[A simplified method of continuous-wave Doppler noninvasive assessment of ventricular relaxation in mitral insufficiency]. / Método simplificado para el análisis no invasivo de la relajación ventricular mediante Doppler continuo en la insufficiencia mitral.

INTRODUCTION AND OBJECTIVES: The minimum value of dP/dT is a parameter of diastolic function that can be estimated noninvasively by analyzing the profile of velocity of the mitral regurgitant jet, recorded by continuous-wave Doppler. This estimation requires a complex analysis of the curves that impedes its practical use. Our objective was to validate a simplified method to estimate noninvasively the value of dP/dTmin when mitral regurgitation exists. We calculated the pendient of the profile of velocity of the curve of mitral regurgitation during its deceleration, between 3 and 1.5 m/s, an interval that defines a difference in pressure using the formula delta p = (4v2(1) - 4v2(2)). We divided this interval by the time needed by the jet to decelerate from 3 to 1.5 m/s, obtaining the rate of pressure decay, in mmHg/s. METHODS: We provoked mitral regurgitation in five pigs and registered dP/dT and the curve velocity of mitral regurgitation simultaneously, by micromanometer-tipped catheter and continuous-wave Doppler, respectively. The rate of pressure decay was calculated on the mitral regurgitation curve. RESULTS: We obtained 29 simultaneous registers. The coefficient for the correlationship between dP/dT and the rate of pressure decay was with an r value of 0.62 (p < 0.0001). The rate of pressure decay underestimated systematically the value of dP/dT. Intra and interobserver variability of TDP was 9 and 11%, respectively. CONCLUSIONS: This study validates a simplified method to estimate dP/dT noninvasively, with acceptable correlation with invasive measurements and adequate reproducibility.

[Penetrating trauma by foreign body in the left heart ventricle]. / Traumatismo penetrante con cuerpo extraño en el ventrículo izquierdo.

We present the case of a patient who suffered a cardiac penetrating trauma due to a 6-cm long steel splinter. He was self-admitted to the emergency room and was asymptomatic. Cardiac trauma was diagnosed by the presence of a foreign body in his chest X-ray. Transthoracic and transesophageal echocardiography showed pericardial effusion and a dense foreign body that crossed the left ventricle from upside down and forward to back. The patient underwent cardiac surgery under extracorporal circulation. A shooting wound was seen on the left ventricular free wall. Transesophageal echocardiography was performed during surgery in order to define the position of the foreign body and to discard lesions due to multidirectional injury. Lesions were repaired and the patient was discharged with no complications. This case report illustrates the possibility of survival after cardiac penetrating trauma, and the role of echocardiography in the diagnosis and surgical repair of this type of trauma.