[Pericardial effusion simulating a tumor. The value of Doppler color echocardiography for its differentiation]. / Derrame pericárdico que simula un tumor. Valor de la ecocardiografía Doppler a color para su diferenciación.

We describe the case of a patient aged 64 with aortic valve disease and pericardial effusion. Echocardiographic evaluation showed an intrapericardial mass of about 7 cm of diameter with clotted appearance, adhered to the visceral leaf, at the level of the atrio-ventricular function. Because of this finding we performed color codified Doppler echocardiography, observing that this mass acquired a blue hue during diastole and mosaic hue at the end of the systole, realizing that this phenomenon was due to fluid retention. There are many publications about the value of echocardiography for the identification of pericardial masses and some of them show how an effusion can hide a tumor. The interest of this particular case lies in that the effusion simulated a tumor and by means of the color codified Doppler we could demonstrate that it corresponded to the stream of the pericardial fluid. During the surgical procedure the absence of the mass was corroborated.

[Study of calcification of the mitral annulus. Importance of echocardiographic analysis]. / Estudio de la calcificación del anillo mitral. Importancia del análisis ecocardiográfico.

Mitral annulus calcification is a common finding in old people. In order to know the association of mitral annulus calcification with other pathologic conditions, 25 patients were studied by echocardiography, 20 females and 5 males. No significant differences _ere observed with respect to sex. The average age was 67 +/- 15 years. Mitral annulus calcification was associated with aortic sclerosis in 100% of the cases, to arterial hypertension in 19 (76%), to obstructive pulmonary disease in 8 (32%), to diabetes mellitus in 5 (20%), and to peripheral arterial insufficiency in 5 (20%). Mitral regurgitation was found in 14 cases, atrial fibrillation in 2 (8%). Complete A-V block was not observed, but there was enlargement of the left ventricle in 23 (92%) and of the left atrium in 17 (68%). The chest X-ray showed mitral annulus calcification in 5 (20%) with a sensitivity of 25% and a specificity of 100%. The M-mode echocardiogram showed LA-Ao ratio of 1.4 +/- 0.3, the mitral valve D-E excursion was reduced 11.9 +/- 3.1 mm. and also the E-F slope 28.6 mm/seg +/- 16.7 with appearance of mitral stenosis, but the two-dimensional study demonstrated that this was false. In all patients the left ventricle was dilated and fractional shortening was diminished. Echocardiography not only is a good diagnostic method for mitral annulus calcification, it also allow us to evaluate the hemodynamic consequences of this pathology which occurs in older patients and is often associated with other common illnesses of advanced age. In our study 56% of mitral annulus calcification cases were associated with mitral regurgitation.

[Hemodynamic and prognostic evaluation of total anomalous pulmonary venous return by means of echocardiographic measurement of the heart cavities]. / Valoración hemodinámica y pronóstica de la conexión anómala total de venas pulmonares mediante medición ecocardiográfica de las cavidades cardiacas.

The purpose was to demonstrate the relationship between cardiac cavity size, measured by echocardiography, with the hemodynamic overload and short-term prognosis in children with total anomalous pulmonary venous return (TAPVR). Ten children were studied; the age varied from 2 weeks to 4 months. The clinical and cardiac catheterization findings were compared with echocardiographic measurements. Children with a smaller left atrium showed severe pulmonary resistance and lower systemic cardiac output (P less than 0.01). Right ventricular dilatation was bigger when pulmonary resistance was more elevated (P less than 0.05). Children with end-diastolic diameter of the left ventricle less than 12.8 mm had lower cardiac output (P less than 0.01) and death rate was significantly elevated during the first twenty weeks of life (80%). Doppler-echocardiography is useful in the recognition of TAPVR type, as well as to evaluate the hemodynamic changes and detect the high risk group.

[Influence of left ventricular hypertrophy on its function in essential arterial hypertension. Analysis by Doppler echocardiography]. / Influencia de la hipertrofia del ventrículo izquierdo sobre su función en la hipertensión arterial esencial, análisis por ecocardiografia Doppler.

In order to evaluate the influence of left ventricular hypertrophy (LVH) on the function of this ventricle, twenty patients with essential arterial hypertension (EAH) were studied using Doppler echocardiography. Patients with diastolic blood pressure greater than 91 mmHg were included. Antihypertensive treatment was stopped 2 weeks before the study. None of them had any concomitant coronary artery disease nor kidney involvement. Left ventricular diameters, left ventricular mass (LVM), stroke volume, fractional shortening, mean velocity of circumferential shortening (Vcfr), mean velocity of circumferential relaxation, mean velocity of aortic flow and mean E and A velocities of mitral flow as well as the ratio of these velocities (E/A) were measured or calculated. With those values from the entire group, arithmetic means were calculated and the population was divided into two groups: those with values greater than the mean and those with values below the mean for each variable for comparative purposes. The relationship of the individual values was also calculated. The interventricular septum thickness and the left ventricular end diastolic diameter were proportional with diastolic blood pressure (p less than 0.05). The LVM values shown an inverse relationship to the fractional shortening (p less than 0.01), Vcfr (p less than 0.05) as well as end diastolic diameter of left ventricle (r = -0.889, p less than 0.01) and with the stroke volume (r = -0.861, p less than 0.01). The E/A ratio was proportional to the fractional shortening (p less than 0.05) and to Vcfr (r = 0.903). The A velocity of the mitral Doppler flow showed an inverse proportion to the Vcfr (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Aneurysm of the membranous interventricular septum. Study by Doppler echocardiography (color mapping in one of the cases)]. / Aneurisma del septum interventricular membranoso. Estudo por ecocardiografía Doppler (mapeo de color en uno de los casos).

Eight patients with aneurysm of the membranous interventricular septum (AMIS) were studied, in all of them the diagnosis was done by Doppler echocardiography (D-E). In all cases, the AMIS was visualized in left parasternal long and short axis views. In six of them by means of apical and subcostal four chamber views. The AMIS was identified as a bag-shaped echo at the level of the interventricular septum; it bulged into right ventricle during systole. Left-to-right shunt was demonstrated by pulsed wave Doppler in 5 patients and in another case with color flow mapping. AMIS has a mild hemodynamic repercussion as is the case with small ventricular septal defects. D-E offers diagnostic advantages, with high specificity if the AMIS is demonstrated in several views and the left-to-right shunt is recognized and quantified by Doppler technique.

[Apical hypertrophic myocardiopathy: presentation of 3 cases and review of the literature]. / Miocardiopatía hipertrófica apical: presentación de tres casos y revisión de la literatura.

Apical hypertrophic myocardiopathy (AHM) is an entity less frequently reported in our country than in Japan. We studied only three patients between 1980 and 1987. Their age varied from 26 to 40 years. Other studies included vectorcardiograms, Holter monitoring, exercise stress testing, phonocardiograms and cardiac catheterization; only one case had a genetic study, program atrial stimulation and technetium-99m pyrophosphate scintigraphy. All patients underwent echocardiographic study. The clinical features had great variations, from asymptomatic cases to the presence of important left ventricular failure and brain embolism. Electrocardiogram was characteristic in two patients; in one, cardiac catheterization showed an intraventricular pressure gradient of 19 mmHg explained by trapping of the catheter and in the other one, the end-diastole pressure of left ventricle was 22 mmHg; in both, the left ventriculogram showed the characteristic spade image. In all of them the echocardiogram showed segmentary left apical ventricular hypertrophy similar to the angiographic image; one patients had mitral regurgitation. This study demonstrates the usefulness of echocardiogram in this pathology.

[Normal values in Mexico of the echocardiographic measurements of the left heart]. / Valores normales en México de las mediciones ecocardiográficas del corazón izquierdo.

The M-Mode echocardiographic measurements, according to the international criteria, were done in tracings of 274 normal subjects residents of Mexico City, in order to know the normal values in its population. One hundred and thirty one males (47.8%), and 143 females (52.2%). The age varied from 1 to 73 years, the predominant group was between the third and fifth decades of the life. The age, weight and body surface area (BSA) were correlated with measurements, better correlation was found with BSA and it was the analysis base. According to the BSA, 6 subgroups were formed, the first one of 0.5 m2; increasing 0.4 m2 for each subgroup until the last one of 2.1(2) or more. Were observed proportional amount respect to BSA of D-E mitral valve excursion, aortic root diameter, aortic excursion, aortic opening amplitude, left atrium diameter, end diastolic and end systolic diameters of left ventricle, as well as interventricular septum (IVS) and posterior wall (PW) thickness. The measures were less than the reported other countries. The mean velocity of circumferential shortening (Vcf), fractional shortening (FS) and normalized velocities (NV) showed inverse proportion to BSA. The values of Vcf and NV were similar to the previous report, but the FS and the ejection fraction were higher. The study let us to know the normal echocardiographic values for people of Mexico and the differences with respect to the altitude of this city and the body frame of its population.

[Tetralogy of Fallot associated with supravalvular mitral membrane]. / Tetralogía de Fallot asociada a membrana supravalvular mitral.

Two children with tetralogy of Fallot and supravalvular mitral membrane are reported. In both, the diagnosis was established before surgery. In the first case, clinical data suggested the associated mitral lesion and a two-dimensional echocardiogram demonstrated a supravalvular membrane. In the second patient, mitral obstruction was diagnosed by Doppler echocardiography and the supravalvular membrane was visualized by means of the angiographic study. Despite the rare association of both malformation, the importance of its clinical recognition is mainly related to the surgical correction of both lesions.

[Clinical diagnosis of left auricular myxoma based on its echocardiographic and surgical verification]. / El diagnostico clínico de mixoma auricular izquierdo en base a su comprobación ecocardiográfica y quirúrgica.

We studied six patients with atrial myxoma, 5 occurred in left atrium and one in the right atrium, the diagnosis was verified with echocardiogram and surgery, we determined the clinical, electrocardiographic and radiological differences between the mitral stenosis and myxoma. We found that patients with atrial myxoma have no history of rheumatic fever, the dyspnea was less severe of shorter and duration, patient had paroxysmal dyspnea. In contrast dizziness, faintness, hemiparesis and/or angina were the more frequent symptoms. A diastolic mitral snap was a very frequent finding, less frequent was the diastolic rumble no patient had pre-systolic murmur. The left atrium was generally not dilated and the left atrial appendage as well as the pulmonary artery were not prominent in chest X-Rays. The P wave in lead II was not more than 0.11 sec and the ventricular complex in VI did not show tall R ware. With the previous elements it is possible to suspect the diagnosis of left atrial myxoma. The diagnosis should, of course, be confirmed by echocardiography.

[Study using non-invasive methods in prostheses of bovine pericardium in aortic position manufactured at the Ignacio Chávez National Institute of Cardiology]. / Estudio por procedimientos no invasivos de las prótesis de pericardio bovino en posición aórtica manufacturadas en el Instituto Nacional de Cardiología Ignacio Chávez.

We studied 28 patients to whom a prosthestic valve of bovine pericardium manufactured in the Instituto Nacional de Cardiología Ignacio Chávez (INCICH) were implanted in aortic position, from February 1983 to May 1985. We analyzed the clinic follow-up and the prosthetic function was studied by Phonocardiography, Echocardiography M mode, Two-Dimensional and pulsed wave Doppler recordings obtained before and after surgery. The patient were 26 males, 2 females whose age varied from 12 to 66 years. The aortic valve disease was rheumatic in 12, congenital in 11 and of other type in 5. After surgery 26 patients are in functional class I, one in class II and one died, but death was not related to prosthetic valve function. In the Phonocardiogram we observed significant diminution of the ventricular ejection time of 32 +/- 2 msec. to 29 +/- 2 msec. (P less than 0.05), the aortic valve opening sound was of less intensity than the valve closure sound, with relation between both of 0.53. All of them had a systolic ejection murmur. In the Echocardiogram we observed a significant decrease of the end diastolic diameter of 53 +/- 11 mm to 45 +/- 10 mm (P less than 0.05), the end systolic diameter decreased from 37 +/- 13 mm to 33 +/- 10 mm., but the difference was not significant. The aortic prosthetic flow by pulsed Doppler Echocardiography had a maximum velocity of 137 +/- 23 cm/sec., it represents a valvular gradient of 7.5 +/- 0.02 mmHg. Early diastolic regurgitant flow was recorded in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Electro-echocardiographic correlation in mitral valve prolapse]. / Correlación electro-ecocardiografía en el prolapso de la válvula mitral.

The study was performed in 33 patients with echocardiographic diagnosis of mitral valve prolapse (PVM), without any other associated heart disease. A 19 derivations electrocardiogram (ECG) was performed a direct inscription 4 channel Samborns 150 machine at 25 and 50 mm/sec. The purpose of the study was determine the alterations in ventricular depolarization and repolarization, and to correlate them with valve prolapse, as well as with cavitary and parietal dimensions, as measured by M mode and/or two-dimensional echocardiography. Left ventricular hypertrophy detected by ECG agreed with the ECO test in 77%; the sensitivity was of 86% and specificity of 67.5%. Left ventricular hypertrophy detected by ECG was not related with the type of prolapse. Ventricular repolarization alteration was very frequent (84.8%). Association of this parameter with initial notch of R in a VF becomes important for diagnosis suspicion (p less than 0.01). When the abnormal repolarization affected the anterolateral wall, posterior valve prolapse was frequent; when the posteroinferior region was the affected one, the prolapse occurred more frequently in both valves. An important correlation (p less than 0.01) was found between left ventricular dilatation detected by ECO and the abnormal ventricular repolarization.

[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 of the left coronary trunk by 2-dimensional echocardiography in ischemic cardiopathy]. / Estudio del tronco de la coronaria izquierda por ecocardiografía bidimensional en la cardiopatía isquemica.

The study of the left main coronary artery (LMCA) obstruction is very important in view of the risk that it represents for coronarography, the high mortality that it has and its indication of early surgical treatment. For these reasons we studied LMCA obstruction by two-dimensional echocardiography (2-D Echo). The study was blind, prospective and included of 50 unselected patients with coronary artery disease proved by coronarography. The LMCA obstruction was recognized in 5 patients (10%) by 2-D Echo, in two of them it was seen as non-obstructive atheroma and in 3 as a significant obstruction. This LMCA correlated with angiographic findings. We had not false negatives. The patients with LMCA obstruction had higher frequency of positive treadmill test and anteroseptal myocardial infarction. Three patients had bypass surgery with good results. Two had not surgery, one of them died and the other one has angina and heart failure. The 2-D Echo is a useful procedure in the study of LMCA obstruction.

[Comparison of the postmortem anatomical study and bidimensional echocardiography in myocardial infarction]. / Comparación del estudio anatómico postmortem y la ecocardiografía bidimensional en el infarto del miocardio.

We studied 10 patients between the ages of 30 and 69 years, all of whom had suffered myocardial infarction (MI) at least 6 months before they died. Two-dimensional echocardiography (2-D E) and catheterism were done no more than 15 days before death. The location and extension of MI were compared to the segmentary mobility (SM), end diastolic wall thickness (EDWT) and percentage of systolic wall thickening (PSWT) determined by 2-D E, in the 15 segments of the left ventricular wall. We also compared 2-D E and coronariographic findings. There was a good correlation between the location (P less than 0.01) and extension (P less than 0.05) of the necrotic area dyssynergy, specially when the MI was transmural. The postmortem measurement of the wall thickness in each one of the segments had also good correlation with the EDWT as measured with 2-D E (r = 0.926). The EDWT was less in the necrotic segments (8.8 +/- 1.8 mm) than in non affected segments (14.1 +/- 1.9 mm) and this difference was significant (P less than 0.05). The wall was thinnest in segment affected by transmural necrosis. The PSWT was significantly less (P less than 0.01) in necrotic segments (12.1 +/- 3%) than in segments without necrosis (24.1 +/- 4.3%). The alteration of SM correlated with coronary obstructions greater than 75%, specially when it was associated with necrosis. The EDWT was less in necrotic segments with important coronary artery obstruction than in those without necrosis even though vascular narrowing was marked (P less than 0.01). The PSWT was also less in the areas with necrosis when coronary obstruction was severe as well as moderate (11.3 +/- 2.3%) than in segments with coronary obstruction but without necrosis (22.3 +/- 4.2%) and even less than that obtained in cases with neither coronary artery obstruction nor necrotic area (30.1 +/- 2.2%) and the difference is statistically significant (P less than 0.01). The segmentary measurement by 2-D E of the EDWT and the PSWT are useful for recognizing areas with necrosis and differentiating it from ischemic areas of left ventricle in coronary artery disease.

[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)