[Aneurysm of the left main coronary artery caused by thoracic trauma]. / Aneurisma del tronco común de la arteria coronaria izquierda secundario a traumatismo torácico.

A 30 years-old female patient, presented with a clinical picture of acute pulmonary edema associated with anterior myocardial necrosis following a car accident with mild blunt chest injury. The coronary angiogram showed the existence of an aneurysm in the left main coronary artery (LMCA) causing extrinsic compression of the artery. Subsequent angiograms showed a complete disappearance of the aneurysm. The patient remains symptom-free three years after the accident. Blunt chest injury is a potential cause of heart damage. Although the coronary arteries may be damaged, the development of an aneurysm has been reported on very few occasions and always in connection with the anterior descending coronary artery. Our case is the first case described with the location of the aneurysm in the left main artery.

[Emboligenic mitral papillary fibroelastoma and positive antiphospholipid antibodies]. / Fibroelastoma papilar mitral embolígeno y anticuerpos antifosfolípidos positivos.

Cardiac papillary fibroelastoma has been associated to high levels of antiphospholipid antibodies, either primary or in the context of systemic lupus erythematosus. We present the case of a young female with several episodes of peripheral emboli. Two-dimensional echocardiography demonstrated a tumor on the anterior mitral leaflet. The mass was resected and histologically showed a papillary architecture covered by hyperplasic endocardial cells on a layer of connective tissue and a central core of collagen and elastic fibers. The immunologic study demonstrated high titers of anticardiolipin antibodies, complement consumption and positive antinuclear antibodies. The patient keep high anticardiolipin antibodies titers at follow-up but embolization has not recurred and has no symptoms.

[Transesophageal echocardiography diagnosis of perforation of the mitral valve secondary to infective endocarditis]. / Diagnóstico por ecocardiografía transesofágica de perforación de la válvula mitral secundaria a endocarditis infecciosa.

We report on a patient with infective endocarditis and severe mitral regurgitation secondary to perforation in the base of the posterior mitral leaflet. Transthoracic echocardiography was inconclusive. Only transesophageal echocardiography could confirm the presence of vegetations, their characteristics and the existence of valvular perforation. We also review the literature on the contribution of transesophageal echocardiography to the diagnosis of infective endocarditis and its complications.

Exercise stress test in young hypertensive patients. Response to vasodilators (prazosin) vs. beta-blocker (atenolol) agents.

Dynamic response of arterial blood pressure during exercise has been studied in 40 normotensive young subjects and 20 mild hypertensive young patients (20-40 years of age). Hypertensive patients were treated with atenolol (beta blocker) and prazosin (vasodilator). Both groups underwent maximal exercise stress test. A double-blind nonrandomized study was practiced in hypertensive patients with placebo, prazosin (3 mg/12 h), and atenolol (100 mg/24 h). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and exercise duration (ED) were analyzed. All parameters remained stable in both groups. The hypertensive patients showed an increase in maximum SBP more than 230 mmHg during the placebo phase. This same group showed a significant increase in HR at rest two hours after administration of prazosin. Atenolol produced a significant reduction in HR both during rest and exercise. Both drugs produced a significant decrease in SBP and DBP (at rest and exercise). We conclude that exercise test is a noninvasive procedure that could distinguish mild arterial hypertension. The dynamic changes of arterial blood pressure can be controlled with prazosin (3 mg/12 h) or 1 daily intake of 100 mg atenolol.

Preliminary study of pirmenol in the treatment of ventricular arrhythmias.

The effects of pirmenol in the treatment of ventricular arrhythmias were studied in 6 patients with heart disease and in 11 control subjects. In the patients with heart disease, ventricular arrhythmias were associated with myocardial infarction in 3, with mild aortic stenosis in 2 and with hypertrophic cardiomyopathy in 1. Pirmenol was administered in a 100 mg, 150 mg or 200 mg twice daily dosing schedule. Dosages were increased if necessary, until response, defined as greater than 70% suppression in the rate of premature ventricular contractions, occurred. Arrhythmia suppression was maintained in all 6 patients with heart disease at 52 weeks of follow-up.

[Differential diagnosis of obstructions to left ventricular outflow (author's transl)]. / Obstrucciones del tracto de salida del ventrículo izquierdo. Diagnóstico diferencial.

A total of 127 patients with different forms of obstruction to left ventricular outflow are studied. There were eight cases with supravalvular aortic stenosis, 79 with valvular aortic stenosis, 25 with hypertrophic subaortic stenosis, and 15 with subvalvular aortic stenosis. Clinical findings and electrocardiographic, radiographic, and angiohemodynamic data corresponding to these groups are reported, as well as the differential characteristics for each category from a clinical, electrocardiographic and radiographic point of view. The presence of a typical face, asymmetrical carotid and brachial pulses, absence of aortic ejection click and little or no aortic button on the chest roentgenogram reveals a supravalvular aortic stenosis. Valvular aortic stenosis shows aortic ejection click, poststenotic dilation of the ascending aorta, electrocardiographic signs of left ventricular hypertrophy and associated aortic regurgitation. Hypertrophic subaortic stenosis is characterized by a typical arterial pulse, marked "a" wave in the jugular venous pulse, double apical impulse on palpation and appearance or modification of the systolic ejection sound with Valsalva's maneuver.

[Isolated rheumatic tricuspid insufficiency (author's transl)]. / Insuficiencia tricúspide reumática aislada.

Insufficiency on the tricuspid valve alone due to cardioarticular rheumatism is a rare condition. A 12-year-old boy had had six episodes of rheumatic fever over the previous 5 years. The only damage done to the heart was insufficiency of the tricuspid valve; none of the other valves were affected. The phonocardiographic response to the amyl nitrate and methoxamine tests as well as the correct evaluation of the jugular phlebogram confirmed the diagnosis of this valve pathology. The study of this heart condition was completed with the diagnosis of rheumatic fever (Jones' criteria, modified) and an angiohemodynamic evaluation of the patient (which must include left and right ventriculography using a Bourassa catheter on the right). This pathology is extremely rare and we have found no reference to it in the literature in this country.