[Adult pulmonary stenosis: percutaneous balloon valvuloplasty]. / Estenosis pulmonar del adulto: valvuloplastia percutánea con balón.

The results of balloon valvuloplasty as treatment for pulmonary stenosis in 8 adults (6 male) whose ages ranged from 17 to 58 years are presented. Three patients had been subjected to cardiac surgery 32, 40 and 10 years before. The procedure was performed through the right femoral vein using one or two balloons with a diameter of not less than 20 mm, without complications and excellent tolerance. The pulmonary gradient and the right ventricular pressure were reduced in 7 patients from 81.4 +/- 26.9 to 26.6 +/- 11.3 and from 99.3 +/- 25.5 to 47.7 +/- 13.6 mm Hg respectively (p < 0.0005). During follow up, 6 of the patients have remained in functional capacity I and in two, Doppler ultrasound examination showed a further reduction in valvular gradient. These results are in accordance with other reports and confirm that this technique is the treatment of choice for adult pulmonary stenosis.

[Cardiac involvement in polymyositis--dermatomyositis associated with Sjogren's syndrome]. / Compromiso cardiaco en polimiositis--dermatomiositis asociada a síndrome de Sjögren.

A 41 years old woman with polymyositis-dermatomyositis with cardiac involvement is presented. The patient evolved with congestive heart failure, the electrocardiogram showed a left anterior hemiblock, lack of progression of R waves from V1 to V4 and unspecific ST and T alterations. Echocardiogram and cardiac catheterization showed global ventricular disfunction and pulmonary hypertension. An endomyocardial biopsy performed at the apex of the right ventricle showed mononuclear inflammatory infiltration, myocardial fiber degeneration and fibrosis. Initially, the patient responded well to diuretic, vasodilator and steroid therapy. Posteriorly she developed an atrial flutter that required electrical cardioversion and later died suddenly during the course of an acute pneumonia.

[Percutaneous mitral valvuloplasty in 2 pregnant women]. / Valvuloplastia mitral percutanea en dos mujeres embarazadas.

In women with a significative mitral stenosis that become pregnant, medical treatment has limitations and surgical treatment is associated with maternal and fetal mortality. We report two pregnant women in whom a mitral valvuloplasty was performed in weeks 30 and 32 of pregnancy, using the single balloon Inoue technique. The indication for the procedure was the persistence of functional capacity IV heart failure in spite of hospital bed rest and the use of diuretics and beta-blockers. Basal mitral valvular area was 0.6 and 0.9 cm2 and improved to 1.7 and 1.8 cm2 after the procedure; six months later, the areas were 1.5 and 1.7 respectively. The procedure was well tolerated and was performed with abdominal and pelvic shielding. No complications occurred, which allowed hospital discharge in functional capacity I; they were readmitted for delivery, giving birth to two healthy girls. It is concluded that mitral valvuloplasty in safe and effective in pregnant women with mitral stenosis refractory to usual medical treatment.

Experimental determination of flux control distribution in biochemical systems: in vitro model to analyze transient metabolite concentrations.

Determination of the control coefficients allows the identification of rate-controlling steps in a reaction system. However, the measurement of the flux control coefficients in a biochemical system is not a trivial task, except for some special cases. We have developed a theoretical basis for the direct determination of these coefficients from dynamic responses. In order to show the validity of this methodology experimentally, the dynamic approach is applied to an in vitro reconstituted partial glycolytic pathway to determine the flux control coefficients of hexokinase and phosphofructokinase. It is shown that the dynamic approach gives consistent results, which agree well with values obtained by the direct enzyme titration method. The detailed procedure and potential applications to other systems, such as immobilized enzyme or cell reactors, are discussed.

[Historic perspective of cardiac catheterization]. / Perspectiva histórica del cateterismo cardíaco.

In 1929 Forssman introduced a catheter into one of his left forearm veins and advanced it up to the right atrium, opening the possibility of cardiac catheterization in man. Since 1940, right heart catheterization was systematically performed by Andre Cournard and Dickinson Williams and many other researchers who contributed in the following decade with different approaches; at the present time the retrograde access through the femoral or brachial artery is the most widely used. Angiocardiography evolved in different countries between 1929 and 1959. Selective coronary cineangiography, developed by Sones, has been one of the most important advances in this field. Cardiac catheterization has been a valuable tool in cardiovascular research and diagnosis. Moreover, it has contributed to the progress of cardiac surgery and critical care medicine. Lately, it has derived to therapeutic procedures such as coronary angioplasty and percutaneous, dilatation of stenotic heart valves and closure of some congenital shunts. "Interventional catheterization" has become one of the most frequent indications for this procedure as long as many heart diseases are correctly diagnosed by means of non invasive technique.

[Percutaneous aortic valvuloplasty: immediate results in calcified aortic stenosis]. / Valvuloplastía aórtica percut[anea: resultados inmediatos en la estenosis aórtica cálcica.

Symptomatic calcific aortic stenosis in elderly patients has a poor prognosis and a relatively high surgical risk. Percutaneous aortic valvuloplasty is a new therapeutic procedure that may be applied in this group of patients. We report immediate results obtained with this technique in a cooperative study of 3 hospitals. In 16 of 19 patients we were able to locate a balloon catheter across the aortic valve following a femoral artery puncture. Mean age was 72 years and almost all patients were considered high surgical risk. Peak aortic gradient fell from 89 + 33 to 47 + 21 mmHg while valve area rose from 0.43 + 0.14 to 0.66 + 0.27 cm2; cardiac output remained unchanged. In 5 patients, an aortic valve area above 0.7 cm2 was obtained. Four patients needed blood transfusion, one developed pericardial tamponade and other recovered uneventfully from ventricular fibrillation. One patient died hours after the procedure in a low output state probably related to aortic insufficiency. We feel that aortic valvuloplasty is indicated in patients with severe calcific aortic stenosis and high surgical risk. Moderate improvement can be obtained with risks commensurate with the severity of the illness.

[Association of coronary disease and valve diseases: implications for coronariography indication]. / Asociacion de enfermedad coronaria y valvulopatias: implicaciones para la indicacion de coronariografia.

We studied 111 patients with valvular heart disease in order to detect associated coronary artery disease (CAD). Fifty had aortic valve disease, 47 mitral lesions and 14 mitro-aortic disease. Coronary angiography was performed in all subjects above 50 years of age and in 13 younger subjects with angina, atypical chest pain, prior myocardial infarction or unexplained left ventricular disfunction. Eight subjects (7.2%) had significant CAD: 1 with triple, 2 with double and 5 with single vessel disease. CAD was diagnosed in 11.5% of 26 patients with angina, in 6% of 17 patients with atypical chest pain and in 6% of 68 patients without pain. CAD was present in males only above age 55. We conclude that in our population, with low incidence of CAD, the association of this disease and valvular heart disease is unusual. Coronary arteriography would be unnecessary in these patients except in the presence of marked risk factors or other clinical findings suggesting CAD, like angina or prior myocardial infarction.

[Efficacy of propylthiouracil in the treatment of amiodarone-induced hyperthyroidism]. / Efectividad del propiltiouracilo en el tratamiento del hipertiroidismo inducido por amiodarona.

Amiodarone is a benzofuranic derivative widely used in cardiologic practice because of its excellent antiarrhythmic properties. Due to its high iodine content, it interferes with thyroid physiology and can cause either hyper or hypothyroidism. Amiodarone-induced hyperthyroidism should be considered as a serious complication since it develops in cardiac patients, the clinical diagnosis can be difficult and because conventional methods of therapy are said to be often ineffective. We analyze the outcome of 10 pts, chronically treated with Amiodarone (16-60 mo, mean 37.6 mo) who develop hyperthyroidism during the antiarrhythmic therapy. All patients had multinodular goiter. Overt clinical picture for thyrotoxicosis was seen in 7 of them and lab tests showed: rT3 = 101.1 +/- 14.9 ng/dl; T3 = 220.2 +/- 25 ng/dl; T4 = 15.6 +/- 1.9 micrograms/dl, TSH = 0.8 +/- 0.2 microU/ml and TRH response 0.0 microU/ml. Thyroid microsomal antibodies were negative in 3 pts studied. After Amiodarone was discontinued, patients were followed-up monthly. In 2, normalization of clinical and laboratory indexes were obtained at 40-60 d and no other medication was given. In the remaining, due to the intensity of clinical manifestations, PTU treatment was started (300 mg/d) After 4 mo, euthyroidism was achieved in 6 and it persisted after discontinuation of PTU has patient failed to respond to PTU, 131I was administered with excellent results. Patients have been followed-up up to 3 years after therapy without observing thyrotoxic relapses nor deterioration of their cardiological condition.2+ conventional therapies (PTU or 131I) have been, very effective.

[Constrictive pericarditis: diagnostic aspects and surgical results in 23 cases]. / Pericarditis constrictiva: aspectos diagnósticos y resultados quirúrgicos en 23 casos.

We reviewed the clinical data on 23 patients operated on for constrictive pericarditis. Mean age was 35 years and 17 were males. The chief complaint was dyspnea (87%). Outstanding physical findings were venous hypertension (96%), hepatomegaly (78%), ascitis (57%), pulsus paradoxus (57%) and Kussmaul sign (43%). The ECG, although always abnormal was non contributory. Chest X ray findings included cardiomegaly (48%) and pericardial calcification (35%). Half of the cases showed pericardial thickening and abnormal septal motion on M mode echocardiography. An equalization of diastolic pressures and the dip and plateau sign was confirmed at cardiac catheterization in all cases. The etiology could be established in only 6 patients (tuberculosis 3, traumatic 2 and septic 1). Surgical mortality was 9% (2 patients). Follow up was available on 10 patients at a mean of 35 months, 9 in functional class I and 1 in FC II.

[Percutaneous aortic valvuloplasty prior to major abdominal surgery]. / Valvuloplastía aórtica percutánea pervia a cirugía abdominal mayor.

A 73 year old woman with severe aortic stenosis, functional class III, developed obstructive jaundice. A percutaneous aortic valvuloplasty was performed and the peak gradient decreased from 80 to 22 mmHg while the cardiac index increased from 1.83 to 2.22 l/min/m2 and the aortic valve area from 0.30 to 0.63 cm2. One week later, cholecystectomy, and common duct drainage was performed with no complications. Thirteen months later the patient remains functional class I with echographic findings supporting a continuous success of the aortic valvuloplasty. This patient illustrates one of the possible indications for percutaneous balloon valvuloplasty for severe aortic stenosis.