[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.

[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