Coronary artery abnormalities in Puerto Rico

A retrospective study was done to determine the frequency of coronary artery anomalies in terms of their origin, course, and structure. The clinical history, catheterization data and surgical reports of patients undergoing coronary angiography at the Cardiovascular Center of Puerto Rico and the Caribbean, from 1999 to 2004, were analyzed. Thirty-eight patients were identified with a coronary artery anomaly in this population. These anomalies were classified according to their clinical consequences and the need for surgical intervention.

Bilobulated atrial myxoma originating from low interatrial septum

Myxomas are the most common type of primary cardiac tumors. Around 70% of patients who have them are females, 86% occur in the left atrium and more than 90% are solitary. In the left atrium the usual site of attachment is in the fossa ovalis. Less common sites within the left atrium are the mitral valve or in areas near it. This patient, with a left atrial myxoma originating low in the interatrial septum near the mitral valve, is one of the first cases reported in Puerto Rico. The patient is a 41 year old female with no previous history of systemic illnesses who one month prior to admission developed episodes of chest pain and shortness of breath. A 2D echo, done by a local physician, revealed a mobile left atrial mass causing diastolic obstruction of the valve. She was referred to our institution for further evaluation. A transesophageal echo was done showing a large bilobulated mass connected to the lowermost portion of the atrial septum, close to the mitral annulus, specially to the anterior leaflet. It also showed concurrent mitral regurgitation caused by the mass. The tumor was successfully resected without major complications and it was proven to be connected to the septum 1 cm above the mitral annulus. Pathological examination confirmed it to be a myxoma

Eleven years experience with the Medtronic Hall Valve

We are reporting our experience of eleven years with the Medtronic Hall Valve. Four hundred twenty two patients received the valve with a mortality of 7.9 por cento

Eleven years experience with the Medtronic Hall Valve.

We are reporting our experience of eleven years with the Medtronic Hall Valve. Four hundred twenty two patients received the valve with a mortality of 7.9%.

Pulmonary dirofilariasis: first reported case in Puerto Rico.

The first case of human pulmonary dirofilariasis in our country is reported. The etiopathogenesis and pathological findings of the zoonosis are discussed.

Intrathecal synthesis of IgG subclasses in multiple sclerosis and in acquired immunodeficiency syndrome (AIDS).

Serum and cerebrospinal fluid (CSF) of 50 neurological patients (24 multiple sclerosis (MS), ten acquired immunodeficiency syndrome (AIDS) and 16 other neurological diseases (OND)) and ten controls were analyzed by enzyme-linked immunosorbent assay (ELISA) for IgG subclass quantification and for the calculation of intrathecal synthesis (ITS). Total IgG was determined by two methods: electroimmunodiffusion (EID) and ELISA. A highly significant correlation was established between both methods. The existence of ITS was proved by the IgG/albumin ratio, the IgG index, Tourtellotte's formula, and Schuller's formula. In AIDS patients all IgG subclasses showed an increase in the CSF, whereas in sera only the IgG1 was significantly increased. CSF of MS patients showed a predominant increase of IgG1 whereas no significant modification of IgG subclasses was observed in sera. In most of the AIDS patients there was an ITS of IgG1, IgG3 and IgG4, but rarely (3/10) IgG2. In contrast, a polyclonal ITS of IgG was exceptional (1/24) in MS patients. No significant correlation could be established between clinical data and IgG subclass ITS in MS. The variations of each IgG subclass in serum and in ITS were not significantly correlated. Measurement of each IgG subclass and calculation of ITS seems essential in order to analyze any subclass antibody repertory inside the central nervous system.

[Quantitative evaluation of serum IgG subclass levels by an immunoenzyme method]. / Estimation quantitative du taux des sous-classes d'IgG sériques par une méthode immunoenzymatique.

We developed a enzyme linked immunosorbent assay (ELISA) for measuring IgG subclasses concentration in serum. For this we used monoclonal antibodies. The specificity of these antibodies was evaluated with a panel of myeloma proteins belonging to the 4 IgG subclasses. The ELISA was sensitive (allowing the detection of subclasses at ng level) and accurate (inter-assay coefficient of variation of 14%). Using the WHO serum 67/97 as reference, we determined the concentration of IgG subclasses in a pool of sera. In addition concentrations were measured in 69 healthy adults to study the distribution of each IgG subclass. A good correlation (r = 0.78) was obtained between the sum of the subclasses measured by ELISA and total IgG measured by immunonephelometry.

Complete replacement of the ascending aorta with reimplantation of the coronary arteries in patients with full Marfan syndrome.

Four patients with Marfan syndrome developed severe aortic insufficiency requiring complete replacement of the ascending aorta with reimplantation of the coronary arteries by the technique of Cabrol. All patients have remained asymptomatic in NYHA class I.

Severe right ventricular outflow tract obstruction caused by an intracavitary cardiac neurilemoma: succesful surgical removal and postoperative diagnosis.

A 32-year-old woman with a one-year history of progressive shortness of breath and chest pain was found to have a grade 4/6 systolic murmur at the base of the heart and left sternal border. Right ventricular enlargement was found by physical examination, ECG, and chest roentgenogram. Cardiac catheterization showed elevated right ventricular pressure, an intracavitary pressure gradient, and inability to enter the pulmonary artery. Angiography revealed a mass in the right ventricular outflow tract. Successful surgical removal of a large, well-encapsulated tumor mass was accomplished, and the tumor was interpreted as a benign neurilemoma. Postoperatively, the patient improved remarkably.