Ultrasonido intravascular: informe preliminar / Intravascular ultrasound: preliminary report

Se presenta la aplicación y uso del ultrasonido intravascular, efectuado en los primeros cuatro pacientes en nuestra institución; dos de ellos con lesión arterial coronaria, uno en arteria periférica y un paciente a quien se efectuó revisión de una derivación portosistemica intrahepática por vía yugular (TIPS). Se plantea la alternativa diagnóstica del ultrasonido intravascular, para valorar las características de la pared vascular, los sitios estenóticos, así como componentes de la estenosis, presentando algunas imagenes características

[Permanent pacemaker implantation. Indications and results]. / Implantación de marcapasos definitivos. Indicaciones y resultados.

Clinical, laboratory and electrocardiographic data from 608 patients with permanent pacemakers implanted over a period of 8 years, were evaluated retrospectively. The number of implants was greater in males (56.5%) and in patients over 60 years of age (77.5%). Atherosclerosis was the most common disease found in this group (50%). Syncope occurred in 96.2% of the cases; and complete AV block was the most common electrocardiographic alteration (50.5%). Electrode displacement occurred in 32 patients (5.2%) and was the most commonly found early complication. Among the late complications, 10.3% of the patients had infections in the area of the generator. The total mortality was 7.7% due to the heart disease rather than pacemaker-related complication.

[Electro-vectorcardiographic aspects of diastolic and mixed overloads of the right ventricle]. / Aspectos electrovectocardiográficos de las sobrecargas diastólica y mixta del ventrículo derecho.

We studied 400 cases of isolated atrial septal defect without severe pulmonary hypertension, in which the diagnosis was established by the hemodynamic data and it was proven by surgical findings in 257 instances. High fidelity unipolar thoracic and intracardiac records, as well as vectorcardiographic curves in three planes, were obtained. Different types of right ventricular conduction disturbances, which were present in all cases, as well as certain electro-vectorcardiographic aspects related to ventricular depolarization and repolarization, were analyzed. Mean angles of the resulting vectors at 60 msc of the ventricular activation, were determined relating to the types of block. The following points should be emphasized: Besides the right proximal blocks, which are more frequent, right distal ones can also be diagnosed by the presence of slurred R wave and delayed onset of the intrinsicoid deflection in only some right leads. The monofascicular and parietal right blocks are observed when the diastolic overload of the ipsilateral ventricle is low. The activation time of the anterior inferior right septal mass generally permits an objective classification of the degree of a right proximal block. The prolonged Q-Tc interval only in right leads, seems to be a function of the magnitude of the right ventricular diastolic overload.

[Origin of the left coronary artery from the trunk of the pulmonary artery. Report of a case]. / Origen de la arteria coronaria izquierda del tronco de la arteria pulmonar. Informe de un caso.

The congenital anomalies of the coronary arteries are varied. The left trunk arising from the pulmonary artery is a rare and serious one. With coronary angiography the diagnosis is possible. The surgical technics offer an effective treatment. We report the first case with these anomalies at the Instituto Nacional de Cardiología Ignacio Chávez. It was diagnosed with coronary angiography and it was treated by suturing the left main coronary artery in its origin, and with implantation of a safenous vein graft between the aorta and the left main coronary artery. The results were satisfactory.

Origen de la arteria coronaria izquierda del tronco de la arteria pulmonar. Informe de un caso. / Origin of left coronary artery from pulmonary artery trunk. Report of a case

Las anomalias congenitas de las arterias coronarias son multiples y variadas. Entre ellas, el origen de la arteria coronaria izquierda naciendo en el tronco de la arteria pulmonar es de las mas raras y graves. Con las tecnicas angiograficas actuales se logra el diagnostico certero en vida y las tecnicas quirurgicas actuales permiten un tratamiento efectivo. Se informa el primer caso visto en este Instituto Nacional de Cardiologia Ignacio Chavez, donde se hizo el diagnostico por medio de angiografia y se practico el tratamiento quirurgico con buen resultado por medio de ligadura de la arteria coronaria izquierda en su origen y la implantacion de un conducto entre la aorta y el tronco de la coronaria izquierda con una porcion de vena safena

[Usefulness of electrophysiologic studies. Report of 224 cases]. / La utilidad de los estudios electrofisiológicos. Informe de 224 casos.

Two hundred and twenty four electrophysiologic studies were performed in 194 patients during a two-year period. One hundred and six (54.6%) had tachyarrhythmias: 21 had atrial tachycardia, 28 had the Wolff-Parkinson-White syndrome. Of 51 patients with a normal electrocardiogram a concealed left Kent bundle was observed in 21 cases and only one concealed right Kent bundle; functional James fibers were seen in 7 patients and Mahaim fibers in two. In 15 patients A-V nodal reentry was diagnosed and functional ectopy was observed in 5 patients. The sick-sinus-syndrome was seen in 24 patients and atrial arrest in three. Thirty patients underwent a second electrophysiologic study to evaluate proper antiarrhythmic therapy. Atrioventricular conduction was evaluated in 52 patients. A "suprahisian" delay was found in 34%, troncular lesions were diagnosed in 31%, a distal delay in 25% and mixed conduction disturbances in 10%. We conclude that electrophysiologic studies are a useful procedure to: 1) establish the etiologic diagnosis of tachyarrhythmias; 2) evaluate their potential danger; 3) objectively evaluate antiarrythmic therapy; 4) establish the need for surgical treatment; 5) give the topographic diagnosis and severity of A-V conduction disturbances and 6) indicate the need for definitive pacemaker implant.

[Amiodarone in the control of supraventricular tachyarrhythmias]. / La amiodarona en el control de las taquiarritmias supraventriculares.

The clinical efficacy of amiodarone was observed in a group of 20 patients (9 women and 11 men) with a total 21 supraventricular tachyarrhythmias (16 paroxysms or premature supraventricular beats (PSB) and 5 with established arrhythmias), to whom amiodarone was given during one month: 800 mg/day the first week and 400 mg/day for 3 weeks. An electrocardiogram and a 24 hour Holter were taken before and after treatment. The results observed for paroxysmal arrhytmias and PSB were excellent in 94% and satisfactory in one patient. As for established arrhythmias the results were excellent or satisfactory in 80%. We conclude that ammiodarone is an effective drug with a wide security range in the treatment of supraventricular arrhythmias.

[Clinical and coronary angiographic characteristics of hypertensive angina]. / Características clínicas y coronariográficas de la angina hipertensiva.

The sample studied consisted of 46 patients with systemic hypertension. Of these, 21 had angor pectoris and constituted group I; 12 showed left ventricular hypertrophy, constituting group II; the other 13 subjects did not have complications and they formed group III. All patients, aside from the usual clinical evaluation, were submitted to exercise electrocardiography, coronary angiography and cineventriculography. The average age of patients in group III was lower than in the others (38.6 +/- 8.4 years), and so was the percentage of smokers (15.3%), and of patients with diabetes (23.0%). The number of smokers in group II represented 41.3% and in group I, 38%. The percentage of patients with diabetes was 33.3% in group II and 52.3% in group I. Pain in the patients of group I had the following characteristics: retrosternal pain was present in all cases, while referred pain to the neck and left arm appeared in 61% of the subjects. In 66.3% of the individuals the pain lasted between 5 and 15 minutes. In 52.3% of the group, pain was not always related to effort, but appeared also at rest. Temporal periodicity was present in 52.7% of the patients. Also in group I, 95.2% of the cases had a depression of the S-T segment in the leads corresponding to the anterior aspect of the left ventricle. In 86.6% of the subjects, there was a positive exercise test. The Sokoloff's index was 26.4 +/- 7.9 mm. In 75% of the subjects in group II, a depression of the S-T segment was present, and a positive exercise test was found in 50% of them. Their sokoloff's index was 26.7 +/- 6.4. None of the patients in group III had depressions of the S-T segment and 20% resulted with a positive exercise test. Their sokoloff's index was 13.3 +/- 2.9. The coronary angiography results showed stenosis in 28% of the subjects in group I and tortuosity of the vessels was apparent in 94.8% of them. None of the patients of group II and III had stenosis of the coronaries, but tortuosity was observed in 74.9% of the individuals in group II and in 69.1% of the cases in group III. Based in these data we conclude that there is a type of angor pectoris in hypertensive subjects which is related to hypertrophy of the left ventricle, but not to coronary stenosis. The management of this type of patient should be different to the regular one.

[Hemodynamic effects of atrial overstimulation in patients with ischemic heart disease]. / Efectos hemodinámicos de la sobreestimulación auricular en pacientes con cardiopatía isquémica.

Auricular over-stimulation is used by some researchers to study patients under suspicion of coronary heart disease. In this paper we discuss the changes in telediastolic pressure of the left ventricle (PT-DVI), stimulating the right auricle with increasing frequencies sent through an external pacemaker. When the ventriculography and coronarography were over, the Sones catheter was left into the left ventricle. An electrode-catheter was introduced through vein in the right auricle, the distal end being very close to the sinusal node, where the electric catch as accomplished. Through this stimulator the cardiac frequency was increased in 20 heart beats more than the basal cardiac frequency and the PTDVI was simultaneously measured every 3 minutes. Through the coronarographic study, the patients were classified in: normal, bi-vascular and tri-vascular. The increase and decrease of PTDVI was calculated in relation to the results obtained during the last minutes of over-stimulation compared with the basal figures. Most of the patients showed a decrease in PTDVI no matter what the vascular engagement was. Our results show there is no difference between the response and the coronary obstruction degree so, this evidence is of no value to judge the functional situation of the left ventricle.

[Comparative study of coronariography and radiocoronariography in ischemic cardiopathy. Preliminary report]. / Estudio comparativo entre la coronariografiá y la radiocoronariografía en la cardiopatía isquémica. Comunicación preliminar.

25 patients with ischemic heart disease were studied by selective coronariography and radiocoronariograpy with 3mCi of human albumin macroaggregates labeled with 99mTc, injected selectively into each coronary artery. Gammagraphic images were then obtained. 17 cases (68%), had coronary obstructions and 8 patients (32%), had a normal coronary angiogram. Of all patients studied, 23 (92%), had areas of hypoperfusion. Patients with coronary obstructions had corresponding image defects. 6 cases with normal coronary angiography had areas of hypoperfusion and finally 2 cases had normal images in both studies. All patients wit EC6 necrosis had abnormal radiocoronariography. The macrocirculation is studied by coronary angiography, while the microcirculation is visualized by radiocoronariography. Both technique are complementary. We conclude that radiocoronariography should be performed routinely after coronary angiography in the study of ischemic heart disease, with special emphasis in cases with normal angiograms.

[Calculation of the left ventricular mass by means of angiography. Study in patients with and without hypertensive cardiopathy]. / Calculo de la masa ventricular izquierda por medio de la angiografía. Estudio en pacientes con y sin cardiopatia hipertensiva.

A modified Rackley et al technique for left ventricular mass calculations is applied to patients with concentric hypertrophy originated by hypertensive cardiopathy and to normal subjects. The values found in 8 normal subjects were 41 +/- 16 g/m2 of body surface and in 20 patients with hypertensive cardiopathy were 63 +/- 20 g/m2 (p = 0.01). The results obtained allow us to state that there is a clear difference between the ventricular mass of the two groups studied even though the values of ventricular volumes and of ventricular ejection fraction were not statistically significant in its variation.

[Corrected transposition of the great arteries without associated abnormalities]. / Transposición corregida de las grandes arterias sin malformaciones asociadas.

We studied 5 cases of corrected tansposition of big arteries without associated defects. Four of them showed situs solitus with apex to the left, and the fifth one showed dextroversion. In four of the cases the second sound was the only one, strong and to the left of the precordium; in four we found mild sistolic murmur in the third left intercostal space. In all of them, XR plates showed the largest liver lobe to the left, apex to the left in four and to the right in one, being possible to see the ascending aorta to the left in four cases. A patient with complete auriculoventricular block showed cardiomegaly and excavated middle arch. Three of them presented sinusal rithm, one had auriculoventricular block of variable degree and the last had complete auriculoventricular block. In four cases the AQRS showed a deviation to the left, and the other one to the right. In the foreground of the first septal vector was going from right to left. The analysis of the unipolar and thoracic morphologies had alterations in the intraventricular conduction which suggested a right branch block in derivations exploring the ventricle located to the left and potential QS in the right pre-cordials. We found a pattern of sistolic overload of the sistemic ventricle. Through determination made by the His Ecg we found that the alterations in conduction were distal. The electro-mechanic latent period of the ventricle located to the right was shorter than the opposite. The angiographic studio helped to establish the auriculoventricular discordant relations and to identify the ventricles position through their angiographic morphology. In the cases showing point to the left, the ventricle anatomically considered as the left one showed a triangular form and smooth walls, while the ventricle anatomically consider being the right one presented trabeculated walls. In dextroversion the anatomically left ventricle was egg-shaped with smooth walls. All of them presented the aorta above the pulmonar artery.

[Fixed fibrous subaortic stenosis. Postoperative evaluation]. / Estenosis subaórtica fibrosa fija Valoración postoperatoria.

Fibrous sub-aortic stenosis in 19 patients surgically treated is discussed. The clinical, radiologic, EKG and cardiac catheterization data in the pre and post-operative evaluations are reviewed. There were no surgical deaths in this series. In 14 cases post-operative cardiac catheterization was carried out, in 11 patients a significant decrease in the gradient was found. In 4 cases pharmacological testing was done during catheterization before and after surgery, without significant change in gradients.

[Coexistence of aorto-pulmonary calcification]. / Calcificación aorto-pulmonar coexistente.

The importance of finding in chest roentgenograms the coexistence of aortic and pulmonary artery calcification in emphasized. This radiologic feature is useful in patients which offered difficulty in the clinical diagnosis, it should suggest as a first possibility in the diagnosis patent ductus arteriosus.