[Usefulness of Levosimendan in patients with ventricular dysfunction before surgery]. / Uso del levosimendan previo a la cirugía cardíaca, en pacientes con mala función ventricular.

UNLABELLED: The purpose of this work was to observe the hemodynamic stability on the first 24 hours in 4 patients with ventricular dysfunction (Ejected Fraction < 40 %), considered of high surgical risk, in which 24 at 48 hr before the surgery received an infusion of Levosimendan for 24 hours. This 4 patients was male, with age 55.5+/-7.9 years old, a left ventricle ejection of fraction (LVEF) of 31+/-5.47%; Two of them was underwent to valve replacement, another one to coronary artery bypass graft and the last one patient underwent combined procedure (coronary artery bypass graft surgery and valve replacement). The behavior of the hemodynamic parameters was stable, without necessity of uses high dose of the inotropios and classic vasopresores in the postoperative. CONCLUSION: the Levosimendan could be an inotropic of great application in this group of patient due to its novel action mechanism and to its sustained hemodynamic effects after having finished its infusion.

Coronary reserve in Takayasu's arteritis: transesophageal echocardiographic analysis.

BACKGROUND: The incidence of coronary arteries lesion in Takayasu's arteritis varies from 9% to 10% and is usually discovered at autopsy. Recent studies have demonstrated the value of echocardiography in noninvasive detection of significant coronary stenosis. AIM: The aim of our study was to evaluate coronary reserve in 15 patients with Takayasu's arteritis using contrast transesophageal echocardiography (Optison). METHODS: Transesophageal echocardiogram under basal conditions and in the hyperemic phase with dipyridamole challenge, myocardial perfusion studies and coronary angiography were performed on all patients. Seventy-three percent of them had histories of systemic hypertension, and the most frequent cardiovascular symptoms were shortness of breath (80%), headache (46%), angina (40%), and dizziness (33%). RESULTS: The transthoracic echocardiogram showed left ventricular systolic dysfunction in 6% and diastolic dysfunction in 53%. Aortic regurgitation was found in 67% of the patients, and 60% had mitral and/or tricuspid regurgitation. Coronary reserve was diminished in 3 patients with significant coronary lesions and in 2 patients with coronary dilation (33%). In the 3 patients with obstructive lesions and diminished coronary reserve, reversible perfusion defects were found with thallium-201 single-photon emission computed tomography. One patient with coronary dilation had normal perfusion, while the other demonstrated reversible and irreversible perfusion defects. One patient without coronary lesions and with normal coronary reserve had an irreversible fibrotic changes and the other reversible defects due to abnormal microcirculation. CONCLUSIONS: Transesophageal echocardiography is a feasible and promising technique for assessing coronary reserve in patients with Takayasu's arteritis.

Ebstein's malformation in the setting of Down's syndrome.

We report a patient with Down's syndrome referred to our Department of Echocardiography for evaluation after an episode of tachyarrhythmia. We diagnosed Ebstein's malformation. As far as we know, this association has been reported previously on only three occasions. We review these previous cases, describe our echocardiographic techniques, and discuss our experience.

Uso del levosimendan previo a la cirugía cardíaca, en pacientes con mala función ventricular / Usefulness of levosimendan in patients with ventricular dysfunction before surgery

El propósito de este trabajo fue observar los resultados hemodinámicos inmediatos (primeras 24 hs) en pacientes con mala función ventricular (< 40%), considerados de alto riesgo quirúrgico, en los cuales 24 a 48 hs antes de la cirugía recibían una infusión por 24 hs con levosimendan. Se incluyeron 4 pacientes de sexo masculino con edad promedio de 55.50 (+ 7.93 años) con una fracción de eyección del ventrículo izquierdo de 31 (+ 5.47%), 2 de ellos sometidos a cambio valvular, otro a revascularización miocárdica y el cuarto se sometió a procedimiento combinado (revascularización + cambio valvular). El comportamiento de los parámetros hemodinámicos estuvo estable, sin necesidad de altas dosis de los inotrópicos y vasopresores clásicos en el postoperatorio. Conclusión: El levosimendan podría ser un inotrópico de gran aplicación en este grupo de pacientes debido a su novedoso mecanismo de acción y a sus sostenidos efectos hemodinámicos luego de terminada su infusión.

The purpose of this work was to observe the hemodynamic stability on the first 24 hours in 4 patients with ventricular dysfunction (Ejected Fraction < 40 %), considered of high surgical risk, in which 24 at 48 hr before the surgery received an infusion of Levosimendan for 24 hours. This 4 patients was male, with age 55.5 ± 7.9 years old, a left ventricle ejection of fraction (LVEF) of 31 ± 5.47%; Two of them was underwent to valve replacement, another one to coronary artery bypass graft and the last one patient underwent combined procedure (coronary artery bypass graft surgery and valve replacement). The behavior of the hemodynamic parameters was stable, without necessity of uses high dose of the inotropics and classic vasopresores in the postoperative. Conclusion: the Levosimendan could be an inotropic of great application in this group of patient due to its novel action mechanism and to its sustained hemodynamic effects after having finished its infusion.