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. However, other forms of valve impairment have appeared over the past several years. The etiology of some of these valvular diseases remains obscure (e. g. myxomatous mitral valve); others, such as the senile type of calcific aortic valve stenosis, seem to be the price to be paid for the extension of life expectancy. With regard to diagnosis, echocardiography has constituted a formidable tool for visualizing anatomic valve changes, interpreting complex hemodynamic derangements, and evaluating repercussion on the left ventricle. In addition, the iteration of this non-invasive examination has allowed a much better understanding of the natural history of non-severe valvular disease and therefore of the precise timing for surgical intervention, without awaiting, in most cases, the appearance of advanced symptomatology. This has also been possible because of the great advances in cardiac surgery which can be summarised as: a) the improvement in extracorporeal circulation and myocardial preservation techniques; b) the greatly improved biologic and mechanic valve substitutes; c) the introduction of imaginative mitral valve repair procedures, and d) the use of intraoperative transesophageal echocardiography to assess the adequacy of valve repair. At the same time, percutaneous catheter balloon valvuloplasty has emerged as a valid alternative to mitral surgical commissurotomy for mitral stenosis. All these changes, and many more that can not be described in this brief summary, make a review of the management of patients with valve heart disease appropriate.

Guías de práctica clínica de la Sociedad Española de Cardiología en valvulopatías

Objetivo Comparar la utilidad de la ecocardiografia con dobutamina-atropina para el diagnostico de la enfermedad coronaria entre varones y mujeres. Metodos Hemos estudiado de forma consecutiva a 137 varones y 99 mujeres sin antecedentes de enfermedad coronaria a los que se realizo una ecocardiografia con dobutamina-atropina y posteriormente una coronariografia. Resultados Se detecto enfermedad coronaria significativa en 102 varones y en 42 mujeres (el 74 y el 42%, respectivamente; p Conclusion La sensibilidad, la especificidad y la precision diagnostica de la ecocardiografia con dobutamina-atropina no se ven afectadas por el sexo. La diferente prevalencia de la enfermedad coronaria entre ambos sexos hace que el valor predictivo de los resultados positivos sea superior en el varon y el valor predictivo de los resultados negativos lo sea en las mujeres.

Influencia del sexo en el rendimiento de la ecocardiografía con dobutamina para el diagnóstico de la cardiopatía isquémica.

Multimodality imaging in pericardial diseases

Presentamos cuatro casos de hematoma en aortaascendente. El diagnostico de sospecha inicial fuediseccion aortica en dos de ellos. Todos fueron intervenidoscon caracter de urgencia. Revisamosotras series y concluimos en la conveniencia de tratarlos hematomas en aorta ascendente del mismomodo que las disecciones aorticas.

Hematomas intramurales en aorta ascendente

Introduccion y objetivos En presencia de enfermedad coronaria y ante un estimulo adecuado (estres), las alteraciones de la perfusion preceden a las alteraciones de la contractilidad. La presencia de alteraciones de la perfusion sin alteraciones de la contractilidad podria ser debida a que no hay isquemia o esta es leve. Nuestro objetivo ha sido comparar las caracteristicas clinicas, respuesta hemodinamica y severidad de los defectos de perfusion en pacientes con enfermedad coronaria y alteraciones de la perfusion con y sin alteraciones de la contractilidad durante la infusion de dobutamina. Pacientes y metodos A 82 pacientes con enfermedad coronaria demostrada angiograficamente sin infarto previo se les administro dobutamina (hasta 40 mg/kg/min) y atropina cuando fue necesario. Se realizo gammagrafia MIBI-SPECT una hora despues del maximo estres y en reposo 24 h despues. Se calculo el indice de perfusion al dividir la suma de la puntuacion segun la captacion de isotopo de los segmentos entre el numero de segmentos afectados. Resultados De los 73 pacientes con defectos de perfusion, la ecocardiografia de estres fue positiva en 59 (grupo A) y negativa en los 14 restantes (grupo B). En el grupo A habia mas hipertensos (33 frente a 4; p = 0,04). Las demas caracteristicas clinicas fueron similares en ambos grupos. El doble producto al final de la prueba fue similar (18.520 ± 5.691 frente a 18.680 ± 5.329; p = NS). La incidencia de alteraciones electricas y angina fue mayor en el grupo A (42 frente a 3; p Conclusion En pacientes con enfermedad coronaria severa y alteraciones de la perfusion demostradas mediante MIBI-SPECT con dobutamina, la presencia de alteraciones de la contractilidad define a un grupo de pacientes con alteraciones mas severas de la perfusion miocardica.

Ecocardiografía-MIBI con dobutamina: significado de las alteraciones de la contractilidad en pacientes con alteraciones de la perfusión

OBJECTIVES: The aim of this study was to assess the usefulness of transesophageal echocardiography for detection of the mechanism of dysfunction in bioprosthetic valves in the mitral position. METHODS: Transthoracic and transesophageal echocardiograms were performed in 40 patients (mean age 61 +/- 12 years) with a dysfunctional bioprosthetic mitral valve. Echocardiographic results were compared to surgical findings in all except 1 patient. RESULTS: All 9 patients with stenotic degenerated bioprosthesis were diagnosed by transthoracic and transesophageal echocardiography. Mechanism of dysfunction in the remaining patients were as follows: cusp tear or rupture in 18, dehiscence in 4 and endocarditis in 6. Transthoracic and transesophageal echocardiography visualized respectively: 8 (44%) and 15 (83%; p < 0.05) with cusp tears or ruptures; 3 (75%) and 3 (75%) with dehiscence; 3 (50%) and 6 (100%; p < 0.1) with endocarditis. One patient with pannus formation and 1 of 2 bioprosthetic thrombosis were not correctly identified by either echocardiographic technique. CONCLUSIONS: Transesophageal echocardiography is suited for the assessment of mechanism of mitral regurgitation and for the diagnosis of vegetations in most of patients with bioprosthetic mitral valves. Transesophageal echocardiography adds little information to the transthoracic study in the evaluation of patients with stenotic bioprosthetic mitral valves, particularly in calcified degeneration.

The evaluation of the mechanism of mitral bioprosthesis malfunction by transesophageal echocardiography

BACKGROUND AND AIM The usefulness of transesophageal echocardiography in the diagnosis and assessment of patients with aortic dissection has been widely demonstrated. The aim of this study was to evaluate the role of this technique in the detection of intramural aortic hematoma and in the follow-up of these patients. METHODS The records of 51 patients with aortic dissection by transesophageal echocardiography diagnosed between May 1990 and May 1994 were reviewed. RESULTS The diagnosis of intramural aortic hematoma was established in 6 patients by transesophageal echocardiography (11%). This diagnosis was confirmed either anatomically (3 patients) or with an additional diagnostic technique (computed tomography or magnetic resonance imaging) and on the basis of echocardiographic follow-up changes (3 patients). CONCLUSIONS Intramural aortic hematoma represents an infrequent variant of aortic dissection that can be detected by transesophageal echocardiography and is usually unrecognized by aortography.

Identification of intramural aortic hematoma by transesophageal echocardiography

INTRODUCTION: The exercise stress test shows limited diagnostic accuracy for the detection of coronary artery disease in hypertensive patients. Echocardiography with dobutamine is a useful tool in the assessment of coronary artery disease. PURPOSE: Our purpose has been to compare dobutamine stress echocardiography and exercise stress test for diagnosing coronary disease in hypertensive patients. MATERIAL AND METHODS: Dobutamine stress echocardiography (administered up to 40 micrograms/kg/min, and atropine when necessary), exercise stress test and coronary arteriography were performed on 74 hypertensive patients with chest pain and no previous history of coronary artery disease. RESULTS: Forty-eight (65%) patients underwent a diagnostic exercise stress test and 66 (89%) a diagnostic dobutamine stress echocardiography. Coronary artery disease (> or = 70% stenosis in, at least, one major vessel) was demonstrated in 28 (58%) patients who underwent a diagnostic exercise stress test, and in 39 (59%) patients who completed a dobutamine stress echocardiography. Sensitivity for exercise stress test was 82%, and 79% for dobutamine stress echocardiography (p = NS). Specificity was higher for dobutamine stress echocardiography (100% vs 60%; p < 0.005). CONCLUSIONS: Dobutamine stress echocardiography has high sensitivity and specificity for the detection of coronary artery disease in hypertensive patients. Dobutamine stress echocardiography has higher feasibility and specificity than exercise stress test in this group of patients.

Echocardiography with dobutamine in hypertensive patients with chest pain

A patient with cardiac tamponade but without hypotension and pulsus paradoxus is reported In this patient, echocardiography confirmed the diagnosis of cardiac tamponade, showing diastolic collapse of the right ventricle and also the presence of an atrial septal defect (ostium secundum) that explains the absence of pulsus paradoxus The role of echocardiography in those rare clinical situations that in the presence of cardiac tamponade showed no pulsus paradoxus are discussed

Cardiac tamponade with the absence of a paradoxical pulse. The practical utility of echocardiography

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The evaluation of the mechanism of mitral bioprosthesis malfunction by transesophageal echocardiography

Identification of intramural aortic hematoma by transesophageal echocardiography

Echocardiography with dobutamine in hypertensive patients with chest pain

Cardiac tamponade with the absence of a paradoxical pulse. The practical utility of echocardiography