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Letters to the Editor

hypertrophy, given that the risk of prosthesis displacement in most patients is very low when the prosthesis is located symmetrically in the balloon.
Ral Moreno,a Luis Calvo,a Eulogio Garca,b and David Dobarroa

Unidad de Cardiologa Intervencionista, Hospital Universitario La Paz, Madrid, Spain b Unidad de Cardiologa Intervencionista, Hospital Clnico San Carlos, Madrid, Spain

REFERENCES

1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart disease: a population-based study. Lancet. 2006;368:1005-11. 2. Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Guidelines on the management of valvular heart disease. Eur Heart J. 2007;428:e1-39. 3. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Brwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: The EuroHeart Survey on Valvular Heart Disease. Eur Heart J. 2003;24:1231-43. 4. McKay RG. The Mansfield Scientific Aortic Valvuloplasty Registry: overview of acute hemodynamic results and procedural complications. J Am Coll Cardiol. 1991;17:189-92. 5. Cribier A, Eltchaninoff H, Tron C, Bauer F, Agatiello C, Nercolini D, et al. Treatment of calcific aortic stenosis with the percutaneous heart valve: mid-term follow-up from the initial feasibility studies: the French experience. J Am Coll Cardiol. 2006;47:1214-23.

6. Webb JG, Pasupati S, Humphries K, Thompson C, Altwegg L, Moss R, et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation. 2007;116:755-63. 7. Grube E, Schuler G, Buellesfeld L, Gerckens U, Linke A, Wenaweser P, et al. Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second and current third generation self-expanding CoreValve prosthesis. J Am Coll Cardiol. 2007;50:69-76. 8. Moreno R, Calvo L, Filgueiras D, Lpez T, Snchez-Recalde A, Jimnez-Valero S, et al. Implantacin percutnea de prtesis valvulares articas en pacientes con estenosis artica severa sintomtica rechazados para ciruga de sustitucin valvular. Rev Esp Cardiol. 2008;61:1215-9. 9. Garca E, Pinto AG, Sarnago F, Pello AM, Paz M, GarcaFernndez MA, et al. Implantacin percutnea de prtesis valvular artica: experiencia inicial en Espaa. Rev Esp Cardiol. 2008;61:1210-4.

Acute Coronary Syndrome in a Young Woman Treated With Sibutramine

To the Editor, In Spain, pharmacologic treatment of obesity depends on 2 authorized drugs, orlistat and

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Rev Esp Cardiol. 2010;63(2):240-52

Document downloaded from http://www.revespcardiol.org, day 12/12/2011. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.

Letters to the Editor

sibutramine, which have different mechanisms of action and different secondary effects profiles. Sibutramine is a selective inhibitor of monoamine re-uptake, especially of serotonin and noradrenaline (and, to a lesser extent, dopamine). It reduces food ingestion by increasing the sensation of satiety and attenuating the fall in the metabolic rate that usually occurs with weight reduction, probably by stimulating thermogenesis.1 Bearing in mind its mechanism of action, one of its possible adverse effects may, logically, be increases in blood pressure and heart rate due to the inhibition of peripheral reuptake of oradrenaline. This has led physicians to contraindicate sibutramine or recommend caution in its use in patients at high cardiovascular risk. The SCOUT study (Sibutramine Cardiovascular Morbidity/Mortality Outcomes Trial) is currently under way. It aims to determine the effects of treatment with sibutramine or a placebo, in combination with lifestyle changes, on incidence of non-fatal myocardial infarction, non-fatal stroke, reanimation after cardiac arrest and cardiovascular death, in a population of obese patients with high cardiovascular risk.2 Reports that relate sibutramine use with acute coronary syndrome are few and far between.3,4 We present the case of a young and otherwise healthy woman who presented acute myocardial infarction associated with sibutramine use. This 39-year-old woman with high blood pressure, in treatment with candesartan, and presenting obesity, had been taking sibutramine for 12 days. From the outset, she presented higher blood pressure and palpitations. On admission, she presented intense retrosternal pain at rest, irradiating to the upper left arm, and perspiration lasting 15 min, which remitted after administration of sublingual nitroglycerine. She was asymptomatic on arrival at the emergency room. Her maximum creatine kinase and troponin T serum values were 388 IU/L (normal, <140) and 0.23 ng/mL (normal, <0.035), respectively, with an enzyme curve typical of acute myocardial infarction. Electrocardiograms performed without chest pain were normal throughout hospitalization and showed no alterations in contractility. Coronary angiography showed normal coronary arteries. Our patient underwent computerized tomography of the chest and a study of hypercoagulability and urine toxins to rule out other possible causes of chest pain and elevated cardiac markers such as cocaine, viral myocarditis, aortic dissection, pulmonary thromboembolism, states of hypercoagulability, and autoimmune vasculitis. Although it is practically impossible to demonstrate a causal relation, the patients age, the fact that high blood pressure was her only cardiovascular risk factor, and the negative results of the other studies,

together with the coincidence between the start of drug treatment for obesity, lead us to conclude sibutramine use may have caused her myocardial infarction.
Jos J. Gmez-Barrado, Soledad Turgano, Francisco J. Garciprez de Vargas, and Yolanda Porras

Servicio de Cardiologa, Hospital San Pedro de Alcntara, Cceres, Spain

REFERENCES

1. Florentin M, Liberopoulos EN, Elisaf MS. Sibutramineassociated adverse effects: a practical quide for its safe use. Obes Rev. 2008;9:378-87. 2. Torp-Pedersen C, Caterson I, Coutinho W, Finer N, van Gaal L, Maggioni A, et al; on the behalf of the SCOUT Investigators. Cardiovascular responses to weight management and sibutramine in high-risk subjects: an anlisis from the SCOUT trial. Eur Heart J. 2007;28:2915-23. 3. Azarisman SM, Magdi YA, Noorfaizan S, Oteh M. Myocardial infarction induced by appetite suppressants in Malaysia. N Engl J Med. 2007;357:1873-4. 4. Yim KM, Ng HW, Chan CK, Yip G, Lau FL. Sibutramineinduced acute myocardial infarction in a young lady. Clin Toxicol (Phila). 2008;46:877-9.

Disconnection of the Right Pulmonary Artery With Bilateral Ductus Arteriosus

To the Editor, Disconnection of the pulmonary artery (PA) is unusual. First described in 1868,1 it is generally associated with other cardiovascular malformations. We present the case of a newborn boy diagnosed in the immediate neonatal period with type III esophagal atresia. The preoperatory echocardiography revealed a left aortic arch, absence of connection of the right pulmonary artery (RPA) with the trunk of the PA, and presence of persistent ductus arteriosus (PDA) in the normal position. Moreover, we observed an anomalous vessel originating in the first supraaortic trunk and descending to the RPA. Cardiac catheterization confirmed RPA discontinuity and a vascular stump at the base of the innominate trunk (Figure 1). Treatment began with prostaglandin E1 (PGE1) given we suspected the
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