[Percutaneous mitral valvuloplasty with Inoue balloon and pregnancy]. / Valvuloplastía mitral percutánea con balón de Inoue y embarazo.

Percutaneous mitral valvuloplasty with Inoue balloon was performed in seven pregnant women with severe mitral stenosis in NYHA state III or IV that were unresponsive to conventional management Usual technique was performed with echocardiographic score of 8 or less except one and average gestational age of 28.5 +/- 6.4 weeks. The mean mitral gradient was 19.8 +/- 6.4 mmHg, and decreased to 3.6 +/- 2.9 mmHg (P < 0.01) and valvular area increased from 0.84 +/- 0.01 to 2.2 +/- 0.05 (P < 0.01) in 5 from 7 (P < 0.05) there was minimal mitral incompetence, there were no cases of atrial septal defect. Two patients had moderate to severe pulmonary hypertension which decreased immediately after treatment. All patients showed an improvement (P < 0.001) in the clinical state. Mean fetal exposure to radiation was seven minutes and the patients had two transesophageal echocardiography done during the procedure. One patient had to be taken to open commissurotomy due to perforation of the aorta which caused minimal hematoma. In two patients transient fetal bradycardias were noted during the hypotensive episodes caused by balloon inflation with no serious fetal distress. All but one pregnancies got to term; four patients delivered vaginally and three underwent cesarean section due to obstetric indication. Neonatal weight and Apgar score were satisfactory. We consider that the significative benefits of the procedure, together with zero maternal and fetal mortality make this technique an acceptable one for this pathology.

[National registry of percutaneous mitral commissurotomy. 8-year's experience]. / Registro nacional de comisurotomía mitral percutánea. Experiencia de 8 años.

From April 1986 to June 1994 we performed percutaneous transvenous mitral commissurotomy in 689 patients with rheumatic mitral stenosis in a multicenter study. Mean age was 40 +/- 11 years, of then 84.9% female, 2.7% to had previous surgical treatment and in 1.4% the procedure was performed during pregnancy. Inoue balloon was used in 89.4%, double balloon 9.7% and monoballoon 0.9%. Mitral valve area (MVA) increased from 0.93 +/- 0.20 to 1.85 +/- 0.37 cm2 (p < 0.001) and mean pulmonary artery pressure from 31.5 +/- 15.8 to 22.4 +/- 11.5 mmHg (p < 0.001), mean left atrial pressure decreased from 20.9 +/- 8.1 to 10.0 +/- 5.9 mmHg (p < 0.001), transvalvular gradient (TVG) from 15.4 +/- 6.4 to 3.4 +/- 3.1 mmHg (p < 0.001) and mean pulmonary artery pressure from 31.5 +/- 15.8 to 22.4 +/- 11.5 mmHg (p < 0.001). Complete procedure without mayor complications was achieved in 93.1%. Severe mitral regurgitation (MR) was present in 3.9%. Optimal result in 82.1%, suboptimal in 8.2% and failure in 9.7%. Major complications 4.7%. Mortality was 0.9%. Six months follow-up MVA decreased to 1.77 +/- 0.38 (p < 0.001) and no changes to 24 months (1.78 +/- 0.37 p ns). Twenty four months follow-up 93.3% are in NYHA class I. Only MVA (> 1 cm2) and good predilatation NYHA class were predictors of optimal results. Severe MR were more frecuently in patients with atrial fibrillation and with high score (> 8). Our results were similar the international experience. We conclude that the technique of PTMC is a safe and effective technique.

[Cardiac autonomic blockade in sinus disease and indication for a pacemaker]. / Bloqueo autonómico cardiaco en la enfermedad del seno e indicación de marcapaso.

Functional autonomic blockade (FAB) with metoprolol (0.2 mg/kg body weight) and atropine sulphate (0.04 mg/kg) was carried out in 23 patients, 20 to 81 years old (mean age 61 years) with symptomatic sick sinus syndrome with clinical indication for permanent pacing. Several measurements were determined before and after FAB, 7 had normal intrinsic heart rate (IHR) and 16 abnormal. With normal IHR, 3 had severe autonomic regulation disturbances and in only two patients the corrected sinus nodal recovery time (SNRTC) and the sinoatrial conduction time (SACT) were prolonged after FAB. On the 16 patients with abnormal IHR only 4 had severe extrinsic autonomic influence and 15 had SACT and SNRTC prolonged after FAB. All measurements were determined by standard electrocardiographic surface tracings. Indications for permanent pacing were reduced to intrinsic sick sinus syndrome and bradycardia with severe autonomic disturbances in symptomatic patients.

[Coronary artery spasm. Study of 66 patients]. / Espasmo arterial coronario. Estudio de 66 pacientes.

We report the vasoactive effects of ergonovine maleate in 66 patients with chest pain and abnormal angiographic studies. In 42 patients this medication was injected directly in the coronary arteries, and in 24 in the aorta. We observed better vasospastic effect in the first group with the advantage of lesser dosage and less side effects. In 25 cases we deemed necessary the administration of intracoronary nitroglycerin due to evident positivity of the test (diameter reduction bigger than 60% or between 30 and 60% of any epicardial branch associated with chest pain and or ST segment shift on the electrocardiogram). Ergonovine and nitroglycerin solutions were prepared during the study without discernible morbidity. We discuss the indications of the ergonovine test: precordial pain with non-significant obstructive lesions, in patients without vasoactive medications for at least 24 hours.