[Asymptomatic aortic valve stenosis and sudden death]. / Estenosis aórtica asintomática y muerte súbita.

Dyspnea, angor and syncope are the most characteristic symptoms in stenosis aortic valve disease. Sudden death, as part of natural history of symptomatic stenosis aortic valve, is well know. On the other hand, sudden death in asymptomatic stenosis aortic valve is rarer. Different guidelines recommend a conservative management of these patients. We present here the case of a 58 year old woman, previously healthy, who arrived at Hospital because of sudden dyspnea at rest. The patient was diagnosed of pulmonary edema and died two hours later. Necropsy showed a stenosis aortica valve with a valve area of less than 0.8 cm2. We make a short review in medical literature about the incidence of sudden death in asymptomatic stenosis aortic valve, the risk groups and their management.

[Diagnose and predict utility of transcranial Doppler in the serious cerebral anoxia]. / Utilidad diagnóstica y pronóstica del Doppler transcraneal en los casos de anoxia cerebral grave.

INTRODUCTION: In the clinical daily practice, exist multiple situations in which could produce phenomenons of serious hypoxia to encephalic level, normally with important repercussions for the patient. OBJECTIVES: Study if after the existence of a situation of serious encephalic hypoxia, any typical pattern in the exploration transcranial Doppler (TCD) exists, and the possible diagnostic and/or prognostic implications could bear. PATIENTS AND METHODS: We presented 10 patients admitted in our Unit of Intensive Care, for clinical situations in which a situation of encephalic hypoxia took place and to which was practiced a TCD like exploration of encephalic flow. We related the discoveries of the DTC, with the clinical situation, the images of the cerebral computed tomography in three of the patients, and the data of the electroencephalogram in the other seven. Like statistical tool, is used the test of square ji, demanding a confidence interval of the 95%. RESULTS: In all the patients, we found a patron TCD, of high speed mean with low Pulsatility Index. Nine patients died, surviving with serious sequels the last patient. CONCLUSIONS: In our series, we could conclude, that the existence of a patron TCD with high speed mean and with low Pulsatility Index, after an episode of brain hypoxia, its associated to a wrong presage, existing a high risk of death of the patient.