Un electrocardiograma inquietante: ondas T negativas en precordiales izquierdas de un deportista afroamericano / A disturbing electrocardiogram: inverted T waves in the left precordial leads of an African-American athlete

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[The transcutaneous treatment of superficial thrombophlebitis with the exogenous nitric oxide donor: nitroglycerin]. / Tratamiento transcutáneo de la tromboflebitis superficial con el donador exógeno de óxido nítrico: nitroglicerina.

Nitroglycerin (glyceryl trinitrate) is a substance that is metabolized to nitric oxide in the cell. Its action is not dependent of the endothelium derived nitric oxide, but imitates those of this biological mediator. We thought that nitroglycerin should have the same in vivo actions as the endogenous nitric oxide in vitro has. We report and discuss the first patient with superficial thrombophlebitis successfully treated with transdermal nitroglycerin.

[Tetralogy of Fallot with abnormal coronary arteries]. / Tetralogía de Fallot asociada a anomalias de las arterias coronarias.

Between 1980 and 1989 nine patients with Tetralogy of Fallot with abnormal coronary artery underwent surgical treatment. In all but one, the abnormal coronary artery was identified at surgery. Seven (group I) had the anterior descending coronary artery arising from the right coronary artery; one (group II) with had the right coronary artery arising from the left coronary artery and finally, the only case of the group III had left coronary artery arising from the main pulmonary artery. Systemic-pulmonary anastomosis was done in two cases of the Group I, in one due to severe hypoplasia of the pulmonary ring and main pulmonary artery and in the other due to the anomaly of the coronary artery. In the case of the Group II the right coronary artery was accidentally cut and the patient developed right ventricular infarction and died. All surviving are in NYHA functional class I. Nowadays, the preoperative evaluation of Tetralogy of Fallot, can be done by echocardiography despite the possibility of its association with abnormal coronary artery. In special cases aortography or arterial coronarography should be considered.

[Immediate and long-term results of aortic valvulotomy in aortic valve stenosis]. / Resultados inmediatos y a largo plazo de la valvulotomía aórtica en la estenosis aórtica valvular.

Between April 1962 and December 1982 we performed valvulotomies on 68 patients to correct valvular aortic stenosis (VAoS). Forty-one were men and 27 women whose ages ranged from 20 months to 47 years (mean = 11.9 +/- 6.4 years). In 95% of cases VAoS was congenital. All patients underwent clinical preoperative evaluation with chest roentgenogram and electrocardiogram (ECG). Catheterization was done on 89.7%. Symptoms varied from none to syncope and stress angina. Symptoms bore no relation to the systolic aortic gradient, which oscillated between 31 and 200 mm Hg. There was a significant postoperative improvement in symptoms and less notable improvement in chest X-rays and ECG. Follow-up was from 1 to 22 years (mean = 7.12 +/- 4.43 years). Thirty-nine patients were followed for 5 or more years with serial clinical, radiological and electrocardiographic control. Fifty percent underwent postoperative catheterization. Seventeen patients continued with residual aortic regurgitation (AoR). Fourteen patients were again operated. A new valvulotomy was performed on 2 and valve replacement was done on the rest. Perioperative mortality was 2.9% and long-term survival 88% with 84.6% of the patients asymptomatic or in functional class I of the NYHA. Survival curves were plotted and the literature reviewed. The conclusion was that although this surgery constitutes a low risk, it should be considered palliative in the majority of the cases.