Correlation between myocardial fibrosis and the occurrence of atrial fibrillation in hypertrophic cardiomyopathy: a cardiac magnetic resonance imaging study.

Cardiac magnetic resonance imaging (CMR) in hypertrophic cardiomyopathy (HCM) often shows delayed contrast enhancement (DE) representing regions of focal myocardial fibrosis. Atrial fibrillation (AF) is a commonly reported complication of HCM. We determined the relationship between the presence of left ventricular myocardial fibrosis (LVMF) detected by DE-CMR and the occurrence AF in a series of patients with HCM. 67 patients with HCM (47 males; mean age 50.1+/-18.5 years) were studied by CMR measuring mass of LVMF, left ventricular mass, volume and function, and left atrial (LA) area. AF was present in 17 (25%) patients. LVMF was observed in 57% of patients. AF was significantly more frequent in patients who also showed LVMF, compared with the group without LVMF (42.1% vs. 3.4%, respectively; p<0.0001). LA size was larger in patients showing DE (LA area: 37.4+/-11.1 vs. 25.9+/-6.8 cm(2); respectively, p=0.0001). AF in HCM is related with myocardial fibrosis detected by DE-CMR and dilatation of the LA. This fact adds to the proven adverse prognostic value of myocardial fibrosis in HCM, thus, reinforcing the usefulness of this technique in the assessment of these patients.

Multiple intracardiac lesions after blunt chest trauma.

Closed chest trauma can cause rupture of intracardiac structures. We report the case of a 17-year-old boy whose chest was trodden by a horse. He sustained rupture of tricuspid and aortic valve leaflets and rupture of the interventricular septum. He underwent surgical repair of these lesions, but aortic insufficiency developed 2 years later and the aortic valve was replaced with a mechanical prosthesis.

[Guidelines of the Spanish Society of Cardiology for clinical practice in exercise testing]. / Guías de práctica clínica de la Sociedad Española de Cardiología en pruebas de esfuerzo.

Most exercise testing is performed in adults with known or suspected ischemic heart disease. In the last few years cardiac imaging techniques have been applied in this field, improving the information obtained with the procedure. However, the exceptions to this rule are emerging rapidly not only in healthy people (asymptomatic individuals, athletes, handicapped people) but also in cardiac patients (advanced congestive heart failure, hypertension, rhythm disorders, congenital heart disease, etc.). All the-se issues justify the need for a multidisciplinary consensus document in Spain. This paper reviews and updates the methodological aspects of the stress test, including those related to oxygen consumption measurements. The main aim of this review was to determine the role of exercise testing in the evaluation of ischemic heart disease as well as the applications of imaging stress testing. The usefulness of this test in other non-ischemic cardiac disorders and in selected subsets of healthy people is also reviewed.

Repair of aortic coarctation in patients more than 50 years of age.

BACKGROUND: Most patients with uncorrected coarctation of the aorta die before reaching age 50 years. In those who survive, the beneficial effect of surgical repair on systolic hypertension has been questioned. METHODS: Surgical repair of aortic coarctation was performed in 8 patients aged 51 to 73 years (mean, 58+/-9 years). Preoperative mean systolic pressure was 185+/-34 mm Hg and systolic gradient, 70+/-11 mm Hg. In addition, 3 patients had significant coronary artery disease. Severe calcification of the aortic arch and left subclavian artery was found in 3 patients. The surgical technique involved bypass of the coarctation with a Dacron tube graft (16 or 18 mm) in all patients. One patient underwent concomitant coronary artery bypass grafting. RESULTS: There were no operative or late deaths during a mean follow-up of 4.3 years. Mean systolic blood pressure decreased significantly in the postoperative period to 128+/-16 mm Hg (p < 0.001). At the last visit, systolic blood pressure was a mean of 127+/-9 mm Hg. Five patients were not taking antihypertensive medication. CONCLUSIONS: Surgical repair of aortic coarctation in patients more than 50 years of age with a Dacron tube bypass graft reduces systolic hypertension and the need of antihypertensive medication.

Mitral valve repair after excision of a fibrolipoma.

A 2-year-old patient with severe mitral regurgitation associated with a mass originating from the anterior leaflet of the mitral valve is reported. Excision of the tumor and mitral valve repair was performed. Four years later the child remains asymptomatic with no recurrence of the tumor or regurgitation.

[Tricuspid and pulmonary valve in a case of carcinoid syndrome]. / Afectación valvular tricuspídea y pulmonar en un caso de síndrome carcinoide.

The presence of liver methastasis and serotonin in plasma in the carcinoid tumor are responsible for the carcinoid syndrome. We present a case of tricuspid and pulmonary valvular disease secondary to this syndrome. The finding of liver hyperechogenic nodules added to the described valvular disease by subcostal echocardiogram oriented the diagnosis.

[Membranous obstruction of the inferior vena cava in its drainage portion in the left atrium. Presentation of a case]. / Obstrucción membranosa de la vena cava inferior en su drenaje a la aurícula derecha. Presentación de un caso.

A child with a membranous obstruction of the inferior vena cava (MOIVC) is presented. The diagnosis was confirmed by angiography. The clinic significance, the evolution, the surgical treatment and the possible complications are described.

[Cardiac hypertrophy associated with subaortic obstruction induced by adrenocorticotropic hormone treatment]. / Hipertrofia cardíaca asociada con obstrucción subaórtica inducida por el tratamiento con hormona adrenocorticotropa.

A 7 months-old child affected of West syndrome presented a cardiac hypertrophy with subaortic obstruction induced by adrenocorticotropic hormone treatment. The administration of this hormone may induce a Cushing syndrome; at high doses has chronotropic and inotropic positive effects and may produce arterial hypertension and cardiac hypertrophy. We pointed out the importance of the echocardiography-Doppler in the diagnosis and follow-up of the cardiac hypertrophy with subaortic obstruction as well as the reversibility of the cardiac involvement when the drug is suppressed.

Recurrent pericarditis. Relief with colchicine.

Recurrence is one of the major complications of pericarditis. Treatment of recurrence is often difficult, and immunosuppressive drugs or surgery may be necessary. We conducted an open-label prospective study of nine patients (seven men and two women; age, 18-64 years; mean age, 41.7 +/- 13.7 years). Patients were treated with colchicine (1 mg/day) to prevent recurrences. All patients had suffered at least three relapses despite treatment with acetylsalicylic acid, indomethacin, prednisone, or a combination. Pericarditis was classified as idiopathic in five patients, postpericardiotomy in two, post-myocardial infarction in one, and associated with disseminated lupus erythematosus in one. For statistical analysis, we conducted a paired comparison design (Student's t test). All patients treated with colchicine responded favorably to therapy. Prednisone was discontinued in all patients after 2-6 weeks (mean, 26.33 +/- 10.9 days), and colchicine alone was continued. After a mean follow-up of 24.3 months (minimum, 10 months; maximum, 54 months), no recurrences were observed in any patient; there was a significant difference between the symptom-free periods before and after treatment with colchicine (p less than 0.002). Our study suggests that colchicine may be useful in avoiding recurrence of pericarditis, although these results need to be confirmed in a larger, double-blind study.

[Anomalous origin of the left coronary artery from the pulmonary artery: diagnosis by two-dimensional Doppler color]. / Origen anómalo de la arteria coronaria izquierda a nivel de la arteria pulmonar: diagnóstico por Doppler bidimensional codificado en color.

A case of anomalous origin of the left coronary artery from the pulmonary artery (ALCA) is presented. The noninvasive diagnosis was made by 2D-color flow Doppler. Application of this technique may alleviate the necessity for angiography in patients with ALCA.

[Aortic subvalvular annular aneurysm after closed thoracic traumatism. Presentation of a case]. / Aneurisma anular subvalvular aórtico postraumatismo torácico cerrado. Presentación de un caso.

A case of a 29 year old man with congenital aortic stenosis who developed a subvalvular annular aneurysm of the left ventricle after being run by a car is presented. At surgery his aortic valve was replaced and the opening of the aneurysm was closed with a patch of Dacron. Due to the dense adhesions to the aorta and left atrium no attempts were made to excise the sac, that was not compromising the dynamics of any one of these structures.

Electrophysiological mechanisms of the SI SII SIII electrocardiographic morphology.

We studied three groups of individuals by means of spatial-velocity electrocardiograms and thallium-201 myocardial imaging to figure out the electrophysiological explanation of the SI SII SIII electrocardiographic morphology. We studied twelve healthy individuals without SI SII SIII, seven healthy individuals with SI SII SIII and fifteen patients with chronic obstructive pulmonary disease with SI SII SIII. The average values of the QRS-E and QRS-F intervals were higher in the second (P less than 0.05 and P less than 0.005) and third groups (P less than 0.01 and P less than 0.001) than in the first. One patient of the second group and thirteen of the third showed right ventricular enlargement. The slowing down of the right ventricular conduction explained the SI SII SIII morphology in normal individuals in more than half the cases. In patients with chronic obstructive pulmonary disease with SI SII SIII the conduction delay plays an important part in the electrogenesis of the right ventricular enlargement electrocardiographic morphology. We think that these observations can give further data about the electrophysiologic mechanism of the SI SII SIII morphology.

Double left innominate vein: an unusual cross-sectional echocardiographic appearance.

A patient is described with ventricular septal defects and two innominate veins which gave rise to an unusual cross-sectional echocardiographic finding thought to be due to a left superior caval vein without connexion to the coronary sinus.