[Echocardiographic indicators of electric cardioversion in patients with atrial fibrillation]. / Indicadores ecocardiográficos de cardioversión eléctrica en pacientes con fibrilación auricular.

We studied 80 patients to evaluate the safety of the transesophageal echocardiography (TEE) as a guidance to identify spontaneous echo contrast or atrial thrombosis in patients with atrial fibrillation (AF). 34 out of these patients were men and 46 women, with a mean age of 61 +/- 12 years. Five were not candidates due to the presence of risk factors. 75 patients have undergone electric cardioversion. The duration of AF was < 2 weeks in 61 > or = 2 and < 6 weeks 13, and > or = 6 weeks and < 1 year 6; 24 patients received previous anticoagulant therapy. The echocardiographic findings revealed left atrial dimension 45 +/- 8.4 mm ejection fraction of left ventricle 61 +/- 7.5%, SEC absent in the left atrium of 35, mild in 40 and severe in 5 patients, flow in left atrial appendage in 78 patients, thrombi in 2. EC was performed with 200 Joules in all patients and it was successful in 74. The study lasted 8.7 +/- 5.7 months; 11 patients were recurrent. The predictors were: left atrial dimension > 50 mm (p > 0.05), > 2 EC performed (p = 0.02), > 200 Joules (p = 0.05) and in patients with AF < or = 2 weeks. We concluded that the TEE is beneficial to detect risk factors in patients with AF, and it helps when deciding to perform the EC early and safely without previous anticoagulation.

[Medical-surgical management of left heart valve prosthesis dysfunction due to obstruction. Eleven year's experience]. / Manejo médico-quirúrgico en la disfunción de prótesis valvular mecánica cardiaca izquierda por obstrucción. Once años de experiencia.

UNLABELLED: We report the surgical-medical experience in left side mechanic prosthesis cardiac valve dysfunction. From January 1986 to June 1997 we included 108 consecutive patients (pts), 24 were men and 84 women, mean age 45 years, they underwent 114 surgical procedures, 104 in mitral and 10 in aortic position. RESULTS: The dysfunction was due to obstruction in fixed disc in 107 pts and intermitent in 7 pts. The pathological findings were thrombosis in 92 pts, pannus in 9 pts and both in 13 pts. The time interval between valve replacement and dysfunction was from 1 to 247 months, mean 53.8 +/- 56.7. Seventy five percent of patients received inadequate anticoagulant therapy, the mean INR was 2.06 +/- 0.79. In 76% of patients the functional class was III or IV NYHA. The diagnosis was made by clinical and echocardiographic findings in 96% of patients. The surgical procedures included valve replacement in 103, and toilette in 11 pts. The time of extracorporeal circulation in patients who died us survival patients were (159.9 +/- 108.95 vs 87.32 +/- 27.53 min) and aortic cross-clamp (64.8 +/- 20.69 vs 48.28 +/- 23.71 min) respectively (p < 0.001). The overall mortality was 12 pts (10.5%), all in functional class III or IV NYHA (p < 0.05), five patients died during surgical procedure. In conclusion the diagnosis must be established clinically as well as by echocardiography. The risk factors associated with mortality were pulmonary edema, shock, delayed surgery, surgical time prolonged and functional class III or IV NYHA.

[Preoperative evaluation of severe aortic stenosis by Doppler echocardiography and hemodynamics]. / Valoracíon preoperatoria de la estenosis aórtica grave por ecocardiografía-Doppler y hemodinámica.

UNLABELLED: Several diagnostic tools have been used in the evaluation of the severity transvalvular gradient and aortic valve area. The advances in cardiac catheterization and Doppler echocardiographic measure these items accurately. We designed a retrospective, observational open and transversal survey that included patients with severe aortic stenosis that required transseptal cardiac catheterization. Their echocardiographic and hemodynamic studies were reviewed. From January 1991 to December 1996 we studied 30 patient from a population of 256. All of them with severe aortic stenosis. There were 17 males and 13 females with an age range from 32 a 71 years. RESULTS: the transvalvular gradient measured by catheterization vs. Doppler echocardiogram was 98.80 +/- 37.29 mmHg vs. 96.63 +/- 38.64 mmHg respectively P = 0.84. The valvular area measured by catheterization vs Doppler echocardiographic 0.63 +/- 0.17 cm2 vs 0.62 +/- 0.15 cm2 respectively P = 0.63. There was not difference in the gradients using these two methods. We conclude that patients with severe aortic stenosis could be referred to surgical procedure without the need of cardiac catheterization if no concurrent coronary disease is suspected.

[Ruptured aneurysm of the sinus of Valsalva. Presentation of 4 cases and review of the literature]. / Aneurisma roto del seno de Valsalva. Presentación de cuatro casos y revisión de la literatura.

We studied four patients with ruptured aneurysms of the sinus of Valsalva. All were men with a mean age of 33 years. The presenting illness was insidious in three and of abrupt onset in one. Physical examination showed a continuous murmur in all. Chest X ray film showed moderate cardiomegaly. Electrocardiogram disclosed left ventricular hypertrophy. Echocardiogram revealed the site of the rupture which was corroborated by aortography. Two aneurysms ruptured to the right ventricle and two to the right atrium. All were corrected by surgery. All patients became asymptomatic.