Three-dimensional versus two-dimensional transesophageal echocardiography in mitral valve repair.

Objectives: We sought to compare the diagnostic performance of 3-dimensional (3D) versus 2-dimensional (2D) echocardiography in patients with regurgitant mitral valve.

Background: An accurate assessment of morphology and function of the mitral valve is essential for surgical repair. Two-dimensional echocardiography has certain spatial limitations that could be overcome by 3D imaging.

[Primary prophylaxis with the implantable cardioverter-defibrillator in heart failure: a clinical point of view].

The implantable cardioverter-defibrillator (ICD) is one of the great inventions of modern cardiology. Its use for the prevention of sudden death in patients with left ventricular dysfunction has meant that clinical cardiologists are now fully involved in decision-making on the implantation of these devices. The majority of clinical trials, which have used low ejection fraction as the only or main criterion for patient recruitment, have shown that ICD use leads to a significant improvement in survival.

[Mitral valve repair for mitral regurgitation].

We analyzed the results of mitral valve repair in 81 consecutive patients with severe mitral regurgitation. Of these patients, 66.6% had myxomatous degeneration, 11% ischemic disease, 8% chordal rupture, 5% congenital disease, and 3.

Sustained monomorphic ventricular tachycardia associated with unrepaired double-chambered right ventricle.

Double-chambered right ventricle (DCRV) is a congenital anomaly characterized by the division of the ventricular cavity into two chambers separated by an abnormal hypertrophied muscular band or by severe hypertrophy of the muscle wall. Two adult patients with a diagnosis of DCRV presented sustained monomorphic ventricular tachycardia. In both cases, the clinical tachycardia was induced with programmed stimulation.

Utility of adenosine 5'-triphosphate in predicting early recurrence after successful ablation of manifest accessory pathways.

Objectives: The purpose of this study was to determine whether administration of adenosine 5'-triphosphate (ATP; 20-40 mg) after successful ablation of accessory pathway (AP) with manifest preexcitation is useful for detecting residual conduction and predicting early recurrences.

Background: The reported incidence of recurrence of AP conduction after an initially successful procedure is 5% to 10%. Little information on the variables related to early recurrence has been reported.

[Left ventricular dysfunction induced by monomorphic ventricular arrhythmias: large improvement in ventricular function after radiofrequency ablation of the arrhythmic source].

Left ventricular systolic dysfunction related to ventricular arrhythmias is a relatively poorly understood entity. To increase our knowledge base, we describe 5 patients in whom the link between ventricular dysfunction and ventricular arrhythmia was unequivocally established. All patients had repetitive monomorphic ventricular arrhythmias and left ventricular systolic dysfunction (ejection fraction < or =40% and end-diastolic size > or =55 mm).

[Does the EuroSCORE identify patients at minimum risk of mortality from heart surgery?].

Introduction And Objectives: Risk of hospital death is one of the key factors considered by the clinical cardiologist when weighting indications for surgery. Risk estimation scales establish distinct levels of risk in quantitative terms. The aim of the present study was to investigate whether a low EuroSCORE value corresponds to low mortality in our setting.

[Infectious endocarditis: degree of discordance between clinical guidelines recommendations and clinical practice].

Introduction And Objectives: The present study was made to investigate the degree of discordance between the recommendations of clinical guidelines and actual practice in the care of patients with infectious endocarditis.

Material And Methods: Data was gathered on 34 patients that were admitted to our hospital for native valve infection over a 4-year period. The degree of discordance (%) was obtained by comparing each clinical history with a catalog of 15 specific actions recommended in the clinical guidelines for four consecutive phases: pre-diagnosis, hospital diagnosis, antibiotic treatment, and surgical treatment.

[Vasovagal syncope in pediatric patients: a medium-term follow-up analysis].

Introduction And Objectives: Little information is available on the evolution of pediatric patients with vasovagal syncope. We therefore aimed to assess the medium-term clinical outcome of children evaluated by tilt testing for syncope of unknown origin.

Patients And Method: Fifty-one children under 17 years of age who had undergone tilt testing were identified from a data base and studied prospectively.

[Prosthetic valve thrombosis: which is the most appropriate initial therapy?].

Introduction And Objectives: This study aims to investigate what is the best initial therapy for patients with obstructive prosthetic valve thrombosis.

Methods: Data from 47 patients diagnosed with prosthetic valve thrombosis in two tertiary hospitals during an 8-years period were analyzed.

Results: The involved prostheses were in mitral position in 34 cases (2 biological valves), in aortic position in 12, and in double mitral and aortic position in one.

In patients with chronic atrial fibrillation and left ventricular systolic dysfunction, restoration of sinus rhythm confers substantial benefit.

Study Objectives: To evaluate the benefit of sinus rhythm (SR) restoration in patients with chronic controlled atrial fibrillation (AF) and left ventricular systolic dysfunction (LVSD).

Design: Prospective case-control study on the short-term outcome (6 to 9 months) of clinical and echocardiographic variables following attempted cardioversion.

Setting: Outpatient clinic of a university hospital.

[Guidelines of the Spanish Society of Cardiology on valve heart disease].

Valvular heart diseases, which continue to be a major cause of morbidity and mortality world wide, have undergone radical changes since the first valve prostheses were implanted 40 years ago. These changes have been the result of both scientific progress and improved standard of living in developed countries. The availability of penicillin to treat streptococcal pharyngitis and less crowded living conditions have now made rheumatic fever uncommon in these countries.

[The practical clinical guidelines of the Sociedad Española de Cardiología on coronary surgery].

Surgery in coronary disease, including myocardial revascularization and the surgery of mechanical complications of acute myocardial infarction, has shown to improve the symptoms, quality of life and/or prognosis in certain groups of patients. The expected benefit in each patient depend on many well-known factors among which the appropriateness of the indication for surgery is fundamental. The objective of these guidelines is to review current indications for cardiac surgery in patients with coronary heart disease through an evaluation of the degree of evidence of effectiveness in the light of current knowledge (systematic review of bibliography) and expert opinion gathered from various reports.

Long-term results of the Spanish trial on treatment and survival of patients with predominantly mild heart failure.

A randomized open-label clinical trial was conducted to determine whether mortality, readmission, or quality of life differed between heart failure patients managed with captopril plus diuretics and those with digoxin plus diuretics. A total of 345 heart failure patients in New York Heart Association functional classes 2 and 3 without atrial fibrillation, dyspnea of bronchopulmonary origin, or hypertension not controlled with diuretics was randomized for digoxin (n = 175) or captopril (n = 170) treatment and followed up for a median of 4.5 years.

[The tilt-table test in assessing syncope of unknown origin: do differences exist between children and adults?].

Background And Objectives: Little is known about the differences between children and adults in the results of head-up tilt test. This study sought to investigate the potential differences concerning: a) the clinical profile and circumstances of spontaneous syncope; b) the overall diagnostic performance of the test, and c) the type of positive response obtained.

Material And Methods: We studied 31 children and 123 adults with unexplained syncope.

[Is the exercise test performed after myocardial infarct really useful in improving prognosis? Arguments in favor].

The evaluation of risk after myocardial infarction accomplishes two objectives: a) selecting patients with high-risk for coronary angiography and revascularization, and b) identifying low-risk patients to avoid unnecessary laboratory investigation and revascularization procedures. Currently, patients eligible for exercise test are those with no evidence of heart failure or angina, and with a preserved left ventricular function. Overall prognosis for such patients, especially if they were thrombolyzed, is very good.

[Valve diseases in the aged: when to operate?].

Valvular lesions, especially aortic stenosis, are not uncommon among the elderly, a sector of the population that is increasing in relative (extreme decrease in birth rates) and absolute terms (reduction of morbidity/mortality due to health and social advances), and their treatment presents a major challenge to the health system. Advanced age constitutes a surgical risk, but this is more likely due to a greater prevalence of comorbid conditions than to an intrinsic effect of old age. Moreover, the morbid effects of age are extremely variable, and an individualized evaluation of the problem is required.

Value of single oral loading dose of propafenone in converting recent-onset atrial fibrillation. Results of a randomized, double-blind, controlled study.

Aims: To evaluate the efficacy and safety of a single loading oral dose of propafenone in the interruption of recent-onset atrial fibrillation.

Methods: After a complete medical history, physical examination, 12-lead ECG, chest X-ray, and routine biochemical laboratory testing, 55 consecutive patients with recent-onset atrial fibrillation were randomized double-blind in the emergency department for the administration of either a single oral dose (450 to 750 mg) of propafenone (29 cases) or a placebo (26 cases). After the 24-h observation period, comprehensive echocardiographic examination was performed.

[Usefulness of the angiographic examination of the left internal mammary artery in patients candidates for coronary bypass surgery].

Background And Objective: The usefulness of preoperative angiographic evaluation of the internal mammary artery (IMA) is controversial. The aim of this study is to evaluate the problem by a basic cost-benefit analysis.

Methods: One hundred and twenty-one patients whose coronary findings (left main disease and/or severe stenosis of the left anterior descending artery) made use of the IMA as a bypass graft a consideration were studied.

The value of exercise electrocardiography testing in the identification of coronary restenosis: a probability analysis.

We studied by means of probability analysis the role of exercise ECG in identifying coronary restenosis. A total of 213 patients were independently evaluated by clinical history, conventional assessment of the exercise ECG ('yes or no' statement), D score (a discriminant function derived from exercise ECG), and coronariography, 5.4 +/- 2.

[Probability analysis of the value of ergometry in the detection of restenosis after coronary angioplasty].

To evaluate the usefulness of treadmill exercise test in the diagnosis of coronary restenosis, we have chosen a sequential and probabilistic analysis. The rate of coronary restenosis found in the sample (n = 213) was of 30%. This initial probability of having restenosis was radically changed by the recurrence of typical angina: 77% in patients with this symptom, 17% in those without (p < 0.