Julio Garcia Tejada

Acute Pancreatitis Mimicking Acute Inferior Myocardial Infarction

A 56-year-old man presented with acute pancreatitis and electrocardiographic abnormalities, suggesting acute inferior myocardial infarction. An emergent coronary angiogram showed normal coronary arteries. The clinical significance and therapeutic implications of this rare finding are discussed.

Percutaneous revascularization in patients with previous coronary artery bypass graft surgery. Immediate and 1-year clinical outcomes

BACKGROUND An increasing number of patients undergoing percutaneous interventions (PI) have experienced previous coronary artery bypass graft surgery (CABG). However, the impact of PI on outcomes in such patients is currently unclear. We evaluated the immediate and 1-year clinical outcomes of post-CABG patients who underwent PI in a tertiary center. METHODS From January-2005 to September-2006, 91 consecutive post-CABG patients underwent 197 stent implantations (84% drug-eluting stents) for 154 lesions. 58% were treated in the native coronary arteries, 34% in the grafts and 8% in both type of vessels. Major adverse cardiac events (MACE) were recorded in-hospital and at 1-year follow-up. RESULTS Procedural success rate was 95.6%. In-hospital MACE rate was 3.3%. At 1 year, the incidence of MACE was 18.6%: death occurred in 5.4% of the patients, myocardial infarction in 2.2%, and 10.9% of the patients underwent repeat revascularization (target lesion revascularization was required in 5.4%). Multivariate analysis revealed left ventricular ejection fraction <50% (OR 4.6, 95% CI 1.8 to 7.5, p=0.01) and multivessel intervention (OR 2.7, 95% CI 1.2 to 4.5, p=0.03) to be independent predictors of MACE at 1 year. CONCLUSIONS Immediate results showed the safety and efficacy of percutaneous revascularization in post-CABG patients. The relatively low risk need for target lesion revascularization obtained is encouraging. Independent predictors of MACE at 1 year were left ventricular disfunction and multivessel intervention.

Anomalous coronary artery origin associated with bicuspid aortic valve in a patient with rheumatic mitral stenosis: a case report.

A rare case of an anomalous left coronary artery arising from the right sinus of Valsalva asso ciated with bicuspid aortic valve is presented. This case is unique because these congenital anomalies were associated with rheumatic mitral stenosis. This anomalous coronary origin was found at catheterization before balloon mitral valvuloplasty. The clinical significance of this finding is discussed.

Taquicardia ventricular incesante como manifestación de isquemia miocárdica

We describe four patients with incessant ventricular tachycardia after the acute phase of a myocardial infarction. Two of them had a slow heart rate, and myocardial revascularization resolved the arrhythmia after ischemia was demonstrated. In the other two cases, very fast tachycardias were interrupted by means of intravenous verapamil and clinical stabilization was achieved after failure of amiodarone and lidocaine. In one of them, revascularization prevented new recurrences, but it was not feasible in the second patient, who developed new arrhythmias. The possible mechanisms of these tachycardias and their clinical and therapeutic implications are discussed.

Bloqueo auriculoventricular completo transitorio tras traumatismo torácico cerrado

La contusion miocardica puede ocasionar trastornos en la formacion y en la propagacion de los impulsos electricos en el sistema especifico de conduccion. La aparicion de un bloqueo auriculoventricular completo transitorio tras un traumatismo toracico cerrado es una complicacion poco frecuente. Se describe el caso de un paciente que tras sufrir un traumatismo toracico cerrado debido a un accidente de trafico presento, de manera transitoria, un bloqueo auriculoventricular completo y posteriormente un bloqueo de rama derecha con hemibloqueo anterior izquierdo. Se resalta la dificultad para el diagnostico de contusion miocardica y se discute la utilidad del estudio electrofisiologico para descartar la existencia de alteraciones basales del sistema especifico de conduccion. Palabras clave: Bloqueo cardiaco. Conduccion. Miocardio.

Direct stenting in single coronary artery arising from the left sinus of Valsalva: A case report

A patient with postinfarction angina was referred for coronary angiography. In addition to severe atherosclerotic coronary disease, which was responsible for clinical presentation, a single coronary artery arising from the left sinus of Valsalva was found. The authors report the use of direct coronary stent deployment without predilation to treat disease in this rare anomaly.

Utilidad de la ecocardiografía de contraste con segundo armónico en un paciente con miocardiopatía hipertrófica y obstrucción mesoventricular

La ecocardiografia es una tecnica utilizada de rutina en la evaluacion de la funcion cardiaca. La definicion de los bordes endocardicos es fundamental para valorar de forma correcta la contractilidad global y segmentaria del ventriculo izquierdo. En algunas ocasiones esto resulta dificil debido a la inadecuada ventana acustica de los pacientes. Las nuevas tecnicas ecocardiograficas podrian ayudar a diagnosticar de forma precisa e incruenta determinadas enfermedades que pasaban inadvertidas con las tecnicas tradicionales. Presentamos el caso de un paciente diagnosticado en el ecocardiograma basal de alteraciones en la contractilidad segmentaria, tipo hipocinesia lateral y apical, en el que la utilizacion de la imagen armonica con ecocardiografia de contraste permitio cambiar el diagnostico inicial. El paciente presentaba realmente una miocardiopatia hipertrofica severa con obstruccion mesoventricular, sin alteraciones segmentarias de la contractilidad.

Sequential Atrioventricular Pacing in Patients With Hypertrophic Cardiomyopathy: An 18-year Experience

INTRODUCTION AND OBJECTIVES Controversy persists regarding the role of sequential atrioventricular pacing in patients with obstructive hypertrophic cardiomyopathy and disabling symptoms. The aim of this study was to evaluate the effect of pacing on symptoms, dynamic gradient, and left ventricular function in patients with hypertrophic cardiomyopathy. METHODS From 1991 to 2009, dual-chamber pacemakers were implanted in 82 patients with obstructive hypertrophic cardiomyopathy and disabling symptoms despite optimal medical therapy. Sequential pacing was performed with a short atrioventricular delay. Clinical and echocardiographic parameters were measured before and immediately after implantation and after a long follow-up (median, 8.5 years [range, 1-18 years]). RESULTS The New York Heart Association functional class was immediately reduced after pacemaker implantation in 95% of patients (P < .0001), and this improvement was maintained until the final follow-up in 89% (P = .016). The gradient was significantly reduced after implantation (94.5 ± 36.5 vs 46.4 ± 26.7mmHg; P < .0001) and at final follow-up (94.5 ± 36.5 vs 35.9 ± 24.0mmHg; P < .0001). Mitral regurgitation permanently improved in 52% of the patients (P < .0001). There were no differences in ventricular thickness or diameters, ejection fraction, or diastolic function. CONCLUSIONS Sequential pacing in selected patients with obstructive hypertrophic cardiomyopathy improves functional class and reduces dynamic gradient and mitral regurgitation immediately after pacemaker implantation and at final follow-up. Prolonged ventricular pacing has no negative effects on systolic or diastolic function in these patients.

Less iodine injected for the same diagnostic performances: comparison of two low-osmolar contrast agents (iobitridol 350 and iopamidol 370) in coronary angiography and ventriculography: a randomized double-blind clinical study

OBJECTIVE Mild reductions in iodine concentration could reduce acute side effects after intraarterial contrast media administration without affecting the quality of coronary artery images. This study was designed to show the equivalence in terms of image quality of two nonionic low-osmolar monomers, iobitridol 350 and iopamidol 370, and to compare their clinical safety in coronary angiography and ventriculography. METHODS AND RESULTS In this multicentre, double-blind clinical trial, 98 adult patients were randomized to receive either iobitridol 350 or iopamidol 370. The image quality (primary evaluation criterion) of the whole examination was assessed using a 5-point scale (poor, fair, moderate, good, excellent). Secondary endpoints were the image quality per territory, diagnostic efficacy, practical comfort (5-point scale: impossible to evaluate, not practical, moderately practical, practical, very practical to use) and clinical safety (adverse events and vital signs). The proportions of examinations presenting with good or excellent global image quality was similar with both contrast media: 87.8% with iobitridol 350 vs. 89.8% with iopamidol 370. Similar results were observed when considering the image quality specifically for each major coronary artery and left ventricle. No difference between groups was found with respect to other secondary criteria. Adverse events occurred in 7 patients with iobitridol 350 (14.3%) and in 10 patients with iopamidol 370 (20.4%). CONCLUSIONS This study showed that, with regard to image quality and diagnostic efficacy and using a lower iodine concentration, iobitridol 350 was comparable to iopamidol 370 in adult patients requiring coronary angiography and ventriculography for diagnostic indications.

Recurrent Myocardial Infarctions Due to Thrombosis of a Coronary Aneurysm in Neurofibromatosis Type 1: Is Antiplatelet Treatment Enough?

A 68-year-old woman was admitted for an anterolateral myocardial infarction (MI). She had neurofibromatosis type 1 (NF-1) and 2 previous hospitalizations for non–ST-segment elevation MI, medically treated. In those episodes, aneurysmal coronary arteries with fresh thrombus in left anterior descending artery (LAD) were described. Emergent coronary angiography (CA) revealed a giant aneurysm in the mid-LAD with multiple small fresh thrombi (Figures 1A to 1C, Online Videos 1, 2, and 3). There were Thrombolysis In Myocardial Infarction flow grade 3 and no significant stenosis. Aneurysmal dilations without significant stenosis were also observed in the right coronary and circumflex arteries (Figures 1A to 1D). Triple antiplatelet therapy (aspirin, clopidogrel, abciximab [intracoronary bolus and 12-h perfusion]) and anticoagulation (enoxaparine 60 mg bid) were administered. One week later, scheduled CA showed a complete angiographic resolution of the thrombus (Figures 1E and 1F, Online Videos 4 and 5). No percutaneous coronary intervention (PCI) was performed. Given that this episode was the third MI in aneurysmal