[A solitary intracardiac metastasis in the left atrium from a pulmonary carcinoma]. / Metástasis intracardíaca solitaria en la aurícula izquierda por un carcinoma pulmonar.

Cardiac metastases are the most common cause of neoplastic disease of the heart. Usually the metastases involve the pericardium and/or myocardium but rarely they form intracavitary masses. We report a patient with a lung cancer and solitary left atrial intracardiac metastases. General features of cardiac metastases and the differential diagnosis of left intra-atrial masses are discussed.

[Dysfunction in a Hancock mitral valve bioprosthesis caused by thrombosis and resolved with heparin]. / Disfunción por trombosis en bioprótesis de Hancock mitral resuelta con heparina.

Thrombotic malfunction is a rare and shortly documented complication of cardiac bioprostheses. Surgical treatment is usually needed. We report a patient with thrombotic occlusion of a Hancock mitral prosthesis which was resolved with heparin. Clinical and therapeutic features are discussed. To our knowledge, this is the first case of a bioprosthetic thrombotic obstruction successfully managed with heparin therapy.

Comparison of Doppler-determined elevated pulmonary arterial pressure with pressure measured at cardiac catheterization.

This study assesses use of pulsed Doppler echocardiography to measure pulmonary artery (PA) pressure. PA flow at the right ventricular (RV) outflow tract was analyzed in 51 patients. Attention was focused on PA flow morphologic pattern, RV systolic intervals, time to peak flow and acceleration time index. Correlation was made with PA pressure and total pulmonary resistance. Three morphologic patterns of PA flow were found: type I indicates normal PA pressure (sensitivity 85%, specificity 100%) and types II and III indicate PA hypertension (sensitivity 100%, specificity 85%). The RV preejection/RV ejection ratio, time to peak flow and acceleration time index show a good correlation coefficient improved when a logarithmic function was applied. The best correlation was achieved with time to peak flow (r = -0.77 with PA pressure, r = -0.79 with total pulmonary resistance), and especially with acceleration time index (r = -0.84 with PA pressure, r = -0.87 with total pulmonary resistance). Analysis of pulmonary flow is a reliable new tool for evaluating PA pressure and is even better for evaluating total pulmonary resistance. Acceleration time index is the parameter that correlates best with these 2 variables.