[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.

[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.

[Angiographic course of advanced ischemic cardiopathy]. / Evolución angiográfica de la cardiopatía isquémica avanzada.

We studied 30 patients with significant coronary artery disease awaiting coronary surgery for 7 to 64 months (mean 16 months), who underwent repeated cineangiogram. On the basis of clinical and angiographic factors the following conclusions were obtained: Age, intervals between angiograms, risk factors, progression in angina, functional class and electrocardiographic changes were associated with progression of angiographic coronary artery obstructions (p greater than 0.05). Lower progression percentages were observed in patients with one-vessel disease compared with those with two or three-vessel involvement (p greater than 0.05). No difference could be found in the progression of obstruction of any of the main coronary vessels. Collateral circulation increased with the anatomic obstruction progression. The changing coronary pathology was significantly related to increasing impairment of left ventricular function manifested as increased segmental motility impairment and decrease in ejection fraction (p less than 0.05). Deterioration of left ventricular contraction measured by means of non-invasive diagnostic tests could predict the need of a second arteriography.

[Tight mitral stenosis with normal unilateral pulmonary capillary pressure]. / Estenosis mitral apretada con presión capilar pulmonar unilateral normal.

There are few reports of severe mitral stenosis with normal pulmonary artery wedge pressure. In order to illustrate this problem we present two adult patients with these abnormalities. Both patients had intact interatrial septum with partial anomalous pulmonary venous drainage, one to the inferior vena cava (The Scimitar Syndrome) and the other to the superior vena cava. In the first case the right pulmonary artery wedge pressure was 11 mm Hg. In the second case this pressure was only 8 mm Hg. Pulmonary arteriograms are of paramount importance in the diagnosis and surgical management. In both cases the surgical procedure with mitral commissurotomy and transplant of the anomalous pulmonary veins to the left atrium was successful.

[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.

[Spontaneous dissection of the coronary arteries]. / Disección espontánea de las arterias coronarias.

We describe a 31 years old female who suffered an spontaneous dissection of the left main coronary trunk. She presented with an acute hemorrhagic myocardial infarction complicated with bifascicular block and fatal left ventricular failure. Pathological features demonstrated severe proximal left coronary artery intimal dissection and extensive hemorrhagic infarction of the left ventricle, as well as absence of atherosclerotic aortic or coronary artery disease. The severity of the clinical picture and relentless deterioration of the patient precluded the utilization of coronary arteriography to assess an emergency surgical procedure. Early and vigorous management including emergency coronary angiography, balloon counterpulsation and surgical treatment are stressed and should be carefully weighted in similar cases.

Diseccion espontanea de las arterias coronarias. / Spontaneous dissection of the coronary arteries

Se presenta el caso de una mujer de 31 anos de edad que presento una diseccon espontanea del tronco principal de la arteria coronaria izquierda y sus ramas principales, la que se manifesto por un cuadro de infarto agudo del miocardio de localizacion anterolateral, complicado con bloqueo bifascicular, angor persistente e insuficiente ventricular izquierda que lo llevaron a la muerte. Describimos los hallazgos anatomopatologicos que muestran la presencia de la diseccion de las arterias coronarias y el infarto hemorragico, asi como la ausencia de lesiones aterosclerosas a nivel coronario y aortico. Son pocas las publicaciones de casos de diseccion coronaria y menos aun abarcando el tronco principal, que al igual que el infarto peripartum constituye un problema particular y complejo de la cardiopatia isquemica aun no resuelto

[Coronary fistula of the left ventricle. Report of a case treated surgically]. / Fístula coronaria al ventrículo izquierdo Reporte de un caso tratado quirúrgicamente

A case of a left coronary artery fistula to the left ventricle successfully by surgery treated is reported. The medical literature was reviewed, and it is concluded that because of the surgical low mortality rate, all cases of coronary fistula, diagnosed by angiography and cardiac catheterization, ought to be submitted to surgical treatment.