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Se analizaron los datos fonomecanocardiográficos en 27 casos de cardiomiopatía dilatada (CMD), diagnosticada en todos ellos por historia clínica, laboratorio, ecocardiograma, estudio hemodinámico y cinecoronariográfico. Los pacientes que presentaban bloqueo completo de rama izquierda fueron excluidos. Se estudió además un grupo control normal de 24 casos, con edad promedio y sexo similar al grupo CMD. Los trazados fueron realizados con un equipo Siemens-Elema (Mingograph-34) con inscripción directa a chorro de tinta, en cuatro canales, con electrocardiograma en derivación DII, fono en foco mitral y pulso carotideo o apicocardiograma en forma simultánea. Los datos analizados fueron los siguientes: frecuencia cardíaca (FC), sístole electromecánica corregida (SEMc) período pre-expulsivo corregido (PPEc), período expulsivo corregido (PEc), índice de Weissler (IW), distancia IIAo-OM (IIAo-OM), tiempo de ascenso del apicocardiograma (TAACG), amplitud de la onda "a"-del apicocardiograma (onda "a"), intensidad del primer ruido cardíaco (IRC) y presencia de tercer o cuarto ruido (IIIRC-IVRC). Los valores promedio y su desvío estandar para normales y grupo CMD, respectivamente fueron: FC = 67.08 + ou - 7.67 lat/min y 88.84 + ou - 15.31 lat/min; SEMc = 554.23 + ou - 28.37 mseg y 561.35 + ou - 30.99 mseg.; PEc = 409.38 + ou - 27.28 mseg y 375.54 + ou - 28.21 mseg; PPEc = 145.13 + ou - 17.64 mseg y 194.11 + ou - 22.09 mseg; PER = 102 + ou - 9.27% y 84.78 + ou - 8.61%; IW = 0.39 + ou - 0.07 y 0.72 + ou - 0.11; onda "a": 7.37 + ou - 2.15% y 19.47 + ou - 6.76%; IIAo-OM = 0.094 + ou - 0.0012 seg y 0.105 + ou - 0.018 seg; TAACG = 0.093 + ou - 0.0015 seg y 0.143 + ou - 0.067 seg. El análisis estadístico comparativo demostró diferencia muy significativa (p<0.001) en: FC, PEc, PPEc, PER, IW, onda "a" y TAACG; significativa (p<0.05) en el IIAo-OM y no significativa en la SEMc. En los casos con CMD hubo disminución de IRC en el 74%, presencia de IIIRC en el 100% y de IVRC en el 83% de los pacientes con ritmo sinusal. Se concluye que el estudio fonomecanocardiográfico, a través del hallazgo de IIIRC, IVRC, disminución del IRC, aumento del PEEc, TAACG, IW, disminución del PEC, PER y el aumento de la amplitud de la onda "a" en el ACG, permite sugerir la presencia de CMD

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Twenty seven patients with dilated cardiomyopathy (DCM) were studied by phonocardiography and mechanocardiography. The diagnosis was made in each case by history, laboratory, echocardiogram, hemodynamic study and coronary arteriography. Patients with left complete bundle branch block were excluded. As controls we studied 24 subjects with comparable age an sex. The phonomecanocardiographic records were performed with a Siemens-Elema machine (Mingograph-34) with direct ink recording with electrocardiogram in lead DII, phonocardiogram in mitral focus, and carotid pulse or apexcardiogram (ACG) simultaneously. The following data were assessed: heart rate (HR) electromechanical interval (Q-S2), preejection period of left ventricular contraction (PEP), left ventricular ejection time (LVET), relative ejection period (REP), ratio PEP/LVET (IW), "a" wave of the ACG ("a" wave), rising period of the apex-cardiogram (RPACG), isovolumic relaxation time (IRT), first heart sound intensity (S1I), third and fourth heart sound presence (S3 and S4) respectively. The average values (mean) and their standard deviation for the groups (N) and DCM respectively were: HR (b/m): 67.08 +/- 7.67 and 88.84 +/- 15.31; Q - S2 (msec.): 554.23 +/- 28.37 and 561.35 +/- 30.99; PEP (msec.): 145.13 +/- 17.64 and 194.11 +/- 22.09; LVET (msec): 409.38 +/- 27.68 and 375.54 +/- 28.21; REP (%): 102 +/- 9.27 and 84.78 +/- 8.61; IW: 0.395 +/- 0.078 and 0.72 +/- 0.11; "a" wave (%): 7.37 +/- 2.15 and 19.47 +/- 6.76; RPACG (sec.): 0.093 +/- 0.0015 and 0.143 +/- 0.067; IRT (sec.): 0.094 +/- 0.0012 and 0.105 +/- 0.018.(ABSTRACT TRUNCATED AT 250 WORDS)

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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.

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Two cases, a sixteen-month-old girl and a 13 year-old bol, were presented who developed myocardial infarction as a consequence of angiocardiographic study. The boy (case 1) showed electrocardiographic signs of lower necrosis with elevation of the TGO and DHL and having a satisfactory clinic evolution. The girl (case 2), in the electrocardiogram, showed an inactivatable zone on the lateral wall and signs suggesting anteroseptal subendocardic necrosis, and enzymatic elevation. She died the fourth day following the hemodynamic study. The literature regarding this complication and the possible triggering causes are reviewed.

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The authors present four cases of rheumatic heart disease with severe dilatation of the left atrium which reached the right profile in the radiologic study. An initial negative deflexion of the P-wave (qP) in the right precordial leads was recorder in these cases. The presence of qP was interpreted in view of the atrial activation and the solid angle of the right precordial leads as a variation of potential of the right atrial ceiling and/or of the high interatrial septum, a consequence of the dislocation of the right atrium produced by severe dilatation of the left atrium, demonstrated radiologically in the cases studied. Thee presence of qP is another undoubtably valuable sign for inferring a severe displacement of the left atrium toward the right profile.

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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.

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