Anomalous left coronary artery originating from the pulmonary artery in an adult.

We report the case of a 63-year-old man who presented at our hospital with paroxysmal atrial fibrillation. He was found to have an anomalous left coronary artery originating from the pulmonary artery. The patient underwent successful revascularization with the use of a left internal mammary artery bypass graft.

Segmentary coronary reserve in hypertensive patients with echocardiographic left ventricular hypertrophy, gamma-graphic ischaemia and normal coronary angiography.

Stress thallium scintigraphies are frequently positive in patients with systemic hypertension (SHT), especially in the presence of left ventricular hypertrophy (LVH). In order to determine whether positive thallium perfusion scans in patients with LVH secondary to SHT and normal coronary angiographies are due to segmentary reduction of coronary reserve (CR), we have studied 10 out of 60 consecutive cases of SHT with echocardiographic LVH, using intracoronary Doppler. We compared coronary blood flow velocity at rest and post-papaverine (PP), and CR in at least two major coronary vessels, always including the one corresponding to the ischaemic segment. In the vessel with the least CR at rest, a new determination of CR was made under intracoronary nitroglycerin. A group of five normal patients acted as controls. The mean CR of the controls and patients, respectively, was 6.2 +/- 1.4 vs 2.7 +/- 0.9 (P < 0.001). In patients with positive thallium perfusion scans, the coronary arteries corresponding to the ischaemic segments had less CR (2.5 +/- 0.6) than arteries from non-ischaemic segments (3.4 +/- 1, P < 0.05). These differences were greater when the ischaemia was anterior. There was no correlation either between CR and left ventricular mass (r = 0.23) or rest coronary blood flow velocity (r = 0.07). Only one patient exhibited functional behaviour indicating reduced CR; this rose from 1.9 to 7.5 after nitroglycerin 300 micrograms. In conclusion, CR determined by intracoronary Doppler and papaverine shows segmentary differences both in normal patients and in patients with LVH and normal coronary angiograms. This could be the cause of segmental ischaemia detected by means of radionuclide stress tests.

[Right ventricular function and effort tolerance in patients with chronic congestive heart insufficiency. A cross-over double-blind study]. / Función ventricular derecha y tolerancia al esfuerzo en los pacientes con insuficiencia cardíaca congestiva crónica. Estudio cruzado a doble ciego.

We tried to assess the value of both ventricular function changes and its correlation with maximal exercise capacity in patients with chronic heart failure. For this purpose, a double blind crossover study was designed, and the change in the exercise tolerance and both ventricular ejection fraction were evaluated. When compared with digoxin treatment (p less than 0.01) and with a control-period (p less than 0.001), the captopril increases total exercise time significantly. The response of right ventricular ejection fraction was similar. The changes in right ventricular ejection fraction, but not those of left ventricular ejection fraction, correlated with the variations of exercise time (r = 0.67). These facts suggest that right ventricular function is an important determinant of exercise capacity in patients with chronic heart failure and that its behaviour explain, in part, the response to captopril treatment.

[Diagnosis of pulmonary hypertension by means of continuous, pulsed and color Doppler, and its correlation with hemodynamics]. / Diagnóstico de la hipertensión pulmonar mediante Doppler continuo, pulsado y color, y su correlación con la hemodinámica.

We have performed a study on 28 patients (20 with valve disease and eight with Eisenmenger syndrome) to evaluate the degree of pulmonary hypertension by means of continuous, pulsed and color Doppler, comparing these results with those obtained at cardiac catheterisation. Invasive systolic pulmonary pressure corresponded excellently with the transtricuspid gradient determined by continuous Doppler (r = 0.97). The study by pulsed Doppler of pulmonary artery flow enabled us to establish a good correlation between total pulmonary resistance with the quotient time to peak flow/ejection time and time to peak flow (r = 0.87 and r = -0.81), and between systolic pulmonary pressure and the time to peak flow (r = -0.80). Color Doppler enabled us to easily establish the presence of tricuspid and pulmonary regurgitation.