[Peripartum cardiomyopathy with biventricular thrombi]. / Miocardiopatía periparto con trombosis biventricular.

Peripartum cardiomyopathy is a rare cause of congestive heart failure which develops in the last month of pregnancy or during five months postpartum in women without previously known cardiac disease. Intraventricular thrombi are no unusual and can be identified by echocardiography. We report the case of a woman with peripartum cardiomyopathy whose echocardiographic study showed the presence of biventricular thrombi. This is a quite rare finding with only two cases reported in the literature. Diagnosis, treatment and special situations that could predispose to intracardiac thrombi formation are discussed.

[Isolated non-compaction of the ventricular myocardium]. / Miocardio ventricular no compacto aislado.

Isolated non-compaction of the ventricular myocardium is a rare disorder of endomyocardial morphogenesis characterized by numerous, excessively prominent ventricular trabeculations, probably due to arrest of normal endomyocardial embryogenesis. We report two cases of isolated non-compaction of the ventricular myocardium.The first patient had a brother who died in the first year of life after heart transplantation due to refractory heart failure caused by restrictive biventricular cardiomyopathy associated with a right ventricular diverticulum. This could have been a case of isolated non-compaction of the ventricular myocardium that was not diagnosed. The patient, who is 8 years old, is asymptomatic and echocardiogram (ECG) showed multiple prominent ventricular trabeculations in the apical portion of the left ventricle, slightly depressed systolic and diastolic function and restrictive ventricular filling pattern.The second patient is a 7-year-old boy who presents recurrent syncopes. ECG showed multiple prominent ventricular trabeculations, restrictive ventricular filling pattern and normal systolic function. The Holter ECG recording showed multiple premature ventricular complexes and nonsustained ventricular tachycardia. An implantable subcutaneous Holter recorder was inserted, which was associated with an episode of aborted sudden death and polymorphic ventricular tachycardia followed by asystole. The patient was then treated with an implantable defibrillator.

[Clinical presentation, diagnosis and treatment of four cases of cor triatriatum]. / Presentación clínica, diagnóstico y tratamiento de cuatro casos de cor triatriatum.

We report four cases of cor triatriatum. In two of them the fibromuscular membrane was obstructive and associated with an atrial septal defect between the left atrial accessory chamber and the right atrium; in those cases the clinical findings were due to the pulmonary hypervascularity. The third case was associated to a small patent foramen ovale, and the clinical findings were due to the obstruction to flow through the membrane in the left atrium, producing venocapilar pulmonary hypertension. In these three cases surgical treatment was carried out through a right atriotomy. In all of them a good corelationship was found between the echocardiographic and the surgical findings. The follow-up has been good, all previous symptoms disappearing, remaining symptom free. The fourth case is an asymptomatic 5-year-old girl, with a non-obstructive membrane and without any associated anomalies.

[II. Role of Doppler echocardiography in the management of chronic ischemic cardiopathy]. / II. Papel de la ecocardiografía Doppler en el manejo de la cardiopatía isquémica crónica.

Doppler echocardiography is a simple, fast and non-invasive method to identify abnormal regional and global left ventricular function. One could consider this method the best application for this end within the techniques of imaging. This chapter reviews the role of Doppler echocardiography in the management of chronic coronary artery disease, as well as for studying the global and regional function at rest, as in the applications derived from their use during stress testing. Frequent techniques of stress echocardiography for the diagnosis of ischemic heart disease, their utility in the study of myocardial viability, and the establishment of recommendations for their use in clinical practice are analyzed.

[Therapeutic options in cardiogenic shock]. / Opciones terapéuticas en el shock cardiogénico.

Cardiogenic shock continues to be a clinical situation which is related with high mortality. Although its etiology is varied, the most frequent cause is an acute myocardial infarction. The poor prognosis of cardiogenic shock can be favourably modified with the diagnosis of the underlying cause followed by the stabilization of the patient and early revascularization. Early treatment with inotropic or vasopressor drugs improves the condition of most patients and the use of circulatory assistance, such as the intraaortic balloon, lead to an acceptable hemodynamic situation in 80% of cases. However, they do not significantly modify the mortality rates. In addition, thrombolytic therapy does not appear to be effective for this kind of patients. Only revascularization methods have proved to be effective; surgery is the only option where ventricular septal, free wall, or papillary muscle rupture occurs, resulting in survival rates of between 50 and 60% with coronary artery by-pass surgery. Angioplasty is frequently successful in reperfusion of the infarct-related artery; the survival rate in these cases is approximately 70%, according to the different series published. As the mortality rate is exceedingly high (70-90%) when conventional therapy is used; when appropriate diagnostic and therapeutic means are available and when the patient's condition is recoverable, the attitude should be aggressive and coronary angiography and angioplasty applied as soon as possible. In centers where these means are not available, once measures have been taken to achieve the stabilization of the patient, the most suitable procedure is to transfer him or her to a hospital in which qualified staff and such treatment methods are available.

[Usefulness of exercise echocardiography for the diagnosis of ischemic heart disease]. / Utilidad de la ecocardiografía de esfuerzo en el diagnóstico de la cardiopatía isquémica.

INTRODUCTION AND PURPOSE: The purpose was assessing the usefulness of exercise digitalized echocardiography for the diagnosis of ischemic heart disease. PATIENTS AND METHODS: Eighty-eight patients, with suspected artery coronary disease, underwent both a exercise echocardiography with treadmill Bruce protocol and a coronary arteriography, within a period less than 2 months, without changes in their clinical evolution. Fifty-eight patients shown significant coronary lesions (> or = 50%). RESULTS: The exercise echocardiography showed a high sensitivity (74%), significantly greater (p < 0.01) than exercise electrocardiography alone. The sensitivity was fixed by the level of exercise done, reaching 91% when submaximal exercise was achieved, and by the severity and extension of coronary disease, being of 68.5% for a single-vessel, 80% for two-vessel and 100% for three-vessel. The specificity was 87%, considering the lesions lesser than 50% as not significant, and it was 100% when the coronary arteries without disease were taken into account. CONCLUSIONS: Exercise echocardiography can be a rutinary method for the diagnosis of ischemic heart disease, and it shows a high sensitivity and specificity, greater than exercise electrocardiography alone.

[Coronary ostial stenosis after an aortic valve replacement diagnosed by transesophageal echocardiography]. / Estenosis de ostium coronario tras recambio valvular aórtico diagnosticado mediante ecocardiografía transesofágica.

We submit the case of a 75-year-old man that underwent aortic valve replacement whose preoperative coronary angiography showed lesion-free coronaries. Two months after surgery he began to feel rapidly progressing effort angina pectoris. Transesophageal echocardiography showed prosthetic normal function while allowing the study of the great coronary trunks. We observed the presence of a 50% stenosis at the ostium of the left coronary artery trunk due to the use of selective coronary cannulation to supply cardioplegia solution during valve replacement. A second coronary angiography confirmed this finding. Transesophageal echocardiography may be used as an initial diagnostic method when coronary ostial stenosis is suspected after aortic valve replacement.

[Hemodynamics of arterial hypertension]. / Hemodinámica de la hipertensión arterial.

Arterial blood pressure depends on the flow rate and peripheral resistances. Arterial blood pressure is regulated in arterial hypertension (AHT) in a very similar fashion as in normotensive subjects, but the peripheral vessels do not respond properly to increases in the cardiac output. The adrenergic nervous system plays a basic part in the mechanisms which provoke and regulate the AHT. The AHT usually begins with an increase in adrenergic tone and cardiac output: hyperkinetic hypertension. It later develops into an intermediate, normokinetic situation with latent left ventricular malfunction and finally augmented peripheral resistances which will become of organic character in time due to autoregulatory mechanisms.