeding complications. There were no cases of subacute thrombosis. All the patients were contacted by telephone one month after the procedure. CONCLUSIONS: In this study we have demonstrated that Wiktor stent implantation is associated with excellent immediate results. The new model makes stent implantation a rapid, safe and relatively easy procedure. If the angiographic result is good, there is no need for an stringent anticoagulation regimen. We have to wait for long term clinical and angiographic results to determine the role of Wiktor stent in novo lesions.

[Perforation of the mitral valve: transesophageal echocardiographic diagnosis in 3 cases]. / Perforación de la válvula mitral: diagnóstico por ecocardiografía transesofágica en 3 casos.

We submit 3 cases of perforation of the mitral valve leaflet as a consequence of infectious endocarditis. In the first of this cases, perforation was the result of the impact of the regurgitant jet of an aortic insufficiency affected by bacterial endocarditis of the anterior mitral leaflet in a young female presenting various congenital malformations. Both the transthoracic and transesophageal echocardiography showed that the regurgitant jet affected the area where the lesions were later detected. In the other 2 cases the perforation appeared in valves previously affected by endocarditis. In these cases, only the transesophageal echocardiography showed the lesions. Surgery was performed in all 3 cases with satisfactory results, confirming the echocardiographical findings. We wish to emphasize the role of transesophageal echocardiography in the diagnosis of this rare process that may be the primary effect of the destructive action of the endocarditis, or a secondary effect, on dissemination by means of affected valves, on previously unaffected valvular leaflets.

Left atrial ball thrombus.

The existence of a freely-floating thrombus in the left auricle is a rare finding in mitral pathology. Diagnosis by two-dimensional echocardiography has been described by various authors (1, 2, 3). In our case echocardiographic diagnosis of auricular thrombus was not possible at the beginning, given the bad ultrasonic window. Only when the thrombus floated freely in the left auricle it was detected in the region of the mitral valve, in spite of the bad ultrasound window.

Posterobasal left ventricular aneurysms: clinical results and surgical treatment.

Of 152 left ventricular aneurysms that occurred after infarction and were treated surgically, eight were located in the posterobasal segment. All of them were true aneurysms. Combined procedures, performed at the time of the aneurysm resection, included mitral valve replacement (two patients), coronary artery bypass grafting (five patients), closure of an interventricular septal defect (one patient), and carotid artery endarterectomy (one patient). Four had slight mitral regurgitation that disappeared after resection of the aneurysm, and two exhibited severe mitral regurgitation that required mitral valve replacement. Six patients survived operation and are free of symptoms. The literature shows a high incidence of false aneurysms that have a propensity toward rupture in this anatomical location. At times, there are difficulties in the differential diagnosis of true and false aneurysms and, consequently, we recommend an aggressive surgical approach.