Influence of the size of aortic valve prostheses on hemodynamics and change in left ventricular mass: implications for the surgical management of aortic stenosis.

UNLABELLED: Discussion of aortic valve replacement has primarily concerned the choice between tissue and mechanical prostheses. Less emphasis has been placed on prosthesis size. Despite technical advances increasing prosthesis orifice area, small valves implanted in the unenlarged aortic root may not be significantly less obstructive than the stenotic native valves they replace. METHODS: In this work we studied 52 patients (31 women, 21 men; mean age 59.2 years) in whom valve prostheses sized 19, 21, 23, or 25 mm (30 bioprostheses and 22 tilting disc valves) had been implanted to replace stenotic aortic valves. Most patients with 19 or 21 mm prostheses were women. Doppler and conventional echocardiographic studies were performed in the 10 days preceding the operation and between 10 and 40 months (mean 18 months) after the operation. The patients receiving larger valve sizes had significantly larger body surface areas than those receiving smaller valve sizes (mainly women). RESULTS: No significant differences were observed between preoperative and postoperative diameters or left ventricular systolic function parameters, but left ventricular mass and mass index decreased in all four groups (albeit nonsignificantly in the 19 mm group, and with less statistical significance in the 21 mm group than in the 23 and 25 mm groups). Postoperative peak and mean transvalvular pressure drops were significantly greater in the 19 mm group than in the other groups, and the 21 mm group had significantly greater transvalvular pressure drops than the 25 mm group. Postoperative effective valve area was significantly smaller in the 19 mm group than in the 21 mm group, and significantly smaller in the 21 mm group than in the 23 and 25 mm groups. CONCLUSION: We conclude that despite undeniable recent improvements in the design of artificial heart valves, 19 mm aortic prostheses continue to create significant obstruction of the left ventricular outflow tract and, possibly as a consequence of this, fail to bring about significant reduction in left ventricular hypertrophy.

The influence of the design on the medium to long-term hemodynamic behavior of 19 mm pericardial aortic valve prostheses.

BACKGROUND AND AIMS OF THE STUDY: The hemodynamics of five designs of 19 mm pericardial aortic valve bioprosthesis were examined by Doppler echocardiography in 48 resting patients at medium or long term follow up. METHODS: The salient differences among the five designs are that valve leaflets are mounted inside the support frame in one (the Carpentier-Edwards valve, evaluated in five patients) and outside the frame in the other four (the Ionescu-Shiley (14 patients), Mitroflow (six patients), Bioflo (eight patients) and Labcor-Santiago (15 patients)); and that two models have either total (Bioflo) or partial (Labcor-Santiago) protective pericardial sheaths on the stent, while the other three do not. The hemodynamic parameters determined included transvalvular pressure drop, valve area, left ventricular outflow tract diameter, subvalvular/valvular velocity ratio and subvalvular/valvular velocity-time integral ratio. RESULTS: There were no significant differences among the various valves as regards left ventricular outflow tract diameter, subvalvular/valvular velocity ratio or subvalvular/valvular velocity-time integral ratio. Negative correlation between left ventricular outflow tract diameter and subvalvular velocity (r = -0.63, p < 0.001) confirmed the need to correct for prevalvular velocities when using the Bernoulli equation to calculate the pressure drop across small pericardial aortic valve bioprostheses. The Bioflo design caused significantly greater pressure drops (peak 49.6 +/- 11.3 mmHg, mean 28.1 +/- 6.1 mmHg) and provided smaller areas (0.80 +/- 0.16 cm2) than the Ionescu-Shiley (26.7 +/- 6.6 and 15.2 +/- 4.1 mmHg, 1.17 +/- 0.17 cm2) and Labcor-Santiago (24.8 +/- 5.9 and 15.1 +/- 3.7 mmHg, 1.24 +/- 0.12 cm2) valves. CONCLUSIONS: Of the currently available 19 mm bovine pericardium heart valve bioprostheses, the Mitroflow and Labcor-Santiago valves, in both of which the leaflets are mounted outside the stent, have better hemodynamics in the aortic position than the Carpentier-Edwards valve, which has internal leaflet mounting. Sheathing the stent totally in pericardium, as in the withdrawn Bioflo valve, gives rise to relatively poor hemodynamics.

Hemodynamics of various designs of 19 mm pericardial aortic valve bioprosthesis.

The hemodynamics of five designs of 19 mm pericardial aortic valve bioprostheses were examined in 47 resting patients by Doppler echocardiography. The salient differences among the five designs are that valve leaflets are mounted inside the support frame in one (the Carpentier-Edwards valve, evaluated in 4 patients) and outside the frame in the other four (the Ionescu-Shiley (16 patients), Mitroflow (4), Bioflo (8) and Labcor-Santiago (15)); and that two models have either total (Bioflo) or partial (Labcor-Santiago) protective pericardial sheaths on the stent, while the other three do not. The hemodynamic parameters determined included transvalvular pressure drop, valve area, left ventricular outflow tract diameter, subvalvular/valvular velocity ratio and subvalvular/valvular velocity-time integral ratio. There were no significant differences among the various valves as regards left ventricular outflow tract diameter, subvalvular/valvular velocity ratio or subvalvular/valvular velocity-time integral ratio. Negative correlation between left ventricular outflow tract diameter and subvalvular velocity (r = -0.66, P < 0.001) confirmed the need to correct for prevalvular velocities when using the Bernouilli equation to calculate the pressure drop across small pericardial aortic valve bioprostheses. The Bioflo design caused significantly greater pressure drops (peak 38.3 +/- 8.3 mmHg, mean 24.6 +/- 4.8 mmHg) and smaller areas (0.82 +/- 0.17 cm2) than the Ionescu-Shiley (20.3 +/- 5.6 and 11.7 +/- 3.8 mmHg, 1.19 +/- 5.3 and 10.1 +/- 3.1 mmHg, 1.27 +/- 0.12 cm2) valves.

[Effect of verapamil and nitrendipine on the left ventricular mass and function (systolic and diastolic) in arterial hypertension]. / Efecto de verapamilo y nitrendipino sobre la masa y función (sistólica y diasólica) ventricular izquierda en la hipertensión arterial.

BACKGROUND: To evaluate the effect of two calcium antagonists (verapamil and nitrendipine) on the regression of left ventricular mass and function (systolic and diastolic) by echocardiography-Doppler, in not treated hypertensive subjects. METHODS: 31 hypertensive subjects were studied in a randomized, placebo controlled, prospective and double blind trial. Verapamil (120-240 mg/day) was administered in 16 and nitrendipine (10-20 mg/day) in 15. The active drug therapy phase was 12 months with rest and effort tensional evaluation. Echo-Doppler was performed in the placebo phase, 6 and 12 months, evaluating left ventricular structure (septal and posterior-wall thicknesses, diameters and mass) and function (systolic and diastolic). RESULTS: Tensional control at rest and under effort was similar with both drugs, heart rate decreased only with verapamil. Left ventricular mass index decreased with verapamil and nitrendipine, due to reduction in the wall thicknesses (with verapamil from 158.5 +/- 31 to 135.7 +/- 20 g/m2 and with nitrendipine from 167.3 +/- 26 to 146.9 +/- 21 g/m2, p < 0.05). Left ventricular systolic function was not modified during the follow-up with both drugs. Only in the verapamil group some left ventricular diastolic function parameters improved (E from 0.82 +/- 0.11 to 0.95 +/- 0.14 and E/A/Age from 0.013 +/- 0.005 to 0.017 +/- 0.005; p < 0.05). CONCLUSIONS: Verapamil and nitrendipine exerts a similar tensional control at rest and under effort and left ventricular mass regression. The improvement of some diastolic function parameters in the verapamil group was probably due to bradycardia.

[Supravalvular aortic stenosis and coronary aneurysm]. / Estenosis aórtica supravalvular y aneurisma coronario.

A 32-year old woman, with endocarditis caused by Streptococcus mitis, and systolic murmur is presented. The Doppler examination was found a systolic gradient of 150 mmHg. Aortography showed a multiple membranous supravalvular aortic stenosis, with aneurysmal dilatation of the left main coronary artery and circumflex artery, associated with bicuspid aortic valve and mild aortic insufficiency. The patient died suddenly by cardiac arrest in stand by to cardiac surgery. Anatomic comprobation was not possible. The coronary artery anomalies associated with the supravalvular aortic stenosis syndrome are reviewed.

[Left ventricular structure and (systolic and diastolic) function in hypertensive patients without atherosclerotic coronaropathy]. / Estructura y función (sistólica y diastólica) ventricular izquierda en hipertensos sin coronariopatía aterosclerosa.

INTRODUCTION AND OBJECTIVES: Electrocardiographic (ECG) ST-T segment abnormalities in hypertensive patients are traditionally associated with hypertrophy and/or ischaemia and a higher cardiovascular risk. Hypertensive patients with typical or non-typical chest discomfort and a normal coronarographic study underwent an echocardiographic and Doppler study in order to assess left ventricular structure and (systolic and diastolic) function. MATERIAL AND METHODS: Hypertensive patients with ST-T changes were classified as follows: Control group (CG) was made up of 12 hypertensive patients (6 women, 6 men, mean age 59.6 +/- 7.4 years) with normal ECG; Group A (GA), 10 patients (6 women, 4 men, mean age 63.1 +/- 6.8 years) with ECG image of strain; Group B (GB) (9 women and 8 men, mean age 61.3 +/- 10.1 years) with other ST-T alterations. We assessed by echocardiographic and transmitral flow Doppler study left ventricular structure and (systolic and diastolic) function. RESULTS: Interventricular septum thickness, left ventricular posterior wall thickness, left ventricular mass and mass index were significantly higher in the GA and GB than in the CG, without differences between GA and GB groups. No differences in left ventricular systolic function parameters were observed between the groups. In comparison with the CG, the GA and GB showed significant differences in E wave deceleration velocity and deceleration time, A wave deceleration time and isovolumetric relaxation time. Between GA and GB differences were observed in A wave deceleration time and isovolumetric relaxation time. CONCLUSIONS: In hypertensive patients without atherosclerotic coronaropathy, ST-T changes identify a group with greater left ventricular mass and worse left ventricular diastolic function. The patients with a ST-T strain pattern showed the impaired diastolic function.

[Acute myocardial infarction in cocaine addicts]. / Infarto agudo de miocardio en adictos a la cocaína.

The cases of 4 young patients (3 males, 1 female) addicts to cocaine with acute myocardial infarction is reported. In the first case, in a 28 year-old woman was found a multisystemic disorder with anterolateral myocardial infarction, acute renal failure, rhabdomyolysis and death. In the necropsy examination no atherosclerotic coronary lesions were found. In other two cases, was carried out coronary angiography, who revealed in one case normal angiographically coronary arteries, and in the other case, a 80% coronary narrowing in the proximal segment of the infarct-related coronary artery. We reviewed the cocaine-induced heart disease, and the pathophysiology of the acute myocardial infarction related to cocaine use.

[Activity of leukocyte elastase in coronary disease diagnosed by coronarography]. / Actividad de la elastasa leucocitaria en la enfermedad arterial coronaria determinada por coronariografía.

OBJECTIVE: To evaluate the clinical usefulness of leukocyte elastase concentration for diagnosis of coronary artery disease. BACKGROUND: Recent research has shown the important role elastase, a proteolytic enzyme released by neutrophils, in the pathogenesis of coronary atherosclerotic disease. METHODS: 95 patients underwent coronary angiography during investigation of chest pain and/or heart valve disease; 38 had normal coronary arteriograms (Group I) and 57 had coronary lesions (Group II). The patients were characterized as regards presence or absence of stable or unstable angina, family history of coronary artery disease, smoking, diabetes mellitus, hypertension, leukocyte counts, plasma lipid and elastase concentrations. Among Group II patients, those with simple atheromatous plaques were distinguished from those with complex plaques. RESULTS: Elastase concentrations were greater in the Group II than in the Group I (41 +/- 21 vs 27 +/- 14 micrograms/L) (p < 0.001), and greater among complex plaque patients than among simple plaque patients (53 +/- 27 vs 33 +/- 12 micrograms/L) (p < 0.001). Logistic regression analysis showed than elastase concentration, angina, age and sex had independent value for prediction of coronary artery disease and that the risk increased by 7% for every 1 microgram/L increase in elastase concentration. Among Group II patients, the risk of complex plaque was greatest for those with unstable angina and high elastase concentration, increasing by 6% for every 1 microgram/L increase in elastase concentration. CONCLUSIONS: Peripheral blood leukocyte elastase concentration is a sensitive diagnostic marker of coronary artery disease. High values suggest the presence of complex atheromatous plaques.

[Congenital anomalies of the origin of the coronary arteries. The diagnostic and therapeutic aspects]. / Anomalías congénitas del origen de las arterias coronarias. Aspectos diagnósticos y terapéuticos.

We report 5 cases of congenital coronary artery anomalies. Two involving the right coronary artery arise from the left sinus of Valsalva, two of the circumflex artery arise from the right sinus of Valsalva and a patient with the left coronary artery arise from the right coronary ostium and passes obliquely posteriorly behind the right ventricular outflow tract and the aorta suffering an acute myocardial infarction and coronary artery by-pass surgery was performed in the acute phase.

[Electrocardiographic patterns in hypertensive patients without atherosclerotic coronary disease. Influence of the left ventricular mass]. / Patrones electrocardiográficos en hipertensos sin coronariopatía aterosclerosa. Influencia de la masa ventricular izquierda.

BACKGROUND: ECG ST-T segment abnormalities in hypertensive patients are traditionally associated with hypertrophy or ischaemia. Hypertensive patients with abnormalities in ST-T segment in DI, aVL and/or V5-V6 underwent an echocardiographic study in order to assess left ventricular structure. All of them, in addition to the electric changes, showed typical or non-typical thoracic discomfort, showing a normal coronariographic study. METHODS: Hypertensive patients with ST-T segment changes were classified as follows: group A, 12 patients (8 women, 4 men, mean age 63.6 +/- 7.2 years) with ECG image of left ventricular overload pattern; group B, 9 patients (3 men, 6 women, mean age 62.3 +/- 6.3 years) with flat ST segment depression; and group C, 10 patients (3 men, 7 women, mean age 62.4 +/- 9.7 years) without changes on the ST-T segment with flat or negative T wave. Control group is made up 12 hypertensive patients (7 women, 5 men, mean age 61.6 +/- 7.6 years) with normal ECG. We assess by echocardiography interventricular septal thickness (IVST) and left ventricular posterior wall thickness (PWT) in mm, left ventricular end-diastolic diameter (DTD) in mm, left ventricular mass (LVM) in grs, and the mass index (MI) in g/m2. RESULTS: IVST, PWT, LVM and MI were significantly (p < 0.05) higher in the groups A, B and C than in the control group. No statistically significant differences were observed between the A, B and C groups. Stepwise discriminant analysis showed that the only parameter with independent value for discriminating between control, group and group ABC (the union of groups A, B and C) was IVST. CONCLUSION: In hypertensive patients without coronariopathy, ST-T changes identify a group with greater left ventricular mass. The different electrocardiographic patterns considered were not associated with a significantly different left ventricular mass.

[Regression of left ventricular mass in arterial hypertension. Efficacy of 3 different treatment protocols]. / Regresión de la masa ventricular izquierda en la hipertensión arterial. Eficacia de tres diferentes pautas de tratamiento.

BACKGROUND: To evaluate the antihypertensive efficacy, at rest and under exercise, in patients treated with three different antihypertensive drugs and the modifications induced on the left ventricular mass. METHODS: Fifty hypertensive males, mean age 51 years, 15 received 50 mg/day of chlorthalidone, 20 atenolol (100 mg/day) and 15 enalapril (20-40 mg/day). Baseline pressure control and echocardiogram, and 3, 6 and 9 months after starting therapy were performed. Thickness of the interventricular septum and posterior left ventricular wall in mm, left ventricular mass index in g/m2 were determined. RESULTS: The baseline septum in the diuretic group was 15 +/- 3 mm and 14 +/- 3 mm at 9 months, in the atenolol group was 16 +/- 3 mm and 12 +/- 2 mm (p less than 0.001), and in the enalapril group 15 +/- 2 mm and 12 +/- 3 mm (p less than 0.01). The posterior wall was 14 +/- 3 mm and 13 +/- 2 mm in the diuretic group, in the atenolol group 15 +/- 2 mm and 12 +/- 2 mm (p less than 0.001) and in the enalapril group 15 +/- 2 mm and 12 +/- 3 mm (p less than 0.01). The left ventricular mass index was in he diuretic group 153 +/- 45 g/m2 and 146 +/- 36 g/m2, in the atenolol group 167 +/- 34 g/m2 and 128 +/- 24 g/m2 (p less than 0.001) and in the enalapril group 156 +/- 36 g/m2 and 131 +/- 26 g/m2 (p less than 0.05). CONCLUSIONS: The antihypertensive efficacy at rest was similar with the three drugs, being under exercise superior atenolol and enalapril. Only atenolol and enalapril induced regression of left ventricular mass.

[Influence of systemic arterial hypertension on mid-term survival of patients with acute myocardial infarction treated with fibrinolytic agents]. / Influencia de la hipertensión arterial sistémica en la supervivencia a medio plazo de los pacientes con infarto agudo de miocardio que han recibido tratamiento fibrinolítico.

BACKGROUND: The purpose of this study to asses the effect of systemic arterial hypertension on mid-term survival of patients with acute myocardial infarction who received thrombolytic treatment. PATIENTS AND METHOD: We studied 202 consecutive patients with acute myocardial infarction, admitted in the Coronary Care Unit of the Hospital Xeral de Galicia who received intravenous thrombolytic therapy within six hours from the onset of symptoms. The thrombolytics used were: urokinase (79.7%), rt-PA (9.9%), streptokinase (4.9%) and APSAC (5.5%). Left heart catheterization with coronary angiography was performed in 162 patients at 2 weeks after infarction. Patency of the infarction-related artery (IRA) was classified according to Thrombolysis in Myocardial Infarction (TIMI) criteria. A patent artery weas defined as having TIMI grades 2 or 3 antegrade flow. RESULTS: Systemic arterial hypertension was found in 34.7% of patients. IRA patency (TIMI 2-3) was demonstrated in the 75.3% of the patients. Early mortality (first month) was 5.4%. Multivariate analysis identified cardiogenic shock as the only variable with independent predictive value for early mortality. Mean follow-up was for 24 +/- 19 months. Late mortality was 5.2% and cardiac death occurred in 4.2% of patients. Reinfarction occurred in 3.1% of patients. Congestive heart failure, arterial hypertension and reinfarction adversely affected prognosis. Actuarial survival at the end of follow-up period was significantly lower in patients with systemic arterial hypertension (70.4% vs 85.9%; p < 0.05). CONCLUSIONS: These data suggest that systemic arterial hypertension adversely affects mid-term prognosis in patients with acute myocardial infarction who received thrombolytic treatment.

[Temporal electric stimulation and right ventricular extension in acute postero-inferior myocardial infarction. Influence on clinical characteristics and prognosis]. / Estimulación eléctrica temporal y extensión ventricular derecha en el infarto agudo de miocardio postero-inferior. Influencia sobre las características clínicas y el pronóstico.

In 386 patients with acute inferior myocardial infarction (AIMI) who were admitted to our institution from 1984 to 1990, temporary pacemaker (TP) was required in 34 patients (9%) due to disturbances in the genesis and/or conduction of the electric stimulus (Group I). The remainder, 352 AIMI, conform the Group II. Each group was divided into groups depending on the presence (Groups Ia and IIa) or absence (Groups Ib and IIb) of right ventricular necrosis (ECG criteria: ST elevation greater than 0.1 mV in a V3r and V4R). Clinical data (cardiovascular risk factors, history of myocardial infarction or angina, CPK and CK-MB peak, Killip class, atrioventricular block and right ventricular infarction) and hospital mortality rate and its cause were analyzed. The Group I patients related to Group II had significantly higher diabetes rate (p less than 0.01), CPK and CK-MB peak (p less than 0.001), Killip class (p less than 0.001), right ventricular involvement and atrioventricular block (p less than 0.001), the mortality rate equally was statistically higher (Group I, 11 patients, 31%, versus group II, 38 patients, 11%) (p less than 0.001). The Group Ia patients related to Group Ib had a higher CPK and CK-MB peak (p less than 0.001), Killip class and atrioventricular block (p less than 0.001). The mortality rate was statistically equal. The group IIb patients related to Group IIb patients had a higher CPK and CK-MB peak (p less than 0.001), without differences in the mortality rates.(ABSTRACT TRUNCATED AT 250 WORDS)

[The midterm inefficacy of 2 different dosages of chlorthalidone (50 and 25 mg/day) in the regression of left ventricular mass in arterial hypertension]. / Ineficacia a medio plazo de dos diferentes dosificaciones de clortalidona (50 y 25 mg/día) en la regresión de la masa ventricular izquierda en la hipertensión arterial.

BACKGROUND: To evaluate the antihypertensive efficacy at rest and under exercise, and the modifications induced on the left ventricular mass in patients treated with two different doses of a diuretic. METHODS: Fifty hypertensive males, mean age 51 years, received during nine months 50 mg/day of chlortalidone and thirteen 25 mg/day for the next nine months. Baseline tension control and echocardiogram and each three months after starting therapy during the two phases of the study were performed. Thickness of the interventricular septum and posterior left ventricular wall in mm, left ventricular mass index in g/m2 were determined. RESULTS: The baseline septum was 15 +/- 3.3 mm, 14.6 +/- 3.1 mm at 9 months and 14.5 +/- 2.9 mm at 18 months, the posterior wall was 14.1 +/- 3.1 mm at baseline, 13.7 +/- 2.9 mm at 9 months and 13.6 +/- 2.9 mm at 18 months. The left ventricular mass index was 153 +/- 45 g/m2 at baseline, 146 +/- 36 g/m2 at 9 months and 144 +/- 39 g/m2 at 18 months. The antihypertensive efficacy at rest and under exertion was similar for the two doses of chlortalidone. CONCLUSIONS: After nine months of therapy the two doses of chlortalidone (50 and 25 mg/day) failed in reducing left ventricular mass. However, the design of the study and the small number of subjects enrolled introduce several important limitations to both the interpretation of our results and conclusions.

[Pericarditis in the acute phase of myocardial infarction: incidence and clinical significance]. / Pericarditis en la fase aguda del infarto de miocardio: incidencia y significado clínico.

STUDY OBJECTIVE: To evaluate the incidence and the clinical significance of pericarditis in the acute myocardial infarction. DESIGN: Retrospective study. SETTING: The Coronary Care Unit of a University Hospital. PATIENTS AND METHODS: We have studied 668 consecutive patients with their first acute myocardial infarction admitted at the Coronary Care Unit, Hospital General de Galicia, Santiago de Compostela, Spain, in the years 1983 to 1988. Pericarditis was defined as the presence of a pericardial friction rub on auscultation during the hospital course. Pericarditis was noted in 86 patients (12.8%), who were considered as group A. The remain 582 patients were considered as group B. Statistical analysis was carried out using the BMDP statistical package. MAIN RESULTS: Pericarditis occurred in 12.8% of the patients. Patients with, compared to those without, pericarditis had a lower age (59.0 +/- 12.4 years; p = .0005), and a higher percentage of males (86.1% versus 75.6%; p = .038), an a higher percentage of smokers (63.9% versus 48.6%; p = .01). The delay to the hospital admission was greater in group A (12.6 +/- 18.5 hours versus 8.0 +/- 11.7 hours; p = .0024). Pericarditis more often occurred in the setting of anterior wall myocardial infarction and in Q-wave infarct. The group A had a higher CPK peak (1877.5 +/- 1548.9 UI/L versus 1240.2 +/- 961.5 UI/I; p = .001) and a higher peak of CK-MB (213.7 +/- 134.7 UI/L versus 160.8 +/- 112.9 UI/L; p = .001). In-hospital mortality was significantly lower in group A (6.9% versus 17.2%; p = .016). The multivariate analysis by stepwise logistic regression identified the Q- wave myocardial infarct, the age, the delay to the hospital admission, the peak of MB creatine kinase and location of infarct as the only independent predictive variables for the pericarditis occurrence. CONCLUSIONS: We conclude that the pericarditis in the setting of Q-wave myocardial infarction, with anterior wall location, and is related to transmural extension of the myocardial necrosis.

[Pulmonary diffusion of carbon monoxide in patients with mitral stenosis]. / Estudio de la difusión pulmonar de monóxido de carbono en enfermos con estenosis mitral.

OBJECTIVE: The aim of our work has been the study of CO diffusion capacity in mitral valve stenosis patients. METHOD: We have studied 15 control subjects and 15 patients with mitral valve stenosis. We performed spirometry study and CO pulmonary diffusion tests (DLCO) by single breath method to determine two components: pulmonary capillary blood volume (Vc) and membrane diffusion factor (Dm). In addition, in mitral valve stenosis patients we performed a ecocardiography-doppler study. RESULTS: The mitral valve stenosis group had higher values of DLCO and Vc and a lower ratio of Dm/Vc than the control group. There is a negative correlation between Vc and the mitral valve area (r = -0.63; p = 0.037). We do not find any another correlation between the rest of ecocardiography doppler parameters and lung function test variables that we have measured. We have not found any differences between both groups in Dm. CONCLUSIONS: Mitral valve stenosis patients present a increase of CO pulmonary diffusion capacity and pulmonary capillary blood volume without changes in membrane diffusion factor.

[Two cases of massive pulmonary embolism associated with estrogen intake. Diagnostic and therapeutic usefulness of pulmonary angiography]. / Dos casos de embolismo pulmonar masivo relacionados con ingesta de estrógenos. Utilidad diagnóstica y terapéutica de la angiografía pulmonar.

Two cases of massive pulmonary embolism observed in patients under estrogen therapy, are presented. We describe the clinical findings, highlighting the value of the arteriography in the diagnosis and the use of fibrinolytic therapy, being successful in both cases.

[Dyslipemia in physicians. The need for a plan of primary prevention of atherosclerosis in our country]. / Dislipemia en médicos. Necesidad de un plan de prevención primaria de ateroesclerosis en nuestro medio.

A comparative study of the total cholesterol (TC) and its fractions was carried out in 3 groups of males. The first group consisted of (C) 53 healthy males (18 between 30-39 years old, 17 between 40-49 and 18 between 50-65); the second group (M) was of 57 male doctors (19 between 30-39 years old, 21 between 40-49, and 17 between 50-65); third group (E) was of 94 males with myocardial infarction (22 between 30-39 years old, 32 between 40-49, and 40 between 50-65). TC was significantly lower (p less than 0.02 and p less than 0.001) in both the lower ages ranges in Group E compared to Groups C and M in all age ranges. Group M showed significantly lower (p less than 0.001) in Group E compared to Groups C and M in all age ranges. Group M showed significantly lower HDL-C (p less than 0.01) and to group M in the lowest age range (p less than 0.005). LDL-C was significantly higher (p less than 0.001) in Group M compared to C in the higher age range. VLDL-C was higher (p less than 0.05) in Group E compared to C in both the higher age ranges (p less than 0.05) as well as to the middle age range of Group M (p less than 0.05). The indexes TC/HDL-C and LDL-C/HDL-C were significantly higher in Group E compared to Groups C and M in all age ranges. These indexes were significantly higher (p less than 0.01 and p less than 0.05) in Group M compared to group C in all age ranges.(ABSTRACT TRUNCATED AT 250 WORDS)

[Sublingual enalapril in hypertensive crisis. A preliminary study]. / Enalapril sublingual en crisis hipertensiva. Estudio preliminar.

The effects of a new angiotensin I-converting enzyme inhibitor (ACEI), enalapril via sublingual was studied in 16 patients (median age 60.5 +/- 8.7 years). 10 were female and 6 male with hypertension crisis defined as systolic pressure (SP) greater than or equal to 220 mmHg and/or diastolic pressure greater than or equal to 120 mmHg (DP). We observed a significant decrease of SP and DP 20 min after the enalapril administration, without affecting the cardiac rate (p less than 0.001). This decrease was maintained during 30 and 60 min (p less than 0.001). Secondary effects were not observed. We concluded that sublingual enalapril can be a useful drug in hypertension crisis when not an urgent life compromising situation in elderly patients, because of its gradual hypotensive and maintained effect, allowing the commencement of an oral treatment.