There weren't many changes made to the American version of El Viento. In the Japanese version, the guy helping the Hastur cult is Al Capone. He was re-named "Vincente DeMarco" in the American version.

Japanese	American
The Japanese version doesn't mention SEGA anywhere on it. For the American version, text was added regarding the game being licensed by them.

Japanese	American
In the cut-scene after level 1 is completed, Al Capone can be seen smoking in the Japanese version, but Vincente DeMarco is cigar free in the American version.

Japanese	American
The same thing happens with the cigar again in the cut-scene after you beat level 4 -the Japanese version has the bad guy smoking, whilst the American version doesn't. One of his scars was also slightly altered. Oddly, despite the in-game cuts to smoking references, the American version's box art features a guy with a cigar, and in the instruction manual, DeMarco's profile art also has him with a cigar.