[Should we try to determine the specific cause of cardiac tamponade?]. / 'Debemos pensar en una etiología específica en pacientes con taponamiento cardíaco?

INTRODUCTION: The causes of cardiac tamponade vary and it has been suggested that underlying causes should be sought in all cases. The purpose of this study was to determine the causes of cardiac tamponade in our environment, distinguishing between specific and idiopathic causes, and analyzing the proportion and causes in the subgroup of patients with relapsing tamponade. PATIENTS AND METHOD: We retrospectively studied all patients who underwent therapeutic pericardiocentesis between 1985 and 2001. The clinical and radiographic features and macroscopic characteristics of the pericardial fluid were analyzed. The final diagnosis in each patient was based on the clinical history, follow-up, pericardial fluid cytology, and pericardial biopsy, if available. RESULTS: Ninety-six patients were included (52 men/44 women), mean age 56.1 16.1 years. The cause of pericardial effusion was neoplasm in 50 patients (52.1%), 14 idiopathic pericarditis (14.6%), 12 renal failure (12.5%), 7 iatrogenic cases (7.3%), 4 mechanical tamponades (4.2%), 2 tuberculosis (2.1%), and 7 other causes (7.3%). Thirty-five patients had relapsing tamponade; only 2 of them had idiopathic pericarditis (5.7%). We found no significant differences in age, development time, extracted volume or fluid features between tamponade of specific or idiopathic origin. CONCLUSIONS: Most of the cardiac tamponades in our series had a specific cause. This made it necessary to identify a specific underlying cause in each case, especially in relapsing effusions. However, we did not find any variable suggestive of the cause of the disease.

[Percutaneous transluminal angioplasty in patients with subclavian stenosis and internal mammary grafts]. / Angioplastia transluminal percutánea en pacientes con estenosis de la arteria subclavia e injertos de arteria mamaria.

Subclavian artery stenosis is an uncommon cause of myocardial ischaemia in patients with internal mammary artery grafts. Coronary subclavian steal and impaired flow through the graft are the two mechanisms implied. We report 2 patients with mammary artery grafts in whom reappraisal of anginal symptoms was related to the presence of proximal subclavian stenoses located just before the origin of the mammary artery grafts. Both patients were successfully treated by percutaneous angioplasty and stent implantation.