[Patent foramen oval as a cause of severe hypoxia during the immediate postoperative period following heart transplantation]. / Foramen oval permeable como causa de hipoxia severa en el postoperatorio inmediato de trasplante cardíaco.

We report the case of a 44-year-old man with dilated cardiomyocardiopathy, pulmonary hypertension and high pulmonary resistance who underwent orthotopic heart transplant. Following transplantation severe hypoxia was observed after weaning of cardiopulmonary bypass secondary to a patent foramen oval in the donor heart. This situation does not usually lead to problems in the donor, however taking into account the special hemodynamic conditions of the transplanted patient, with high pressure in the right side, an opening occurred producing a significant right-left shunt causing severe receptor hypoxia. Successful closure of the patent foramen oval was performed.

[A right-to-left shunt through a patent foramen ovale without pulmonary hypertension]. / Cortocircuito derecha-izquierda a través de foramen oval permeable sin hipertensión arterial pulmonar.

We report the case of a man 67-years-old with right-to-left shunt through a patent foramen ovale in absence of pulmonary hypertension. The contrast and transesophageal echocardiography showed significant right-to-left shunt and provided insight about the mechanisms that cause it. The aortic root was enlarged compressing the right atrium. Surgical repair was performed, the foramen ovale was closed and right atrial enlargement with a patch was carried out. Disappearance of the shunt was confirmed by means of transesophageal echocardiography in surgical-room.

Comparison of acute and steady-state conditions of gallopamil therapy in stable angina pectoris.

We studied 12 patients with stable effort angina in a randomized, double-blind, cross-over and placebo-controlled trial to compare the different antianginal efficacy of "acute" and "chronic" (after reaching a steady-state level) gallopamil therapy. Efficacy was assessed using treadmill exercise testing (Bruce protocol) after a 50 mg single-dose and at the end of a nine-dose course of 50 mg of gallopamil (given three times a day). Three daily exercise tests were performed the first, second, fifth and eighth day of the study protocol at 8, 12 and 16 h. Four hours after a single-dose of gallopamil 50 mg both angina-free exercise time and time to 1 mm ST segment depression increased by a mean value of 78 s (p < 0.003) and 53 s (p < 0.03), respectively, with respect to placebo values. Under steady-state conditions exercise time and time to 1 mm ST segment depression increased by a mean value of 59 s (p < 0.009) and 46 s (p < 0.015), respectively, 4 h after the last dose. The duration of the anti-ischemic effects was no longer present after 8 h for both treatment schedules. Furthermore no significant differences were observed on parameters of ischemia after a single dose as compared to "chronic" therapy. The results of this study reveal that, in accordance with the pharmacodynamic properties of the drug, the anti-ischemic efficacy of 50 mg of gallopamil remains for approximately 4 h. Reaching a steady-state condition does not imply a prolongation of the anti-ischemic effect.

[The acute and chronic effects of 50 mg of isosorbide 5-mononitrate with delayed action in patients with stable angina of effort]. / Estudio del efecto agudo y crónico de 50 mg de 5-mononitrato de isosorbida de liberación retardada en pacientes con angina de esfuerzo estable.

In 10 patients with stable effort angina and angiographically demonstrated coronary artery disease, serial exercise test were performed in order to assess the efficacy and duration of the anti-ischemic effects of a single dose (50 mg) of a sustained-release preparation of 5-isosorbide mononitrate (5-IMN). The possible presence of a tolerance phenomenon was also sought. The study was randomized, double-blind and placebo-controlled. Four hours after an acute dose of 5-IMN, time for -1 mm ST segment depression significatively increased as compared with basal test and placebo test (367 +/- 92 vs 199 +/- 87 and 250 +/- 78 sec respectively, p less than 0.0004). At the same test, total exercise time also increased from 282 +/- 92 sec (basal) and 323 +/- 91 sec (placebo) to 424 +/- 91 sec (p less than 0.008). At 12 hours test, total exercise time was also significantly increased as compared with basal test and placebo test (354 +/- 109 vs 282 +/- 92 and 291 +/- 90 sec respectively; p less than 0.01). These effects were not present when the patients were tested 24 hours after active drug administration. After daily administration of a single dose of 5-IMN during a 3 week period, 4 and 12 hours test demonstrated a persistent and significant anti-ischemic effect, similar to the acute figures. Thus, an acute dose of 50 mg of a sustained-release preparation of 5-IMN reveals significant anti-ischemic effects which remain 4 and 12 hours after drug administration. Chronic administration of the preparation for 3 weeks (single daily dose) is equally effective, without any evidence of tolerance phenomenon.