Assessment of aortic stenosis severity by cardiovascular magnetic resonance / Evaluación de la severidad de la estenosis aórtica usando resonancia magnética cardiovascular

Cardiovascular magnetic resonance (CMR) has become a valuable tool to corroborate aortic stenosis (AS) severity when echocardiography assessment is discordant. Moreover, CMR can provide useful complementary information about AS severity and hemodynamic markers. In particular, the use of advanced 4D flow CMR allows a comprehensive assessment of complex flow alterations produced by AS. This review provides an overview of the added value obtained by standard 2D flow and advanced 4D flow quantification for AS severity assessment and discusses the advantages and disadvantages of current clinical metrics. This includes an introduction of promising new hemodynamic markers, and discusses how these novel makers may identify potential complications and disease progression in patients with AS.

La imagenología de resonancia magnética cardiovascular (RMC) se ha establecido como una importante herramienta para corroborar la severidad de la estenosis aórtica (EA) cuando el examen por ecocardiografía es contradictorio. Además, la RMC puede proveer importante información complementaria con respecto a la severidad de la EA y diversos indicadores hemodinámicos. En particular, el uso de técnicas avanzadas de flujo en 4D por RMC permite una extensiva evaluación de las complejas alteraciones de flujo provocadas por la presencia de la EA. Este artículo de revisión describe de manera detallada el valor agregado obtenido en la práctica clínica con el uso de las técnicas de medición de flujo bidimensionales, así como las técnicas avanzadas de flujo en 4D para la cuantificación y evaluación de la severidad de la EA. De igual modo, se discuten las ventajas y desventajas de los parámetros clínicos comúnmente utilizados para la estratificación de la severidad de la EA. Además, incluye una introducción a nuevos y prometedores índices hemodinámicos, discute su utilidad para la identificación de potenciales complicaciones y de progresión de la EA in vivo.

[Myxoma of the right ventricle. Report of a case operated on]. / Mixoma del ventrículo derecho. Informe de un caso operado.

A case of right ventricular tumor in a 14 year old male is presented. Congestive heart failure and a systolic pulmonary murmur due to right ventricular obstruction were the main symptoms. The diagnosis was confirmed by echocardiogram (M mode) and right ventricular angiography. The surgical treatment was curative and the histological exam revealed a myxoma.

[Indomethacin and persistent ductus arterious in the pre-term newborn infant with respiratory insufficiency]. / Indometacina y conducto arterioso persistente en el recién nacido de pretérmino con insuficiencia respiratoria.

Forty-two cases of preterm infants with respiratory distress syndrome who developed congestive heart failure secondary to large arteriovenous shunt across permeable ductus arteriosus and who were treated with indomethacin are presented. The cases were divided into three groups according to birth weight: group I less than 1,200 g, group II between 1,250 and 2,000 g and group III from 2,000 to 2,500 g. Satisfactory results were obtained by either ductal closure or by important reduction in the left to right shunt with disappearance of the congestive failure in 37.5% of group 1, 71% in group II and 69% in group III. We concluded that indomethacin is the treatment of choice for patients weighing more than 1,050 g and over 30 weeks gestational age and that surgical ligation is the treatment of choice in patients under this weight and gestational age.

[Auricular flutter associated with interauricular communication in an infant]. / Flutter auriular asociado a comunicación interauricular en un lactante.

A case of a two year old child with atrial flutter diagnosed at four months of age is presented. The child also had a large atrial septal defect. We were not able to convert the atrial flutter to sinus rhythm with medical treatment of electroshock. However, it did respond to mechanical stimulation during cardiac catheterization. The atrial septal defect was repaired and the patient has not had a recurrence of the flutter.

[Management of persistent ductus arteriosus in the newborn with respiratory insufficiency]. / Manejo del conducto arterioso persistente en el recién nacido con insuficiencia respiratoria.

Sixteen newborn babies with severe respiratory distress and patent ductus arteriosus with congestive heart failure are presented. Fifteen of them were premature and one at full term. Management consisted of the accepted medical and ventilatory aids such as digitalis, diuretics, ventilators, etc. Thirteen cases were given indomethacin with clinical closure in five of them (38%). Ten cases underwent surgical closure with 30% mortality. It is recommended that these patients be given indomethacin inicially; if there is no response in 36 hours surgical closure of the duct should be performed prior to progressive deterioration and eventual death.

[Right aortic arch associated with congenital heart defects]. / Arco aórtico derecho asociado a cardiopatías congénitas.

The author's experience in the association of right aortic arch and congenital cardiac malformations is reported. We found 56 cases out of 1200 congenital cardiac malformations which constitutes 4.6%. In the classification of Knight and Edwards, type I right aortic arch was the most frequent (96%) and it was associated principally with Tetralogy of Fallot (46%), transposition of the great vessels (14.3%), truncus arteriosus (12%), tricuspid atresia (10.7%) and complex cardiac malformations associated with the syndrome of visceral heterotaxy (10.7%). In type II and type III we found only one case of each and these were associated with pulmonary valvular stenosis, atrial septal defect and ventricular septal defect. It is noted that the right aortic arch has never been associated with total anomalous pulmonary venous return nor with mitral or aortic valvular malformations.