[Anomalous origin of the circumflex artery from the pulmonary artery in a patient with rheumatic mitral stenosis]. / Origen anómalo de la arteria circunfleja en la arteria pulmonar en un paciente con estenosis mitral reumática.

Left circumflex coronary artery arising from the pulmonary artery is an infrequent congenital anomaly, only described once in an adult patient. We present one patient with rheumatic mitral stenosis in whom this anomaly was noticed when an angiography was performed prior to a percutaneous mitral valvuloplasty.

[Lipomatous hypertrophy of the interatrial septum simulating an atrial mass in a patient with a pulmonary embolism: its diagnosis by transesophageal echocardiography and percutaneous biopsy]. / Hipertrofia lipomatosa de septo interauricular simulando masa auricular en paciente con embolismo pulmonar: diagnóstico mediante ecocardiografía transesofágica y biopsia percutánea.

A case of lipomatous hypertrophy of the interatrial septum in a patient with a history of repeated pulmonary embolism is presented. Thickening of the interatrial septum mimicking the presence of a right atrial mass was evidenced by transthoracic and transesophageal echocardiography. Lipomatous hypertrophy was suspected. The diagnostic was confirmed by echo guided (transesophageal) percutaneous transvenous biopsy. To our knowledge, there is no relationship between lipomatous hypertrophy and pulmonary embolism and in this case, it could be associated with smoking habit and oral contraceptives.

[Pulsed Doppler of the hepatic veins: a new test in the assessment of aortic insufficiency]. / Doppler pulsado de las venas hepáticas: un nuevo test en la valoración de la insuficiencia aórtica.

In order to determine the value of the analysis of the hepatic vein flow pattern in the gradation of aortic regurgitation, two-dimensional and Doppler studies were carried out in 13 healthy individuals (control group) and 36 patients with aortic regurgitation (study group), in a prospective fashion. By 2-D and Doppler Echocardiography, aortic regurgitation was graded as mild in 5 patients, moderate in 13 and severe in the remaining. In 25 patients of the study group, hemodynamic and angiographic studies were available. Moderate or severe pulmonary hypertension was detected in 11 patients. Peak and integral velocities of the systolic, diastolic and "A" waves were measured on pulsed Doppler hepatic veins flow tracings. Both peak and integral hepatic vein diastolic flow velocities in postexpiratory apnea were significant lower in patients with severe aortic regurgitation with respect to the remaining study group patients and control group patients. Sensitivity and specificity for the detection of severe aortic regurgitation were 100 and 67% respectively. An postexpiratory increase in the retrograde "A" wave was observed in 11 patients with severe and 6 with moderate aortic regurgitation. Sensitivity and specificity for the detection of severe aortic regurgitation were 58 and 67% respectively. In this study, characteristic pulsed Doppler hepatic vein flow patterns are defined for patients with aortic regurgitation. Sensitivity and specificity of the findings allows the identification of severe AR. This results could have diagnostic and therapeutic implications.

[Changes in the flow patterns of the hepatic veins obtained by pulsed Doppler during the postoperative follow-up of a patient with acute aortic insufficiency]. / Modificación de los patrones de flujo de las venas hepáticas obtenidos por Doppler pulsado durante el seguimiento postoperatorio de un paciente con insuficiencia aórtica aguda.

Blood flow pattern recording of hepatic veins using pulsed Doppler technique is a valid method for the assessment of hemodynamic changes in right atrium. We describe a patient with severe aortic regurgitation secondary to acute infective endocarditis who underwent surgical repair. Before surgery and during the postoperative period, several evolutive studies (including conventional echo and hepatic veins pulsed Doppler recordings) were performed. The different central blood flow patterns were correlated with changing hemodynamic conditions during follow-up of the patient. These central flow velocities reflect changes in right atrial pressure contours, and are easily obtained non-invasively with pulsed wave Doppler ultrasound of the hepatic veins. They could be an useful method for assessing right heart filling dynamics, reporting characteristic patterns in other cardiac disease states.

[The importance of the echocardiographic diagnosis of a mycotic aneurysm of the mitral septal leaflet in infectious endocarditis of the aortic valve: the surgical implications]. / Importancia del diagnóstico ecocardiográfico del aneurisma micótico del velo septal mitral en la endocarditis infecciosa de la válvula aórtica: implicaciones quirúrgicas.

Mycotic aneurysm of the septal leaflet of the mitral valve is an infrequent complication associated with aortic infective endocarditis. The most probable mechanisms implicated on its formation are two: the lesion induced by regurgitant jet striking on septal mitral leaflet and the direct spreading of infection through the fibrosa inter-valvular. We describe the preoperative diagnosis of mycotic aneurysms of the septal mitral leaflet by two-dimensional echocardiography and color flow mapping in 2 patients. Surgical management will depend on the anatomic characteristics of the aneurysm and its hemodynamic repercussion. Careful echocardiographic search for mycotic mitral aneurysms should be performed in cases of aortic valve endocarditis, in view of its important prognostic implications.