[Mechanical mitral valve prosthesis dysfunction in pregnant women. Report of 2 cases]. / Disfunción de prótesis mitral mecánica en embarazadas. Informe de dos casos.

We present two cases of pregnant women associated with mechanical mitral valve prostheses dysfunction, treated between October 1998 and September 2000, in congestive heart failure, functional class III, without fetal distress. Emergency surgery consisted in cesarean procedure immediately followed for mitral prostheses removal and implantation of new mechanical heart valve prostheses was realized in both patients. In each case a single live infant was obtained with good Apgar evaluation. Both patients had successful surgical procedures. In both patients were found thrombi in the mechanical heart valves. Actually patients and their children have good evolution, without any problem.

[Myxoma of the left auricle and ischemic cardiopathy. Report of a case]. / Mixoma de aurícula izquierda y cardiopatía isquémica. Informe de un caso.

Myxoma is most frequent tumor of the heart, and usually appears isolated. This case involves a 64-year-old female with left atrial myxoma and associated ischemic heart disease. The patient was surgically treated with excision of the myxoma and coronary artery bypass grafting with internal mammary artery to left anterior descending artery. There were no perioperative complications, and the patient is asymptomatic at present. In conclusion, when there exists evidence of associated pathology to a cardiac myxoma, the case must be integrally evaluated in order to effect a complete treatment.

Effect on acute rejection reaction and survival of the heart with the addition of dextran 60 to conventional immunosuppressive therapy in an experimental model of heterotopic heart transplantation.

BACKGROUND: Rejection reaction is an important complication in heart transplantation. Recent physiopathological findings suggest new immunosuppressive alternatives such as the use of substances that block interaction between leukocytes and endothelium or subsequent events. The objective of this work was to evaluate the effect of the combination of dextran 60 and conventional immunosuppressive therapy. METHODS: We used Sprague-Dawley rats, both sexes, with mean weight of 317.3 +/- 31.3 g on which we carried out heterotopic heart transplantation and then randomized into four groups. All groups received cyclosporine (2 mg/kg/day) and prednisone (0.5 mg/day). Group I (n = 5) also received 0.5 cc/kg/day of dextran 60, group II (n = 5) 1.0 cc/kg/day of dextran 60, group III (n = 5) 2 cc/kg/day, and group IV (n = 4) 0.9% saline solution 0.5 cc/kg/day. The incidence and severity of rejection reaction was evaluated as survival of transplanted hearts. RESULTS: Significant differences were found between groups III and IV for incidence of rejection reaction (p = 0.039). However, there were no differences among groups (grade 3A or 3B) in the magnitude of the rejection reaction. Survival of hearts was better in all groups receiving dextran 60 (p = 0.031). CONCLUSION: It was concluded that dextran 60 improves survival of transplanted hearts and decreases incidence of rejection reaction.

[De novo neoplasms in transplant patients]. / Neoplasias de novo en pacientes trasplantados.

To identify the number of patients with de novo tumors in organ transplant recipients, we collected the information from eleven hospitals of the Instituto Mexicano del Seguro Social with organ transplant programs. During a period of 9 years, we found only five cases of neoplasia. The median age was 26 years. All tumor occurred in renal transplant recipients. All patients received cyclosporine, azathioprine and steroids. One breast tumor, one renal carcinoma, two Kaposi's sarcoma and one angioleiomyosarcoma were found. The frequency of tumors in these patients is lower than reported by other authors, probably due, in our series to the fact that the patients were younger and the existence of a recently created transplant program with a short period of follow-up.

[Thrombosis of mechanical heart valve prosthesis. Predisposing factors and results of surgical treatment]. / Trombosis de las prótesis valvulares cardíacas mecánicas. Factores predisponentes y resultados del tratamiento quirúrgico.

Heart valve thrombosis is a serious complication. From February, 1995 to January, 1996, 19 patients were studied to identify predisposing factors and results of surgical management. Mean age was 47.3 years. Thirteen patients (73.6%) had an irregular surveillance of anticoagulation therapy. Fifteen patients showed low anticoagulation effect during their evolution. Sixteen patients were in functional class III and 80% (15 patients) showed imaging of thrombus in the echocardiographic study. All patients presented thrombus on both sides of the prothesis. There were no deaths, and 15 patients returned to functional class I. It was concluded that the main predisposing factor in this series of patients was deficient anticoagulation therapy, and surgical results are comparable to those other authors.

[Tutorial training in cardiology and cardiothoracic surgery. Preliminary report]. / Enseñanza tutelar en cardiología y cirugía cardiotorácica. Informe preliminar.

INTRODUCTION AND OBJECTIVES: Personal contact has been lost in medical training due to the increase in numbers of medical students but not of teachers. This fact has impaired training in medical specialties. This is the reason that the Hospital for Cardiology has developed a program of tutelary training. In this paper we present our initial evaluation of this program. METHODS: The inclusive criteria for tutors and students have been defined as have the procedures to develop the program. After three months, 20 residents involved in the tutelary training program were randomly analyzed. Academic activities, clinical practice, research activities and extra-academic activities were evaluated. RESULTS: Currently there are 14 tutors. 50% of residents have developed research projects, 60% has increased academic activities, 50% has improved clinical practice and 65% has defined their postgraduate research projects. CONCLUSIONS: It was concluded that tutelary training in Cardiology and Cardiothoracic Surgery is a useful alternative to improve quality of graduates in these specialties.

[Observer variation in diagnostic procedures related to cardiothoracic surgery]. / Variabilidad de observador en procedimientos diagnósticos afines a la cirugía cardiotorácica.

The results reliability is a predominant condition in the validity of clinical research. The observer agreement determination is a useful procedure in the confirmation of the obtained results in clinical research. The present work is a presentation of the basis about observer agreement and a review of national publications in cardiology, pneumology and cardiothoracic surgery between january 1980 and july 1993, where we found just two publications with the application of observer agreement determination in echocardiography, electrocardiography, microscopy and hemodynamics. It was concluded that is necessary the increase in determination of observer agreement and inform this results in our publications, excluding the variability attributed to patients, diagnostics equipment or the circumstances.