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J Mispireta

Publications and source records attributed to J Mispireta.

6 recordsLinked to original sources
PubMed1977

Takayasu's arteritis. Clinical study of 107 cases.

The clinical experience derived from the retrospective study of 107 cases of TA over a 19 year period is presented. The disease predominated in females (8.5:1), with age of onset usually less than 20 years. In half of the cases an acute inflammatory phase was observed, characterized mainly by systemic and cardiovascular symptoms. Subsequently the natural course of TA was toward chronicity with gradual deterioration. The most frequent variety of TA (65 per cent of the patients) was Type III, in which the supra-aortic trunks and the abdominal aorta were involved. The predominant clinical features were reduction of amplitude of peripheral arterial pulses (96 per cent), vascular bruits (94 per cent), and raised blood pressure (72 per cent), mainly resulting from renal arterial involvement (62 per cent). Heart failure (28 per cent) is rarely the result of direct coronary arteritis. TA is most often confused with aortic coarctation, but usually the aortogram distinguishes these. The etiology of TA is discussed. The high incidence of previous and present active tuberculous (48 per cent) in the present series and previous experimental work suggest that tuberculosis may play an important role in the etiology of TA. Treatment for antihypertension and heart failure should be employed when indicated. Treatment with corticosteroids requires further evaluation. Treatment for tuberculosis is not justified in all cases until the exact role of tuberculosis is well established.

Acute Disease↗
PubMedDate not supplied

[Stable fibrous subaortic stenosis].

The authors studied 37 patients belonging to the Pediatric Cardiology Service of the Institute National of Cardiology who were carriers of fixed fibrinous subaortic stenosis. The diagnosis was established by surgery or autopsy. Isolated subvalvular obstruction was found in 24 patients (63%), which represents the most important number of cases in the literature. The analysis of the 24 cases permitted important conclusions: 1. All the patients had systolic thrills in the suprasternal hollow and carotidinous pathways. 2. No case had protosystolic click. In all, the murmur's epicenter was in the 3rd and 4th IIS in the parasternal line, a fact which can lead to a mistaken diagnosis of interventricular septal defect. 66.6% of the patients had a diastolic murmur heard in the aortic focus, a secondary accompaniement to secondary valvular aortic insufficiency. The intensity of the second aortic sound held an inverse relationship to the magnitude of the gradient. The presence of paradoxic splitting of the second heart sound as well as prolongation of the expulsion period in the carotidogram are indexes for the severity of the obstruction. 3. A relationship between the severity of the lesion and the dilatation of the left atrium was found. The cardiomegaly had no relationship to the severity of the obstruction with the increase in ventricular telediastolic pressure or to the evolution time. 4. An adequate hemodynamic study permits evaluating and locating the site of the obstruction. Likewise, precise ventriculography appraises the nature of the narrowing. 5. Aortic regurgitation is located at the valvular level. Aortography permits its affirmation. Probably the stream coming from subvalvular stenosis produces fibrosis or asynchronism in the closing of the aortic valves. 6. Surgical treatment offers excelent perspectives in mortality as well as reducing the gradient. None of our patients operated on had hospital or later death. 7. Postoperatory evaluation was performed on six patients, and by means of measuring the gradient between the left ventricle and the aorta, the good surgical results could be demonstrated. 8. The natural evolution of patients with fixed fibrous subaortic stenosis is similar to that of other forms of congenital aortic stenosis. Taking into consideration this concept, and before the low risk (0%) in this type of surgery, this is the treatment of choice.

Adolescent↗
PubMedDate not supplied

[Supravalvular aortic stenosis. Report of clinical findings in 5 patients].

Five cases of supravalvular aortic stenosis (SAS) diagnosed by heart catheterization were studied in the Instituto Nacional de Cardiologia of Mexico. The clinic and laboratory data of interest of the differential diagnosis with other forms of obstruction of the left ventricle as follows: 1. Three cases had mental retardation and "elfin" face (SAS with specific psychophysical syndrome), the rest had a normal psyco-physical state without family antecedents (sporadic SAS). 2. The aortic focus was the epicenter of the expulsion murmur. In the phoncarodiographic study, two patients had protosistolic click and another had, in addition, a descending protodiastolic murmur (Int. I-IV). In the radial sphigmograms, one case had an amplitude difference in favor of the right side. 3. All had serum calcium figures within normal limits. 4. A chromosomatic analysis of preperipheral blood was performed on two patients, with normal results. 5. In the electrocardiogram, one case had right ventricular enlargement secondary to pulmonary arterial hypertension, due to stenosis of the main pulmonary arteries. 6. The radiologic study did not show dilatation of the ascending aorta and aortic bud in any case. 7. The angiocardiography showed: stenosis directly above the Valsalva sinuses; absence of dilatation or hypoplasia of the aorta above the stenosis; and the coronary network, indirectly opaqued, showed no abnormalities. One case had aortic coarctation and abnormal implantation of the right sublaviar artery, and another, stenosis of the right and left branch of its origen of the truncus of the pulmonary artery. The literature up to the present is reviewed and an anatomo-functional classification is proposed with the objective of including new varieties.

Adult↗
PubMedDate not supplied

[Mycotic aneurysm of the ascending thoracic aorta. Clinico-pathological report of a case].

The case of a six year old girl with a congenital aortic stenosis is presented. A few months before being admitted to the Instituto Nacional de Cardiologia; her clinical manifestations suggested a bacterial endocarditis. The existance of an aneurismatic area in the ascending aorta and the later development of a crisis of angor pectoris, suggested a mycotic aneurism of the ascending aorta as a possible diagnosis; and the dissection or migration of septic material to the aneurism was found, it has a sacular form of 3.5 by 3.8 cm in the ascending aorta. There was also dissection into the left coronary artery at the ostium level. Microscopic study showed areas of recent myocardial necrosis on the free wall of the left ventricle and in the lower part of the interventricular septum. The etiopathogeny, clinical manifesations, radiology, evolution and treatment of mycotic aneurism were considered. The need of an early clinical diagnosis and early medical and surgical treatment is emphasized.

Aneurysm, Infected↗
PubMedDate not supplied

[Aneurysm of the membranous portion of the interventricular septum].

The membranous portion of the interventricular septum represents the final phase of the ventricular growth. It is situated between the orifice of the coronary sinus and the supraventricular crest; immediately below the right aortic semilunar valves and not the coronary. Four cases of aneurism of the membranous portion of the interventricular septum are presented; in two, the diagnosis was made by angiocardiography study and in the rest it was made with the findings of an autopsy. All were of the female sex. Two patients presented a systolic murmur in the low mesocardia; three had heart failure, two of which were secondary to an arteriovenous short circuit through an interventricular communication, and the other due to alternations in the automatism and in the atrioventricular circulation. One case had W-P-W, type A and during its evolution presented paroxysms of atrial fibrillation and flutter, variable degrees of atrioventricular block with Stokes-Adams syndrome and ventricular fibrillation. In one case an obstruction at the level of the outflow tract of the right ventricle was suspected through phonocardiographic studies, and was confirmed subsequently with hemodynamic study. This same case presented a protosystolic aortic snap, at 0.13-0.14 sec. of the q wave of the electrocardiogram, described as of value for the diagnosis of this malformation. In two cases the angiocardiographic study showed the presence of the aneurism in the membranous portion of the interventricular septum, in one, it was visualized in the posterioanterior projection and in another in the lateral. One of the specimens had the aneurism adhered to the tricuspid septal valve, and also a fissure which communicated the left ventricle with the right atrium. In the other, the aneurismal sac was located below the septal valve of the tricuspid, producing a distortion in the anatomical architecture of the atrioventricular orifice.

Autopsy↗