UNLABELLED:Left ventricular dP/dt is estimated from mitral regurgitation (MR) jet as the rate of pressure rise (RPR) from 1 to 3 m/sec. In order to establish if this measure is made during the isovolumetric contraction (IC), we with MR studied 38 patients (age average 51 +/- 8 years) of different etiology. IC was estimated as pre-ejection time minus Q-first sound (S1). Velocity of the MR was measured at the onset and at the end of IC to estimate RPR during IC and time from 1 m/s to S1 (T1-S1) to indicate the mismatch between the two methods.RESULTS:There was not difference between RPR 1 to 3 m/s and RPR (IC). T 1-S1 was 26 +/- 24 ms indicating that the measure of RPR 1 to 3 m/s was made prior to the onset of IC.CONCLUSION:Noninvasive assessment of left ventricular dP/dt from 1 to 3 m/s is made prior to the onset of IC.
This article describes the first case in Mexico city that received a three chamber pacing system. A 40 year-old man with dilated cardiomyopathy with variant cardiac rhythm and bradycardia. The three leads were introduced by right subclavian approaches. The right chamber leads were placed in atrial's appendage and in the right ventricular outflow tract and the last one was placed in the great cardiac vein. The two ventricular lead were connected a Y-connector to the ventricular channel of a standard bipolar DDDR pacemaker. The right ventricular lead was connected to the distal pole (anode) and the left ventricular lead to the proximal pole (cathode). Eight days later, the patient's clinical status improved, his functional class improved from IV to II and his left ventricular ejection fraction increased from 30% to 35% by conventional ventriculography. In this type of patients the improvement in cardiac output is this result an of increase in left ventricular filling, reduced mitral and tricuspid regurgitation a better synchronization of ventricular contraction. Multisite pacing has added a mayor complexity to contemporary pacing and a modification of the standard pacer-maker code should be considered to accommodate multisite pacing. The letter in the first and second position might be T (three) or F (four) according to number of pacing chamber and also the letter "t" may be suitable to designate trigger in the third position. We conclude that implant of three chamber pacing in patients with dilated cardiomyopathy is technically feasible. An improvement in the patient's condition may be obtained and a modification in standard pacemaker code is necessary.
Acetyl-salicylic acid inhibits thromboxane A2 production and reduces the risk of vascular occlusive events by 20 to 25%. Ticlopidine inhibits ADP-dependent platelet aggregation and reduces the same risk by 30 to 35%, but produces some adverse effects. Clopidogrel is a ticlopidin-derived antiplatelet-drug, with the same mechanism of action; reduces the expression of the glycoprotein IIb/IIIa, the fibrinogen receptor on the platelet surface. Clopidogrel has the same clinical efficacy of ticlopidin and lowers the incidence of adverse effects. In this study, we evaluated the effects of one daily dosis of 75 mg of clopidogrel on platelet function in 33 subjects with coronary artery disease. Before treatment and after the 6th and 12th week, the following parameters were evaluated: 5 microM-ADP and 20 micrograms/mL collagen-induced platelet aggregation, bleeding time and fibrinogen concentration. In basal and in the 6th and 12th week samples, ADP-induced platelet aggregation was 90.7% +/- 13.2, 54.6% +/- 23.2 and 49.2% +/- 23.7 respectively, that represents a significant reduction of 38.6% and 44.4%. Reduction of collagen-induced platelet aggregation was not significative. Plasmatic fibrinogen did not suffer variation during treatment. Bleeding time was significant prolonged from 4.1 minutes to 15.4 and 14.6 minutes (3.7-3.5 times compared with the test before treatment). There were no haemorrhagic complications, only digestive discomfort in fewer than 3% of patients. We concluded that clopidogrel is a safe and efficacious drug for patients, it efficiently reduces ADP-induced platelet aggregation and prolongs bleeding time.
This is the case of a 27 years-old woman with signs and symptoms of severe untreatable congestive heart failure, anemia, gingival mucosa ulcers, photosensitivity and alopecia. The electrocardiographic, echocardiographic, angiographic and hemodynamic data oriented the diagnosis of restrictive cardiomyopathy, mitral insufficiency secondary to mitral prolapse and bi-atrial dilation. The histologic study of the endomyocardial biopsy, performed during catheterization, showed signs of endomyocardial fibrosis, and immunological analysis was compatible with systemic lupus erythematosus. As far as we know, this is the first case of endomyocardial fibrosis (Davies disease) associated with systemic lupus erythematosus published in the medical literature. The etiology of Davies disease remains unrevealed and its association with systemic lupus erythematosus suggest a probable autoimmune origin.
OBJECTIVES:We hypothesized that the anaerobic ATP synthesis mediated by the creatine kinase/phosphocreatine (CK/PCr) system is sexually dimorphic during maturation and aging of the rat heart.BACKGROUND:Gender-related morphological and functional differences in cardiovascular aging seem to explain the greater longevity of mammalian females, including women.MATERIAL AND METHODS:By means of heart CK specific activity and cytosolic CK isoenzyme analyses we studied 46 male and female Wistar rats of similar weight divided in groups of 200, 250, and 300 g of body weight.RESULTS:No sex differences were observed in heart weight and post 27,000 x g heart protein content at any studied weight. Heart/body weight ratios did not show any significant gender difference along the study. Differences of heart CK specific activity were found only at 257 +/- 6 g of rat body weight due to a decrease of the male enzyme activity. The female heart showed a larger variety of cytosolic CK isoenzymes at any studied weight. Heavily catalytically stained BB-CK type cytosolic isoenzymes were consistently found in the heart of rats of either sex at the studied weights, contrarily to the accepted view of CK tissue specificity.CONCLUSIONS:In this work, significant gender differences were mainly found in the patterns and number of catalytical cytosolic CK cardiac isoforms. Regarding the alternate anaerobic mechanism of ATP production, these differences may explain in part the sex differential susceptibility to hemodynamic compromise in response to cardiovascular stress, in favor of females.
A case of direct communication between right pulmonary artery and left atrium is reported. The diagnosis was made before surgical correction. A surgical ligation of the fistula resolved the cyanosis of the patient. Selective angiocardiogram of the right pulmonary artery 4 months after surgery revealed no residual shunt. This very rare malformation should be considered in the clinical setting of unexplained cyanosis. This is the number 50 case reported in the literature.
We describe the case of a 26-year-old female in functional class I (NYHA), with aortic origin of the right pulmonary artery associated with a persistent ductus arteriosus and severe pulmonary artery hypertension (101/40-70 mm Hg), which remained elevated (89/40-60 mm Hg) after the administration of 100% oxygen. Right pulmonary artery pressure (125/60-86 mm Hg) was higher than that of main pulmonary artery and similar to aorta pressure. The patient was successfully treated: surgical closure of the ductus arteriosus and end-to-end anastomosis between the pulmonary artery and right pulmonary artery were carried out. Systolic pulmonary arterial pressure, estimated by echocardiography Doppler, was 60 mm Hg six months after surgery. Cross-sectional echocardiogram showed the anastomosis of the right pulmonary artery with the main pulmonary artery. Pulmonary gammagraphy showed both lungs perfused through the main pulmonary artery; right lung perfusion was lesser than left lung perfusion, 30 vs. 70% respectively. Aortic origin of a right or left pulmonary artery is a heart disease seen in patients during the course of the first year of life. Its frequency is < 1% among all the congenital cardiopathies and the survival rate to adult life is very low. The originality of this paper is the presentation of a rare congenital cardiopathy treated surgically in an adult.
patient admitted to the Emergency Room with chest pain syndrome has always been a challenge for the cardiologist. About one third of the patients sent home come back with an acute myocardial infarction (AMI) 1,2 and in about one third of those admitted to the Coronary Unit the AMI diagnosis cannot be confirmed. 3,4 Frequently, the conservative behavior of observation and/ or diagnostic wait is opted for, which increases the number of patients being admitted at the Intensive Care Coronary Unit (ICCU) and overpopulates this critical, costly and fast mobility area. This scenery also serves the risk of iprofessional liabilityi lawsuits. 5 In the 1985-90 period, a 25% reduction of AMI morbidity and mortality was achieved, 6 thanks to a better knowledge of the etiopathogenesis, the continuous development of new technologies that provide a fast and reliable diagnosis, and very specially to the immediate use of new revascularization techniques. Finally, education of the medical staff and the public in general, with respect to primary and secondary means of ischemic coronary heart disease (CHD) prevention, have also
We assessed the diagnostic usefulness of helical CT scan of the thorax in the setting of chronic thromboembolic pulmonary hypertension by prospectively comparing the results of helical CT scan to those of the pulmonary angiogram (gold standard). We studied 40 patients with diagnosis of pulmonary hypertension of diverse etiology (mean age: 40.7 +/- 12 y.o.; mean systolic pulmonary artery pressure: 91 +/- 33 mmHg)). Thirty of these patients fulfilled the diagnostic criteria of chronic thromboembolic pulmonary hypertension and the other ten were used as controls. Diagnosis in control patients included: primary pulmonary hypertension (4); patent ductus arteriosus (2); atrial septal defect (1); rheumatic valve disease (1); ischemic heart disease (1); and acute pulmonary embolism (1). Both helical CT scan and pulmonary angiogram were part of the routine diagnostic work up of these patients, and were, performed and interpreted almost simultaneously (within one week) by a different group of investigators in a blind manner. Only the diagnostic accuracy of the method regarding central (major arteries) vascular lesions was evaluated. Helical CT scan had an overall sensitivity of 100% (29/29), and a specificity of 91% (10/11). Positive predictive and negative predictive values were 96.6% (29/30) and 100% (10/10), respectively. Overall diagnostic accuracy was 97.5% (39/40). We conclude that helical CT scan of the thorax is an excellent alternative approach for the diagnosis of major arteries lesions in the setting of chronic thromboembolic pulmonary hypertension.
UNLABELLED:We present the immediate results of mitral valvuloplasty in 10 patients using Nucleus balloon. Several publications show highly successful results obtained with the Inoue balloon and double balloon technique. There are no publications of Nucleus balloon. We consider that this device could offer several advantages according to its physical and technical characteristics. We performed the procedure in 10 female patients, with severe mitral valve stenosis, with an average age of 44.8 years (23-70) and an average Wilkins score of 7.5 (6-9), using a combined technique. The increase in mitral valve area with Gorlin equation was 1.03 +/- .13 to 2.6 +/- .67 cm2, the decrease in transmitral gradient from 15 +/- 4.1 to 3.42 +/- 2.6 mm Hg, and decrease in systolic pulmonary pressure from 54.1 +/- 18.8 to 24.9 +/- 5.1 mm Hg. One patient developed grade I mitral insufficiency after the procedure, and another non significant interatrial shunt.CONCLUSIONS:Good results are obtained with this balloon, the valvuloplasty technique is more simple than with double balloon, it is much cheaper than Inoue balloon and we consider it could be useful in moderately calcified valves.
We present the results and follow up of ductus arteriosus closure with the Rashkind device. Sixty-six devices were implanted in 63 patients, 41 women and 22 men, with a mean age of 8.2 years. We determined the diameter of the duct, the presence or absence of immediate residual leak at 3 months, 6 months, 1 year, and every year of follow-up by ecocardiography. The hemodynamic determinations showed: type A morphology in 49, type C in 7 and type E in 7; with a mean diameter of 4.2 +/- 1.4 mm (range of 2.3 to 8.7 mm) and a Qp/Qs 2.2 +/- 1.5 (range 0.7 to 8.6). Forty-five 17 mm devices and 18 of 12 mm were used. The incidence of immediate residual leak was 65% (n-41); at 24 hrs. Post-procedure was 31.7% (n-20) and at one year 7.9% (n-5). Three patients with persistent leak had implantation of a second Rashkind device and one more patient an endovascular coil, the other patient is waiting for a second occlusor. Minor complications occurred in 15.8% (n-10). Results show an occlusion rate at 24 hrs of 68% and at one year of 92%; no patient presented migration of the device, hemolysis or obstruction of the pulmonary artery branches. We consider that occlusion of the ductus arteriosus with the Rashkind device is a safe and effective option for the treatment of this pathology.
This is the diagnostic experiences as well as the surgical mode of treatment used in a 31 years old women suffering diversion of the inferior vena cava into the left atrium associated with atrial septal defect. The patient had been previously studied and operated thrice under conventional circumstances at different institutions in order to solve the septal defect. The hemodynamic solution had not been reached due to a missing pathological definition. The cineangiogram through the saphenous vein specified the left atrium form the inferior vena cava. Some considerations are made on the surgical methods used for the fourth operation, and in regard of the fact that the patient refused blood transfusion because of religious convictions (Jehova Witness).
A case of acute myocardial infarction in a 36 years old patient is presented. Maleness was male, as the only mayor coronary risk factor. He had myocardial infarction associated with ingestion of cold beverage after strenuous physical exercise. A coronariographic study was done postmyocardial infarction, which showed a mild obstruction of the LAD. The most likely cause of the coronary event in this case is coronary spasm and atherosclerosis. A review of the literature on this subject is made.
UNLABELLED:Gated SPECT is a useful technique to evaluate myocardial perfusion, wall motion abnormalities and wall thickening. There is not published experience in Latin-America using dual isotope rest Thallium-201/stress Tc-99m Tetrofosmin Gated SPECT.METHOD:We studied 27 patients with coronary artery disease. Coronary angiography was performed in all the patients. We used an injection at rest of 3 mCi of Thallium-201 followed by stress and the administration of 15 mCi of Tetrofosmin and Gated SPECT acquisition. Five days after, the patients were injected with 20 mCi of Sestamibi at stress, with a second Gated SPECT acquisition. Perfusion data were analyzed using 20 SPECT segment analysis. To study the wall motion, we divided the heart in 29 segments and every segment was scored using a 4 points scale (3 = normal, 2 = mild hipokinesia, 1 = severe hipokinesia, 0 = akinesia).RESULTS:The perfusion and wall motion segmental score agreement between stress Tc-99m tetrofosmin and stress Tc-99m sestamibi were 97% and 84% respectively.CONCLUSIONS:Rest Thailium-201/stress Tc-99m Tetrofosmin Dual isotope Gated SPECT technique is a good protocol to assess simultaneous myocardial perfusion and wall motion. There is a good agreement of the results with the use of rest Thallium-201/stress Tc-99m Sestamibi Dual isotope Gated SPECT study.
The Renaissance savants essentially repelled the scholastic translations and commentaries of the ancient writings. Nevertheless they did not reach a modern vision of the experimental science. Moreover, the education at the universities was not credited for the science's development. In fact, the academic training of students was rather precarious. The first professional associations, such as the "Royal College of Physicians" of London, were not any better. Regarding hermetic influence on the Renaissance thought, the cultured and philosophical reformed magic (the so called white magic) was the equivalent of science at the time. Once the animistic universe, operated by magic, is transformed into the mathematical universe, operated by mechanics, the era of science came into being. This movement began during the post-Renaissance age and gradually progressed following the physical-mathematical orientation of Galileo and his pupils: Borelli, Fabrizi, Santorio, Harvey, etc. They initiated the physiological studies and introduced the quantitative method into the research field. Harvey's circulatory doctrine was the first adequate explication of an organic phenomenon and a starting point for the way toward experimental physiology. However the English physician did not leave completely the pre-scientific era, as can be inferred from his monography on animals reproduction. In this work, some points suggesting the birth of modern scientific reasoning alternate with confused, vague and capricious assertions. In fact, the modern science did not arise suddenly, but was elaborated and sustained slowly starting from the XVII century: the Galileo's century.
Fifty seven hearts with absence of atrioventricular (A-V) connection were studied morphologically to specify their types of ventriculoarterial connection and their associated anomalies; the anatomic features of the hearts were correlated with their echocardiographic and cardioangiographic images in order to establish their mutual correspondence. Fifty six hearts had situs solitus; fifty specimens had right absent A-V connection and six had left absent A-V connection. One had situs inversus. All the specimens had: A deep A-V sulcus at the site of the absent A-V connection, a dimple in the muscular floor of the involved atrium connected with the dilated and hypertrophic left ventricle, incomplete right ventricle without inlet portion, ventricular septal defect of variable dimensions (it was obliterated in two), atrial septal defect, the ventricular septum deviated from the crux cordis. The left absent A-V connection had ventricular inversion and discordant ventriculoarterial connection. In the right absent A-V connection the ventriculoarterial connections were concordant in thirty eight hearts, from which thirty four had pulmonary stenosis both infundibular and valvular (five had the tetrad of Fallot), two had pulmonary valve atresia and two had a dilated pulmonary artery; discordant in nine hearts, one with aortic atresia; double outlet, from the right ventricle in two, (one with the tetrad of Fallot) and from the left ventricle in one. The heart in situs inversus had ventricular inversion, right absent A-V connection (left-sided), single (right) ventricle and atresia of the left ventricle. The correlations between cardiac morphology and imaging were precise. Developmentally, this cardiopathy is the result of an ectopic unequally lateralized septation of the common atrioventricular canal, which separates two canals, one stenotic leading to atresia and the other which develops too wide.
The authors report 7 cases of gangrenous ergotism (six women and one man) secondary to an overdose of ergotamine ingested in order to relieve migraine crisis. In all cases, patients presented symptoms and signs of severe arterial constriction confirmed by echography and angiography. Hallucinations were absent. Ergotamine ingestion was discontinued and treatment was based on vasodilators and sympathectomy. After treatment, all seven patients showed clinical improvement with disappearance of the vasospastic symptoms and signs, and an increase in the plethysmographic index of blood perfusion, measured by Doppler echography. These changes were observed even in a patient who lost two toes of the right foot. Although, none of the patients presented hallucinations, the authors made reference to the historical first use of the ergot in magic and religious rites that took place in Eleusis, at the time of classic Greece, as well as the more recent mystic use of ergot in Salem, New England, in 1692. Migraine is indeed a serious disease, frequently causing despair to the patient, who attempts to alleviate the migraneous crisis with an overdose of ergotamine. Accordingly, physicians must be aware of prophylactic vasodilating drugs, reducing the risk of ergotism.
