Estenosis aórtica: ¿Cuándo intervenir?

La estenosis aórtica es la valvulopatía más frecuente en los países desarrollados. La etiología degenerativa es la principal, esto está íntimamente relacionado con una tendencia exponencial en la longevidad de la población actual; por lo que sería correcto esperar un aumento en la casuística de esta patología. El reemplazo valvular aórtico, ya sea percutáneo o quirúrgico, es la estrategia casi única de manejo. Las guías de manejo de las distintas sociedades científicas, actualmente, norman la realización del reemplazo valvular como indicación principal en aquellos pacientes portadores de estenosis aórtica severa que, además, presenten síntomas o bien presenten datos de reducción en su fracción de eyección. Sin embargo, varios estudios han demostrado el beneficio de no retrasar la intervención de estos pacientes y por el contrario realizar la intervención valvular de forma temprana.

Aortic stenosis is currently the most common valve disease in developed countries. Degenerative ethology is the main one, this being intimately related to the exponential trend towards longevity in the current population. Aortic valve replacement, either percutaneous or open, is almost the only management strategy. The current management guidelines of the different scientific societies regulate the performance of valve replacement in patients with severe aortic stenosis who also present symptoms or data of reduced ejection fraction. However, several studies have shown the benefit of not delaying the management of these patients and, on the contrary, performing valve intervention early.

Efecto del Medio Condicionado de la Línea Celular H9C2 Tratada con Dehidroepiandrosterona y Expuesta a Daño sobre la Motilidad de Células Troncales Mesenquimales / Effect of the Conditioned Medium from H9C2 Cell Line Treated with Dehydroepiandrosterone and Exposed to Damage on the Motility of Mesenchymal Stem Cells

RESUMEN: Las enfermedades cardiovasculares (ECV) son la principal causa de muerte a nivel mundial, donde la terapia con Células Troncales Mesenquimales (CTM) representa una alternativa para los pacientes que no logran recuperarse con los tratamientos actuales. El lograr que las CTM residentes se movilicen al órgano afectado representaría una ventaja para el manejo terapéutico de las ECV. La dehidroepiandrosterona (DHEA) es un precursor hormonal cuyos niveles disminuyen a lo largo de la vida, lo que se ha asociado al desarrollo de ECV. Diversos estudios han demostrado que el consumo de DHEA previene y mejora la condición cardiaca, aunque no se sabe si esto ocurre porque se ejerce un efecto en los cardiomiocitos y estos, a su vez, hacia las CTM. El objetivo del presente estudio fue determinar el efecto del medio condicionado procedente de la línea H9C2 pretratada con DHEA y sometida a daño, sobre la motilidad de CTM, llevando a cabo un ensayo de cierre de herida. El pretratamiento con DHEA y el daño en la línea H9C2, promueve la motilidad de CTM. El estímulo de la motilidad de CTM por un efecto indirecto de DHEA podría ser una estrategia terapéutica para el daño cardiaco.

ABSTRACT: Cardiovascular diseases (CVD) are the leading cause of death worldwide. Mesenchymal Stem Cell (MSC) therapy is an alternative for patients who cannot recover with current treatments. Ensure movilization of MSC to the affected organs would represent an advantage for therapeutic management of CVD. Dehydroepiandrosterone (DHEA) is a hormone precursor whose levels decrease throughout life, which has been associated with the onset of CVD. Several studies have shown that DHEA consumption, prevents and improves heart condition, although it is not known if this is because an effect on cardiomyocytes is exercised on these cells and this, in turn, to CTM. The aim of this study was to determine the effect of conditioned medium from H9C2 cell line pretreated with DHEA and subjected to damage, on the motility of CTM, performing a wound healing assay. Pretreatment with DHEA and damage to H9C2 cell line, promotes motility of CTM. Stimulation of CTM motility by an indirect effect of DHEA could be a therapeutic strategy for heart damage.

Baroreflex deficit are associated with target organ damage / Os déficits de barorreflexo estão associados ao dano do órgão alvo

As is well known, there are different pathophysiological conditions in which baroreflex deficit is enrolled in end-organ damage like hypertension, heart failure and myocardial infarction. The purpose of this study was to investigate the mechanisms enrolled in those relationships using a baroreflex deficit­induced model. Sinoaortic-denervated (SAD) rats were used as a model of arterial baroreflex impairment. Male Wistar rats were divided into: control (n = 9), and SAD (n = 8, 30 days) groups. SAD was performed using the method previously described by Krieger (1964). Cardiac morphology was assessed by echocardiography BP, HR and BP, and pulse interval (PI) variabilities were analyzed using a data acquisition system (Codas, 2kHz). Stroke volume and peripheral and regional resistance were evaluated using colored microspheres. SAD induced LV hypertrophy estimated by LV/BW mass using echocardiography. BP (C: 106±0.6 vs. SAD: 108±2 mmHg) and HR (C: 355±7 vs. SAD: 357±15 bpm) were not modified by SAD, while BP variability (C: 6.2±0.84 vs SAD: 14±0.9 mmHg) and PI variability (C: 24±0.7 vs SAD:17±0.8 ms) were increased and decreased, respectively. Moreover, a reduction was observed in stroke volume (C: 0.31±0.02 vs SAD: 0.25±0.01 mL/ min) and an increase in total peripheral resistance (C: 0.97±0.07 vs. SAD: 1.23±0.07 mL/min/mmHg) in SAD animals. Those alterations resulted in increased cardiac vascular resistance (C: 35±1.6 vs. SAD:66±2.3 mmHg/mL/min/g) and renal vascular resistance (C: 31±1.2 vs. SAD: 75±2.2 mmHg/mL/min/g) in the SAD group. SAD induced an augment in cardiac and renal damage as cardiac morphology by histological techniques showed increased arterial wall and interstitial fibroses, and renal morphology showed interstitial fibroses and a decreased Bowmann space. Conclusion: Total baroreflex dysfunction impaired BP and HR variabilities associated with decreased stroke volume and increased peripheral and regional resistance. These adjustments may play an important role in target organ damage in different pathological conditions; even BP values were maintained at the control levels

Existem diferentes condições fisiopatológicas em que o déficit de barorreflexo está associado ao dano do órgão final, como hipertensão, insuficiência cardíaca e infarto do miocárdio. O objetivo deste estudo foi investigar os mecanismos inscritos nestes relacionamentos usando um modelo induzido por déficit de barorreflexo. Foram utilizados ratos com desnervação sino-aórtica (SAD) como modelo de comprometimento barorreflexo arterial. Os ratos Wistar machos foram divididos em grupos controle (n = 9) e SAD (n = 8, 30 dias). O SAD foi realizado utilizando o método anteriormente descrito por Krieger (1964). A morfologia cardíaca foi avaliada pela ecocardiografia PA, e as variabilidades de FC e PA, e do intervalo de pulso (IP) foram analisadas usando um sistema de aquisição de dados (Codas, 2kHz). O volume sistólico e a resistência periférica e regional foram avaliados utilizando microesferas coloridas. SAD induziu hipertrofia do VE estimada pela massa de VE/PC usando ecocardiografia. PA (C: 106±0,6 vs. SAD: 108±2 mmHg) e FC (C: 355±7 vs. SAD: 357±15 bpm) não foram modificados pelo SAD, enquanto a variabilidade da PA (C: 6,2±0,84 vs. SAD: 14±0,9 mmHg) e a variabilidade de PI (C: 24±0,7 vs. SAD: 17±0,8 ms) aumentaram e diminuíram, respectivamente. Além disso, observou-se uma redução no volume sistólico (C: 0,31± 0,02 vs SAD: 0,25 ± 0,01 mL/min) e um aumento na resistência periférica total (C: 0,97±0,07 vs. SAD: 1,23±0,07 mL/min/mmHg) em animais SAD. Essas alterações resultaram em aumento da resistência vascular cardíaca (C: 35±1,6 vs. SAD: 66 ± 2,3 mmHg/mL/min/g) e resistência vascular renal (C: 31±1,2 vs. SAD: 75±2,2 mmHg/mL/min/g) no grupo SAD. SAD induziu um aumento no dano cardíaco e renal como a morfologia cardíaca por técnicas histológicas mostrou aumento da parede arterial e fibrose intersticial, e a morfologia renal mostrou fibrose intersticial e uma diminuição do espaço de Bowmann. A disfunção barorreflexa total prejudicou as variabilidades de PA e FC associadas à diminuição do volume sistólico e ao aumento da resistência periférica e regional. Esses ajustes podem desempenhar um papel importante no dano de órgãos alvo em diferentes condições patológicas; até mesmo os valores da PA foram mantidos nos níveis de controle

Contrapulsación intraaórtica / Intraaortic counterpulsation

Los objetivos de esta información son revisar la indicación clínica del balón de contrapulsación, describir su manejo, los cuidados y habilidades de enfermería requeridos y las posibles complicaciones que pueden presentarse por su uso, a fin de entender su despliegue técnico y la asistencia con este procedimiento tan específico al paciente con falla cardiaca secundaria a cardiopatía isquémica aguda. Sobre todo, destacar el trabajo especializado que realiza la enfermera en cuidados intensivos. Las indicaciones sobre esta forma de tratamiento siguen siendo controvertidas y muy específicas, ya que se trata de una técnica invasiva que aunque tiene una influencia favorable en la hemodinamia, evolución, clínica y promedio de sobrevivencia de los pacientes con choque cardiogénico, no está exento de complicaciones y exige competencia profesional y habilidades específicas por parte de todos los integrantes del equipo de salud.

The intraaortic counterpulsation is the method to procure an attendance mechanic balloon for the treatment of the severe cardiac dysfunction and reversible potentially. It is indicated in shock associated with acute myocardial infarction or other complications associated to the heart injuries like the severe cardiac ischemia without infarct. The intraaortic counterpulsation utilized a catheter with standard balloon with a tubulation semiflexible of double light and central hollow that could be utilized for the pass of a guide, middle of contrast or monitory of pressure. Approximately it has 90 cm of length, an antitrombogenic surface and their capacity oscillate between 8 and 40 mL. The external console of control permit the synchronization between the balloon and the beats of the heart; it is synchronized with a circuit of perception of the ECG interfere in the synchronization. This procedure is not free of complication like vascular trauma, infection or another like platelet destruction. It is necessary in all the team a professional competence.