Aortic valve tethering: embryonic remnant of a common origin?

A 14-year-old asymptomatic girl without relevant medical history was referred to our department for heart murmur evaluation. The echocardiogram showed cardiac chambers with normal size and function. Noteworthy was the presence of an apparently fibrous tissue joining the ventricular surfaces of the aortic non-coronary and right coronary leaflets with the anterior mitral leaflet. Both valves were slightly thickened and there was a mild anterior mitral valve 'billowing' causing an eccentric mild-to-moderate regurgitant jet. During systole, tethering of this tissue caused the incomplete opening of both mentioned aortic leaflets, causing a turbulent flow with no significant gradient across the valve. During diastole, moderate eccentric aortic regurgitation jet was noted, probably related to incomplete coaptation at the insertion point of this anomalous tissue. We speculate that this finding may represent the remnant of some tissue during heart development that abnormally persisted in this young lady.

[Acute coronary syndrome and cocaine]. / Síndrome coronario agudo y cocaína.

BACKGROUND AND OBJECTIVES: Cocaine is directly related to the occurrence of acute coronary syndromes (ACS). We analyzed the differential characteristics of consumers who suffer an ACS in our environment. MATERIAL AND METHODS: A retrospective study of 914 patients with ACS who entered consecutively to our hospital. RESULTS: Thirty four patients were consumers (3.7%, CI95%: 2.7-5.2), with an average age of 40.1+/-9.1 years, significantly lower than non-consumers (63.6+/-12.15 years, P<.001). The prevalence increased progressively in younger groups. Most were men (82.4%), with higher consumption of tobacco (88.2% vs. 34.2%, P<.001) and other illegal drugs (35.3% vs 0.9%, P<.001). By contrast, they had less frequently hypertension (26.5 vs. 60.5%, P<.001) or diabetes (11.7 vs. 39.8%, P<.001). There was single vessel disease in 44.1%, and a coronary angiography without significant lesions in 20.6% cases. CONCLUSIONS: The typical patient with ACS who consumes cocaine is usually a young man, who often takes other drugs and with a lower prevalence of classic risk factors. These data have to be taken into account when considering preventive and therapeutic manoeuvres.

[Diagnostic usefulness of N-terminal brain natriuretic peptide in patients admitted to a cardiology service]. / Utilidad diagnóstica del fragmento N-terminal del propéptido natriurético cerebral en los pacientes ingresados en un servicio de cardiología.

BACKGROUND AND OBJECTIVE: The N-terminal brain natriuretic peptide (NT-proBNP) is a new tool for the diagnosis of patients with evidence of heart failure (HF). The diagnosis of HF is improbable in patients with a level of NT-proBNP<300 pg/ml. Our objective is to determine the validity of the cut-off points proposed by literature (inclusion/exclusion) regarding the age for NT-proBNP in patients admitted to our service. PATIENTS AND METHOD: We gathered consecutively the data of 76 patients admitted to our service with the diagnosis of HF (n=37) and with other diseases (n=39), taking a sample of plasma to determine NT-proBNP. We studied the sensitivity, specificity and predictive values of this test, as well as the relation between the levels of that marker and the clinical and echocardiographic variables. RESULTS: The ventricular diameter was larger and the ejection fraction was lower in patients with HF. Sensitivity for the diagnosis of exclusion reached a value of 97% and the negative predictive value was 94%. CONCLUSIONS: The cut-off point proposed for exclusion (300 pg/ml) shows high sensitivity and negative predictive value in the diagnosis of HF in patients admitted to our service.

Utilidad diagnóstica del fragmento N-terminal del propéptido natriurético cerebral en los pacientes ingresados en un servicio de cardiología / Diagnostic usefulness of N-terminal brain natriuretic peptide in patients admitted to a cardiology service

FUNDAMENTO Y OBJETIVO: El fragmento N-terminaldel propéptido natriurético cerebral o tipo B (NTproBNP)se utiliza para el diagnóstico de pacientescon sospecha de insuficiencia cardíaca (IC). Los valoresde NT-proBNP inferiores a 300 pg/ml indicanun diagnóstico improbable de IC. Nuestro objetivoha sido determinar la validez de los puntos de cortedel NT-proBNP según la edad, propuestos en la bibliografíamédica (inclusión/exclusión), en los pacientesingresados en nuestro servicio.PACIENTES Y MÉTODO: Hemos recogido de formaprospectiva los datos de 90 pacientes que ingresaronen nuestro servicio con diagnóstico de IC (n= 37) y de otras enfermedades (n = 39), y en quienesse determinó la concentración de NT-proBNP.Se estudiaron la sensibilidad, la especificidad y losvalores predictivos de este análisis, así como la relaciónde los valores de dicho marcador con las variablesclínicas y ecocardiográficas.RESULTADOS: En los pacientes con IC el diámetroventricular era mayor y la fracción de eyección,menor. La sensibilidad para el diagnóstico de exclusiónfue del 97% y el valor predictivo negativo,del 94%.CONCLUSIONES: El punto de corte de exclusión propuesto(300 pg/ml) posee una alta sensibilidad yvalor predictivo negativo para el diagnóstico de ICen los pacientes ingresados en nuestro servicio

BACKGROUND AND OBJECTIVE: The N-terminal brainnatriuretic peptide (NT-proBNP) is a new tool forthe diagnosis of patients with evidence of heart failure(HF). The diagnosis of HF is improbable in patientswith a level of NT-proBNP < 300 pg/ml. Ourobjective is to determine the validity of the cut-offpoints proposed by literature (inclusion/exclusion)regarding the age for NT-proBNP in patients admittedto our service.PATIENTS AND METHOD: We gathered consecutivelythe data of 76 patients admitted to our service withthe diagnosis of HF (n = 37) and with other diseases(n = 39), taking a sample of plasma to determineNT-proBNP. We studied the sensitivity, specificityand predictive values of this test, as well as the relationbetween the levels of that marker and the clinicaland echocardiographic variables.RESULTS: The ventricular diameter was larger andthe ejection fraction was lower in patients with HF.Sensitivity for the diagnosis of exclusion reached avalue of 97% and the negative predictive value was94%.CONCLUSIONS: The cut-off point proposed for exclusion(300 pg/ml) shows high sensitivity and negativepredictive value in the diagnosis of HF in patientsadmitted to our service