Balloon catheter valvuloplasty for calcified aortic stenosis in adults. Report of a case and review of the literature]

The first procedure of balloon valvuloplasty in adult calcific aortic stenosis was performed in Mexico on July 17 of 1987. It was a 69 year old female with calcific aortic stenosis and unstable, progressive angina pectoris. Cardiac catheterization showed trans-aortic gradient of 90 mmHg, minimal aortic regurgitation and ejection fraction of 85 percent. Aortic valvuloplasty was performed immediately after cardiac catheterization using the arterial retrograde way by means of a 15 mm. in diameter catheter initially and another of 18 mm. in diameter afterwards. At the end of procedure the gradient diminished to 56 mmHg and an slight increase of the aortic insufficiency was observed. The Doppler echocardiogram showed decreased severity of the stenosis. The patient was discharged asymptomatic and continued to do well for six months. She died suddenly after that period of time. A review of the literature is also presented.     

Primary heart tumors. Report of a clinical case]

The authors describe the case of a 52-year-old patient with several hospitalizations due to acute pulmonary edema, clarified only during the performance of cardiac surgery for the correction of presumable mitral valvular pathology. A leiomiossarcome of the left auricle was concerned, which involved the posterior ring of the mitral valve, the interauricular septum and the orifices of the pulmonary veins. Due to the impossibility of proceeding with the complete resection of the tumor, the tumoral mass was wasted away in order to liberate the involved structures, this followed by chemotherapy. Two years since, the patient shows a generally deteriorated state, submitted to various hospitalizations due to cardiac insufficiency, having been objectivated hepatic metastization and recurrence of the primary neoplasm.     

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.     

Bronchoesophageal cyst in adults. Apropos of a case]

The authors report the case of a 61-year old woman who was operated upon for a paraoesophageal cyst of the bronchogenic type. Having reviewed the French literature on the latest cases, they underline the scarcity of these congenital formations which present as mediastinal cystic tumours with benign expression and course. Computed tomography suggests the diagnosis and reveals the intraparietal site of the cyst. A return to the histogenesis of these cysts makes it possible to understand the nosological distinction with the true bronchogenic cysts and to evaluate the recent classifications.     

Pulmonary metastasis from a glioblastoma. A case report]

Glioblastoma is a primary malignant astrocyte tumor of the central nervous system. Extraneural metastasis is uncommon. We report a case of spontaneous lung metastasis from a glioblastoma without prior surgery. Positive diagnosis was achieved from histology and immunohistochemistry     

Osteo-neuro-meningeal-lumbosacral involvement in Marfan syndrome. Report of a case]

Marfan syndrome is an hereditary condition which primarily affects conjunctive tissue with predominant vascular lesions, aortic insufficiency and aortic dissection which condition vital prognosis. Until further progress is made in the genetic determination of the disease, the diagnosis is currently based on the association of clinical criteria, which enables multidisciplinary management. This approach should lead to specific medical and surgical treatment--which may reduce Marfan morbidity and mortality. We report the case of a 45 year-old patient with suspected Marfan syndrome during adolescence. The presence of a cardiovascular lesion and a recently reported abnormality i.e. a sacral erosion by a dural ectasia, enabled us to confirm the diagnosis. We reviewed the current criteria in Marfan diagnosis and their specific management.     

Congenital mitral stenosis. Report on 33 patients]

Thirty-three patients with congenital mitral stenosis are presented. Congenital mitral stenosis occurs as an isolated malformation and in combination with additional cardiac lesions. A new classification into 5 groups is suggested. It is possible to classify congenital mitral stenosis with and without additional lesions according to these 5 groups. This is of particular clinical advantage. Isolated congenital mitral stenosis is a rare malformation. In combination with additional obstructive left-sided cardiac malformations mitral stenosis occurs more frequently. In infancy and early childhood the so-called parachute valve is a stenotic lesion. According to our experience the parachute valve tends to the development of additional mitral incompetence in older children. This observation is of clinical and diagnostic importance. In patients with additional valvular aortic stenosis the mortality is very high. The operative treatment of congenital mitral stenosis with a parachute valve in combination with other obstructive lesions of the left ventricular outflow tract and the aorta without removal of the parachute valve seems to be unable to improve the hemodynamic situation and the prognosis of these patients. There is not enough experience with artificial valves in congenital mitral stenosis in early childhood.     

Silent Q fever endocarditis. Report of a case]

A murmur of aortic regurgitation was discovered in an asymptomatic patient who had suffered from an acute Coxiella Burnetti infection several months before hand. Transoesophageal echocardiography, serology and direct immunofluorescence of the aortic valve confirmed the diagnosis of Q fever endocarditis. Treatment with Vibramycin and Plaquenil was instituted after aortic valve replacement. Cardiac complications of Q fever should be recognised as they may remain asymptomatic for long periods of time. Transthoracic and transoesophageal echocardiography should be widely used in acute forms of Q fever and systematic in chronic infections with Coxiella Burnetti.     

Pulmonary histiocytosis X. Report of a case and review of the literature

Histiocytosis X or Langerhans cell histiocytosis is an infrequent disease, which consists on proliferation of Langerhans cells. The etiology is unknown. Diagnosis is reached by electron microscope study of the biopsy, in which the Birbeck intracytoplasmatic granules of the Langerhans cells are found and/or by immunohistochemistry procedures able to detect S-100 antigen and CD1 cells. Diagnosis can also be reached with a bronchoalveolar lavage in which CD1 cells will appear in a score higher than 5%. We present the case of a 16 year-old girl that first appeared with a pulmonary lesion with a honey comb X-ray pattern and unsyntomatic mandibular bone affectation. Diagnosis was reached by biopsy study using S-100 antigen detection procedures. We consider this case an important one due to the infrequency of this particular disease.     

Endomyocardial fibrosis. Presentation of a clinical case]

The authors report a case of right ventricle endomyocardial fibrosis in a 6-year-old boy. Particular attention is paid to the discussion of the new methods for diagnosing and treating these conditions, namely echocardiography, endomyocardial biopsy and surgery.     

Pulmonary stenosis with tricuspid insufficiency in the child]

The authors report 3 cases of pulmonary stenosis with an intact interventricular septum and tricuspid incompetence. The tricuspid regurgitation was corrected in all 3 cases. After recalling the clinical features, they emphasize the importance of seeking for this condition and correcting it in every case if the immediate and long-term results are to be satisfactory.