[Cardiovascular syphilis: a case report]. / Sífilis cardiovascular: a propósito de un caso.

Nowdays, cardiovascular manifestations of syphilis are uncommon. We report the case of a 69-year-old man who underwent surgery for saccular aneurysm of the ascending aorta associated with aortic regurgitation of this etiology, due to sexual transmission of the disease 25 years previously. The patient was born in Morocco and 2 years after surgery he remains asymptomatic.

[Preoperative coronarography in heart valve disease patients. A probability analysis of coronary lesion]. / Coronariografía preoperatoria en pacientes valvulares. Análisis de probabilidad de lesión coronaria.

INTRODUCTION AND OBJECTIVES: The indication of preoperative coronary angiography is routinely performed for patients who are going to valve replacement surgery. The need of coronary angiography is based on age, gender and previous angina, but it is not usually based on risk factors. The purpose of this study has been to find markers to predict the probability of coronary lesion in this group of patients. PATIENTS AND METHODS: We studied retrospectively a population of 541 patients with valvular heart disease who underwent preoperative coronary angiography from 1989 to 1994. Mean age was 61.8 (range 34-82). There were 301 men and 240 women. We analyzed in each patient different variables such as age, gender, previous angina, hypertension, diabetes mellitus, tobacco and familial predisposition. We correlated these variables with the presence of coronary lesion by multivariate analysis. RESULTS: There were 73 patients with coronary lesion greater than 50%. The prevalence of significant coronary artery disease was 13.4%. Angina was present in 34.6%. The risk of coronary lesion was defined as odds ratio: previous angina 3.3; tobacco 2.6; diabetes 2.2; hypertension 1.8 and age 1.4. The others variables were not predictor of coronary lesion. The probability of coronary lesion in patients without those variables (angina, tobacco, diabetes, hypertension) was 4%. If we analyzed age, the probability of coronary lesion was 3% in patients under 65 years and 6% above 65 years. CONCLUSIONS: The lack of previous angina and at least the three risk factors described as predictors of coronary lesion (hypertension, tobacco and diabetes) can define a group of patients with a very low prevalence of coronary lesion, especially if they are under 65 years. It can allow us to avoid preoperatory coronary angiography in patients who undergo valve replacement.

[Actuarial follow-up after percutaneous mitral valvulotomy. Incidence and event-predicting factors]. / Seguimiento actuarial tras valvulotomía mitral percutánea. Incidencia y factores predictores de eventos.

INTRODUCTION: The goal of this study is to analyse the follow-up of patients who underwent percutaneous mitral valvuloplasty and the predicting factors of event-free survival. METHODS: We analysed 220 consecutive valvuloplasty performed between 1988 and 1996 in order to establish the incidence of events (death, restenosis, mitral valve surgery, New York Heart Association class IV, new valvuloplasty or systemic embolia) and the baseline and postprocedural characteristics predicting events, during a mean follow-up of 42 months (range 1-96 months). RESULTS: Overall survival was 94.7%, and event-free survival was 59.2% at 96 months. We analyzed the baseline characteristics in order to predict the mid-term outcome (actuarial survival Kaplan-Meier method) that atrial fibrillation (p < 0.01), age > or = 56 years (p < 0.005), and echocardiographic score > or = 9 (p < 0.005) were baseline characteristics related to adverse events in follow up. An index based on the number of adverse factors in the baseline characteristics provided a significant difference in concerning the number of follow up to even-free between the group without baseline adverse characteristics and the group with two (p = 0.008, OR = 4.5), or three adverse characteristics (p = 0.005, OR 6.4). Among the postprocedural characteristics, while patients with mitral valve area after valvuloplasty > or = 1.5 cm2 had an event-free survival of 72.9% at 96 months, those with postprocedural mitral valve area < 1.5 cm2 had an event-free survival of 10.5% (log-rank test p < 0.0001). CONCLUSIONS: Mid-term event-free survival after percutaneous mitral balloon valvuloplasty can be predicted by baseline and postprocedural characteristics. Age > or = 56, echocardiographic score > or = 9 and atrial fibrillation are baseline factors related with adverse events. Patients with 0 or 1 baseline adverse factors do not have significant differences concerning mid-term outcome while, those with 2, and above all, 3 adverse baseline characteristics have a poorer event-free survival. Mitral valve area > or = 1.5 cm2 is the only postprocedural independent predictor of event-free survival.

[Fallot's tetralogy with severe symptomatology during the first year of life (author's transl)]. / Tetralogía de Fallot grave en el primer año de vida. Aspectos clínicos e implicaciones quirúrgicas

Seventeen cases of Fallot's Tetralogy with severe symptomatology during the first year of life are reviewed. In all of them, a cardiac catheterization and angiocardiography were performed. In 2 cases the pulmonary outflow tract was atretic. In general, the clinical, radiologic, electrocardiographic and hemodynamic findings were similar to those previously reported, although in 3 patients of the present series atypical electrocardiographic findings were found. Pronounced narrowing and horizontal orientation of the infundibular chamber, and accentuated hypoplasia of the pulmonary artery branches and of the left heart cavities and were all unfavourable findings for total correction frequently found in the present material. Minimal or non-existent aortic dextroposition was observed in association with cases of Fallot's Tetralogy with extreme severity. Surgery was indicated as an emergency measure in the majority of the cases. Palliatives procedures were performed in 10 patients, and corrective surgery in one. Surgical results agree with the extreme severity that this lesion has, when it gives rise to important symptomatology so early in the life.

[Ventricular septal defect in the first year of life (author's transl)]. / Comunicación interventricular en el primer año de la vida.

Thirty cases of CIV in the first year of life are presented. Association with prematurity and other malformations anticipate cardiac failure. Left ventricular hypertrophy is more frequent in conal defects. Repolarization disturbances were found in 73% of the cases in left precordial derivation with significative relief after surgical repair (banding). Conduction disturbances after surgical closure of ventricular septal defect was found in 15% of the cases. Surgical treatment during the first year was needed in 86% of patients. Only one case had good evolution without surgery. After four months of life total correction of septal defect as prefered. In patients with previous pulmonary artery banding, correction must be made one or two years later.