[Cardiac magnetic resonance imaging of congenital heart defects in adults]. / Resonancia magnética cardíaca de las cardiopatías congénitas en el adulto.

The study of congenital cardiopathies (CC) is one of the most clearly established indications of cardiac magnetic resonance imaging (CMRI). Different sequences, including anatomic, functional, flow (phase contrast), and 3D angiographic sequences, enable the diagnosis, treatment planning, and follow-up of these conditions. CMRI allows the anatomy, function, and alterations of flow in these cardiopathies to be evaluated in a single examination. Three-dimensional MR angiography enables the study of the great vessels and the anomalies associated to congenital heart defects in adults. This article describes an examination protocol and provides examples of MR images of the most common CC in adults: atrial septal defect, interventricular communication, atrioventricular canal, tetralogy of Fallot, transposition of the great arteries, congenitally corrected transposition of the great arteries, bicuspid aortic valve, subaortic stenosis, aortic coarctation, and Ebstein's anomaly.

Resonancia magnética cardíaca de las cardiopatías congénitas en el adulto / Diffusion-weighted whole-body MRI (virtual PET) in screening for osseous metastases

Objetivo. Presentar nuestra experiencia preliminar en resonancia magnética de cuerpo entero (RMCE) en el cribado de metástasis óseas, añadiendo la secuencia de difusión de todo el cuerpo. Material y métodos. Veinticuatro pacientes con neoplasias malignas fueron estudiados con gammagrafía ósea (GO) y RM de cuerpo entero añadiendo secuencia de difusión. La RMCE se realizó con un equipo de 1.5 T en 3 estaciones en el plano coronal FSE T1 y STIR y plano sagital FSE T1 del raquis. Se añadió la secuencia de difusión (b: 600 s/mm2) de RMCE en el plano axial en 5 estaciones diferentes y presentación iconográfica en reconstrucción en el plano coronal con inversión del contraste para obtener una imagen similar a la de la tomografía por emisión de positrones (PET) (PET virtual). Los hallazgos de la GO y la RM fueron comparados para la existencia o no de metástasis óseas, valorando al paciente tanto globalmente como por regiones óseas. Las lesiones metastásicas se confirmaron por biopsia o seguimiento en 6-8 meses Resultados. Globalmente, la RMCE con difusión fue superior a la GO, sensibilidad 100% (GO 71%), especificidad 90% (GO 80%) y fiabilidad 96% (GO 75%). Valorando por regiones óseas, la RM tuvo también unos resultados superiores a la GO: sensibilidad 96% (GO 52%). En difusión las metástasis líticas fueron hiperintensas en todos los casos, con un valor ADC superior al hueso sano pero inferior a las lesiones con edema agudo de etiología benigna. La RMCE mostró, además, hallazgos extraóseos desconocidos relacionados con el tumor y en un 42% de los pacientes metástasis extraóseas. Conclusiones. La RMCE añadiendo la secuencia de difusión es un método eficaz para detectar metástasis óseas con fiabilidad superior a la gammagrafía; aportando además información sobre lesiones extraóseas. Las metástasis líticas se comportan de forma hiperintensa en difusión y tienen un valor ADC inferior al edema benigno (AU)

Objective. To present our preliminary experience in whole-body MRI with an added diffusion-weighted sequence in screening for osseous metastases. Material and methods. 24 patients with malignant neoplasms underwent bone scintigraphy and whole-body MRI with the addition of a diffusion-weighted sequence. Whole-body MRI was performed on a 1.5 T unit using a three-station protocol; coronal T1-weighted FSE and STIR sequences and sagittal T1-weighted FSE of the spine were acquired. A diffusion-weighted sequence (b: 600 s/mm2) was added in the axial plane at five different stations and iconographic presentation in coronal-plane reconstructions with contrast inversion was used to obtain an image similar to that provided by PET (virtual PET). The findings at bone scintigraphy (BS) and MRI were compared for the presence of osseous metastases, evaluating the results for each patient both globally and for different osseous regions. Metastatic lesions were confirmed by biopsy or by six to eight months' follow-up. Results. Globally, whole-body MRI with diffusion-weighted sequences was superior to bone scintigraphy, with a sensitivity of 100% (BS 71%), specificity 90% (BS 80%), and reliability 96% (BS 75%). In the evaluation by osseous region, the results of MRI were also better than those of bone scintigraphy: sensitivity 96% (BS 52%). In the diffusion-weighted sequence, lytic metastases were hyperintense in all cases, with an apparent diffusion coefficient (ADC) value higher than normal bone but lower than lesions with acute edema of benign etiology. Whole-body MRI also revealed unknown extraosseous findings related to the tumors and extraosseous metastases in 42% of the patients. Conclusions. Whole-body MRI with an added diffusion-weighted sequence is an efficacious method of detecting osseous metastases and is more reliable than bone scintigraphy. Moreover, whole-body MRI provides information about extraosseous lesions. Lytic metastases are hyperintense in diffusion-weighted sequences and have a lower ADC than benign edema (AU)

[Cardiac magnetic resonance: clinical applications]. / Resonancia magnética cardíaca: aplicaciones clínicas.

Cardiovascular disease is the most frequent cause of mortality in the developed countries and represents a serious social, economic and health problem. Although very diverse, useful techniques exist for diagnosing cardiac diseases, it is frequently necessary to ask for more than one test to reach a specific diagnosis. Magnetic resonance is a harmless, well tolerated and safe technique, which is currently available in the majority of hospitals. This technique makes it possible in a single exploration to study the anatomy of the heart and to make a qualitative, semi-quantitative and quantitative assessment of the parameters of cardiac function. It provides information of cardiac and vascular anatomy and function in complex congenital cardiopathies. Besides, with the administration of intravenous contrast, it enables knowledge to be gained of myocardial viability in ischaemic cardiopathy. Hence, cardiac magnetic resonance is emerging as one of the most promising techniques for the study of congenital and acquired cardiac pathology.

Resonancia magnética cardíaca: aplicaciones clínicas / Cardiac magnetic resonance: clinical applications

La enfermedad cardiovascular es la causa más frecuentede mortalidad en los países desarrollados yconstituye un grave problema social, económico ysanitario. Aunque existen muy diversas técnicas útilespara diagnosticar las enfermedades cardíacas, con frecuenciaes preciso realizar más de una prueba para llegara un diagnóstico concreto. La resonancia magnéticaes una técnica inocua, bien tolerada y segura queactualmente se encuentra disponible en la mayoría delos centros hospitalarios. Esta técnica permite estudiaren una única exploración la anatomía del corazón yvalorar de forma cualitativa, semicuantitativa y cuantitativalos parámetros de función cardíaca. Es útil parael estudio de las enfermedades valvulares, miocardiopatíasy de la enfermedad pericárdica. Aporta informaciónde la anatomía y función cardíaca y vascular en lascardiopatías congénitas complejas. Además, con laadministración de contraste intravenoso, permiteconocer la viabilidad miocárdica en la cardiopatíaisquémica. Por tanto, la resonancia magnética cardíacase perfila como una de las técnicas más prometedoraspara el estudio de la patología cardíaca congénita yadquirida

Cardiovascular disease is the most frequent causeof mortality in the developed countries and representsa serious social, economic and health problem.Although very diverse, useful techniques exist fordiagnosing cardiac diseases, it is frequently necessaryto ask for more than one test to reach a specificdiagnosis. Magnetic resonance is a harmless, welltolerated and safe technique, which is currentlyavailable in the majority of hospitals. This techniquemakes it possible in a single exploration to study theanatomy of the heart and to make a qualitative, semiquantitativeand quantitative assessment of theparameters of cardiac function. It provides informationof cardiac and vascular anatomy and function incomplex congenital cardiopathies. Besides, with theadministration of intravenous contrast, it enablesknowledge to be gained of myocardial viability inischaemic cardiopathy. Hence, cardiac magneticresonance is emerging as one of the most promisingtechniques for the study of congenital and acquiredcardiac pathology

[New strategies in cardiovascular prevention]. / Nuevas estrategias en prevención cardiovascular.

Cardiovascular diseases, especially coronary heart disease, are the leading cause of mortality in Spain and western countries. The prevention of complications is based on a cardiovascular risk stratification that is based on the presence of classical cardiovascular risk factors. There are many scales for cardiovascular risk stratification that classify subjects into low, intermediate or high risk. Despite the fact that the impact and treatment of risk factors are well known, their control remains poor. Obesity, diabetes, and hypertension seems also seem to be increasing trends due to the changes in lifestyles and nutritional habits of our communities. In recent decades some new, or emerging, cardiovascular risk factors have been identified that can improve the stratification of cardiovascular risk: C-reactive protein, homocysteine, and lipoprotein a. The metabolic syndrome is an association of cardiovascular risk factors that cluster in the same subject because they share a physiopathologic link: insulin resistance. Its presence is related to most cardiovascular risk factors, classical or emerging, especially obesity, hypertension, and C-reactive protein. On the other hand, detection of subclinical or incipient atherosclerosis, especially with the measurement of intima-media thickness, offers indirect information closely related to coronary atherosclerosis that improves the stratification of subjects at intermediate risk.

[Large false aortic aneurysm after 30 years of a coarctation repair]. / Falso aneurisma aórtico 30 años después de la corrección de una coartación: tratamiento quirúrgico bajo hipotermia profunda.

We report a case of a large false aortic aneurysm that had developed in a 43-year-old man who had had coarctation repair 30 years previously. The coarctation repair had been done by inserting an end-to-end Dacron tubular graft which was sutured with silk. The re-operation was successfully performed under deep hypothermic arrest and it was noted that there was complete separation of the graft from both ends and no sutures were visualised. The deep hypothermic technique has considerably improved the ease and safety of this operation. We attribute this complication to the reabsorption of the silk sutures. Patients after coarctectomy with graft material should have regular chest X-rays for life in order to detect false aneurysms.

Aortic valve replacement with bioprostheses in liver transplant recipients.

Three cases of aortic valve replacement with porcine bioprostheses are reported in liver transplant recipients at two to six years after transplantation. Indications for aortic valve replacement (AVR) were aortic stenosis (n = 2) and aortic regurgitation (n = 1). The use of bioprostheses was recommended because of patient age, the need for multiple liver biopsies, and contraindication to the use of anticoagulation therapy. The patient who underwent AVR because of aortic regurgitation developed structural valve deterioration (SVD) during the next five years after surgery, and thus replacement of the bioprosthetic valve was required. Recipients of liver transplant who undergo valve replacement with tissue valves should be carefully followed up because of the risk of early SVD. AVR may be performed safely after liver transplantation.

Food consumption patterns in the adult population of the Basque Country (EINUT-I).

OBJECTIVE: Dietary surveys are a valuable tool in nutrition surveillance programmes to monitor the nutritional status of a group or population of a country. The objective of this study was to assess the food consumption pattern in the adult population of the Basque Country (Spain). DESIGN: A cross-sectional nutritional survey was carried out in 1990. Dietary habits were assessed by means of '24-h recall' during 3 non-consecutive days and a food frequency questionnaire. SETTING: Population survey in the Basque Country (Spain). SUBJECTS: Random sample of the adult population (25-60 years) in the Basque Country (n = 2348). RESULTS: Results draw a food pattern characterized by a high consumption of meat, 163+/-3.04 g day(-1) (mean +/- SEM), supplied mainly by poultry, butchery products, veal and fish (88+/-2.68 g day(-1)). The average consumption of milk and dairy products was 359+/-5.19 g day(-1), although 39% of the sample did consume less than 2 portions from this group of foods daily. Olive oil was the most widely used fat for cooking (45%), followed by sunflower seed oil (30%). Cereals supplied 21.5% of the average energy intake and the consumption of vegetables and garden products was 159+/-3.13 g day(-1). Only 29% of the group usually had 2 or more portions of vegetables per day. Women consumed higher amounts of chocolate, cookies, sweets and coffee (P < 0.01) than men. Younger adults consumed more meat (P < 0.01), while the older community consumed more fish, vegetables and fruit (P < 0.01). More highly educated people consumed more dairy products, vegetables and butter (P < 0.01). Conversely, less educated people consumed higher amounts of olive oil, pulses and bread (P < 0.01). CONCLUSIONS: The dietary pattern observed in the Basque Country, although in keeping with its traditions, is in harmony with the actual dietary trends in Mediterranean countries. In order to satisfy the dietary guidelines suggested by the Spanish Society of Community Nutrition, it would be desirable to gradually increase the consumption of vegetables, fresh garden produce, fruit and cereals. At the same time, it would be advisable to decrease the consumption of animal products (whole fat dairy products, meat, added fats) so the proportion of energy intake from fat can be reduced by 5% (3% from saturated fatty acids).

[The pediatric heart transplant. Its evolution and early postoperative complications]. / Trasplante cardíaco pediátrico. Evolución y complicaciones postoperatorias tempranas.

BACKGROUND: Cardiac transplantation is an acceptable therapeutic alternative for cardiac diseases refractory to other forms of management in adults as well as in infants and children. METHODS: Between 1987-1992 7 children (4 girls and 3 boys) underwent cardiac transplantation: four with dilated cardiomyopathy, one with cardiac fibroma and two with hypertrophic cardiomyopathy. Age at transplantation ranged from 2 months to 13 years and 5 months, with a follow-up ranging from 15 months to 5 years and 9 months. Prophylaxis of acute rejection consisted of cyclosporine, azathioprine and glucocorticoids. RESULTS: Two patients presented acute rejection three weeks after cardiac transplantation, with a good response to high dose glucocorticoids. Two patients developed severe infection (sepsis by Staphylococcus aureus) with successful outcome after antibiotic treatment. One patient died in the early postoperative period and other after 4 years 11 months postransplantation because myelodysplastic syndrome. At present only one case is receiving glucocorticoids in immunoprophylaxis. The status is asymptomatic in the other 5 patients with a normal height-weight development. CONCLUSIONS: Heart transplantation provides durable therapy for congenital and myopathic heart disease in infants and children with an excellent quality of life.

Fat and alcohol intake in the Basque Country.

A cross-sectional nutritional survey was carried out in the Basque Country, on a random sample of the population aged 25-60 years (n = 2348). Socioeconomic data, anthropometric measurements and food consumption data were collected. 24-h recall on three non-consecutive days plus a food frequency questionnaire were used for dietary assessment. The participation rate was 73.4%. Mean energy intake for men was 2944 kcal and 2049 kcal for women, decreasing with age. Energy distribution pattern (non-alcohol) showed 16% from protein; 38% from fat: 13% SFA; 16% MUFA and 9% PUFA; carbohydrates supplied 46% energy. Alcohol intake was 8%. Better-educated people had higher intakes of SFA, cholesterol and sugar (P < 0.001). Consumption of meat (162 g/person/d) and fish (89 person/d) were high. Cereals and potatoes were the main sources of energy in the Basque diet (23.24%) followed by meat, fish and eggs (20%). Percentage contribution to energy intake from meat was higher in men than in women, and also energy intake from alcohol. Women obtain more energy from milk. Edible fat was the main source of fat in the diet (46%) followed by meat (22%). Milk products and meat are the main sources of SFA in the Basque diet. Males had a high intake of alcohol, especially in the 35-44-year age group. Alcohol consumers usually drink every day and often not in the home.

[Chronologic study of signs of myocardiopathy in progressive muscular dystrophy]. / Estudio cronológico de los signos de miocardiopatía en las distrofias musculares progresivas.

In order to analyze the evolution of cardiomyopathy in progressive muscular dystrophies, thirty-three patients (17 with Duchenne type, 11 with Becker type and 5 with the autosomal recessive type dystrophy) were studied retrospectively. Cardiac and systemic follow-up every 3-6 months was made in 29 patients. The electrocardiogram was the first test that became altered, followed by the echocardiogram and thoracic radiograph and finally heart failure manifestations. There was a direct correlation between age and the appearance of abnormal cardiac tests. Electrocardiographic alterations, in patients who were less than 12.5 years of age, were significantly more frequent in the group with Duchenne dystrophy that in the no-Duchenne group. In regards to the appearance of the echocardiographic and radiographic abnormalities, there were no significant differences between the two groups. However, we have noticed a trend towards a more frequent and earlier presentation of these abnormalities in the Duchenne's muscular dystrophy than in the no-Duchenne group.

[Changes in rhythm and conduction after atrial correction of transposition of great vessels]. / Alteraciones del ritmo y de la conducción tras la corrección auricular de la transposición de las grandes arterias.

Disorders of rhythm or conduction after correction by baffle of transposition of the great arteries (TGA) has been widely reported. In order to avoid them, transformations on Mustard original technique have been carried out. We analize here the incidence of arrhythmias during the follow up of 20 patients operated, following a modification of the Mustard technique, as well as the postoperative changes on the P wave. The 75% of the patients remained in sinus rhythm during the postoperative first year, but only 28% continued on it after 6 years. The rest of the patients presented nodal or low auricular rhythm, alternating with sinus rhythm. Seven patients fulfilled diagnostic criteria of sick sinus syndrome. Ninety five percent of the patients were asymptomatic. The 9 patients that performed a stress testing after operation presented sinus rhythm and heart rate acceleration, in spite of the rhythm was nodal at the beginning in 4 of them. The modifications of the Mustard technique apparently do not avoid the arrhythmias and disorders of conduction. Nevertheless, the exercise tolerance remain acceptable.

[Echocardiographic study following corrective surgery for transposition of the great arteries using a baffle]. / Estudio ecocardiográfico después de cirugía correctora de la transposición de las grandes arterias mediante parche.

Sixteen patients undergoing corrective surgery of transposition of the great arteries following Arcas' technique were studied by echocardiography. Mean age was 8.7 years, ranging from 2 to 25 years. The echocardiographic studies were performed between 6 months and 10 years after surgery (X: 5.6 years). Paradoxical movement of the interventricular septum, right ventricle dilatation, diastolic fluttering of the mitral valve and tricuspid incompetence are commonly recorded. Tricuspid insufficiency does not necessarily mean right ventricular disfunction in these patients. Due to the particular baffle shape, bidimensional echocardiographic recognition of superior cava vein obstruction is easy. In addition, the waves of cava veins showed a characteristic pattern with predominant diastolic wave, which is an argument against its obstruction. In conclusion, echo and Doppler studies are reliable means for an adequate follow-up of these patients.