Resection of the atrial appendages and its impact in the natriuretic homeostasis: development and validation of an animal model in an academic medical center

ABSTRACT Background: The left atrial appendage (LAAp) resection is an effective treatment approach to reduce the risk of thromboembolism in patients with atrial fibrillation. Objective: To study was to study the impact of removing atrial appendages in the production of natriuretic peptides (NPs) in conditions of volume overload and to develop an experimental model of LAAp resection. Materials and Methods: In a swine model of ischemic heart failure (HF), serum NP levels were measured before (Basal-1A) and after (Basal-1B) a fluid overload. Animals were grouped as follows: (0) preserved appendages, (1) resected LAAp, and (2) both atrial appendages resected. Levels of NP were measured before (2A) and after a fluid overload (2B). Results: Furin levels were higher in Group 0-2A than in Group 2-2A, and a significant increase was found in Group 0-2B compared to Groups 1-2B and 2-2B. Corin levels increased in Basal-1B versus Basal-1A. Atrial NP (ANP) decreased in Basal-1B compared to Basal-1A. After HF induction, ANP increased in Groups 2-2A and 2-2B. Conclusions: Resection of atrial appendages drastically modifies the natriuretic mechanisms of cardiac homeostasis, especially after a fluid overload challenge. Herein, we describe the face and predictive validation of an animal model of atrial appendage resection useful to investigations in translational medicine.

Evaluation of the global longitudinal strain and segmental strain of the right ventricle with two-dimensional speckle-tracking echocardiography with elevation of the legs / Evaluación de la deformación longitudinal global y segmentaria del ventrículo derecho con ecocardiografía bidimensional speckle-tracking con la elevación de las piernas

Abstract Introduction: Speckle-tracking echocardiography has shown its usefulness in the evaluation of the right ventricle (RV) in healthy subjects and in pulmonary hypertension. It is unknown whether this technique could be sensitive to assess healthy RV with increases in preload. Methods: Consecutive subjects were studied without evidence of cardiopulmonary disease. They underwent speckle-tracking echocardiography in General Electric Vivid 7® equipment. The "segmental longitudinal strain" (SLS) and "global longitudinal strain" (GLS) of the RV was determined at rest and with an increase in the preload through elevation the legs to 45°. Results: We analyzed 31 subjects, 16 men and 15 women, aged 16-53 years, in which were measured SLS and GLS. Basal of the RV free wall: —29.1 ± 3.3 versus −32.7 ± 5.5%, p = 0.0002. Mid of the RV free wall: —28.6 ± 6.4 versus —31.5 ± 4.9 %, p = 0.001. Apical of the free wall of the RV: —21.9 ± 6.5 versus —23.3 ± 6.1 %, p = 0.118. Basal inferoseptum: —19.40 ± 3.2 versus —18.9 ± 3.0 %, p = 0.204. Mid inferoseptum: —19.3 ± 3.2 versus —19 ± 3.1 %, p = 0.249. Apical septum: —17.1 ± 5.1 versus —17 ± 5.4 %, p = 0.457. GLS of the RV: —23.06 ± 3.4 versus —24.5 ± 2.9 %, p = 0.002. ICC: 0.773, 95 % CI: 0.534-0.890, p < 0.001. Conclusions: This method was sensitive to detect differences in the GLS and SLS basal and mid of the RV free wall.

Resumen Introducción: La ecocardiografía speckle-tracking (EST) ha mostrado su utilidad en la evaluación del ventrículo derecho (VD) en sujetos sanos y en hipertensión pulmonar. Se desconoce si esta técnica es sensible para evaluar el VD en sujetos sanos con aumento en la precarga. Método: Se evaluaron sujetos consecutivos sin evidencia de enfermedad cardiopulmonar. Se realizó EST con equipo General Electric Vivid 7®. La deformación longitudinal segmentaria (DLS) y la deformación longitudinal global (DLG) del VD se determinaron en reposo y con incremento en la precarga mediante la elevación de las piernas a 45°. Resultados: Analizamos 31 sujetos, 16 hombres y 15 mujeres. Edad: 16-53 años. Basal de la pared libre del VD: —29.1 ± 3.3 vs. —32.7 ± 5.5%, p = 0.0002. Medio de la pared libre del VD: —28.6 ± 6.4 vs. —31.5 ± 4.9%, p = 0.001. Apical de la pared libre del VD: —21.9 ± 6.5 vs. —23.3 ± 6.1, p = 0.118. Basal septum inferior: —19.40 ± 3.2 vs. —18.9 ± 3.0%, p = 0.204. Medio septum inferior: —19.3 ± 3.2 vs. —19 ± 3.1%, p = 0.249. Apical septal −17.1% ± 5.1 vs. −17 ± 5.4, p = 0.457. DLG del VD: —23.06 ± 3.4 vs. —24.5 ± 2.9%, p = 0.002. CCI: 0.773, IC 95%: 0.534-0.890, p < 0.001. Conclusiones: El método fue sensible para detectar diferencias en la DLG y DLS basal y media de la pared libre del VD.

Dyslipidemia and tobacco smoking synergistically increase serum manganese / La dislipidemia y el tabaquismo aumentan de manera sinérgica el manganeso sérico

Manganese is a trace metal involved in both physiology and toxicity. The association between manganese and dyslipidemia has been scarcely revised, and results from studies in both animals and humans are inconsistent. The aim of this study was to evaluate the association between serum manganese levels and dyslipidemia, considering some manganese sources and factors that could affect its concentration, especially tobacco smoking. Serum manganese concentration in 63 volunteers was determined and their smoking habits were recorded. Dietary manganese, iron, fat and alcohol consumption was also estimated by a food-frequency questionnaire. A bivariate analysis was carried out to identify those factors affecting manganese concentration. Only dyslipidemia and smoking resulted statistically significant and thus were considered for the subsequent two-way analysis of variance, to test a possible interaction between dyslipidemia and smoking. Marginal means for serum manganese were as follows: 8.32 ± 2.14 nmol/L for nonsmokers without dyslipidemia, 9.21 ± 2.22 nmol/L for smokers without dyslipidemia, 10.21 ± 2.53 nmol/L for nonsmokers with dyslipidemia, and 14.21 ± 3.44 nmol/L for smokers with dyslipidemia. Dyslipidemia and tobacco smoking were synergistically associated with increased serum manganese. To maintain adequate manganese levels in the organism, other factors in addition to its dietary intake should be considered, for instance, lipid status and smoking habits, particularly in those conditions in which manganese accumulation is an issue.

El manganeso es un metal traza esencial involucrado tanto en procesos fisiológicos como en toxicidad. La asociación entre el manganeso y las dislipidemias se ha estudiado poco, y los resultados de estudios en animales y en humanos son inconsistentes. El objetivo de este trabajo fue evaluar la asociación entre el manganeso sérico y las dislipidemias, considerando algunas fuentes de manganeso y factores que pudieran afectar su concentración, especialmente el tabaquismo. Se determinaron las concentraciones séricas de manganeso de 63 voluntarios y se registraron sus hábitos de consumo de tabaco. Se estimó la ingesta de manganeso, hierro, grasa y alcohol mediante un cuestionario de frecuencia de consumo. Se realizó un análisis bivariado para identificar los factores que afectaron las concentraciones de manganeso; únicamente las dislipidemias y el tabaquismo resultaron estadísticamente significativos y se consideraron enel subsecuente análisis de varianza de dos vías, para examinar una posible interacción entre las dislipidemias y el tabaquismo. Las medias marginales para el manganeso sérico fueron: 8,32 ± 2,14 nmol/L para no fumadores sin dislipidemia, 9,21 ± 2,22 nmol/L para fumadores sin dislipidemia, 10,21 ± 2,53 nmol/L para no fumadores con dislipidemia, y 14,21 ± 3,44 nmol/L para fumadores con dislipidemia. Las dislipidemias y el tabaquismo se asociaron sinérgicamente con el aumento del manganeso sérico. Para mantener niveles adecuados de manganeso en el organismo, se deben tomar en cuenta factores adicionales a su consumo dietético, como el estatus lipídico y el tabaquismo, particularmente en condiciones en las que la acumulación de manganeso sea un problema.

Inhibir la contractilidad sin provocar necrosis: ¿sería útil en miocardiopatía hipertrófica? Modelo experimental de administración intramiocárdica de toxina botulínica y de wortmanina / Inhibiting contractility without necrosis: Would it be helpful for hypertrophic cardiomyopathy? Experimental model of intramyocardial botulinum toxin and wortmannin

En este artículo se presenta una idea original: inhibir la contracción miocárdica en forma regional y selectiva sin inducir necrosis. Se propone como una posible opción terapéutica en miocardiopatía hipertrófica asimétrica obstructiva, y se plantean 2 modelos farmacológicos basados en la administración intramiocárdica de toxina botulínica y de wortmanina.

The purpose of this paper is to introduce a new idea: local inhibition of contractility without necrosis. It's potential usefulness in hypertrophic cardiomyopathy treatment is discussed and 2 pharmacological models, administrating botulinum toxin and wortmannin directly in the myocardium are disclosed.

Evaluación ecocardiográfica de la sincronía ventricular: implicaciones en la selección de pacientes y en los resultados del tratamiento / Echocardiographic assessment of ventriculara synchrony: implications to patient selection and treatment outcome

Heart failure is one of the most prevalent diseases in industrialized countries. Up to 30% of the patients with advanced heart failure present disturbances in intra-ventricular conduction, and this produce asynchrony of ventricular contractility, leading to further deterioration in heart function. Cardiac resynchronization (TRC) is an increasingly important therapeutic option for a subgroup of patients with heart failure. Several methods have been show to be useful in study the mechanical asynchrony. However, there are discrepancies between the results of the different methods. The echocardiography provides the best parameters in predicting a good response.

Ten-year clinical and echocardiographic follow-up of patients undergoing percutaneous mitral commissurotomy with Inoue balloon / Comisurotomía mitral percutánea con balón de Inoue: seguimiento clínico y ecocardiográfi co a 10 años

Percutaneous mitral commissurotomy (PMC) has emerged as an effective nonsurgical technique for the treatment of patients with symptomatic mitral stenosis. This report highlights the immediate and long-term follow-up results of this procedure in an unselected cohort of patients with rheumatic mitral stenosis from a single center. PMC with Inoue balloon was performed in 70 patients in a 2-year period (1993-1994). Age of patients ranged from 18 to 67 years (mean 38 +/- 11). Atrial fibrillation was present in 18 (30%) patients. A detailed clinical and echocardiographic (two-dimensional, continuous-wave Doppler and color-flow imaging) assessment was done at follow-up. The procedure was technically successful in 61 (85%) patients with an increase in mitral valve area (MVA) from 0.96 +/- 0.2 to 1.7 +/- 0.28 cm2 (P < .001) and a reduction in mean trans-mitral gradient from 14.3 +/- 4.8 to 6.0 +/- 2.8 mmHg (P < .01). Mitral regurgitation appeared or worsened in 25 (30%) patients, of which 3 (4%) developed severe mitral regurgitation. Urgent mitral valve replacement was performed in these 3 patients. Data of 52 patients followed over a period of 105 +/- 10 months revealed MVA of 1.4 +/- 0.4 cm. Elective mitral valve replacement was done in 14 (23%) patients. Mitral restenosis diagnosed with echocardiography was seen in 24 (50%) patients, of which 14 were having recurrence of class III or more symptoms and were treated with surgery. Thus, percutaneous mitral commissurotomy is an effective and safe procedure and over 2/3 of the patients were event-free at the end of follow-up. The benefits are sustained in most of these patients on long-term follow-up.

Espectro anatómico entre el defecto de la tabicación atrioventricular completo y parcial. Evaluación con ecocardiografía bi y tridimensional / Anatomic spectrum between complete and partial atrioventricular septal defect. Two and three-dimensional echocardiography approach

INTRODUCTION: It has been postulated that there is a morphogenetic relation between the atrioventricular septal defect (AVSD) type A of Rastelli and the type of two separated orifices, this so called partial forms, existent between both types a spectrum of anatomical forms in which interchordal spaces determinate the ventricular septal defects (VSD) size to forms in which the VSD is closed by fusion of the left septal valves to the crest of ventricular septum. METHODS: We present five patients which illustrates the variability of the atrioventricular defect by means of two dimensional and three-dimensional echocardiography. In each case was made a transesophagic echocardiogram using three-dimensional reconstruction with an Echo-Scan system (4.0 TomTec Gmb version, Munich, Germany). RESULTS: It was observed the following spectrum of atrioventricular defect: one patient had a complete closure of the VSD by the insertion of the left septal valves to the interventricular septal crest. One patient has a partially closed VSD. The last 3 patients had a large VSD with a large shunt and high pulmonary pressure. In those patients in whom the VSD was completely or partially closed, the hemodynamic behavior depended of the interatrial shunt and the regurgitation of the atrioventricular valve. They didn't present pulmonary hypertension, what allowed them to be less symptomatic. CONCLUSIONS: The three-dimensional echocardiographic study of the spectrum of AVSD type A of Rastelli, defines accurately the valve components and septal structures, so we can understand the transition between complete and partial forms. This difference determines the clinical evolution of the patients.

Ruptura ventricular por hematoma disecante intramiocárdico / Postinfarction intramyocardial dissection

The evolution of 16 patients with acute myocardial infarction in whom the intramyocardial ventricular dissection has been demonstrated with echocardiography, in the operating room and/or during necropsy is described. Ten patients had inital septal hemorrhagic dissection and in 6 patients the dissection was of the free wall of the left ventricle. The myocardial infarction affected the inferior wall of the left ventricle in 2 cases and in 14 the anterior wall. ECG recordings demonstrated extension of the infarction to the right ventricle in 7 of the 16 patients and in 15 a persistent elevated ST segment in the leads associated with the infarction site. There was a 50% global mortality and in the group with septal hematoma it reached 80%. Echocardiographic studies showed different acoustic densities according to the type of evolution: spontaneous reabsortion, extension through the hemorrhagic dissection as well as the communication with ventricular chambers. Based on these results TEE is the non invasive selected method in the sudy of patients with acute myocardial infarction and suspected cardiac rupture.

Ecocardiografía: aportaciones en la evaluación del daño valvular: nuevas perspectivas / Echocardiography in valvular heart disease: new perspectives

Echocardiography occupies an excellent place in the field of valvular heart disease study. Its presence is being increased in the catheterism and surgery rooms as well as in the intensive cares units. The ultrasound machines development has improved its technology and echocardiographic diagnoses has a greater repercussion in clinical decisions every time. The greater challenge than appears to us is to be able to have prepared enough professionals that know the tool, the physiopathology, the therapeutics modalities, and who can apply and take advantage of the new technological developments for a better cardiological practice.

Hipertensión arterial pulmonar en niños con síndrome de Down y cardiopatía congénita. Es realmente más severa? / Pulmonary hypertension in children with Down's syndrome and congenital heart disease. Is it really more severe?

OBJECTIVE: To compare the hemodynamic state, the severity and reversibility of pulmonary arterial hypertension (PAH) in patients with Down's syndrome and congenital heart disease (CHD) with respect to those without chromosomal pathologies. MATERIAL AND METHODS: 30 patients with congenital heart disease and left to right shunt were studied, corroborated by echocardiography; 16 patients had Down's syndrome and CHD and the control group was constituted by 14 patients without chromosomal abnormalities and with CHD. The age was R = 4.7 +/- 5.8 years for the Down's syndrome group and x = 5.3 +/- 4.5 years for the control group. All patients were subjected to a complete hemodynamic study, as well as to structural analysis by pulmonary wedge angiography (PWA), tested with oxygen administration. RESULTS: The most frequent diagnosis was ventricular septal defect for the control group and common atrioventricular canal for the Down's group. The systolic and mean pulmonary pressure depicted very similar values in both groups, with an average of 84.87 +/- 13.16 mm Hg for the Down's group and 84.21 +/- 22.05 for the control group. After oxygen administration, a tendency of increased Qp/Qs was found with a drop in pulmonary resistance in both groups, but being more important in the control group. During PWA assessment no quantitative differences were observed in PAH between both groups nor after the angiography with oxygen administration. CONCLUSIONS: Although patients with Down's syndrome present CHD with greater predisposition to develop irreversible pulmonary arterial hypertension like common atrioventricular canal, the hemodynamic behavior of pulmonary hypertension and during the challenge with oxygen was similar in both groups.

Válvula aórtica cuadricúspide (VAC) en transposición de grandes arterias: Reporte de un caso diagnosticado por ecocardiografia bidimensional / Quadricuspid aortic valve in a patient with D- transposition of the great arteries

En este reporte presentamos el caso de un paciente con discordancia ventrículo arterial (d-TGA) en quien se diagnosticó por ecocardiografia bidimensional la presencia de válvula aórtica cuadricúspide, con el propósito de ampliar las lesiones asociadas a d-TGA y manifestar la preocupación de la repercusión clínica de anomalías en el número de velos valvulares en la evolución de este tipo de pacientes.

In this report we present the case of a patient with ventricular-arterial discordance in which a QAV was diagnosed by bidimensional echocardiogram with the purpose of expanding the anatomical spectrum of the anomalies associated with d-TGA and to manifest the clinical awareness of the consequence that the QAV has on the evolution of the patients that undergo to anatomic correction.

Mixoma recidivante: Diagnóstico ecocardiográfico bi y tridimensional / Recurrent myxoma: Bi and three-Dimensional echocardiography approach

Se presenta el caso clínico y ecocardiográfico de una paciente en edad pediátrica con mixomas recidivantes, que se manifiesta a los 16 años con embolismo cerebral. Se detecta mixoma auricular izquierdo y se realiza resección quirúrgica y electrocoagulación. A los 40 meses de seguimiento inicia con disnea de grandes esfuerzos, auscultándose soplo expulsivo aórtico. El ecocardiograma bidimensional muestra la presencia de 3 masas tumorales: en aurícula y ventrículo izquierdo y en ventrículo derecho. El mixoma de ventrículo izquierdo obstruía casi en su totalidad la válvula aórtica. Se discuten la utilidad de la ecocardiografía bi y tridimensional como método diagnóstico inicial.

The case of a 16-years old female patient with left atrial myxoma and cerebral embolism is reported. She was subjected to surgical excision of the mass. At 40 months of follow-up she initiates with dyspnea and an aortic murmur is detected. The transthoracic and transesophageal echocardiographic analysis revealed the presence of three tumors: in the left atrium, left and right ventricle. The myxoma of the left ventricle obstructs the aortic valve. We discuss the usefulness of bi-and three-dimensional echocardiography as initial diagnostic method.

Pseudoaneurisma ventricular. Evolución clínica y ecocardiográfica / Ventricular pseudoaneurysm. Clinical and echocardiographic evolution

Presentamos el caso de un paciente con una ruptura cardíaca secundaria a un infarto miocárdico al nivel del ápex del ventrículo izquierdo. La complicación mecánica condicionó la formación de un pseudoaneurisma que fue ocupado por un trombo que selló el punto de ruptura. El paciente sobrevive sin tratamiento quirúrgico tras 5 años de seguimiento.

The case of a patient with cardiac rupture following a myocardial infarction is presented. The rupture led to the formation of a ventricular pseudoaneurysm that was occupied by a thrombus that sealed the breakthrough point. The patient has survived without surgical treatment during the last 5 years. (Arch Cardiol Mex 2005; 75: 182-183).

Diagnóstico ecocardiográfico de disfunción por obstrucción intermitente de prótesis de disco mitral / Echocardiographic diagnosis of obstructive intermittent dysfunction of a mitral disc prosthetic valve

Se describen los hallazgos Ecocardiográficos en seis pacientes con disfunción por obstrucción intermitente de prótesis (DOIP) mecánica de disco en posición mitral. Todos con cuadro clínico de instalación gradual, con disnea progresiva de varias semanas de evolución. Se les practicó ETT con registros Bd y de modo M "orientado" desde apical 4/C y se compararon los hallazgos con un grupo control de 14 pts con prótesis normo-funcionante. En el grupo de DOIP, todos presentaban un retardo variable en la apertura de la prótesis, registrada como un "escalón" protodiastólico en el modo M. En la mitad la disfunción fue por trombos. En dos porpannus. Tres se operaron. Uno se trombolizó. En dos se incrementó el tratamiento con heparina IV y con anticoagulante oral. Ninguno falleció durante el manejo agudo de la disfunción intermitente. Dos fallecieron: uno siete meses después en insuficiencia cardíaca y otro, un año después por retrombosis protésica. En pacientes con prótesis mecánica en posición mitral y disnea progresiva, la presencia de un retardo variable en la apertura de la prótesis, es diagnóstica de DOIP y requiere manejo urgente con trombólisis o cirugía.

Echocardiographic findings in six patients with obstructive intermittent dysfunction of mechanical disc prosthetic mitral valve (OIPD) are described. All with a clinical picture of gradual installation and progressive dyspnea of several weeks of evolution. TTE with Bd recordings were performed in all of them with "oriented" M mode from apical 4/C view. The findings were compared with a control group of 14 patients with normal prosthetic valves. In the group of OIDP, all patients displayed a variable delay in the opening of the prosthetic disc, registered as a "protodiastolic step" in M mode. In three patients, the dysfunction was due to a thrombus. In two, due to pannus. Three were operated. One with thrombolysis. In two, the treatment consisted of heparin and increased oral anticoagulation. None die during the acute handling of the intermittent dysfunction. Two patients died: one seven months later due to cardiac failure and the other a year later due to prosthetic rethrombosis. In patients with mechanical prosthetic valve in mitral valve position and progressive dyspnea, the presence of a variable delay in the opening of the prosthesis is diagnostic of OIDP and requires urgent handling with thrombolysis or surgery. (Arch Cardiol Mex 2005; 75: 141-147).

Valoración ecocardiográfica bi y tridimensional de aneurisma no roto del seno de Valsalva / Unruptured sinus of Valsalva aneurysm. Bi and three-dimensional echocardiography approach

Los aneurismas de los senos de Valsalva son malformaciones raras que pueden ser congénitas o adquiridas. La causa más común de los adquiridos es la endocarditis aórtica. Actualmente la ecocardiografía se ha convertido en el método diagnóstico de elección. Se presentan dos pacientes en edad pediátrica con aneurismas del seno de Valsalva no roto y manifestaciones de falla cardíaca secundaria a insuficiencia aórtica aguda. Se compararon las imágenes ecocardiográficas bidimensionales transtorácicas y transesofágicas y en uno de ellos tridimensionales, analizando la calidad de la imagen, localización y detalles anatómicos del aneurisma, obstrucción o compresión de estructuras adyacentes y la presencia de otros defectos asociados. Se demuestra la utilidad de la valoración ecocardiográfica tridimensional en el abordaje diagnóstico de estas lesiones.

Aneurysm of the sinus of Valsalva is a rare anomaly that can be congenital or acquire. The most common among the acquire is aortic endocarditis. At the present time echocardiography has be come the election diagnostic method. We present two pediatric patients with unrupture aneurysm of the sinus of Valsalva and cardiac failure secondary to a acute aortic insufficiency manifestations. Transthoracic and transesophageal bidimensional images were compared, in one of them also three-dimensional image. Assessing the quality of images, localization and anatomical morphology of aneurysm, obstruction or compression and presence of associated defects. The usefulness of the three dimensional echocardiography assessment for these congenital malformations is demonstrated. (Arch Cardiol Mex 2005; 75: 148-153).

Anillo vascular por doble arco aórtico simétrico. Reporte de un caso / Double symmetrical aortic arch. Case report

Describimos un paciente de 6 meses de edad con doble arco aórtico simétrico y sintomatología obstructiva traqueal y esofágica, tratado quirúrgicamente. Se realizó una correlación entre las imágenes diagnósticas obtenidas con esofagograma, ecococardiografía y angiografía con un espécimen anatómico, dando énfasis a la utilidad del ecocardiograma como estudio inicial.

We report a six-month-old patient with a double symmetrical aortic arch with tracheal and esophageal obstructive symptoms, who was treated surgically. The diagnostic images consisting of esophagogram, echocardiography and angiography were correlated with an anatomical specimen; the usefulness of the echocardiogram as an initial test is emphasized. (Arch Cardiol Mex 2005; 75: 178-181).

Tratamiento de conducto arterioso permeable: Comparación de costos del cierre quirúrgico y transcateterismo en una institución pública / Treatment of patent ductus arteriosus: Comparison of costs between surgical and trans-catheter closures in a public institution

El costo del tratamiento transcateterismo del conducto arterioso permeable en comparación con el quirúrgico es un asunto controvertido en nuestro medio. El propósito de este estudio fue estimar y comparar los costos directos relacionados con ambos procedimientos. Método: Se incluyeron 57 pacientes tratados con intervencionismo y 26 con cirugía. Se obtuvo información sobre las características sociodemográficas, el número y tipo de exámenes de laboratorio y de gabinete, el tipo y duración de anestesia, la duración del procedimiento y la estancia hospitalaria y de terapia intensiva. Se construyó una matriz que integró los costos del sistema institucional de costos unitarios vigente. Resultados: Ambos grupos compartían características sociodemográficas. El diámetro del conducto fue mayor en el grupo quirúrgico (p<0.05). Tanto la estancia hospitalaria como el número de complicaciones post intervención fueron menores en los pacientes tratados con intervencionismo (p<0.05). El tratamiento con dispositivo Amplatzer® es más costoso que el tratamiento quirúrgico y ambos más costosos que el oclusor tipo resorte. En el tratamiento quirúrgico el 86.5% de los costos totales lo consumen la estancia hospitalaria, con el Amplatzer® este rubro fue del 36%, sin embargo el dispositivo representa el 40% del costo total. Conclusiones: No obstante el costo del tratamiento con dispositivo Amplatzer® es mayor que el quirúrgico, el cierre con oclusor representa ventajas con relación a menor estancia hospitalaria, consumo de recursos y número de complicaciones, lo que permite la optimización de los recursos hospitalarios.

The costs of transcatheter closure of patent ductus arteriosus in relation to the surgical closure still a controvertial issue in our hospitals. The aim of the study was compared the costs of both treatments. Methods: We included 57 patients treated with transcatheter occlusion and 26 underwent surgery. Information about laboratory tests, average in hospital days of stay, anesthesia type and duration, operating and hemodinamic room costs, was gather. A database containing the costs from the institution unitary costs system in force was designed. Results: sociodemographyc characteristics were similar in both groups. Ductus size was larger in patients treated with surgery (p<0.05). In hospital stay, as well as, the number of complications after the procedure were less in the patients treated with transcatheter occlusion (p<0.05). The closure with Amplatzer® device was more expensive than the surgical one, and both were more expensive than coil. With surgical treatment, 86.5% of the costs are due to in hospital stay, with the Amplatzer® this issues represented a 36%, however, the cost of the devices by itself represents a 40% of the total treatment cost. Conclusions: Even though total charges of Amplatzer® devices are more expensive than surgery, transcatheter occlusion represents advantages in relation to less in hospital stay, resources used and number of complications, which allows hospital resources optimization.

Mixoma intraventricular izquierdo / Left ventricular myxoma

Los tumores primarios del corazón son entidades poco frecuentes. Se reporta el caso de una mujer joven con un mixoma del ventrículo izquierdo, el cual se manifestó como enfermedad coronaria, y cuyo diagnóstico se hizo mediante ecocardiografía. Se realiza tratamiento quirúrgico por vía transeptal, con resección extensa del tumor, su pedículo, el músculo papilar al cual se encuentra adherido, y la valva anterior de la válvula mitral por encontrarse ésta deformada por la presencia misma de la tumoración. Simultáneamente se realiza cambio valvular mitral. Se hace una revisión acerca de esta patología.

Primary tumors of the heart are rare entities. We report a unique case of a young woman presenting a left ventricular myxoma, which manifested itself as coronary artery disease and was diagnosed by echocardiography. Emergency surgical treatment was indicated, done through a transeptal approach with extensive resection of the tumor, its pedicle and the papilar muscle to which it was attached as well as the anterior mitral leaflet, which was thinned and deformed by the presence of the mass. Mitral valve replacement was mandatory. A complete retrospective review of the literature is presented.

Ecocardiografía intracardíaca (EIC) en sala de operaciones como método de apoyo en la evaluación de resultados quirúrgicos inmediatos en cardiopatías congénitas / Intracardiac Echocardiography (ICE) in the Operating Room as a Support Measure in the Evaluation of Immediate Surgical Results in Congenital Cardiopathies

La utilización de ecocardiografía intracardíaca es una alternativa reciente en el control de procedimientos en la sala de hemodinámica. Presentamos el resultado de un estudio piloto, en 10 pacientes sometidos a corrección total de su cardiopatía, en quienes la valoración inmediata de los resultados quirúrgicos se realizó en base a la aplicación de ecocardiografía intracardíaca (EIC) en sala de operaciones. En todos los pacientes fue posible obtener imágenes adecuadas con EIC, sólo se presentó un caso falso negativo, postoperado de corrección de conexión anómala de venas pulmonares, en el que no se identificó obstrucción de venas pulmonares derechas. Concluimos que EIC es una alternativa en la evaluación de resultados quirúrgicos inmediatos.

The utilization of intracardiac echocardiography (ICE) is a recent alternative in the control of procedures in the Cath Lab. In this paper we presents the results of a pilot study, in 10 patients submitted to total correction of its congenital heart disease, in who the analysis of the surgical results was done in base to the application of intracardiac echocardiography in operations room. In all the patients it was possible to obtain adequate images with ICE, there was a case false negative, a Total anomalous return Pulmonary Veins, in whom there not indentified a obstruction in right pulmonary veins flow. We conclude that ICE is a good alternative in the evaluation of surgical results.