[Cardiac failure due to traumatic aortic valve rupture]. / Insuficiencia cardíaca secundaria a rotura traumática de la válvula aórtica.

Cardiac failure due to valvular dysfunction is frequent as a complication of acute myocardial infarction, endocarditis or penetrating thoracic trauma affecting the heart and large vessels. Less frequently it is associate with nonpenetrating chest trauma. We presented a 69-year-old male with acute left heart failure after nonpenetrating thoracic trauma and sternum fracture. Transesophageal echocardiogram confirmed severe aortic regurgitation. A bilateral tear in the right coronary and non-coronary cusp was found. The aortic valve was removed and replaced with a number 27 Carpentier Edwards prosthesis. The postoperative course was uneventful.

[Cardiac osteogenic sarcoma with chondroblastic differentiation]. / Sarcoma osteogénico cardiaco con diferenciación condroblástica.

Cardiac tumors are a rare disease. We show here one patient with a heart osteogenic sarcoma with chondroblastic differentiation. The clinical status was initiated with a cadre of cardiac tamponade. Transesophageal echocardiography and thoracic scanner were used to diagnose the cardiac tumor. The definitive diagnosis was confirmed with biopsy. At the present moment, there are very few cases reported in the references on osteogenic sarcoma with chondroblastic differentiation. The methods of diagnosis, the treatment and the histopathology are discussed.

[Pulmonary hypertension and early mortality after orthotopic heart transplantation]. / Hipertensión pulmonar y mortalidad precoz después del trasplante cardíaco ortotópico.

INTRODUCTION AND OBJECTIVES: To study the relationship between hemodynamic parameters before heart transplantation and the mortality rate at the first week posttransplant. METHODS: 85 patients had an orthotopic heart transplant. Before the operation we measured: vascular pulmonary resistance, index of vascular pulmonary resistance, pulmonary arterial pressure systolic and median and transpulmonary gradient. Ten patients with values of vascular pulmonary resistance higher than four Wood units and/or pulmonary artery systolic pressure higher than 60 mmHg, had a test of pulmonary vascular reactivity, the result of that test did not contraindicate the transplant. We used the Student's t test and chi 2 with continuity correction and the Fisher's exact test for the analysis of the data. RESULTS: During the study period eight patients were dead (9.4%). The causes of death were: acute disfunction of the graft, 5 patients; multiorgan failure, 2 patients and septic shock, 1 patient. We compared the parameters of both groups of patients live and dead and could find a significant difference between the data with higher values in the death group: pulmonary arterial systolic pressure (p < 0.01); pulmonary arterial median pressure (p < 0.03) and transpulmonary gradient (p < 0.02). We also saw that the relative risk of mortality was 10.4 when the pulmonary artery systolic pressure was > or = 50 mmHg and 5.7 when the pulmonary vascular resistance was > or = 5 Wood units. CONCLUSIONS: It is important a good evaluation of the pulmonary hemodynamic before the heart transplantation for a better selection of the receptor. The severe pulmonary hypertension (pulmonary vascular resistance > or = 5 Wood units or pulmonary artery systolic pressure > or = 50 mmHg) was associated with a higher rate of early death.