Mitral valve prolapse and sudden deafness.

To examine the association between MVP and Idiopathic Sudden Sensorineural Hearing loss (ISSNHL). 349 subjects, 86 with ISSNHL and 263 controls underwent a 2D-echocardiography. Patients with ISSNHL had higher rates of MVP (29.1% vs 2.7%, p<0.001), mitral leaflet thickening (15.1% vs 2.3%, p<0.001), mitral regurgitation (16.3% vs 6.5%, p=0.02) and left atrial enlargement (11.6% vs 3.8%, p=0.01). Our results support the hypothesis that MVP could be one of the etiological factors of ISSNHL.

[Pseudoaneurysm as a complication of the reconstruction of the ascending aorta using valved graft: periannular dehiscence simulating severe aortic insufficiency]. / Seudoaneurisma como complicación de la reconstrucción de aorta ascendente mediante injerto valvulado: dehiscencia perianular simulando una insuficiencia aórtica severa.

The development of a pseudoaneurysms of the ascending aorta is a potential complication after composite grafts surgery for combined disorders that simultaneously affect the aortic valve and ascending aorta. Pseudoaneurysm has been reported to range from 7% to 25% of cases, and it is due to dehiscence of the suture line at anastomosis. Clinical spectrum, which depends on the location of this dehiscence varies from the totally asymptomatic patient to one with NYHA class IV heart failure, with the possibility of its clinical status rapidly worsening. We report a case of progressive haemodynamic deterioration as a consequence of a peri-annular dehiscence that led to a significant regurgitant volume from the pseudoaneurysm cavity to the left ventricle mimicking a severe aortic insufficiency. The role of echocardiography is reviewed in the diagnosis and the management of complications, as well as the necessary follow up of patients with composite aortic grafts.

[A right atrial thrombus in transit: its echocardiographic diagnosis 72 hours before a pulmonary embolism]. / Trombo en tránsito en aurícula derecha: diagnóstico ecocardiográfico 72 horas antes de un embolismo pulmonar.

We report a case of a 72-year-old woman with coronary artery disease in whom a thrombus in transit in the right atrium was diagnosed accidentally. After 72 hours of treatment with intravenous anticoagulants she developed a pulmonary thromboembolism resolved with systemic fibrinolysis. This is a rare case in which such a diagnosis preceded an embolic event. This fact raises the controversy about the best therapeutic management of this unusual form of thromboembolic illness.

[Aortic coarctation: different anatomo-clinical forms depending on the age of presentation]. / Coartación de aorta: diferentes formas anatomoclínicas según la edad de presentación.

OBJECTIVE: To analyse the anatomo-clinical characteristics of the coarctation of the aorta at different ages of presentation as well as the findings and results of its surgical correction at different periods. PATIENTS AND METHODS: We retrospectively studied the clinical and angiographic data, as well as the intraoperative findings and surgical outcomes of 82 consecutive patients (54 M and 28 F) with coarctation of the aorta. Mean age was 16.2 +/- 13.7 years (1 month to 63 years). The patients were divided into three groups according to age: Group A (n = 10) under 1 year; Group B (n = 30) from 1 to 12 years and Group C (n = 42) over 12 years. RESULTS: A preductal form was found in 20.7% cases (50.0%, 30.0% and 7.1% of groups A, B, and C respectively; p = 0.003). An associated left-to-right shunt was present in 19.5% (40.0%, 16.7% and 16.7% of groups A, B and C respectively; p = NS). The first manifestation of the disease was different in groups A, B and C. Among group A patients, congestive heart failure was the most frequent presentation (70.0%). In group B, the most frequent presentation (30%) was as an incidental finding in an asymptomatic patient. Finally, systemic hypertension or its complications predominated among group C patients (38.0%). Left ventricular hypertrophy on ECG was present in 0.0%, 30.0% and 54.7% of patients in groups A, B and C (p = 0.003) respectively. Postoperative complications including death, hypertensive crisis and re-coarctation were observed in 90.0%, 33.3% and 21.4% in groups A, B and C (p = 0.01) respectively. CONCLUSIONS: Among patients with coarctation of the aorta, the age of clinical presentation allows us to define groups of patients with different anatomical characteristics, clinical course and postoperative outcome.