[Echocardiographic indicators of electric cardioversion in patients with atrial fibrillation]. / Indicadores ecocardiográficos de cardioversión eléctrica en pacientes con fibrilación auricular.

We studied 80 patients to evaluate the safety of the transesophageal echocardiography (TEE) as a guidance to identify spontaneous echo contrast or atrial thrombosis in patients with atrial fibrillation (AF). 34 out of these patients were men and 46 women, with a mean age of 61 +/- 12 years. Five were not candidates due to the presence of risk factors. 75 patients have undergone electric cardioversion. The duration of AF was < 2 weeks in 61 > or = 2 and < 6 weeks 13, and > or = 6 weeks and < 1 year 6; 24 patients received previous anticoagulant therapy. The echocardiographic findings revealed left atrial dimension 45 +/- 8.4 mm ejection fraction of left ventricle 61 +/- 7.5%, SEC absent in the left atrium of 35, mild in 40 and severe in 5 patients, flow in left atrial appendage in 78 patients, thrombi in 2. EC was performed with 200 Joules in all patients and it was successful in 74. The study lasted 8.7 +/- 5.7 months; 11 patients were recurrent. The predictors were: left atrial dimension > 50 mm (p > 0.05), > 2 EC performed (p = 0.02), > 200 Joules (p = 0.05) and in patients with AF < or = 2 weeks. We concluded that the TEE is beneficial to detect risk factors in patients with AF, and it helps when deciding to perform the EC early and safely without previous anticoagulation.

[Preliminary pilot study in humans with coronary endovascular prosthesis (stent SAQ). Immediate and medium-term results]. / Estudio piloto preliminar en humanos con la prótesis endovascular coronaria (stent SAQ). Resultados inmediatos y a mediano plazo.

We report the results obtained of 23 patients in whom 25 intracoronary stents (SAQ) were placed. All had atherosclerotic coronary artery disease with different clinical types of presentation, such as stable angina, unstable angina, myocardial infarction. In others cases the reason for the procedure was postangioplasty complications. The majority of cases had complex lesions: total occlusion, long plaques and patients in critical and unstable state. The immediate results were considered satisfactory due to the fact that there was angiographic improvement compared to just conventional angioplasty, the final flow was TIMI-3 in 23 and TIMI-2 en two others, in these cases the initial flow was TIMI-0. The arterial diameter improved compared to prior angioplasty. Acute thrombosis occurred in one case and was resolved with repeated dilatation, in two cases the atherosclerotic plaque protruded within the stent, in both cases the occlusion was considered non significant, without modifications in the flow. All patients had a 3 months follow up with treadmill test. In 10 cases angiography was indicated, in 4 due to positive treadmill. Restenosis was resolved in three cases, in another coronary arterial by-pass was necessary. In all other cases angiographic findings were normal, included one patient with two stents.

[Medical-surgical management of left heart valve prosthesis dysfunction due to obstruction. Eleven year's experience]. / Manejo médico-quirúrgico en la disfunción de prótesis valvular mecánica cardiaca izquierda por obstrucción. Once años de experiencia.

UNLABELLED: We report the surgical-medical experience in left side mechanic prosthesis cardiac valve dysfunction. From January 1986 to June 1997 we included 108 consecutive patients (pts), 24 were men and 84 women, mean age 45 years, they underwent 114 surgical procedures, 104 in mitral and 10 in aortic position. RESULTS: The dysfunction was due to obstruction in fixed disc in 107 pts and intermitent in 7 pts. The pathological findings were thrombosis in 92 pts, pannus in 9 pts and both in 13 pts. The time interval between valve replacement and dysfunction was from 1 to 247 months, mean 53.8 +/- 56.7. Seventy five percent of patients received inadequate anticoagulant therapy, the mean INR was 2.06 +/- 0.79. In 76% of patients the functional class was III or IV NYHA. The diagnosis was made by clinical and echocardiographic findings in 96% of patients. The surgical procedures included valve replacement in 103, and toilette in 11 pts. The time of extracorporeal circulation in patients who died us survival patients were (159.9 +/- 108.95 vs 87.32 +/- 27.53 min) and aortic cross-clamp (64.8 +/- 20.69 vs 48.28 +/- 23.71 min) respectively (p < 0.001). The overall mortality was 12 pts (10.5%), all in functional class III or IV NYHA (p < 0.05), five patients died during surgical procedure. In conclusion the diagnosis must be established clinically as well as by echocardiography. The risk factors associated with mortality were pulmonary edema, shock, delayed surgery, surgical time prolonged and functional class III or IV NYHA.

[Design and development of a stent (SAQ) for the treatment of arterial coronary arterioscleotic obstruction]. / Desarrollo y diseño de un stent (SAQ) para el tratamiento de obstrucciones arteriales aterosclerosas coronarias.

The practice of percutaneous transluminal coronary angioplasty has shown that the major complications are acute dissection as well as suboptimal results and restenosis. The effort to reduce these complications has led to create an intravascular device called Stent. The technology is complex and very expensive, for this reason we designed and made a new model of stent named SAQ. We introduce: The methodology of development, fabrication and modifications of a new intravascular device Stent SAQ. The results obtained in coronary arteries of ex vivo hearts of pigs and humans. The results in two model of animals, rabbit aorta and peripheral arteries in dogs. This investigation at this phase, shows satisfactory properties of SAQ which is secure and effective, with similar properties to the stents in use.

[Electrocardiographic data suggesting anteroseptal myocardial infarction, in presence of infarction of the left ventricle]. / Datos electrocardiográficos sugestivos de infarto del miocardio anteroseptal, en presencia de infarto del ventrículo derecho.

We present a case of right ventricular myocardial infarction, secondary to postangioplasty occlusion of ventricular ramus of the right coronary artery, that developed electrocardiographic changes suggestive of septal myocardial infarction, this diagnosis was eliminated through angiographic study. We conclude that the carefully analysis of the electrocardiographic changes in ST segment in V1 to V4 can guide to the diagnosis of right ventricular myocardial infarction. For that reason we recommend the routinary register of the right electrocardiographic derivations as V3R and V4R, and left derivations V7 and V8, that is, the thoracic circle, in all patients with acute myocardial infarction regardless its location.

[The prevention of postinfarction left ventricular dilatation by captopril]. / Prevención de la dilatación del ventrículo izquierdo postinfarto del miocardio por captopril.

Thirty patients admitted to the ICCU with a first myocardial infarction (MI) of any localization, with left ventricular dysfunction revealed by echo-Doppler ejection fraction (EF) < 40%, where randomly divided in three groups of ten: GROUP 1 who was treated with captopril 25 mg orally between the 5th and 7th day post MI, and sustained until the end of the study. GROUP 2 received nifedipine, 10 mg capsules t.i.d. also started between days 5 and 7 post MI. GROUP 3 as a control group was treated conventionally, according to the ICCU routine. The treatment was maintained during 12 months. All patients had a second echo-Doppler at the 5th day post MI to confirm the EF criteria. Also left ventricular end-systolic and end-diastolic diameters were measured. At the 5th day post MI and before the drug administration, a low level treadmill stress test was performed in all patients. Subsequently a maximal stress test (Bruce protocol) was done at the first month and at 6 and 12 months of the study. The results showed a significant increase EF in patients of GROUP 1 from an average basal value of 38 +/- 2 to 54 +/- 5 at six months (p < 0.01) and to 60 +/- 3 at 12 months (p < 0.005). The increments observed in patients of GROUP 2 and 3 were more modest; only the 12 month value in GROUP 3, from a basal figure of 41 +/- 3 to 50 +/- 4, had a p < 0.05.(ABSTRACT TRUNCATED AT 250 WORDS)

[A comparative clinical study of calcium blockers, gallopamil and nifedipine, in the treatment of stable chest angina]. / Estudio clínico comparativo de los bloqueadores del calcio, galopamil y nifedipina, en el tratamiento de la angina de pecho estable.

Twenty seven patients, 43 to 69 years of age, all with disabling stable angina and positive Bruce stress test, no amendable for revascularization procedures mainly because of poor distal coronary run-off by angiography, were studied with two calcium-channel blockers, the recently developed gallopamil hydrochloride and nifedipine hydrochloride. According to a double blind, cross-over protocol of 12 week duration and after a 2-week washout period, the patients randomly received during 4 weeks 50 mg gallopamil capsules t i d, or 10 mg nifedipine capsules t i d. After a second 2-week wash-out, the alternative drug was administered for another 4 weeks. The number of anginal episodes decreased significantly (p less than 0.01) with both treatments (from 6.4 to 1.8 crisis with gallopamil and from 6.2 to 2.1 with nifedipine). Heart rate (HR) was progressively reduced with gallopamil (-7.9%, p less than 0.05) but increased with nifedipine (+5.7%) in relation to basal figures. Both medications reduced the level of ST depression during the stress test (52.4% with gallopamil and 41.8% with nifedipine, N.S.). The time for angina at the stress test increased 92.5% with gallopamil and 40.7% with nifedipine (p less than 0.05). HR systolic product at peak exercise was 23,101 with gallopamil and 24,906 with nifedipine (p less than 0.001). Both calcium-channel blockers are drugs with significant anti-anginal effects in patients with stable, disabling angina.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ruptured aneurysm of the sinus of Valsalva. Presentation of 4 cases and review of the literature]. / Aneurisma roto del seno de Valsalva. Presentación de cuatro casos y revisión de la literatura.

We studied four patients with ruptured aneurysms of the sinus of Valsalva. All were men with a mean age of 33 years. The presenting illness was insidious in three and of abrupt onset in one. Physical examination showed a continuous murmur in all. Chest X ray film showed moderate cardiomegaly. Electrocardiogram disclosed left ventricular hypertrophy. Echocardiogram revealed the site of the rupture which was corroborated by aortography. Two aneurysms ruptured to the right ventricle and two to the right atrium. All were corrected by surgery. All patients became asymptomatic.