Primary cardiac paraganglioma. Case report and review of surgically treated cases.

A 58 year old man with an infiltrating non-resectable left atrial paraganglioma was diagnosed by sternotomy and open biopsy. The patient remains symptom free 16 months after the operation. No evidence of an increase in the size of the tumour has been detected by echocardiography. The literature regarding surgically treated patients with cardiac paragangliomas is reviewed.

[The use of the Gott shunt in the surgical repair of a dissecting aneurysm of the descending thoracic aorta]. / Uso del shunt de Gott en la reparación quirúrgica de un aneurisma disecante de aorta torácica descendente.

A 49-years-old man was operated on of a descending thoracic dissecting aneurysm by means of a heparin-less external Gott shunt. A review of spinal irrigation, neurological deficits postclamping of the descending thoracic aorta and methods of spinal preservation in aortic surgery are presented.

[Transesophageal echocardiography in the selection of patients prior to percutaneous mitral valvuloplasty. Study of 71 consecutive patients]. / ECO transesofágico en la selección de los pacientes para valvuloplastia mitral percutánea. Estudio de 71 pacientes consecutivos.

We studied 71 consecutive patients with mitral stenosis candidates for mitral valvuloplasty by means of transthoracic (TTE) and transesophageal echocardiography (TEE). We compared the information obtained by the two methods with respect to: mitral valve morphology (echocardiographic score), severity of mitral regurgitation, prevalence of atrial thrombus and incidence of spontaneous contrast in the left atrium. The assessment of valvular thickening, mobility and calcification was similar by the two methods. The assessment of the subvalvular disease was significantly lower by TEE than the assessed by TTE (1.66 +/- 0.6 vs 2.12 +/- 0.5; p less than 0.001). The total "score" obtained by TEE was significantly lower than the "score" obtained by TTE (7.32 +/- 1.9 vs 7.88 +/- 1.8; p +/- 0.001), but when we classified the patients in groups according to the "score", there were no significant differences between the groups obtained by the two methods. We detected mitral regurgitation in 27 patients (38%) by TTE and in 36 (50%) by TEE. The difference in the quantification of the mitral regurgitation was no more than one grade in any case. Atrial thrombus were detected in 16 patients (22%) by TEE and in 2 patients by TTE. Spontaneous contrast was seen in 53 patients (75%) by TEE and in only 1 by TTE. We conclude that TEE is essential in detecting atrial thrombus, but does not provide any new information about mitral valve morphology and mitral regurgitation in the selection of patients for percutaneous mitral valvuloplasty.

False tendon rupture simulating chordal rupture after percutaneous mitral balloon dilation. A report of two cases.

We describe two cases of ruptured false tendons following percutaneous balloon dilation of the mitral valve in one case, and combined mitral and aortic balloon valvotomy in the other, using in both the retrograde approach. The echocardiographic characteristics of this previously unreported complication of the procedure are presented with special emphasis on the differentiation with true chordal rupture. No short or mid term adverse effects were noted following this complication.

Factors influencing progression of mitral regurgitation after transarterial balloon valvuloplasty for mitral stenosis.

This study analyzes the clinical, echocardiographic and hemodynamic factors affecting progression of mitral regurgitation (MR) after transarterial balloon valvuloplasty in 200 consecutive patients with rheumatic mitral stenosis. After valvuloplasty, the mitral valve area increased in all patients, from 1.03 +/- 0.36 to 2.06 +/- 0.71 cm2 (p less than 0.0001). With regard to the basal stage, the mitral valve was competent in 139 patients and there was mild MR in 61 (grade I in 53, and grade II in 8). Three patients had progression of MR induced by a technical deficiency and they were excluded from analysis. Patients were classified into 2 groups on the basis of the degree of MR before and after valvuloplasty: group A--no progression of MR (n = 167; 85%) when the degree of MR did not change, disappeared after valvuloplasty, or increased from grade 0 to I; group B--progression of MR (n = 30; 15%) when the degree of MR increased to greater than or equal to grade II. Progression of MR was observed more frequently in older patients with presence of chronic atrial fibrillation, larger left atrial size and left ventricular volumes, baseline MR, more severe stenosis and a lower ejection fraction. Multivariate analysis selected age, left ventricular volumes and ejection fraction as independent predictors of progression of MR. All these factors suggest that progression of MR after balloon valvuloplasty could be related to a more advanced degree of disease.

Prevention of early aortocoronary bypass occlusion by low-dose aspirin and dipyridamole. Grupo Español para el Seguimiento del Injerto Coronario (GESIC)

To analyze the efficacy of low-dose aspirin in preventing early aortocoronary vein graft occlusion, 1,112 consecutive patients were enrolled in a multicenter, randomized, double-blind, placebo-controlled trial comparing 50 mg t.i.d. aspirin, 50 mg aspirin plus 75 mg t.i.d. dipyridamole, and placebo. All patients received 100 mg q.i.d. dipyridamole for 48 hours before surgery, and assigned treatment was started 7 hours after surgery. Vein graft angiography was performed in 927 patients (83%) within 28 days of surgery (mean, 10 days). Aspirin plus dipyridamole significantly (p = 0.017) reduced the occlusion rate of distal anastomoses from 18% (placebo) to 12.9%. Occlusion rate in the aspirin group was 14%, which approached statistical significance (p = 0.058). Furthermore, only aspirin plus dipyridamole reduced (p = 0.01) the number of patients with occluded grafts (placebo, 33%; aspirin, 27.1%; aspirin plus dipyridamole, 24.3%). Mediastinal drainage was slightly higher (p = 0.04) in the aspirin plus dipyridamole group (713 +/- 456 ml) than in the other two groups (placebo, 670 +/- 437 ml; aspirin, 629 +/- 337 ml), but hospital mortality (average, 4.6%) and early reoperation (average, 3.9%) rates were similar among the three groups. Thus, low-dose aspirin plus dipyridamole safely improves early saphenous vein aortocoronary graft patency; this effect is an added benefit to a preoperative regimen of dipyridamole.

[Transesophageal echocardiographic diagnosis of a left atrial myxoma]. / Diagnóstico por ecocardiografía transesofágica de un mixoma auricular izquierdo.

We report the case of a 65 year old woman with a left atrial myxoma. The only clinical manifestation were two transient ischemic attacks of cerebral origin. The diagnosis was established by transesophageal echocardiography because of poor definition of the transtoracic approach. We comment the clinical and diagnostic features of this type of tumors, with emphasize in the value of transesophageal echocardiography.

[Coronary transluminal angioplasty and determination of the intracoronary gradient with a new monorail system]. / Angioplastía transluminal coronaria y determinación del gradiente intracoronario con un nuevo sistema "monorail".

STUDY OBJECTIVE: To evaluate the results obtained in coronary angioplasty using the new very low profile monorail catheter. DESIGN: A retrospective study to define the causes and frequency of successful and unsuccessful coronary angioplasty on proximal and distal lesions located in the three coronary vessels. SETTING: Patients referred to the Hemodynamic Unit for coronary angioplasty. PATIENTS: Coronary angioplasty was performed in 106 patients with cardiac ischemic disease (stable angina, unstable angina and myocardial infarction after thrombolytic therapy). INTERVENTIONS: To perform coronary angioplasty using a monorail system, including dilatation of vessels (angioplasty) and to measure the intracoronary gradient. RESULTS: A high success rate was achieved (92%) independent of vessel dilated or of the position of the stenosis. There was a lower success rate in complex lesions. CONCLUSION: In this study, this newly modified system for coronary angioplasty with balloon catheter and monorail pressure catheter gave a very high performance.

Combined percutaneous mitral and aortic balloon valvuloplasty.

Between August 1987 and November 1988, combined mitral and aortic balloon valvuloplasty was performed in 10 patients (mean age 42 +/- 9 years), all of whom had symptomatic mitral and aortic stenosis. The procedure was performed using a transarterial approach with a multiballoon catheter and an exteriorized intracardiac long guidewire circuit. The procedure could be considered successful in 9 patients where significant increases in the mean mitral (0.97 +/- 0.19 to 1.80 +/- 0.26 cm2) and aortic (0.63 +/- 0.18 to 1.15 +/- 0.32 cm2) areas were achieved. Severe mitral regurgitation that required surgery developed in 1 patient in the following 24 hours. Femoral vascular surgery was necessary in 1 patient. Mid-term follow-up was available in 8 patients for a period averaging 8 +/- 3 months. The 9 patients in whom the procedure was successful showed persistent clinical improvement in functional class, Doppler echocardiography showed 2 cases of aortic restenosis and none of mitral restenosis. Combined mitral and aortic balloon valvuloplasty could be a valid alternative treatment in selected patients with both mitral and aortic rheumatic stenosis. Further experience and long-term hemodynamic follow-up are necessary to define the role of this mode of treatment.

Intraoperative balloon valvuloplasty in pulmonary valve stenosis.

Balloon valvuloplasty was used in the operating room on 7 patients to visually assess the valvular changes induced by inflation of a balloon catheter. All patients had typical pulmonary valve stenosis and an associated cardiac condition which necessitated surgery. Of 23 fused commissures present, 21 were successfully opened with a single balloon inflation. In 2 patients, damage to the leaflets was observed. In 1 patient there was partial detachment and in the other a small tear was noted at the margin of one leaflet. These intraoperative results may be similar to the results obtained with percutaneous balloon valvuloplasty.

A new type of adjustable vascular introducer for balloon valvuloplasty: technical note.

To minimize vascular damage in percutaneous balloon valvuloplasty, a new type of dynamic adjustable vascular introducer has been developed which is capable of both expanding and contracting on the passage of a balloon catheter. This ability greatly reduces damage to the vessel and limits blood loss at the site of entry during the procedure. It has been used in both mitral and aortic balloon valvuloplasty.

[Aortic valvuloplasty using the transatrial route in aortic valve stenosis]. / Valvuloplastia aórtica utilizando la ruta transatrial en la estenosis valvular aórtica.

We describe a new technique for aortic valvuloplasty in four patients. The balloon catheter was inserted percutaneously from the right femoral vein over a long guidewire introduced into the right femoral vein and advanced transseptally to the left atrium and left ventricle and drawn out of the body through the left femoral artery using an intravascular retriever set. With both ends of the long guidewire under manual control outside the body, the balloon could be easily fixed during inflation. The procedure was easy to perform and caused no complications.

[Double mitral orifice associated with a bicuspid aortic valve detected using bidimensional echocardiography]. / Doble orificio mitral asociado a válvula aórtica bicúspide detectado mediante ecocardiografía bidimensional.

We present the case of a 16 year old girl with the rare association of double mitral orifice and bicuspid aortic valve. The patient was asymptomatic and the defect was noted in two-dimensional echocardiographic examination. The clinical and therapeutical implications are discussed.