Relación neutrófilos, linfocitos y plaquetas como predictor de lesión renal aguda en sepsis por COVID-19 en la Unidad de Cuidados Intensivos / Neutrophiles, lymphocytes and platelets ratio as a predictor of acute kidney injury in sepsis by COVID-19 in the Intensive Care Unit / Relação de neutrófilos, linfócitos e plaquetas como preditor de lesão renal aguda na sepse por COVID-19 na Unidade de Terapia Intensiva

Resumen: Introducción: La lesión renal aguda se encuentra en 40% de los pacientes que presentan sepsis (S-LRA), ya que la inflamación es una de las causas fisiopatológicas de la lesión renal aguda. Durante la pandemia, la principal causa de sepsis en la unidad de cuidados intensivos (UCI) fue secundaria a enfermedad por coronavirus 2019 (COVID-19), en ésta se ha reportado incidencia de lesión renal de 36 a 75%. La fisiopatología de esta complicación aún no se conoce, pero se han demostrado mecanismos similares a la lesión renal séptica típica. La relación neutrófilos, linfocitos y plaquetas (RNLP) previamente se ha asociado con la presencia de lesión renal aguda en otros ámbitos (cirugía cardiaca y cirugía abdominal mayor), y en pacientes con sepsis secundaria a COVID-19 puede ser un marcador que identifique a los pacientes con riesgo de presentar esta complicación. Objetivo: Determinar si la relación neutrófilos, linfocitos y plaquetas es un predictor de lesión renal aguda en sepsis secundaria a COVID-19 en la UCI adultos. Material y métodos: Estudio de cohorte prospectiva, unicéntrico. En pacientes mayores de 18 años que ingresen a la UCI con diagnóstico de sepsis por COVID-19 se realizará el cálculo de la RNLP desde el día uno hasta el día siete. Se dividen en dos grupos: RNLP mayor de tres puntos y RNLP igual o menor de tres puntos, observando presencia o no de lesión renal aguda durante su estancia, y posterior al desenlace. Para el objetivo principal se hace prueba χ2, y se realiza prueba de regresión logística multivariable para valorar la asociación de las diferentes variables con el desenlace (OR IC95%). Resultados: Se estudió una población de 119 pacientes, se obtuvo una incidencia de lesión renal aguda inducida por sepsis (S-LRA) de 53.8% (IC95% 44-62%) en pacientes con sepsis secundaria a COVID-19, siendo la mayoría KDIGO I (53.2%). El grupo de RNLP mayor de tres tuvo una incidencia de 68.4% de S-LRA en comparación con el grupo de RNLP igual o menor de tres con 28% (p = 0.001, OR 4.255 IC95% 1.782-10.16), los pacientes con RNLP mayor de tres tuvieron estancia más prolongada en la UCI (12 versus 10 días, p = 0.018), y más tiempo de ventilación mecánica (11 versus ocho días, p = 0.003). Conclusión: El incremento de la relación neutrófilos, linfocitos y plaquetas es un factor de riesgo y puede ser pronóstico para la presencia de lesión renal aguda en sepsis por COVID-19 en la UCI.

Abstract: Introduction: Acute kidney injury is found in 40% of patients with sepsis (S-AKI), since inflammation is one of the pathophysiological causes of acute kidney injury. During the pandemic, the main cause of sepsis in the ICU was secondary to COVID-19, in which an incidence of kidney injury of 36 to 75% has been reported. The pathophysiology of this complication is not yet known, but mechanisms similar to typical septic kidney injury have been demonstrated. The neutrophil, lymphocyte and platelet ratio (RNLP) has previously been associated with the presence of acute kidney injury in other settings (cardiac surgery and major abdominal surgery) and in patients with sepsis secondary to COVID-19 it may be a marker that identifies the patients at risk of presenting this complication. Objective: To determine if the ratio of neutrophils, lymphocytes and platelets is a predictor of acute kidney injury in sepsis secondary to COVID-19 in the adult ICU. Material and methods: Prospective, single-center cohort study. In patients over 18 years of age who are admitted to the ICU with a diagnosis of sepsis due to COVID-19, the RNLP will be calculated from day 1 to day 7, it is divided into 2 groups: RNLP greater than 3 and RNLP equal or less than 3, observing the presence or not of acute kidney injury during their stay, and after the outcome, for the main objective a χ2 test is performed, and a multivariate logistic regression test is performed to assess the Association of the different variables with the outcome (OR with 95% CI). Results: A population of 119 patients was studied, there was an incidence of S-AKI of 53.8% (95% CI 44-62%) in patients with sepsis secondary to COIVD-19, the majority being KDIGO I (53.2%). In the RNLP group greater than 3 I had a 68.4% incidence of S-AKI compared to the RNLP group less than or equal to 3 with 28% (p = 0.001, OR 4.255 95% CI 1.72-10.16), the patients with RNLP greater than 3 had a longer stay in the ICU (12 vs 10 days, p = 0.018), and a longer time of mechanical ventilation (11 vs 8 days, p = 0.003). Conclusion: The increase in the neutrophil, lymphocyte and platelet ratio is a risk factor and can be a prognostic for the presence of acute kidney injury in sepsis due to COVID-19 in the ICU.

Resumo: Introdução: A lesão renal aguda é encontrada em 40% dos pacientes com sepse (S-LRA), uma vez que a inflamação é uma das causas fisiopatológicas da lesão renal aguda. Durante a pandemia, a principal causa de sepse na UTI foi secundária à COVID-19, na qual a incidência de lesão renal foi relatada de 36 a 75%. A fisiopatologia dessa complicação ainda não é conhecida, mas mecanismos semelhantes à lesão renal séptica típica foram demonstrados. A proporção de neutrófilos, linfócitos e plaquetas (RNLP) já foi associada à presença de lesão renal aguda em outros âmbitos (cirurgia cardíaca e cirurgia abdominal de grande porte) e em pacientes com sepse secundária à COVID-19 pode ser um marcador que identifica os pacientes em risco de apresentar esta complicação. Objetivo: Determinar se a proporção de neutrófilos, linfócitos e plaquetas é um preditor de lesão renal aguda na sepse secundária à COVID-19 na UTI adulto. Material e métodos: Estudo de coorte prospectivo, unicêntrico. Pacientes maiores de 18 anos admitidos na UTI com diagnóstico de sepse por COVID-19, o RNLP será calculado do dia 1 ao dia 7, dividido em 2 grupos: RNLP maior que 3 e RNLP igual ou inferior a 3, observando a presença ou não de lesão renal aguda durante sua internação, e posteriormente o desfecho, para o objetivo principal, é realizado um teste de χ2, e se realiza um teste de regressão logística multivariável para avaliar a associação das diferentes variáveis com o resultado (OR com 95% IC). Resultados: Estudou-se uma população de 119 pacientes, com incidência de S-LRA de 53.8% (IC 95% 44-62%) em pacientes com sepse secundária a COVID-19, sendo a maioria KDIGO I (53.2%). No grupo RNLP maior que 3, houve uma incidência de 68.4% de S-LRA comparado ao grupo RNLP menor ou igual a 3 com 28% (p = 0.001, OR 4.255, IC 95% 1.782-10.16), os pacientes com RNLP maior que 3 tiveram maior tempo de permanência na UTI (12 vs 10 dias, p = 0.018) e maior tempo em ventilação mecânica (11 vs 8 dias, p = 0.003). Conclusão: O aumento da proporção de neutrófilos, linfócitos e plaquetas é um fator de risco e pode ser prognóstico para a presença de lesão renal aguda na sepse por COVID-19 na UTI.

Terapia de electroestimulación para el tratamiento de la atrofia diafragmática inducida por ventilación mecánica / Electrostimulation therapy for the treatment of diaphragmatic atrophy induced by mechanical ventilation / Terapia de eletroestimulação para o tratamento da atrofia diafragmática induzida por ventilação mecânica

Resumen: Introducción: La atrofia y disfunción del músculo diafragmático es frecuente en pacientes sometidos a ventilación mecánica. La terapia de electroestimulación diafragmática transcutánea (TEDT) ha demostrado mejorar la fuerza en pacientes con debilidad muscular; sin embargo, no ha sido evaluada como tratamiento para la atrofia en la disfunción diafragmática inducida por ventilación mecánica (DDIVM). Objetivo: Determinar si la TEDT puede mejorar el grosor diafragmático de los pacientes que se encuentran bajo ventilación mecánica. Material y métodos: Se realizó un ensayo clínico aleatorizado en dos grupos independientes: un grupo intervención con 15 pacientes y un grupo control con 17 pacientes. El grupo de intervención recibió TEDT con sesiones de 20 minutos cada seis horas en las 72 horas subsecuentes a su inclusión al estudio. El grosor diafragmático basal fue medido mediante ecografía en ambos grupos, después de la TEDT para el grupo intervención y 72 horas después en el grupo control. Resultados: De los 32 pacientes evaluados se documentó una media de grosor diafragmático inicial para el grupo control de 2.04 ± 0.43 mm y de 1.9 ± 0.52 mm para el grupo intervención con un valor de p = 0.652. Posterior a la intervención, se registró una media de grosor diafragmático final de 1.7 ± 0.43 mm para el grupo control y 2.3 ± 0.55 mm para el grupo intervención con un valor de p = 0.002 al comparar ambos grupos. Conclusión: Se encontró diferencia estadísticamente significativa en ambos grupos al aplicar la TEDT, evidenciando un aumento del grosor diafragmático basal en el grupo intervención y disminución del mismo en el grupo control.

Abstract: Introduction: Muscle involvement in critically ill patients is present in the majority of those admitted to the intensive care unit, including alteration of the diaphragmatic muscle, especially during mechanical ventilation (MV). Transcutaneous diaphragmatic electrostimulation therapy (TEDT) has been shown to improve respiratory strength in patients with muscle weakness. However, it has not been evaluated as a treatment for atrophy in Ventilation-Induced Diaphragmatic Dysfunction (DDIVM). Objective: To determine if TEDT can improve diaphragmatic thickness in patients undergoing mechanical ventilation. Material and methods: A randomized clinical trial was carried out in two independent groups: an intervention group with 15 patients and a control group with 17 patients. The intervention group received TEDT with sessions of 20 minutes every 6 hours in the 72 hours after their inclusion in the study. Baseline diaphragm thickness was measured by ultrasound in both groups, after TEDT for the intervention group and 72 hours later in the control group. Results: Of the 32 patients evaluated, a mean initial diaphragmatic thickness was documented for the control group of 2.04 ± 0.43 mm and of 1.9 ± 0.52 mm for the intervention group with a p value of 0.652. After the intervention, a mean final diaphragmatic thickness of 1.7 ± 0.43 mm was recorded for the control group and 2.3 ± 0.55 mm for the intervention group with a p value of 0.002 when comparing both groups. Conclusion: A statistically significant difference was found in both groups when applying TEDT, showing an increase in baseline diaphragmatic thickness in the intervention group and a decrease in it in the control group.

Resumo: Introdução: Atrofia e disfunção do músculo diafragmático é comum em pacientes submetidos à ventilação mecânica. A terapia de estimulação elétrica diafragmática transcutânea (TEDT) demonstrou melhorar a força em pacientes com debilidade muscular, mas não foi avaliada como tratamento para atrofia na disfunção diafragmática induzida pela ventilação (DDIVM). Objetivo: Determinar se a TEDT pode melhorar a espessura diafragmática de pacientes com ventilação mecânica. Material e métodos: Realizou-se um ensaio clínico randomizado em 2 grupos independentes: um grupo intervenção com 15 pacientes e um grupo controle com 17 pacientes. O grupo intervenção recebeu TEDT com sessões de 20 minutos a cada 6 horas por 72 horas após a inclusão no estudo. A espessura diafragmática basal foi medida por ultra-som em ambos os grupos, após TEDT para o grupo de intervenção e 72 horas depois no grupo controle. Resultados: Dos 32 pacientes avaliados, (17 grupo controle, 15 grupo intervenção). Documentou-se uma média da espessura diafragmática basal para o grupo controle de 2.04 ± 0.43 mm e 1.9 ± 0.52 mm para o grupo intervenção com um valor de p = 0.652. Após a intervenção, foi registrada uma espessura média final do diafragma de 1.7 ± 0.43 mm para o grupo controle e 2.3 ± 0.55 mm para o grupo intervenção, com valor de p = 0.002 na comparação entre os dois grupos. Conclusão: Encontrou-se diferença estatisticamente significativa em ambos os grupos na aplicação do TEDT, mostrando aumento da espessura basal do diafragma no grupo intervenção e diminuição da mesma no grupo controle.

Determinación niveles de glucosa por medio de espectroscopía como método no invasivo / Determination of glucose levels by means of spectroscopy as a non-invasive method

Introducción: la diabetes mellitus es uno de los problemas más graves de salud pública que enfrenta México. El factor más preocupante es la falta de control de la misma, lo que incide de manera directa, causando daños severos a la salud y la calidad de vida del paciente y familiares, así como una carga económica al país. Por lo tanto, el desarrollo de un método no invasivo para la medición de la glucemia proporcionaría a los pacientes una forma sencilla e indolora de monitoreo y, en consecuencia, un mejor control de la diabetes. Objetivo: investigar, desarrollar y validar un sensor no invasivo por medio de la espectroscopía para la estimación del nivel de glucosa en sangre. Material y métodos: se realizó un análisis de estudio transversal analítico de correlación realizado en las instalaciones del laboratorio de la UMAE No 1, Bajío. Se incluyeron pacientes adultos voluntarios que acudieron al laboratorio de dicha unidad para la toma de niveles de glucosa sérica y de manera simultánea se realizó la medición a través de método no invasivo por espectroscopía y, posteriormente, se compararon ambos resultados para demostrar la validez del dispositivo. Resultados: mediante el análisis de la diferencia de medias de Bland-Altman, se identificó que solamente un paciente tuvo un valor extremo, y que el método para medir la glucosa de manera no invasiva sobreestima hasta un 10.2% del valor de glucosa central. Conclusión: comparando dichos resultados con las normas para glucómetros digitales se concluye que nuestro dispositivo es capaz de proporcionar niveles de glucosa certeros.

Background: Diabetes mellitus is one of the most serious public health problems in Mexico. The most worrying factor is the lack of control of it, which has a direct impact, causing severe damage to the health and quality of life of the patient and its family, as well as an economic burden to the health system. Therefore, the development of a non-invasive method for measuring blood glucose would provide to patients a simple and painless way of monitoring and consequently better control of diabetes. Objective: Research, development and validation of a non-invasive sensor by means of spectroscopy for the estimation of the blood glucose level. Material and methods: An analysis of a cross-sectional analytical correlation study was carried out in the facilities of the laboratory at the UMAE No. 1, Bajío. Voluntary adult patients who attended the laboratory of the UMAE to take serum glucose levels were included, and simultaneously the measurement was carried out through a non-invasive method by spectroscopy and, later, both results were compared to demonstrate the validity of the device. Results: By the Bland-Altman mean difference analysis, it was identified that only one patient had an extreme value, and that the method to measure glucose non-invasively overestimates up to 10.2% of the central glucose value. Conclusion: Comparing these results with the standards for digital glucometers, it is concluded that our device is capable of providing accurate glucose levels.

Resultados del cálculo de la lente intraocular con la fórmula Holladay 2 en pacientes con catarata / Results of intraocular lens calculation with the Holladay 2 formula in cataract patients

RESUMEN Objetivo: Determinar los resultados refractivos en pacientes operados de catarata, según el cálculo del poder dióptrico de la lente intraocular con la fórmula Holladay 2. Métodos: Se realizó un estudio descriptivo prospectivo y longitudinal en 222 ojos de 173 pacientes operados de catarata mediante la técnica de facoemulsificación. Se empleó para el cálculo de la lente el IOL Master 700 y la fórmula Holladay 2. Resultados: Predominó el sexo femenino y el grupo etario mayor de 60 años. En el posoperatorio se observó una mejoría en la agudeza visual sin corrección y corregida de más de 4 líneas en la cartilla de Snellen, independiente de la longitud axial, sin cambios significativos en el cilindro queratométrico. En 69,0 por ciento de los casos el resultado refractivo final estuvo en el rango de la emetropía. Los ojos mayores de 26 mm presentaron una disminución del equivalente esférico superior a 6 dioptrías en el posoperatorio; los menores de 22 mm mostraron la mayor diferencia entre el poder dióptrico de la lente intraocular que se implantó y el que sugiere la fórmula convencional. Conclusiones: La fórmula Holladay 2 resulta útil para el cálculo de la lente intraocular en todos los rangos de longitud axial(AU)

ABSTRACT Objective: Determine refractive results in patients undergoing cataract surgery based on intraocular lens dioptric power calculation with the Holladay 2 formula. Methods: A prospective longitudinal descriptive study was conducted of 222 eyes of 173 patients undergoing cataract surgery by phacoemulsification technique. IOL Master 700 and the Holladay 2 formula were used for lens calculation. Results: There was a predominance of the female sex and the over-60 years age group. The postoperative period was characterized by improvement in visual acuity without correction and corrected of more than 4 lines on the Snellen chart, regardless of axial length, with no significant changes in the keratometric cylinder. In 69.0 percent of the cases, the final refractive result was within the range of emmetropia. Eyes larger than 26 mm displayed a spherical equivalent reduction above 6 diopters postoperative, whereas eyes smaller than 22 mm showed the greatest difference between the dioptric power of the intraocular lens implanted and the one suggested by the conventional formula. Conclusion: The Holladay 2 formula is useful for intraocular lens calculation in all axial length ranges(AU)

Comparación entre la técnica de malla cupular elíptica (MCE) con la técnica de Lichtenstein para disminuir el dolor postquirúrgico en plastía inguinal abierta: Resultados preliminares / Comparison of a dome-shaped elyptical mesh (DSEM) technique with the Lichtenstein technique to diminish post-surgical pain in open hernioplasty: Preliminary results

Objetivo: Comparar la técnica de Lichtenstein con la técnica de la malla cupular elíptica (MCE) en cuanto a dolor postoperatorio. Sede: Unidad Médica de Atención Ambulatoria número 55 del Instituto Mexicano del Seguro Social. León, Gto. Diseño: Ensayo clínico controlado, aleatorizado, doble ciego. Análisis estadístico: Chi cuadrada, prueba Logrank-KaplanMeier, análisis de varianza de medidas repetidas con factor agrupante, análisis de riesgo de Cox. Material y métodos: Aleatorizamos 90 pacientes con hernia inguinal en dos grupos: MCE y Lichtenstein. Seguimiento a la semana, uno, tres y seis meses. Variables estudiadas: intensidad del dolor por escala visual análoga, frecuencia de dolor, consumo de analgésicos, tipo de disestesias, complicaciones y recidiva a seis meses. Resultados: Grupos comparables en características generales. Encontramos proporción menor de pacientes con dolor en grupo MCE (X2 = 7.28, p = 0.007). MCE mostró menor intensidad del dolor con (F = 22.37, p = 0.000003). No hubo diferencias en tiempo quirúrgico, consumo de analgésicos o frecuencia de disestesias a excepción de la primera semana. La técnica quirúrgica demostró ser determinante para dolor en análisis de riesgo (p = 0.009). Se presentó una recidiva en grupo MCE. Conclusiones: MCE es una técnica quirúrgica, igual de efectiva y segura que la técnica Lichtenstein y produce menor dolor postoperatorio.

Las cardiopatías congénitas asociadas a ductus persistente pueden tratarse con stent: presentación de tres casos y revisión de la literatura / Congenital heart defects associated with persistent ductus and stent treatment: case report and literature review

Presentación de tres casos de cardiopatías asociadas al ductus persistente, donde la colocación de stentfue una alternativa de tratamiento, como paso previo a la corrección quirúrgica.

Improvement of diastolic function after regression of left ventricular hypertrophy / Mejora de la función diastólica tras regresión de la hipertrofia ventricular izquierda

OBJECTIVE: To evaluate the diastolic function after regression of left ventricular hypertrophy, in mild to moderate hypertension treated with angiotensin converting enzyme(ACE) inhibitor and, if necessary, with a diuretic. METHODS: Ninety-eight hypertensive patients with left ventricular hypertrophy (LVH) and abnormal left ventricle diastolic function indexes received captopril (Capotena) 50 to 200 mg/day plus chlortalidone during 12 months to reach blood pressure control, defined as a diastolic blood pressure < or =90 and systolic blood pressure < or =140 mm Hg. Left ventricular (LV) mass index was calculated by M mode and two-dimensional echocardiography, and left ventricular diastolic function was assessed by transmitral pulsed Doppler ultrasound every 3 months. RESULTS: Sixty-three patients were women and 35 were men, mean age was 53.4 +/- 8.4 years (range 34-70). Thirty-six patients had mild (36.7%) and 62 (63.3%) moderate hypertension. Treatment reduced significantly both systolic pressure from 165 +/- 13 to 137 +/- 12.9 mm Hg (p<0.05) and diastolic pressure from 99 +/- 8.6 to 86 +/- 6.37 mm Hg (p<0.05). LV mass index decreased from 155.4 +/- 32.9 to 121.7 +/- 29.14 g/m2 (p<0.05). Late diastolic filling velocity (A wave) and the ratio of E/A waves improved (p<0.05), but early diastolic filling velocity (E wave) and isovolumetric relaxation time did not change with treatment. CONCLUSIONS: Some indexes of diastolic function improved after regression of left ventricular hypertrophy and good blood pressure control with captopril and chlortalidone.

La cirugía de revascularización per toracotomía izquierda sin circulación extracorpórea, es una alternativa viable en la re-operación de puentes coronaries / Revascularization surgery through left off-pump thoracotomy is a viable alternative for coronary bypass re-operation

Despite substantial advances in treatment, coronary atherosclerosis is a progressive disease, for this reason a second surgery is frequent. The left anterior small thoracotomy operation on a beating heart is an alternative with less morbidity and mortality than the conventional surgery. CASES REPORT: We report two cases of coronary surgery with limited access. The first corresponds to a 72-year-old man with diabetes, hypertension, dyslipidemia, obesity, with myocardial damage and bypass surgery to anterior descendent coronary artery and first diagonal coronary artery with saphenous vein graft performed 13 years ago. Due to unstable angina and positive test for myocardial ischemia, we performed bypass surgery of minimal access to the anterior descendent coronary artery and obtuse marginal coronary artery. The second case corresponds to a man with hypertension, diabetes, obesity, previous bypass surgery of two vessels performed 4 years ago, complicated with perioperative inferior myocardial infarction. Due to unstable angina and positive test for myocardial viability, we performed a re-do coronary artery bypass graft surgery to the left anterior descending artery and first diagonal coronary arteries through a minimal access incision. In both the clinical evolution was satisfactory, they were discharged 7 days after surgery and remain asymptomatic at one year of follow-up. CONCLUSION: The antero-lateral thoracotomy off-pump coronary bypass surgery is an alternative indicated in high risk patient with coronary revascularization.

Factores relacionados con hemorragia mayor durante la cirugía cardíaca bajo circulación extracorpórea / Factors associated to heavy bleeding during heart surgery with cardiopulmonary bypass

OBJECTIVE: To evaluate the risk factors related to bleeding in patients subjected to cardiac surgery using an extracorporeal circulation pump. MATERIAL AND METHODS: A study of cases and controls was designed performed in adults, matched by age and gender with indication of elective cardiac surgery using an extracorporeal circulation pump. Those patients with hepatic failure or blood coagulation disorders were excluded. Results were analyzed by Student t test, chi-square, and logistic regression analysis, considering p values significant at <0.05. RESULTS: The patients with functional class III or IV of the CCS presented more bleeding (p = 0.006), although there were no differences when comparing the ejection fraction in both. Obesity, dyslipidemia, and arterial hypertension were identified as risk factors. The coronary artery bypass graft, multivessels bypass surgery, and prolonged surgical times are associated to the complication (p < 0.05). According to the discriminant function analysis, the cardiopulmonary derivation time, weight, aortic clamp time, and heparin doses are the factors that better discriminate the possibility of hemorrhage. CONCLUSIONS: Heavy bleeding is related to ischemic patients, longer cardiac surgery time, overweight, and heparin doses during surgery.

Estenosis aórtica pura y resonancia magnética en el adulto / Pure aortic stenosis and magnetic resonance in adult patients

OBJECTIVE: To evaluate the utility of the cardiovascular magnetic resonance imaging (cMRI) for quantify the aortic area in adult patients with pure aortic stenosis (AS). METHOD: Comparative cross-sectional study, blinded, in patients with AS, without another valvular pathology associated. A transthoracic echocardiogram (TTE) and cMRI were performed, in all of them. Results were analyzed by Student t test and ji-square, considering significant values p < 0.05. Bayesian analysis and ROC curve, for the determination of the disease severity. RESULTS: No were significant differences with respect to quantification of the speed of transvalvular flow between both methods (TTE 4.593 +/- 0.9114 m/s vs. cMRI 4.233 +/- 0.6894 m/s, p = 0.080), nor the ejection fraction (TTE 54.27 +/-16.451 vs. cMRI 48.40 +/-17.332, p = 0.760). The cMRI seems to underestimate the maximum and medium gradients compared with the TTE, in 12.53 mm Hg and 10.07 mm Hg respectively. The sensitivity for the diagnosis of severe aortic stenosis is 90% with specificity 80%. CONCLUSIONS: The cMRI is a useful diagnostic method for the evaluation of patients with pure aortic valve stenosis, as good as TTE. cMRI can to be a diagnostic alternative in cases with limitations to TTE.

Cardiopatía isquémica en mujeres mexicanas / Coronary artery disease in Mexican women

OBJECTIVE: To identify differences between both genders regarding coronary artery disease occurrence. PATIENTS AND METHODS: In referred patients for cardiac catheterization we investigated coronary risk factors, clinical diagnosis, associated diseases, left ventricle ejection fraction, and coronary lesions. Data were analyzed by X2 test, Student t test, odds ratio and confidence intervals, a p value < 0.05 was considered significant. RESULTS: We studied 586 patients, 409 were men. Women were older than men (59.43 +/- 9.93 vs 56.80 +/- 10.14 years old, p < 0.05). The frequency of coronary lesions in women was 56 vs 81% in men. The proportions of positive nuclear medicine studies (14 vs 16%) and exercise treadmill test (36 vs 28%) were similar. Acute myocardial infarction was the most frequent diagnosis in men (46%) whereas in women it was angor pectoris (57%). Smoking was observed more in men (72 vs 26%) and systemic arterial hypertension in women (65 vs 48%), There were no differences in diabetes mellitus and dyslipidemia frequencies. CONCLUSION: Systemic arterial hypertension was the risk factor more frequent in women, where as in men it was smoking. Ischemia induction tests are less specific to identify coronary atherosclerosis in women. In spite of the clinical data, image and laboratory results, we had a great proportion of women without coronary lesions.

Pentalogía de Cantrell. A propósito de un caso / Pentalogy of Cantrell. A case report

Ectopia cordis is an extremely rare cardiac anomaly. The heart is localized partially or totally outside the thorax cavity. This anomaly occurs as an isolated defect or combined with others midline defects. Cantrell and colleagues described, in 1958, a syndrome including defects of the abdominal wall, sternum, diaphragm, pericardium and heart. There are few successful surgical cases with this pentalogy. We describe a case with this Cantrell's pentalogy. The cardiac malformation was a univentricular heart with pulmonary stenosis. The patient underwent successful surgical palliation with a systemic-to-pulmonary anastomosis and uneventful recovering.

Valvuloplastía pulmonar con balón, experiencia de 15 años en el Centro Médico Nacional Siglo XXI IMSS / Balloon pulmonary valvuloplasty: 15-years experience at the Centro Médico Nacional "Siglo XXI", IMSS

Objetivo: Evaluar la experiencia de 15 años, de la valvuloplastía pulmonar con balón en el Centro Médico Nacional Siglo XXI. Material y métodos: Se estudiaron 150 pacientes 73 (48.7%) masculino y 77 (51.7%) femenino. La edad promedio de los 141 en quienes se realizó la valvuloplastía pulmonar con balón fue de 10.5 ± 11.3 años. Resultados: El gradiente promedio prevalvuloplastía de 86 ± 35 descendió a 21.67 ± 12.20 mm Hg p < .001. La presión sistólica del ventrículo derecho de 106 ± 34.8 mm Hg disminuyó a 53 ± 27 mm Hg p < 0.0001. El gradiente valvular pulmonar en el seguimiento promedio de 48 ± 44 meses fue de 13.43 ± 8.73 mm Hg p < 0.001. Se presentaron complicaciones en 9 (6%) pacientes. Se obtuvo éxito técnico inmediato post en 111 (74%) y fracaso inmediato en 39 (26%). Al final del seguimiento se obtuvo éxito en 104 (89.6%) y fracaso en 12 (10.4%) pacientes, p < 0.0001, con una mortalidad global de 2 (1.33 %) pacientes. Las variables significativas para fracaso fueron: la edad de, 1.5 ± 1.33 años para falla de procedimiento, p < .004; morfología valvular displásica p < 0.001. gradiente valvular pulmonar prevalvuloplastía elevado con p < 0.002 y presión sistólica del ventrículo derecho pre valvuloplastía elevados. p < 0.0001, no descendiendo ambos en el post inmediato. Conclusión: La valvuloplastía pulmonar con balón es el tratamiento de elección, efectivo y seguro de la estenosis valvular pulmonar congénita.

Objective: To evaluate 15 years of experience with balloon pulmonary valvuloplasty in a single third level health care center. Material and methods: Hundred-fifty patients underwent the procedure, 73 (48%) men and 77 (52%) women, mean age 10.5 ± 11.3 years. Results: The initial systolic gradient decreased from 86 ± 35 to 21.67 ± 12.20 mm Hg, p < 0.001, whereas the initial right ventricular systolic pressure decreased from 106 ± 34-8 to 53 ± 27 mm Hg, p < 0.0001. At the end of the follow-up, 48 ± 44 months, the systolic gradient was 13.43 ± 8.73 mm Hg, p < 0.001. Major complications occurred in 9 (6.4%) patients. Immediate technical success was achieved in 111 (74%) patients and failure in 39 (26%). At the end of the follow-up period, successful outcomes were achieved in 104 (89.6%); in contrast, failures were present in 12 (10.4%) patients, p < 0.001. Death occurred in 2 (1.33%) patients. The predictors for failure were age < 1.5 ± 1-33 years (p < 0.004), dysplastic valve (p < 0.001), high initial systolic gradient (p < 0.002), and high initial systolic right ventricular pressure (p < 0.0001). Conclusion: Balloon pulmonary valvuloplasty is an effective, safe, and first choice treatment for congenital pulmonary valve stenosis. (Arch Cardiol Mex 2003; 73:190-196).

Stent y redilatación con globo del conducto arterioso en ventrÝculo único con atresia pulmonar. Descripción de un caso / Stenting and redilatation of the ductus arteriosus in univentricular heart with pulmonary atresia. A case report

Complex congenital heart disease with pulmonary atresia is ductus arteriosus-dependent. Two palliative treatments have been available for years: a systemic pulmonary shunt and prostaglandin E1 infusion. Recently, interventional cardiology has offered a new procedure for these patients: stenting of the patent arterial duct. We report a case with univentricular heart and pulmonary atresia in which percutaneous balloon angioplasty and stenting of the arterial ductus were performed successfully. Nineteen months later the patient is in good clinical conditions with 75 of oxygen saturation.