[Oral enalapril in patients with symptomatic ventricular septal defects]

Experimental and clinical studies have demonstrated that the inhibitors of angiotensin-converting enzyme may reduce the left-to-right shunt over a ventricular septal defect (VSD). The objective of the study is to evaluate the effects of enalapril on short and medium follow-up in patients with symptomatic VSD and Qp/Qs ratio > 1.5 and compare the results with conventional anti-congestive treatment in children. Twenty-four patients with ages from 3 months to 8 years were studied, dividing them in 3 groups of 8 patients each. Group I received treatment with enalapril, group II with furosemide an digoxin, and group III was treated with a combination of the three medicaments. Patients were evaluated after one, three and six months. Evaluation considered clinical signs of congestive failure, weight, heart rate, blood pressure, cardiothoracic index, and with echocardiography the dimensions of the cardiac chambers, size of the VSD and hemodynamic parameters as Qp/Qs, pulmonary artery pressure (PAP), systolic pressure gradient over the VSD, EF and SF. Statistic analysis was done for each group and was compared the three groups. The results demonstrated significant weight gain (p > 0.05) in the three groups. A decrease in heart rate, Qp/Qs and PAP was observed in group III, however without statistic significance. No side effects were observed. The use of enalapril in combination with furosemide and digoxin may have beneficial effects in patients with symptomatic VSD, awaiting surgery.

[Auricular flutter associated with an interatrial septal aneurysm submitted to radiofrequency ablation]

We present the case of a young man who began with type I atrial flutter, he had no response to antiarrhythmic drugs. The echocardiogram showed an atrial septal aneurysm in the region of the fossa ovalis. We performed an electrophysiologic study which showed an atrial flutter with atrial rate of 257 bpm, and 2:1/3:1 AV conduction. The flutter waves were negatives in leads II, III and a VF (type I atrial flutter). An endocardial mapping was obtained in order to localize the area of slow conduction. It was located in the isthmus of atrial tissue bounded by the inferior vena cava and the tricuspid valve annulus in the low posterior septal right atrium. In this area we applied radiofrequency energy in 10 occasions but the arrhythmia was not suppressed. With atrial pacing we achieve a concealed entrainment and then resumption of atrial flutter after cessation of pacing. After another 6 applications of radiofrequency in this same area in sinus rhythm, we paced the atrium without inducing any form of arrhythmia. He was asymptomatic 15 days later, but one month after the ablation, the flutter reappeared, we performed a second successful radiofrequency ablation. In this time he was asymptomatic.

[Radiofrequency ablation of an accessory left lateral pathway in an infant, using a transeptal approach]

We describe the case of a 4 month old child with supraventricular tachycardia detected on his second day of life, refractory to medical treatment, who was treated with radiofrequency catheter ablation of an accessory auriculoventricular pathway located on the left lateral wall. A venous femoral approach was used and the left atrium was entered through a patent foramen ovale, avoiding the risks of the arterial puncture and allowing us to administrate the radiofrequency current on the proper site. We discuss the potential risks of the therapeutic procedure in children and the benefits of the transeptal over the retrograde approaches for the treatment of left sided accessory pathways. Our conclusion is that catheter radiofrequency ablation of accessory pathways in children is possible with low risk, which can be diminished with the use of the transseptal approach when indicated.

[Valve replacement using an artificial ball prosthesis manufactured in Mexico]

This report documents our early experience with a cage ball valve manufactured in Mexico. Between May 1985 and March, 1986, 25 consecutive replacements have been performed in 23 patients, 14 underwent aortic valve replacement, 9 received a mitral valve, and 2 received both aortic and mitral valves. Their mean age was 32 years. Most of the patients had rheumatic heart disease. Their functional class prior to operation was as follows: six patients fell into class II, 15 into class III and 2 into class IV. One case died in the operative period. All patients have been followed for a mean period of 5 months. Late mortality has not occurred in any patient. Valve-related complications were not present. The post-operative NYHA functional class was as follows: seventeen (80%) fell into class I and five (20%) fell into class II. The actuarial survival rate 10 months after operation was 96.0%. Our study suggests that the cage ball valve has a good performance, the clinical results justify continuing investigation of this prosthesis.

Microorganisms in semen used for artificial insemination

The effect of freezing semen in a cryopreservative media consisting of egg yolk glycerol with or without erythromycin was tested for its effect on the viability of microorganisms present in donor semen and on sexually transmitted pathogens seeded into semen. All donor semen contained two or three species of microorganisms that could be considered skin flora. Five of ten donor semen specimens contained Ureaplasma urealyticum that was not affected by either freezing or antimicrobial treatment. Some strains of Neisseria gonorrhoeae, when seeded into semen, survived all conditions except freezing in egg yolk glycerol containing erythromycin. Chlamydia trachomatis was erradicated when erythromycin was present in the cryopreservative. There was no detectable effect of any treatment tested on the survival of herpes simplex virus.