Masa auricular izquierda / Left auricular mass

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Infective endocarditis of an interventricular patch caused by Acinetobacter haemolyticus.

A case of infective endocarditis caused by Acinetobacter haemolyticus affecting and interventricular patch is reported. The patient, a 21-year-old man with a Fallot's tetralogy who had undergone cardiovascular surgery several years before, received imipenem and gentamicin for 6 and 4 weeks respectively and showed a good response without needing surgical treatment. Endocarditis by Acinetobacter species is very unusual and, to our knowledge, this is the first reported case of infective endocarditis caused by A. haemolyticus. As the clinical characteristics and the response to antibiotics appear to be similar to those reported for infective endocarditis by Acinetobacter lwoffi, prosthetic infective endocarditis by A. haemolyticus is apparently not always an indication for surgical treatment.

[A suicide attempt with oral verapamil: a case report]. / Intento de autólisis con verapamilo oral: presentación de un caso.

We report a case of a 29-years-old patient who tried to commit suicide by taking a high dose of verapamil (22 pills containing 240 mg, each, equivalent to 5.28 g). Ten hours after the ingestion he presented a complete atrioventricular heart block which was resolved with medical treatment presenting a normal ECG 36 hours later. To our knowledge this is the only published case of intoxication caused by such a high dose of verapamil.

[Spontaneous calcific embolization in calcified aortic valve stenosis. A case report]. / Embolia cálcica espontánea en la estenosis valvular aórtica calcificada. Presentación de un caso.

Calcific embolism from an aortic stenosis is an uncommon event that can be seen after cardiac surgery or left heart catheterization but extremely rare in a spontaneous way. We report a case of a patient with calcified aortic stenosis presenting a spontaneous calcareous embolism in the retinal artery. We review the literature about this problem as well.

[The long-term evolution of patients with senile aortic stenosis undergoing percutaneous valve dilatation]. / Evolución a largo plazo de los pacientes con estenosis aórtica senil sometidos a dilatación valvular percutánea.

The long-term follow-up of 35 patients with mean age of 74.3 +/- 8 years (64-86) who underwent percutaneous aortic valvuloplasty (PAV) is presented. The mean duration of the follow-up study was 33 months (range 1-48). Global mortality was 42% (14 patients) and was related to post-PAV aortic valvular area (47% mortality in less than 0.7 cm2 area group vs 28% in greater than or equal to 0.7 cm2 group) and left ventricular ejection fraction (67% in EF less than 35% group vs 35% in EF greater than or equal to 35% group). The actuarial probability of remaining alive and free of symptoms and of cardiac surgery or new PAV was 57, 41, 33, and 20% at 1, 2, 3 and 4 years. After PAV clinical improvement was obtained in most of the patients (68%), but only 42% of those with successful dilatation remain asymptomatic after a 24 months period (85 +/- 28 mmHg, p = NS). Transvalvular gradient studied by Doppler decreased immediately after PAV (92.8 +/- 26 mmHg vs 51 +/- 16 mmHg, p less than 0.001), but returned to baseline values after 12 months. These results show that PAV yields a clinical improvement in most of the patients, but this improvement is transitory, does not modify the natural history of the disease and has a high degree of restenosis. Thus, its use must be limited to a reduced group of patients who are not candidates for cardiac surgery.