Estenosis aórtica en mayores de 75 años / Aortic stenosis in those over 75 years of age

En este trabajo se analizan diversos aspectos de la estenosis aórtica degenerativa. Esta entidad clínica se está convirtiendo en un problema sanitario importante, ligado al envejecimiento progresivo de la población. Diversos estudios poblacionales han puesto de manifiesto que la prevalencia de la patología de la válvula aórtica en el anciano es elevada, y por otra parte distintos trabajos clínicos han evidenciado el carácter habitualmente progresivo de este tipo de lesión valvular. Recientes estudios han considerado la posibilidad de que esta lesión valvular sea una forma de arteriosclerosis, y por ello se ha hecho hincapié en la necesidad de un estricto control de los factores de riesgo para intentar prevenir la progresión de la lesión. Por último, la cirugía puede ser una excelente opción terapéutica en muchos casos. (AU)

[Prosthetic valve endocarditis]. / Endocarditis protésica.

Infective endocarditis occurs in 4% of prosthetic valve carriers. The infection is related to both the injured endocardium and circulating microorganisms. Early prosthetic endocarditis, occurring in the first 12 months after valvular surgery is mainly caused by staphylococci, and late prosthetic endocarditis has a similar etiology as native valve endocarditis. Clinical manifestations of early cases are due to both bacteremia and prosthetic malfunction. In late cases the clinical picture is similar to native valve disease. Mortality in prosthetic endocarditis remains high, especially in early cases, despite combined medical and surgical treatment.

[Intraventricular transient obstruction related to bronchodilator treatment]. / Obstrucción intraventricular transitoria en relación con tratamiento broncodilatador.

A 66-year-old woman with a previous history of chronic lung disease, without evidence of heart disease and without signs of left ventricular hypertrophy developed a dynamic intraventricular obstruction documented by a Doppler-derived gradient of 25 mmHg and by physical signs consisting of a brisk carotid pulse and a harsh systolic murmur while she was on treatment with theophylline and hexoprenaline. Both physical signs and Doppler-derived gradient disappeared after withdrawal of bronchodilator drugs.

[Restrictive myocardiopathy caused by endomyocardial fibrosis]. / Miocardiopatía restrictiva por fibrosis endomiocárdica.

Endomyocardial fibrosis, an uncommon condition, is the most important cause of restrictive cardiomyopathy. Etiology of endomyocardial fibrosis is unknown, but evidence continues to accumulate that a close connection exists between eosinophilia and endomyocardial disease. Patients with this condition respond poorly to medical treatment, and survival is only for a few months or years when late stage heart disease is present. Surgery is nowadays recommended in these cases. A marked eosinophilia was found in a 58 years old woman that was admitted to the hospital because of a severe congestive cardiac insufficiency. Two-dimensional echocardiographic study and typical angiographic appearance suggested the presence of endomyocardial fibrosis. Endocardectomy and mitral valvular replacement were performed.

Cardiac tamponade as an initial clinical presentation of infective endocarditis.

Two cases of aortic valve endocarditis with valvar ring abscesses are described which presented clinically with pericardial tamponade. The difficulties in establishing the diagnosis are discussed, as well as the role of echocardiography. The diagnosis was confirmed at surgery in both cases.

Long-term follow-up of native valve infective endocarditis.

Seventy-eight consecutive episodes of infective endocarditis on native valves have been prospectively treated and followed-up after discharge from 1975 to 1982 (mean follow-up period 31 months). Twenty one patients needed valvular replacement in the active phase of the disease. Overall mortality was 15 cases, 7 from the medical group and 8 from the surgical group. At last clinical control 21 from the 46 survivors of the medical group remained asymptomatic, 17 had needed valvular replacement, 5 had died 2 of congestive heart failure and 3 (addicts) were lost to follow-up. From the 13 survivors of the surgical group 8 remained asymptomatic with good prosthetic function, 4 had needed reoperation due to severe periprosthetic leak and 1 died suddenly during follow-up. Figures at the end of follow-up showed that 28% of the initial patients had died, 39% carried a valvular prosthesis and 28% remained asymptomatic. A retrospective analysis of factors predictive of poor prognosis has been carried out.

Late prosthetic valve endocarditis.

A report is given of 13 patients with late prosthetic valve endocarditis (1975-1982). Follow-up ranged from 1 to 8 years (mean 33 months). Causative organisms were streptococci in 8 cases, staphylococci in 2, and Cardiobacterium hominis in 1. Cultures were negative in 2. Surgical treatment in the acute phase was performed in 3 patients. At the latest clinical control, 3 patients had died and 10 patients were asymptomatic, 3 of them having required late operation. These fair results are attributable to the particular spectrum of causative organisms and to the proper timing of surgical treatment in the 3 patients operated during the acute phase.