[Echocardiographic study of congenital mitral valvulopathy]. / Estudio ecocardiográfico de la valvulopatía mitral congénita.

M mode, two dimensional and Doppler echocardiographic findings of eleven patients with congenital abnormalities of mitral valve are described. Nine of them had mitral stenosis and two had predominant regurgitation. Six of our patients had other associated cardiovascular malformations (3 coarctation of the aorta, two tetralogy of Fallot and one patent ductus arteriosus). In none of them, there was demonstration of abnormal echoes in the left atrium. In patients with congenital mitral stenosis the M mode echocardiographic findings were indistinguishable of those present in rheumatic mitral stenosis. With two dimensional echocardiography the anatomy was determined from the subvalvular characteristics and the mitral valve diastolic area. The Doppler study showed increase of the peak velocity of the mitral flow in all cases. We conclude that the M mode and two dimensional-Doppler echocardiography are helpful in the recognition of the isolated congenital mitral pathology or when it is associated to other malformations.

[Surgical treatment of infectious endocarditis]. / Tratamiento quirúrgico de la endocarditis infecciosa.

Fifteen patients with diagnosis of infective endocarditis underwent surgical treatment. They were divided in two groups, the first one in which the infection rested in the patient's own valve, and the second in which the patients already had had valve replacement. Forty percent had a previous history of invasive procedure. Fifty-three percent had been treated with antibiotics prior to admission. Blood cultures were positive in 60%, gram positive germ such as streptococcus and staphylococcus predominated. Echocardiogram showed vegetation in 73% of our patients. The indications for surgery was: lack of response to medical treatment (34%), septic emboli (27%), heart failure (27%), severe renal damage (13%). The mortality rate was 20%. In none of the cases a relapse of the infection was observed.

[Unilateral agenesis of the main branch of the pulmonary artery]. / Agenesia unilateral de rama principal de la arteria pulmonar.

We studied ten patients with unilateral absence of main branch of pulmonary artery (UAMBPA). Six patients with absent right pulmonary artery (ARPA) and four with the left pulmonary artery (ALPA). The presence of either atrial septal defect, ventricular septal defect and patent ductus arteriosus alone or combinated were associated with pulmonary hypertension (mean pressure of the pulmonary artery greater than 48 mm Hg). The patients without associated cardiac defects were asymptomatic and with little elevation of the pulmonary arterial pressure (mean pressure of the pulmonary artery less than 26 mmHg).

[Clinical applications of Doppler echocardiography]. / Aplicaciones clínicas de la ecocardiografía Doppler.

In this review, we demonstrate the normal patterns of flow and some quantitative applications of Doppler echocardiography combined with two-dimensional imaging. Flow information can be accurately measured and valve gradient calculations can be made in patients with stenotic diseases. Further corroborative work in this area is necessary before definitive statements can be made, but this appears to be a promising noninvasive technique which can be applied at the bedside or in an ambulatory setting with a fair degree of confidence.

Tratamiento quirurgico de la endocartidis infecciosa. / The surgical treatment of infectious endocarditis

Quince pacientes con diagnostico de endocarditis infecciosa fureron sometidos a tratamiento quirurgico. Se dividieron en dos grupos de acuerdo a si la endocarditis se habia injertado sobre valvulas naturales o protesicas. En el 40% de los casos, se obtuvo el antecedente de manipulaciones previas al desarrollo del proceso infeccioso. El 53% de los pacientes habian recibido tratamiento con antibioticos antes de su ingreso al Instituto. Los hemocultivos fueron positivos en el 60%, con predominio de germenes gram positivos del tipo del estreptococo y el estafilococo. La ecocardiografia demostro la presencia de vegetaciones en el 73% de los casos.La indicacion quirurgica fue, en el 34%, por falta de repuesta al tratamiento medico, embolias septicas e insuficiencia cardiaca en el 27% cada uno, y la alteracion de la funcion renal en el 13% restante. La mortalidad quirurgica fue de 20% y en ningun caso se observo reinfeccion de la protesis

[Echocardiographic diagnosis of atrial thrombosis]. / Diagnóstico ecocardiográfico de la trombosis auricular.

Seventy patients with rheumatic mitral disease were studied by M-Mode and 2D echocardiography in order to detect left atrial thrombosis before surgery. Thrombosis were suspected by the observation of abnormal echoes in the left atrium. During surgery 17 (24%) patients had atrial thrombosis. It had been suspected by echocardiography in 12 (sensitivity 70%). In 53 patients thrombosis were not found during surgery; in 46 the echo had been also negative (specificity 86%). There was a false positive detection of thrombosis by echo in 7 patients (14%) and false negativity in 5 (30%). Patients with atrial thrombosis had atrial fibrilation in 91% of cases; and the most frequent valvular disease was mitral stenosis. There was not a direct relationship among existence of left atrial thrombosis and the anteroposterior diameter of the left atrium as measured by echo. We conclude that echocardiography has good specificity to rule out atrial thrombosis and moderate sensitivity to detect it in rheumatic mitral disease.

[Echocardiographic abnormalities of the mitral valve in interatrial communication of the ostium secundum type]. / Anormalidades ecocardiográficas de la válvula mitral en la comunicación interauricular tipo ostium secundum.

Thirty one patients with atrial septal defect were studied by M-mode echocardiography. In sixteen patients (control group) there only findings suggesting right ventricular volume overload. The remaining fifteen patients, were divided into three groups. Group 1 consisted of five patients with mitral valve abnormalities related to the left ventricular pattern. The macroscopic aspect of the mitral valve in this group was reported by the surgeon to be rheumatic or myxomatous degeneration. In four patients (group II), there was prolapse of an atrioventricular valve, three mitral and one tricuspid. Group III consisted of six patients with an abnormal movement of the posterior mitral leaflet, related to a deformed left ventricle. The QP/QS ratio as well as the interatrial shunt was larger in groups I and III. These data suggest that there are abnormal mitral flow patterns and changes in the left ventricular geometry, related to right ventricular volume overload that cause altered mitral valve movement that can be detected by echocardiography.

[Echocardiographic study of different forms of pulmonary atresia]. / Estudio ecocardiográfico de las differentes formas de atresia pulmonar.

Echocardiographic recognition of pulmonary atresia with either ventricular septal defect or intact ventricular septum is of great value in the differential diagnosis with other forms of right ventricular outflow tract obstruction or hypoplasia of the right ventricle. We studied nine patients with pulmonary atresia seven with ventricular septal defect and two with intact ventricular septum. It was not possible in either group of these patients to register systolic opening and diastolic closure movements of the pulmonary valve. In the group with ventricular septal defect, aortic straddling was present in all cases. In one patient it was possible to register the echoes of an imperforated pulmonary valve. In the remaining patients, the differential diagnosis with persistent truncus arteriosus was not possible. M-mode and Two-dimensional echocardiographic features of pulmonary atresia with intact ventricular septum are specific of this malformation and can differentiate it from other forms of hypoplasia of the right ventricle.

Anormalidades ecocardiograficas de la valvula mitral en la comunicacion interauricular tipo ostium secundum. / Echocardiographic abnormalities of the mitral valve in patients with atrial septal defect

Se estudiaron con ecocardiografia modo-M, 31 pacientes con comunicacion interauricular, patologia comprobada por cateterismo y/o cirugia. Dieciseis de ellos formaron el grupo control y en sus ecocardiogramas exclusivamente se encontraron datos de sobrecarga de volumen del ventriculo derecho. De los 15 pacientes restantes, se hicieron III grupos: en el grupo I, cinco tuvieron anormalidades valvulares mitrales, las cuales no se relacionaron con el patron de contractilidad del ventriculo izquierdo. Durante la cirugia, el aspecto externo de las valvulas se informo como sugestivo de lesion reumatica o degeneracion fibromixomatosa. En el grupo II, de 4 pacientes, existia prolapso de una de las valvulas atrioventriculares; en tres era de la mitral y en uno de la tricuspide. El grupo III se formo con 6 pacientes que tenian movilidad anormal de la valva mural mitral, secundaria a la deformidad del ventriculo izquierdo. La relacion gasto pulmonar/gasto sistemico asi como el cortocircuito interauricular fue mayor en los grupos I y III. Con los datos obtenidos se sugiere que existen alteraciones en los patrones de flujo atrio-ventricular y cambios en la geometria del ventriculo izquierdo, condicionados por la sobrecarga de volumen del ventriculo derecho los que provocan anormalidades en la movilidad de la valvula mitral detectables por ecocardiografia

Diagnostico ecocardiografico de la trombosis auricular. / Echocardiography of atrial thrombosis

Se estudiaron 70 pacientes con valvulopatia mitral reumatica con ecocardiografia modo M y bidimensional, para detectar trombos en la auricula izquierda, previamente a la cirugia. La trombosis se sospecho por la observacion de ecos anormales en el interior auricular. Durante la correccion quirurgica se encontraron trombos auriculares en 17 (24%). De ellos, la trombosis se sospecho por ecocardiografia en 12 (o sea, sensibilidad de 70%). No se encontraron trombos durante la cirugia en 53 pacientes; en 46 de ellos el eco tampoco la sugirio (especificidad 86%). El eco mostro falsa positividad en 7 pacientes (14%) y falsa negatividad en 5 (30%). En el 91% de los pacientes con trombosis auricular existia fibrilacion auricular y la lesion valvular mas frecuentemente encontrada fue la estenosis mitral. No se encontro relacion directa entre la existencia de trombosis auricular y el diametro anteroposterior de dicha cavidad medido por ecocardiografia. Por los resultados obtenidos podemos concluir que la ecocardiografia tiene buena especificidad para descartar trombosis auricular y moderada sensibilidad para detectarla en la valvulopatia mitral