[The long-term follow-up of 1000 patients with a valve replacement by the prosthesis of the Instituto Nacional de Cardiología Ignacio Chávez]. / Evolución a largo plazo de mil pacientes con reemplazo valvular con prótesis "Instituto Nacional de Cardiología Ignacio Chávez".

The long-term follow-up of patients with bioprosthetic valves manufactured at the Instituto Nacional de Cardiología Ignacio Chávez is presented. From February 1983 to May 1990, 1068 patients were operated and 1252 valves were replaced. Eighty two percent had rheumatic heart disease with one or more injured valves. In 17% it was a replacement of a failing valve. Seventy three percent of the patients had a low or medium-low socioeconomical status. There were 176 perioperative deaths in the first month after the operation and 150 patients were lost to follow-up. The rest (740) are the subject of this report. Mortality associated with valve related complications had a probability of 0.74 +/- 0.05, it had a significative increase after month 70th, with a 88% survival at that time. The functional class in the whole group improved 90%, with confidence limits for binomial distribution between 85 and 97%. There was also a significant reduction in heart enlargement. There were 161 prosthesis dysfunctions due to valve calcification or rupture, 50 were replaced. Twenty-three patients had hemolysis, and 19 infective endocarditis. There were 6.5% with systemic embolism in spite that only one half of those in which there was an indication, different of the valve replacement, received anticoagulant medication. The use of this prosthesis is on economical and medical satisfactory solution for the problem of a great number of our population of patients.

Importancia del inicio precoz en la administración de estreptoquinasa intravenosa en el infarto agudo del miocardio / The importance of early administation of in acute myocardial infarction intravenous streptokinase

Para evaluar la importancia del tiempo de inicio de la terapia fibrinolítica con estreptoquinasa por vía intravenosa (EQIV) en la reperfusión coronaria, se estudiaron 34 pacientes consecutivos, con menos de 6 horas de iniciada la sintomatología del episodio de infarto agudo del miocardio y a quienes se les administró 1.5 de estreptoquinasa en 1 hora. En todos se realizó coronariografía en las primeras 72 horas. Se correlacionó el tiempo de inicio de la EQIV con los hallazgos coronariográficos. Los pacientes se dividieron en 3 grupos. El grupo I, de 0 de 2 horas con 12 pacientes; el grupo II, de 2 a 4 horas con 13 pacientes y el grupo III, de 4 a 6 horas con pacientes. Se observó reperfusión angiográfica en 24 pacientes (70.2%), p < 0.05. En el grupo I se obtuvo recanalización en 10 (83.3%). En el grupo II, 9 (69%) y el grupo III, 5 (55.5%), con significación estadística solo en el grupo I (p < 0.05). En este estudio también se demuestra la utilidad de los criterios enzimáticos y electrocardiográficos para precidir si ocurre reperfusión. No hubo mortalidad relacionada con el procedimiento. Se concluye que se obtiene un porcentaje de reperfusion mayor, cuanto mas precoz es el inicio de la terapia fibrinolítica

[Importance of the early intravenous administration of streptokinase in acute myocardial infarct]. / Importancia del inicio precoz en la administración de estreptoquinasa intravenosa en el infarto agudo del miocardio.

To evaluate the importance of early initiation of fibrinolytic therapy with intravenous streptokinase (IVSK), we studied 34 consecutive patients, within less than six hours of the onset of acute myocardial infarction, who were treated with 1.5 million units of intravenous streptokinase. All the patients had coronary angiograms in the first seventy two hours. We correlated the angiograms with the time of onset of the IVSK. The patients were divided into 3 groups: Group num. 1: From zero to two hours (twelve patients); Group num. 2: From two to four hours (13 patients); and Group num. 3: From four to six hours (nine patients). We had angiographic reperfusion in twenty-four patients (70.2%) P less than 0.05. We observed reopening in the patients of group num. 1 (83.3%); in group 2, nine patients (69%) and in group num. 3, five patients, (55.5%), with statistical significance only in group num. 1 (p less than 0.05). We also demonstrated the utility of the electrocardiographic and enzymatic criteria to predict reperfusion. No mortality was related to the procedure. We concluded that a higher percentage of reperfusion is obtained the sooner intravenous streptokinase therapy is initiated.

[Initial phase of the left ventricular ejection (mesosystole) in coronary artery disease]. / La fase inicial de la expulsión del ventrículo izquierdo (mesosístole) en la enfermedad arterial coronaria.

In patients with coronary artery disease (CAD), the ventricular ejection is altered specially the initial phase or the mid-systole. We studied such abnormalities through two-dimensional echocardiography and phonocardiography. We studied 40 patients with CAD and 11 normal subjects, we determined the times and volumes of total, initial and end of systole for to calculate the ejection fraction, integrated ejection and mean ejection rate. The measurements of total systole did not show important differences. In contrast, the initial ejection time (IET), the initial integrated ejection (IIE), the mid-systolic stroke volume (MSV), the mid-systolic ejection fraction (MEF) and the mean mid-systolic ejection rate (MMER) showed significant differences. The CAD group compared with normal subjects, had lower values of IET (P less than 0.05), MSV and MEF (P less than 0.01). The presence of myocardial infarction, the number of arteries with significant obstruction and the elevation of the left ventricular enddiastolic pressure had relationship with decrease in IIE (P less than 0.01) and with amount of MSV, MMER and MSV/end systolic stroke volume ratio (P less than 0.01). On the other hand, patients with angina, specially unstable and in those with ventricular aneurysm, the IIE showed higher values (P less than 0.01) and MSV, MMER, the percentage of mid-systolic ejection fraction and MSV/ESV ratio were lower (P less than 0.01). We conclude that in CAD, the mid-systolic changes are more sensitive than those of the whole systole. In presence of heart failure, the reduced stroke volume is ejected almost totally in the initial period or mid-systole. In patients with ventricular aneurysm or in those with unstable angina is the opposite behavior, the mid-systolic ejection is reduced and the small volume is ejected in the end last period or end systole. These observations could be useful to recognize the damage and the severity of it in CAD.

[Study, using non-invasive methods, of prostheses manufactured at the Instituto Nacional de Cardiología Ignacio Chávez]. / Estudio por métodos no invasivos de las prótesis manufacturadas en el Instituto Nacional de Cardiología Ignacio Chávez.

We study the phonocardiogram, M mode, two-dimensional and Doppler pulsed echocardiogram of 30 patients, who underwent implantation of a bovine pericardial bioprosthesis manufactured at the Instituto Nacional de Cardiología Ignacio Chávez. We describe 26 patients with prosthesis in mitral position, 22 females and 4 males, with age between 19 to 60 years. After surgery, 22 were in functional I and 2 in class II of the New York Heart Association Criteria. Two patients (6.6%) died of extracardiac complications. Phonocardiogram: Mitral prosthesis closing click (MPCC) were recorded at all, the interval Q wave-MPCC was of 0.09 +/- 0.02 sec. The interval second sound-mitral prosthesis opening click (S2-MPOC) measured 0.10 +/- 0.01 sec. Mid-diastolic murmur were recorded in 8 patients (30.7%). The O-F slope of the apexcardiogram was of 82 +/- 40 mm/sec. Ten patients had tricuspid insufficiency. Echocardiogram: The D-E velocity of mitral prosthesis opening was of 318 +/- 99 mm/sec and the E-F slope velocity of 15 +/- 6.2 mm/sec. All patients except one showed paradoxical motion of the intraventricular septum. The prosthesis stents distance was of 14.1 +/- 2 mm, the internal diameter of 17.8 +/- 2.9 mm and the valvular area was calculated in 2.5 +/- 0.08 cm2. The flow velocity/diameter was 62.6 +/- 26.8 cm/sec/mm and the flow velocity/opening area of 52.5 +/- 26.1 cm/sec/cm2.(ABSTRACT TRUNCATED AT 250 WORDS)

[Manufacture of valvular prostheses from bovine pericardium, their evaluation and the initial results of the 1st group of implants]. / Manufactura de protésis valvulares de pericardio bovino, su valoración y resultados iniciales del primer grupo de implante.

The results obtained with some types of bioprostheses together with the present economical situation of the country pointed out that the manufacture of another type of bioprostheses was necessary. After a careful analysis of the results that had been reported in the literature with the diverse types of bioprostheses had been made, it was concluded that pericardial valves were the best choice for our specific requirements. The first problem that had to be solved was the identification of the adequate fraction of purified glutaraldehyde that would provide for adequate tissue fixation. This was determined using several types of biophysical and biochemical techniques. The next step was to find the adequate manufacturing techniques that would provide us with optimal function valves. This was achieved by testing the functional characteristics of these valves on a cardiac cycle simulator. The first group of 132 patients that received this type of valve includes 9 multiple valve replacements, 24 aortic, 98 mitral and 1 pulmonary valve replacements. All the surviving patients have shown a clear improvement and they all show adequate function of their bioprostheses. The function of the valves has not been involved in any of the patient deaths. Since there has not been any evidence of disfunction, these results show that the manufacturing techniques and the design of these bioprostheses is adequate. Naturally to long-term durability of these valves will have to wait before it can be valorated.

[Clinical impact of the Bezold-Jarisch reflex in coronary arteriography]. / Repercusiones clínicas del reflejo de Bezold-Jarisch en la arteriografía coronaria.

To evaluate the role that coronary arteriography has in the induction of the Bezold-Jarisch reflex we study 9 patients (group I) to whom 1 mg. of atropine was administered 45 min. before the coronary arteriography and 9 patients (group II) without pre-medication. The heart rate was measured before, during and after each intracoronary injection. In group I there was no change in heart rate in 6 patients, in 3 cases the heart rate dropped to 15 beats/min. In group II the heart rate decreased in 8 cases. We conclude that the injection of radiologic contrast material in the coronary arteries triggers the Bezold-Jarisch reflex and that this reflex is prevented by the administration of atropine.

[Coronary thrombolysis in acute myocardial infarction. Initial experience with an intravenous thrombolytic agent]. / Trombolisis coronaria en el infarto agudo del miocardio. Experiencia inicial con un agente trombolítico intravenoso.

Thirteen patients with less than 5 hours of the onset of symptoms of acute myocardial infarction underwent selective coronary angiography. Ten of them had angiographic signs of coronary thrombosis. In these ten patients 15 mgs of an acylated streptokinase-plasminogen complex (BRL 26921 Beecham Farmaceuticals) were administered intravenously. Total angiographic recanalization was observed in 7 patients. The coronary arteries involved were the left anterior descending in 4 cases and the right coronary artery in 3. In 8 out of the 10 patients significant diminution of injury pattern in EKG was registered, however in all of them the necrosis pattern supervened. Prolongation of the thrombin and thromboplastin times, as well as an important fibrinogen disminution were documented in all instances. There were not complications related to the administration of the drug. An increase of muscle enzimes was documented in all cases. The follow-up was uneventfull with excellent results in all the patients. This study proves that with IV trombolitic therapy coronary recanalization can be achieved in the mayority of the patients; however there is no question that myocardial infarction finally ocurred. We speculate about the possibility of avoiding infarction by the administration of the drug within the first hour after the onset of the symptoms.

[Effect of intravenous disopyramide in supraventricular paroxysmal tachycardia refractory to vagal maneuvers]. / Efecto de la disopiramida intravenosa en la taquicardia paroxistica supraventricular refractaria a maniobras vagales.

The objective of this study was to prove the efficacy of intravenous disopyramide in the treatment of paroxysmal supraventricular tachycardia resistant to vagal maneuvers. Nine patients with this condition were admitted to the emergency service of the Instituto Nacional de Cardiología Ignacio Chávez. They were given an intravenous bolus of 2 mg/kg of the drug a maintenance dose of 0.4 mg/kg during 3 hours. The undesirable effects of the drug were arterial hypotension, dizziness, dry mouth, transient A-V dissociation and scape-capture rhythm. In conclussion, disopyramide is an excellent drug in the treatment of paroxysmal supra-ventricular tachycardia resistant to vagal maneuvers, but an strict monitorization of the arterial pressure and electrocardiogram should be kept during its administration.

Efecto de la disopiramida intravenosa en la taquicardia paroxistica supraventricular refractaria a maniobras vagales. / Effect of intravenous disopyramide in paroxysmal ventricular tachycardia resistant to vagal maneuvers

El objetivo del presente estudio fue comprobar la eficacia de la disopiramida intravenosa en el tratamiento de las taquicardias paroxisticas supraventriculares que no respondieron a maniobras vagales.Se seleccionaron nueve enfermos atendidos en el servicio de urgencia del Instituto Nacional de Cardiologia Ignacio Chavez, a los cuales se les interno en la Unidad Coronaria y se les administro una dosis de 2 mg/kg, seguida de otra dosis para un mantenimiento de 0,4 mg/kg por hora durante tres horas. Los resultados obtenidos mostraron el cese del trastorno del ritmo en el 100% de los enfermos. Todos ellos fueron dados de alta del hospital en ritmo sinusal. Como efectos indeseables secundarios al uso del farmaco, se encontro hipotension arterial, manero, sequedad de mucosas, asi como alteraciones electrocardiograficas transitorias que consistieron en disociacion auriculo-ventricular y ritmo de escape-captura. Se concluye que el medicamento es muy eficaz en el tratamiento de este trastorno del ritmo, pero se requiere vigilancia estrecha de las cifras de tension arterial y de las alteraciones electrocardiograficas durante la administracion del mismo

[Comparative study of coronariography and radiocoronariography in ischemic cardiopathy. Preliminary report]. / Estudio comparativo entre la coronariografiá y la radiocoronariografía en la cardiopatía isquémica. Comunicación preliminar.

25 patients with ischemic heart disease were studied by selective coronariography and radiocoronariograpy with 3mCi of human albumin macroaggregates labeled with 99mTc, injected selectively into each coronary artery. Gammagraphic images were then obtained. 17 cases (68%), had coronary obstructions and 8 patients (32%), had a normal coronary angiogram. Of all patients studied, 23 (92%), had areas of hypoperfusion. Patients with coronary obstructions had corresponding image defects. 6 cases with normal coronary angiography had areas of hypoperfusion and finally 2 cases had normal images in both studies. All patients wit EC6 necrosis had abnormal radiocoronariography. The macrocirculation is studied by coronary angiography, while the microcirculation is visualized by radiocoronariography. Both technique are complementary. We conclude that radiocoronariography should be performed routinely after coronary angiography in the study of ischemic heart disease, with special emphasis in cases with normal angiograms.

[Correlation between ventricular volume calculated manually and by computer]. / Correlación entre los volumenes ventriculares calculados manualmente y por computadora.

We present here a program of ventricular volumes measurements in which an area-lenght procedure and a digital computer were used. The results were compared with those obtained by the manual method using the same formula. The correlative estatistical analysis of these results showed a high index of 0.95 when compared to the telediastolic volumes obtained by both technics, while the index reached 0.99 in reference to the telesistolic volumes and the ejection fraction.

[Congestive myocardiopathy and early dyastolic closure of the tricuspid valve. Report of a case with acute tricuspidization]. / Miocardiopatía congestiva y cierre diastólico temprano de la válvula tricúspide. Presentación de un caso con "tricuspidización" grave.

A case with congestive cardiomiopathy and early diastolic closure of the tricuspid valve is presented. This abnormal echocardiographic finding was probably the result of severe tricuspid regurgitation occurring in a restricted right ventricle. The absence of paradoxical septum was determinedly the left ventricular pathology. In this case, echocardiography was more sensitive for the detection of the left sided abnormalities, than the heart cath data.

[Prolapse of the mitral valve]. / Prolapso de la válvula mitral.

Intending to find out which is the prevalence of mitral valvular prolapse in cases of ischemic cardiopathy with "normal" coronariography, a review was made of the coronary-ventriculographic studies at the I.N.C. archives, which showed as clinical diagnosis that of ischemic cardiopathy with "normal" coronaries. In the present studies we record 47 cases showing chest angina and/or electrocardiographic changes in rest or effort tests, compatible with myocardic ischemia and coronariography undoubtedly normal. We found 30 cases (63.8%) showing strong evidence of mitral prolapse in the left cineventriculography taken in right-front oblique position.