Surgical patch angioplasty with saphenous vein for isolated ostial LMCA stenosis is a safe operative technique with good long-term results. MRI is able to adequately depict the operative result of left main coronary ostium reconstruction.

RESUMENLa enfermedad cardiovascular es la causa más frecuente de mortalidad en los países desarrollados y constituye un grave problema social, económico y sanitario. Aunque existen muy diversas técnicas útiles para diagnosticar las enfermedades cardíacas, con frecuencia es preciso realizar más de una prueba para llegar a un diagnóstico concreto. La resonancia magnéti-ca es una técnica inocua, bien tolerada y segura que actualmente se encuentra disponible en la mayoría de los centros hospitalarios. Esta técnica permite estudiar en una única exploración la anatomía del corazón y valorar de forma cualitativa, semicuantitativa y cuantitativa los parámetros de función cardíaca. Es útil para el estudio de las enfermedades valvulares, miocardiopatías y de la enfermedad pericárdica. Aporta información de la anatomía y función cardíaca y vascular en las cardiopatías congénitas complejas. Además, con la administración de contraste intravenoso, permite conocer la viabilidad miocárdica en la cardiopatía isquémica. Por tanto, la resonancia magnética cardíaca se perfila como una de las técnicas más prometedoras para el estudio de la patología cardíaca congénita y adquirida. Palabras clave. Resonancia magnética. Corazón. Enfermedades cardíacas. ABSTRACTCardiovascular disease is the most frequent cause of mortality in the developed countries and represents a serious social, economic and health problem. Although very diverse, useful techniques exist for diagnosing cardiac diseases, it is frequently necessary to ask for more than one test to reach a specific diagnosis. Magnetic resonance is a harmless, well tolerated and safe technique, which is currently available in the majority of hospitals. This technique makes it possible in a single exploration to study the anatomy of the heart and to make a qualitative, semiquantitative and quantitative assessment of the parameters of cardiac function. It provides information of cardiac and vascular anatomy and function in complex congenital cardiopathies. Besides, with the administration of intravenous contrast, it enables knowledge to be gained of myocardial viability in ischaemic cardiopathy. Hence, cardiac magnetic resonance is emerging as one of the most promising techniques for the study of congenital and acquired cardiac pathology.

Cardiovascular magnetic resonance is a valid and accurate tool for the assessment of structural and functional disorders of the heart. Through combination of morphologic and functional studies, it is possible to form a quick diagnosis with a noninvasive examination. In this case, MR-imaging shows a pericardial effusion and a 5 x 5 cm large, well-circumscribed hematoma with displacement of the right coronary artery, which was also visible with other examination techniques as an unclear intracardial mass. At operation a large aneurysm of the right coronary artery was exposed, in addition to a hemorrhagic pericardial effusion.

This study investigated whether reperfusion results in an increase of ultrastructurally determined myocardial injury in pig hearts. The left anterior descending coronary artery (LAD) was distally occluded in 12 pigs for 35-45 minutes and then reperfused for 3 hours. At the end of ischemia, as well as after 3 hours of reperfusion, one transmural biopsy was removed from the center of the risk region and subdivided into four-specimens, representing the subendocardial (I), subendo-midmyocardial (II), subepi-midmyocardial (III), and subepicardial layers (IV). The degree of injury was assessed by electronmicroscopy and was scored as reversible (1), an almost equal mixture of reversible and irreversible (2), and totally irreversible (3) damage. In addition, infarct size was determined as the ratio of infarcted (tetrazolium stain) to ischemic (dye technique) myocardium. Infarct sizes ranged from 29.3% to 93% (mean 61.2%). The scores of injury of the four tissue layers before and after reperfusion did not differ significantly: layer I, 2.4 +/- 0.8/2.3 +/- 0.9; layer II, 2.2 +/- 0.9/2.0 +/- 0.9; layer III, 1.8 +/- 0.9/2.0 +/- 0.9; and layer IV, 1.6 +/- 0.9/1.3 +/- 0.6. The means of the four layers were almost identical at the end of ischemia (2.1 +/- 0.8) and after 3 hours of reperfusion (2.0 +/- 0.6). A linear regression analysis with 95% confidence limits of the score values before and after reperfusion indicated that maximally 25% of a mean final infarct size of about 50% may be due to lethal reperfusion injury. This study suggests that cell death in regional ischemia and reperfusion occurs predominantly during ischemia and not during reperfusion.