[Atherosclerotic coronary ectasia or a lymphomucocutaneous syndrome in an adult (Kawasaki's disease)?]. / Ectasia coronaria aterosclerótica o síndrome linfomucocutáneo del adulto (enfermedad de Kawasaki)?

We report the case of a 42-year-old man, who was admitted to hospital with an inferior myocardial infarction. He was treated with tissue plasminogen activator without complications in the acute phase. The stress testing performed before discharge showed residual myocardial ischemia. A catheterization study was indicated. The coronary angiogram demonstrated diffuse three vessel coronary artery aneurysmal disease. Two years before the patient had an aneurysm of the right iliac artery being operated on. The differential diagnosis of adult aneurysmal coronary disease is discussed with emphasis on Kawasaki's disease and atherosclerotic coronary artery ectasia.

[The effect of antihypertensive therapy on left ventricular mass and diastolic filling in light and moderate hypertension]. / Efecto de la terapia antihipertensiva sobre la masa ventricular izquierda y el llenado diastólico en la hipertensión ligera a moderada.

BACKGROUND: To valorate the effect of four antihypertensive drugs on the regression of cardiac mass and diastolic function, by echocardiography-Doppler, in not treated hypertensive subjects. METHODS: 60 mild-moderate hypertensive subjects were studied randomized in four groups of 15 patients each one: enalapril (10-40 mg/d), atenolol (25-100 mg/d), verapamil-retard (120-240 mg/d), alphametildopa (250 mg/8h to 3 g/d). The active drug therapy phase was 6 months, performing echo-Doppler, evaluating posterior-wall and septal-wall thicknesses, ventricular mass index, ratio of early to atrial peak diastolic filling velocity (E/A), the first-third filling fraction and atrial filling fraction. RESULTS: The cardiac mass index decreased with the four drugs: with enalapril from 178 +/- 28 to 155 +/- 29 g/m2 (p < 0.05), with atenolol from 170 +/- 23 to 154 +/- 19 g/m2 (p < 0.05), with verapamil from 180 +/- 27 to 159 +/- 22 g/m2 (p < 0.05) and with alphametildopa from 176 +/- 30 to 142 +/- 22 g/m2 (p < 0.01). The E/A ratio and first-third filling fraction only improved in the atenolol subgroup, from 0.79 +/- 0.13 to 0.97 +/- 0.16 (p < 0.01) and from 36 +/- 5 to 44 +/- 9% (p < 0.01), decreasing atrial filling fraction from 37 +/- 6 to 30 +/- 8% (p < 0.01), without modifying with enalapril (0.74 +/- 0.14 to 0.76 +/- 0.20, 35 +/- 5% to 36 +/- 7%, 38 +/- 5 to 39 +/- 7%, p = NS), verapamil (0.69 +/- 0.12 to 0.74 +/- 0.17, 35 +/- 6% to 36 +/- 8% to 40 +/- 12%, p = NS) neither alphametildopa (0.72 +/- 0.14 to 0.71 +/- 0.21, 34 +/- 5% to 35 +/- 7%, 40 +/- 6% to 41 +/- 9%, p = NS). The heart rate decreased more with atenolol than with the other drugs (61 +/- 15 vs 71 +/- 12, p < 0.01). CONCLUSIONS: In hypertensive patients the decreasing of cardiac mass is not accompanied of improvement of the diastolic function except in patients treated with atenolol, probably due to bradycardia.

Fixed subaortic stenosis: the value of cross-sectional echocardiography in evaluating different anatomical patterns.

We present a study using cross-sectional echocardiography in 39 patients (29 male and 10 female) with discrete subaortic stenosis. Five parameters were evaluated in the study: the morphology of the obstruction, the distance of the stenosis from the aortic valve, the type of insertion, the base of implantation, and any associated anomalies. The lesion could be divided into groups with either fibrous or fibromuscular shelves. In the group of 14 patients with fibrous shelves, the distances from the stenotic lesion to the aortic valve was less than 15% of the length of the left ventricle. The obstructive fibrous tissue was inserted on the septum and extended onto the aortic leaflet of the mitral valve (circumferential lesion) in 12 cases. The base of implantation was narrow in all 14 of them. In the 25 patients having fibromuscular lesions, the distance between obstruction and valve was greater than 18.4% of the length of the left ventricle. The insertion of the obstructive lesion was circumferential in 18 cases and its base of implantation was wide in 20 of the patients. Nineteen patients, 16 of whom had fibromuscular lesions, showed associated anomalies. Statistical analysis showed a good correlation between the type of stenosis and the base of implantation of the stenotic lesion (P less than 0.001) or associated anomalies (less than 0.01), but there was no distinction between the groups with regard to the type of insertion (less than 0.38). Twenty-five patients underwent surgical correction which was carried out between the ages of 4-14 years. Prosthetic valves (3 aortic and 1 mitral) were inserted in 4 patients.(ABSTRACT TRUNCATED AT 400 WORDS)