Four hundred patients with atrial septal defect treated surgically were reviewed. Thirty five (8.7%) developed arrhytmias post-surgery which persisted for over a year. Sinus bradycardia was found in 10 patients, nodal rhythm in 21, and atrial fibrilation and flutter in 4 patients. Thirty five per cent of the patients with late arrhythmias developed related symptomatology. In 14 patients the function of the sinus node was studied with electrical stimulation of the atrium and with His registry. The interatrial conduction time, AV node and His Purkinje were analized employing various stimulation frequencies. All the cases studied had normal intra-atrial conduction; the response of the atrio-ventricular node to increasing frequencies was normal, an the intraventricular conduction remained constant. In 8 patients (52%), alterations of the sinus node were found; these consisted of prolonged post-stimulation pauses, Wenckebach's type sinoatrial block and suppression of sinus automatism employing vagal procedures or through electrical stimulation. A patient with severe bradycardia detected by dynamic electrocardiography had to be treated with a permanent pacemaker. We confirm that these arrhytmias are not produced by lesions of the internodal tracts, and that an alteration of the sinus node is frequent without a concomitant lesion of the intraventricular pathway. The lesion to the nutrient artery could be due to trauma and/or surgically induced. The response to anticholinergic drugs was good. Prolonged observation of these patients could increase the morbility of these arrythmias and raise doubts of the surgical indications in cases with moderate hemodynamic repercussion.

Adolescent↗

PubMedDate not supplied

[The long-term follow-up of 400 coronary angioplasty patients].

From October 1985 to May 1992, 400 patients had coronary angioplasty of 518 stenotic lesions with a 92% success rate. Mean stenosis was reduced from 88 to 15%. We had 25 major complications (6%): 8 emergency bypass surgery (2%), MI in 12 pts (3%) and 5 deaths (1%). Follow-up was possible in 329 of the 367 patients with a successful procedure (90%), with a mean follow-up of 44 months. We performed coronary angiogram in 113 patients with clinical data suggestive of restenosis, restenosis was found in 73, progression of the coronary atherosclerosis in 18 and 22 (19%) had no evidence of restenosis. A second coronary angioplasty was performed in 44 pts with a 93% success rate, 22 were sent to coronary bypass surgery and medical treatment was given to 7 patients. The 18 pts with progression of the disease were also sent to bypass surgery. During follow-up 25% of the patients required a second angioplasty or bypass surgery. A total of 115 (35%) pts showed evidence of restenosis: in 73 pts (22%) a coronary angiogram revealed restenosis, 12 had angina, 15 myocardial infarction and 15 died of cardiovascular disease. At the end of follow-up 259 pts (79%) were free of myocardial infarction, bypass surgery or cardiovascular death. Survival rate at 3.7 years was 94.5%. In conclusion, coronary angioplasty showed to be safe, effective and with a good long term outcome.

Aged↗

PubMedDate not supplied

[Importance of the systemicopulmonary collateral arterial circulation in congenital cardiopathies].

This paper manifests the importance of the systemic-pulmonary collateral circulation in congenital heart diseases. It shows that through the angiographic and hemodynamic study you should recognize the number, origin, course, and size of each of these arteries because during the corrective surgical treatment of certain types of heart diseases, these arteries should be tied off to prevent cardiac overload during the procedure and to prevent intrapulmonary short circuits from left to right in the postoperative period. The knowledge of the central and peripheral pulmonary arteries is important and because of this it should be remembered that the area of the section of the pulmonary arteries, right to left, together should be at least the equivalent of half of the area of the section of the aorta in its diaphragmatic level, the diameter which permits an acceptable cardiac output after the intervention. If the arteries are adequate a plan of surgical intervention which permits the control of the collateral systemic-pulmonary great arteries should be drawn up.

Collateral Circulation↗

PubMedDate not supplied

[Coronary angioplasty in 40 patients with 518 stenoses: complications and surgical support].

We analyze the outcome of 400 patients (pts) with coronary angioplasty in 518 stenosis (314 men, age 29 to 80). The clinical syndromes were unstable angina in 252 pts, acute myocardial infarction (MI) in 26, angina or residual ischemia after thrombolysis for MI in 34 and 18 pts with post-MI angina. Success was achieved in 478 of 518 segments (92%). Mean stenosis was reduced from 88 to 15%. Revascularization was complete in 92% of pts. Primary success was 74% in total occlusions. We had 25 major complications (6%): 8 emergency bypass surgery (2%), MI in 12 pts (3%) and 5 deaths (1%). The procedures were performed without surgical standby in 220 pts: in 68 it was an emergency and in 152 it was considered a low risk procedure. Major complications in emergency cases were 3 MI (4%) and 2 deaths (3%). In the low risk procedures there were no deaths, 3 MI (2%) and 1 aortic dissection. We conclude that in well selected patients coronary angioplasty gives a high success rate with very few complications. Furthermore, it is possible to identify a very low risk subset of patients in whom the procedure can be performed without having a surgical standby.

Adult↗

PubMedDate not supplied

[Study of the 1st outbreak of rheumatic fever. Long-term observation and clinical evolution of 40 patients].

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Adolescent↗

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↗