Hipertrofia ventricular izquierda medioventricular y aneurisma apical del ventrículo izquierdo: ¿un síndrome con entidad propia? / Left midventricular hypertrophy and apival aneurysm of the left ventricle: a syndrome with real entity?

Una paciente de 67 años ingresa en nuestro hospital por infarto agudo de miocardio inferior. La ventriculografía izquierda reveló la presencia de una obliteración sistólica medioventricular importante y un aneurisma en el ápex del ventrículo izquierdo (VI), y la coronariografía una estenosis ligera de la arteria coronaria derecha. La coexistencia de hipertrofia ventricular izquierda medioventricular y un aneurisma apical del VI es extraordinariamente infrecuente. Se revisa la literatura y los posibles mecanismos etiopatogénicaos de esta asociación anatomoclínica (AU)

[Aortic coarctation: different anatomo-clinical forms depending on the age of presentation]. / Coartación de aorta: diferentes formas anatomoclínicas según la edad de presentación.

OBJECTIVE: To analyse the anatomo-clinical characteristics of the coarctation of the aorta at different ages of presentation as well as the findings and results of its surgical correction at different periods. PATIENTS AND METHODS: We retrospectively studied the clinical and angiographic data, as well as the intraoperative findings and surgical outcomes of 82 consecutive patients (54 M and 28 F) with coarctation of the aorta. Mean age was 16.2 +/- 13.7 years (1 month to 63 years). The patients were divided into three groups according to age: Group A (n = 10) under 1 year; Group B (n = 30) from 1 to 12 years and Group C (n = 42) over 12 years. RESULTS: A preductal form was found in 20.7% cases (50.0%, 30.0% and 7.1% of groups A, B, and C respectively; p = 0.003). An associated left-to-right shunt was present in 19.5% (40.0%, 16.7% and 16.7% of groups A, B and C respectively; p = NS). The first manifestation of the disease was different in groups A, B and C. Among group A patients, congestive heart failure was the most frequent presentation (70.0%). In group B, the most frequent presentation (30%) was as an incidental finding in an asymptomatic patient. Finally, systemic hypertension or its complications predominated among group C patients (38.0%). Left ventricular hypertrophy on ECG was present in 0.0%, 30.0% and 54.7% of patients in groups A, B and C (p = 0.003) respectively. Postoperative complications including death, hypertensive crisis and re-coarctation were observed in 90.0%, 33.3% and 21.4% in groups A, B and C (p = 0.01) respectively. CONCLUSIONS: Among patients with coarctation of the aorta, the age of clinical presentation allows us to define groups of patients with different anatomical characteristics, clinical course and postoperative outcome.

[The reduction of the ST segment during ergometry is not useful for the location of coronary stenosis]. / El descenso del segmento ST durante la ergometría no es útil para localizar las estenosis coronarias.

We have analyzed 44 consecutive patients with significant ST-segment depression during the exercise stress test, with the aim of testing the ability of localizing the coronary stenoses. There was a significant correlation only between maximal ST-segment depression in V1-V4 and stenosis in the left anterior descending artery (r = 0.402, p = 0.0067), but the accuracy of the presence of ischemic ST depression in anterior leads to detect disease of the left anterior descending artery was 59% (26 correct, 18 wrong). The low lateral leads (V5 and V6) were the more accurate to detect coronary disease, as much for the left anterior descending artery as for the right or the circumflex coronary arteries. We conclude that ST segment depressions are of little value to localize the coronary stenoses.

[Significance of angina in patients with aortic valvulopathy]. / Significación de la angina en los pacientes con valvulopatía aórtica.

We have analyzed coronary arteriographies of 170 patients, 120 with isolated aortic stenosis and 50 with isolated aortic failure. Patients with stenosis showed higher frequency of angina (73% versus 54%, p = 0.0223). No significant differences were observed with respect to the incidence of the coronary artery disease (26.7% versus 31.8%, p = 0.18). The presence of angina was significantly more specific in aortic failure (specificity 52.4% versus 31.8% in aortic stenosis, p = 0.039). Among the patients with less than 56 years of age, the probability of developing coronary artery disease in absence of angina was 6.3% (1 out of 16), the confidence interval ranging from 1.5% to 30.2%. Our results do not support any modification of the conventional criteria for conducting coronary arteriographies in patients with aortic valvulopathy.

Is the prevalence of severe stenoses of left circumflex different from that of the right coronary artery?

We reviewed the last 911 coronary arteriograms performed in our laboratory because of chest pain. Among 215 patients with single-vessel disease, 40 had stenosis in the right coronary artery and 43 in the left circumflex. This finding conflicts with previous reports. Perhaps racial differences could explain this discrepancy.

[Pulmonary arteriovenous fistula treated using percutaneous transcatheter embolization]. / Fístulas arteriovenosas pulmonares tratadas mediante embolización percutánea transcatéter.

Authors report results of treatment of two patients with congenital pulmonary arteriovenous fistulae by means of percutaneous transcatheter embolization utilizing metallic coils. They found a total regression of clinical signs after a follow-up of 36 and 30 months respectively.

[Congenital heart block and pacemaker implantation (author's transl)]. / Bloqueo cardíaco congénito con implantación de marcapaso

A six years old boy was sent to our service due to a loss of conscience spell. He had no preceding history E.K.G. showed a complete A-V block. Laboratory findings were within normal limits. Cardiac catheterism was performed and it ruled out any antomic abnormality, making evident a good contraction ability. To decide pacemaker implantation we evaluted: 1. That cardiac frequency was not increased by exercise neither by action of pharmacologyc agents (atropine, insoproterenol).-2. The existence of wide and bizarre QRS ocmplex.-3. And dizziness spels. The patient has been controlled during the past two years. Parasistolia has appeared, not showing modification till today.