Swirling Due to Misaligned Perception-Dependent Motility.

A system of particles with motility variable in terms of a vision-type of perception is investigated by a combination of Langevin dynamics simulations in two-dimensional systems and an analytical approach based on conservation law principles. Persistent swirling with predetermined direction is here induced by differentiating the self-propulsion direction and the perception cone axis. Clusters can have a fluidlike center with a rotating outer layer or display a solidlike rotation driven by the outer layer activity. Discontinuous motility with misaligned perception might therefore serve as a powerful self-organization strategy in microrobots.

Factor de crecimiento análogo a insulina-1 y cardiotrofina-1 inducido por ejercicio y su relación con hipertrofia miocárdica en maratonistas / Cardiotrophin-1 and Insulin like growth factor induced by exercise are associated to cardiac hypertrophy in marathon runners

Antecedentes: El ejercicio de alta intensidad induce hipertrofia miocárdica necesaria para adaptar al corazón a la mayor demanda de trabajo. Se desconoce si correr una maratón induce de forma aguda factores humorales asociados al desarrollo de hipertrofia miocárdica en atletas. Objetivo: Evaluar cardiotrofina-1 (CT1) y el factor de crecimiento análogo a insulina-1 (IGF-1), conocidos inductores de hipertrofia, en maratonistas previo y justo después de correr una maratón y su relación con hipertrofia cardíaca. Métodos: Estudio prospectivo ciego simple de atletas hombres que corrieron la maratón de Santiago. Se incluyó un grupo control sedentario. En todos los sujetos se realizó un ecocardiograma transtorácico estándar. Los niveles de CT1 e IGF-1 se determinaron en plasma obtenidos antes (basal) y justo después de haber terminado (antes de 15 minutos) la maratón, usando test de ELISA. Resultados: Los atletas tenían frecuencias cardíacas menores que los controles, asociado con una mayor hipertrofia miocárdica, determinado por el grosor del septo y pared posterior del corazón, y volúmenes del ventrículo y aurícula izquierda. Los niveles basales de CT1 e IGF-1 fueron similares entre atletas y controles sedentarios. El correr la maratón aumentó los niveles de estas dos hormonas en un subgrupo de atletas. Solo los atletas que incrementaron los niveles de IGF-1, pero no de CT1, tenían volúmenes de ventrículo izquierdo y derecho más grandes que los otros atletas. Conclusiones: IGF-1 que se incrementa de forma aguda por el ejercicio, pero no CT1, estaría asociado con el aumento de los volúmenes ventriculares observado en los atletas.

Background: High intensity exercise induces the development of myocardial hypertrophy necessary to adapt the heart to the increased work demand. Whether running a marathon is associated with acutely induced humoral factors responsible for the development of myocardial hypertrophy observed in athletes is not known. Objective: To evaluate the levels of cardiotrophin-1 (CT1) and insulin-like growth factor-1 (IGF-1), known hypertrophy inducers, in marathon runners before and just after running a marathon and their relationship with cardiac hypertrophy. Methodology: Single-blind prospective study of male athletes who ran the Santiago's marathon. A sedentary control group was included. All subjects underwent a standard transthoracic echocardiogram. CT1 and IGF-1 levels were determined in plasma obtained before (basal) and just after finishing (within 15 min) the marathon using ELISA assays. Results: Athletes had lower heart rates than controls, associated with greater myocardial hypertrophy, as determined by thickness of the heart's septum and posterior wall, and left atrial and ventricular volumes. Basal CT1 and IGF-1 levels were similar between athletes and sedentary controls. Marathon running increased the levels of these two hormones in a subgroup of athletes. Only the athletes who increased IGF-1 levels, but not CT1, had larger left and right ventricular volumes. Conclusion: IGF-1 acutely increased by exercise, but not CT1, was associated with the augmented ventricular volumes observed in athletes.

Perceptions of professionals about factors affecting the implementation of early childhood support systems: A case study evaluation from an ecological perspective.

This evaluation research looked at factors affecting collaboration across the various levels of implementation of early childhood support systems. An ecological conceptual framework was used to examine barriers and facilitators to implementing social and health care services from the perspective of the professionals involved at the national, state, and local level of government. A single case study following a qualitative research strategy was conducted with a total of 29 professionals from social development and health ministries, one municipality and a family health center responsible for implementing the Chile Grows with You system. The results show that at the national level, the main factors include socio-political aspects, funding, and the empathy that professional employees hold for peers who are at lower rungs in the hierarchy. At the state level workplace conditions play a key role. For the local level those factors include information system management and the political support of the local government. The discussion section emphasizes the relevance of considering the interdependence of such factors that influence implementation outcomes and the need to move away from a single program evaluation to a multilevel implementation analysis of public policy.

A 45-Year-Old Man With Progressive Dyspnea, Chest Pain, and Hypereosinophilia.

CASE PRESENTATION: A previously healthy 45-year-old man was admitted to our ED with a 3-week history of progressive dyspnea on exertion. He also presented with orthopnea, paroxysmal nocturnal dyspnea, and mild ankle swelling, but he showed no fever, wheezing, coughing, or sputum production. Outpatient laboratory studies, performed 1 week after symptom onset, revealed hypereosinophilia (4.100/µL). He was diagnosed with asthma and prescribed inhaled corticosteroids and low-dose prednisone, but he showed no symptomatic improvement. Over the last 48 h, he experienced rapid progression of dyspnea that made it difficult to speak with accompanying resting, substernal, nonradiating chest pain that became worse on inspiration. He had no allergies and reported no recent travels. Before symptom onset, he had not been taking any medication. He denied eating raw fish or meat and had not been exposed to mildew. His only exposure to animals was from his two indoor cats.

Entrenamiento físico de alta intensidad en maratonistas produce mayor remodelado cardíaco y reduce respuesta de estrés oxidativo / High-intensity training in marathon runners increases cardiac remodeling and diminishes oxidative stress response

Resumen: Introducción: El ejercicio físico reduce la mortalidad cardiovascular y genera remodelado cardíaco. Altas cargas de entrenamiento pueden generar remodelado cardíaco adverso. Biomarcadores (BMC) de inflamación Interleukina 6 (IL-6) y de estrés oxidativo Malondialdehído (MDA), potencialmente pueden caracterizar la respuesta al esfuerzo. Objetivo: Evaluar actividad de IL-6 y MDA en respuesta a una maratón en atletas con distinto nivel de entrenamiento y remodelado cardíaco asociado. Sujetos y Métodos: Estudio prospectivo, simple ciego, incluyó 16 atletas que completaron la maratón de Santiago (42 k), separados según entrenamiento previo, grupo 1 (G1, n: 8): Alto ≥ 100 km/semana y grupo 2 (G2, n: 8): Bajo <100 km/semana). Se obtuvo pre y post maratón: niveles de IL-6, MDA y ecocardiografía Doppler transtorácica (ETT); cuantificando cámaras cardíacas izquierdas, derechas y deformación del ventrículo izquierdo (strain longitudinal). Se utilizaron las pruebas de Mann-Whitney, Wilcoxon y Kruskal-Wallis. Resultados: Edad G1: 38.13±7.18 años vs G2: 40.38±6.63 años (NS). Tiempo maratón G1: 185.75±14.87 min vs G2: 219.75±24.92 min (p<0.01). Masa del ventrículo izquierdo G1: 91±21 g/m2 vs G2: 73±12 g/m2 (p<0.01). Volumen aurícula izquierda G1: 39.4±12.6 ml/m2 vs 30.6±4.6 ml/m2 (p<0.01). FEVI G1: 55.8±3.3% vs G2: 58.6±6.7% (NS). MDA G1: PRE 0.17±0.13 uM/L, POST 0.67±0.59 uM/L, G2: PRE 0.29±0.24 uM/L, POST 1.01±1.15 uM/L (p<0.01). IL-6 G1: PRE 2.50±1.35 pg/ml, POST 93.91±27.23 pg/ml vs G2: PRE 4.65±5.89 pg/ml, POST 97.83±30.72 pg/ml (NS). Conclusión: El ejercicio físico aumenta los BMC de inflamación y estés oxidativo (IL-6, MDA). Un entrenamiento físico de alta intensidad disminuye la respuesta de estrés oxidativo y se asocia a un mayor remodelado cardíaco.

Abstract: Background: Exercise reduces cardiovascular mortality and generates cardiac remodeling. High training loads can induce adverse cardiac remodeling, and its associated cardiac remodeling. Therefore, interleukin 6 (IL 6) and malondialdehyde (MDA), biomarkers of inflammatory response and oxidative stress respectively, may have a role in stratifying this risk. Objective: To assess the activity of IL-6 and MDA in response to a marathon race in athletes with different previous training status. Subjects And Methods: Prospective, single-blind study involving 16 male athletes that finished the Santiago Marathon (42 k), allocated into two groups according to their previous training: Group 1 (G1, n: 8) with high training (≥ 100 km/weekly) and Group 2 (G2, n: 8) with low training (< 100 km/weekly). Before and after the race serum levels of IL-6, MDA and transthoracic Doppler echocardiography for cardiac chamber quantification and left ventricle deformation (longitudinal strain) were measured. Mann-Whitney, Wilcoxon, and Kruskal-Wallis tests were used to assess statistical significance. Results: Age G1: 38.13±7.18 years-old vs G2: 40.38±6.63 years-old (NS). Marathon finishing time G1: 185.75±14.87 min vs G2: 219.75±24.92 min (p<0.01). Left ventricle mass G1: 91±21 g/m2 vs G2: 73±12 g/m2 (p<0.01). Left atrium volume G1: 39.4±12.6 ml/m2 vs 30.6±4.6 ml/m2 (p<0.01). LVEF G1: 55.8±3.3% vs G2: 58.6±6.7% (NS). MDA G1: PRE 0.17±0.13 uM/L, POST 0.67±0.59 uM/L, G2: PRE 0.29±0.24 uM/L, POST 1.01±1.15 uM/L (p<0.01). IL-6 G1: PRE 2.50±1.35 pg/ml, POST 93.91±27.23 vs G2: PRE 4.65±5.89 pg/ml, POST 97.83±30.72 pg/ml (NS). Conclusion: Physical exercise generates a rise in biomarkers (IL-6, MDA). Athletes with high-intensity training level have a diminished oxidative stress response post effort and greater cardiac remodeling.

Increased active phase atrial contraction is related to marathon runner performance.

PURPOSE: Left atrial (LA) contraction is essential for left ventricular (LV) filling during exertion. We sought to evaluate the relationship of LA contraction and exercise capacity in trained athletes. METHODS: Sixteen male marathon runners were recruited and allocated into two groups according to their previous training status (≥ or < 100 km peer week). All subjects underwent a baseline cardiopulmonary test to evaluate maximal aerobic capacity and a transthoracic echocardiography previous and immediate post-marathon. LA contractile function evaluation was accomplished by measuring the negative deformation of the post P wave strain curve (LASa). LASa change was defined as LASa pre-marathon minus LASa immediate post-marathon. RESULTS: Mean age was 39 ± 6 years. LA volume index (39 ± 13 vs. 31 ± 5 mL/m2, p = 0.04), LV mass index (91 ± 21 vs. 73 ± 12 g/m2, p = 0.04), VO2 max (59 ± 3 vs. 50 ± 8 mL/kg/min, p = 0.036) were higher in more intensive trained group and marathon time was lower (185 ± 14 vs. 219 ± 24 min, p = 0.017). An increase in LASa after immediate post-marathon was observed in both groups, which was significantly greater in the highly trained group (18.9 ± 5.8 vs. 6.3 ± 3.5%, p < 0.003). Maximum VO2 measured previous to the marathon was inversely related to marathon time and directly correlated to LASa change (rho = 0.744, p = 0.001, rho = 0.546, p = 0.028, respectively). CONCLUSIONS: Athletes with more intensive training load have larger LV mass and LA size. An increase in LA contraction was seen post-marathon, which was significantly greater in the highly trained group. This increase in the LA contraction was related to the maximum VO2 measured previous to the marathon and to performance in a highly demanding test.

Potential adverse cardiac remodelling in highly trained athletes: still unknown clinical significance.

Moderate endurance exercise has long been considered an essential element to maintain cardiovascular health, and sedentary behaviour in the general population has been related to a significant increase in all-causes of mortality, cardiovascular disease mortality and cardiovascular disease incidence. However, a growing group of people performs an intense exercise that leads to multiple heart adaptive changes that are collectively called "athlete's heart". In this review, we discussed the evidence of cardiac remodelling process secondary to repetitive and strenuous exercise in some predisposed athletes that produces intense and probably deleterious changes in cardiac morphology and function with no clear clinical significance in long-term follow-up. Moreover, we also discussed the individual biological response to exercise assessed by myocardial damage, inflammation, oxidative stress, fibrosis and ventricular hypertrophy biomarkers showing different intensities with equivalent exertion.

"Gigantic" biatrial myxoma with right heart functional impairment.

Cardiac myxomas are frequently located in the left or right atria, with multiple locations being rare. We report a 59-year-old healthy female with 5 months of cough and exertional dyspnea. A transthoracic echocardiography (TTE) exhibits a 9 × 5 cm nonpedunculated tumor arising from the interatrial septum (IAS) and inhabiting both atria, but was unable to depict the relation with the IAS. Transesophageal echocardiography exposes a single tumor crossing the IAS through an ostium secundum atrial septal defect (ASD) causing right heart functional impairment. Uneventful cardiac surgery allowed complete resection of the lesion and ASD closure. Pathology reported a myxoma.

Aporte de la ecocardiografía tridimensional en el diagnóstico y manejo de la endocarditis infecciosa: experiencia clínica / Added value of three-dimensional echocardiography in the diagnosis and management of infective endocarditis: clinical experience

Resumen: El diagnóstico ecocardiográfico (eco) de la endocarditis infecciosa ha tenido una evolución vertiginosa, destacando el desarrollo de la ecocardiografía transesofágica (ETE), la imagen armónica y la ecocardiografía tridimensional (Eco 3D), tecnologías que han incrementado su capacidad diagnóstica. Presentamos una serie de endocarditis donde el Eco 3D tuvo un rol importante. CASO 1: Hombre de 18 años, antecedente remoto de artritis séptica y deterioro de capacidad funcional asociado a soplo de insuficiencia mitral. La ecocardiografía transtorácica (ETT) objetivó leve dilatación ventricular izquierda e insuficiencia mitral severa, el Eco 3D identificó una perforación circular en el velo anterior mitral, logrando la reparación valvular con un parche de pericardio. CASO 2. Hombre de 29 años, con absceso dental reciente, se presenta en shock séptico, el ETT y ETE mostraron una válvula aórtica bicúspide (VAB) con insuficiencia severa y un absceso del velo anterior mitral. El Eco 3D identificó una perforación del velo no rafial, se realizó un doble recambio valvular. CASO 3: Hombre de 61 años, con antecedente previo de endocarditis y VAB. Consulta por estado infeccioso. El ETT y ETE informaron insuficiencia aórtica moderada asociado a insuficiencia mitral severa, el eco 3D identificó prolapso del segmento P3 de la válvula mitral, ayudando a programar su reparación. CASO 4. Mujer de 78 años, con diagnóstico de endocarditis mitral protésica, el Eco 3D objetivó un absceso periprotésico posterior de 16 mm, siendo referida a cirugía. El Eco 3D aporta información complementaria en diversos escenarios de la endocarditis, tales como: perforaciones valvulares, compromiso perianular, endocarditis protésica, optimizando su manejo.

Abstracts: The echocardiographic diagnosis of infective endocarditis has evolved in a vertiginous manner. Among its main hallmarks are; the development of transesophageal echocardiography (TEE), harmonics imaging and three-dimensional echocardiography (3D Echo), thereby enhancing its diagnosis capability. The following endocarditis cases revealed the usefulness of 3D Echo. CASE 1. 18 year-old male, past history of septic arthritis, refers decline in functional capacity associated with a mitral regurgitation murmur. Transthoracic echocardiography (TTE) pictured a mildly dilated left ventricle and severe mitral regurgitation. 3D Echo identified a circular perforation of the anterior mitral leaflet; successful mitral valve repair was accomplished. CASE 2. 29 year-old male, with recent dental abscess, presents in septic shock. TTE and TEE portrayed a bicuspid aortic valve (BAV) with severe regurgitation along with an abscess of the anterior mitral valve leaflet. 3D Echo showed a perforation of the nonfused aortic leaflet; double valve replacement was uneventfully performed. CASE 3. 61 year-old male, with remote history of endocarditis and BAV, evaluated with TTE and TEE due to sepsis, depicting moderate aortic regurgitation and P3 prolapse with rupture chordae and severe mitral regurgitation. Based on the 3D Echo data the mitral valve was repaired and the aortic valve replaced. CASE 4. 78 year-old woman with prosthetic mitral valve endocarditis, 3D Echo allowed complete visualization of a 16 mm diameter posterior abscess, being referred to surgery. Thus, 3D Echo has added value in several endocarditis scenarios such as; leaflet perforations, periannular involvement, prosthetic valve endocarditis, improving its management.

Hipertrofia ventricular izquierda con patrón de strain característico / Left ventricular hypertrophy with a characteristic strain pattern

Abstracts: A 68 year-old male, with no past medical history, presented progressive shortness of breath on exertion and leg edema during the previous year. Trans-thoracic echocardiography depicted; severe left ventricular hypertrophy with mild systolic dysfunction (LVEF 50% biplane Simpson's method), severe diastolic dysfunction and moderate left atrial enlargement. Left ventricular myocardial deformation imaging by two-dimensional speckle-tracking was paramount for elucidating the differential diagnosis.

Transforming Social Regularities in a Multicomponent Community-Based Intervention: A Case Study of Professionals' Adaptability to Better Support Parents to Meet Their Children's Needs.

This paper presents an in-depth case study of the dynamic processes of mutual adjustment that occurred between two professional teams participating in a multicomponent community-based intervention (CBI). Drawing on the concept of social regularities, we focus on patterns of social interaction within and across the two microsystems involved in delivering the intervention. Two research strategies, narrative analysis and structural network analysis, were used to reveal the social regularities linking the two microsystems. Results document strategies and actions undertaken by the professionals responsible for the intervention to modify intersetting social regularities to deal with a problem situation that arose during the course of one intervention cycle. The results illustrate how key social regularities were modified in order to resolve the problem situation and allow the intervention to continue to function smoothly. We propose that these changes represent a transition to a new state of the ecological intervention system. This transformation appeared to be the result of certain key intervening mechanisms: changing key role relationships, boundary spanning, and synergy. The transformation also appeared to be linked to positive setting-level and individual-level outcomes: confidence of key team members, joint planning, decision-making and intervention activities, and the achievement of desired intervention objectives.

Big thrombus "sitting" in an atrial septal aneurysm.

A 79 year-old-man presented three episodes of upper gastrointestinal bleeding and weight loss. Endoscopy revealed bleeding and extrinsic compression at the pyloric region. Computed tomography scan showed a pancreatic tumor, peritoneal carcinomatosis, vascular infiltration, and incidentally found a partially calcified hypodense lesion of 35 mm in the left atrium, suggesting a myxoma or a thrombus. Echocardiography revealed moderate left atrium enlargement, dilated left atrial appendage with spontaneous echo contrast, moderate dilatation and dysfunction of the left ventricle, ejection fraction was 39%, and an atrial septal aneurysm in which a piriform, mass of 35×33×25 mm, was "sitting," suggesting an organized thrombus.

Acute effect of iloprost inhalation on right atrial function and ventricular dyssynchrony in patients with pulmonary artery hypertension.

BACKGROUND: Right atrium function and ventricular function have significant prognostic value in pulmonary arterial hypertension patients. Acute changes in right ventricular synchrony and right atrium function postiloprost inhalation have not been evaluated. METHODS: Cross-sectional study. Consecutive pulmonary arterial hypertension patients (group I from Nice classification) were included. Echocardiographic right atrium and right ventricular function pre- and postiloprost inhalation, including a right ventricular dyssynchrony index and right atrium function using speckle tracking, were performed in all patients. RESULTS: Twenty pulmonary arterial hypertension patients, 44±7 years and 90% females, were included. After iloprost inhalation, we observed a significant increment in right ventricular fractional area change and a significant decrease in right ventricular dyssynchrony index (21.4±5.6% vs 26.1±4.0 %, P=.007 and 79±44 vs 32±22 mseconds, P<.01, respectively), also an improvement in right atrium reservoir function (8.6±3.1% vs 11.7±3.5 %, P=.002). CONCLUSIONS: Iloprost inhalation induces acute changes in right ventricular function, dyssynchrony, and right atrium performance that may add relevant clinical information in the management and risk stratification of pulmonary arterial hypertension patients.

Factores asociados a bajo gradiente en estenosis aórtica severa con fracción de eyección preservada / Factors associated with low gradient in severe aortic valve stenosis with preserved ejection fraction

Introducción: La estenosis aórtica es frecuente en países desarrollados, cuando es severa (EAS) y sintomática se recomienda reemplazo valvular. Su diagnóstico ecocardiográfico se realiza con cualquiera de; área valvular aórtica (AVA) <1.0 cm², gradiente medio (GM) >40 mmHg, velocidad máxima >4 m/s. Habitualmente existe concordancia entre estos criterios, pero diversas razones generan discordancia hasta en un 40%, principalmente entre área y gradiente (DAG), causando incertidumbre diagnóstica en presencia de fracción de eyección preservada del ventrículo izquierdo (FEp) (FEVI >50%). Objetivos: Caracterizar pacientes con EAS en la red UC. Establecer prevalencia y factores asociados a DAG en pacientes con EAS y FEp. Métodos: Estudio de corte transversal, incluyó todos los pacientes con AVA<1.0 cm2 durante 17.5 años en la red UC. Se registraron variables biodemográficas y eco-cardiográficas. Los pacientes con EAS y FEp se subdivi-dieron en 2 grupos según GM, bajo (<40 mmHg) y alto (>40mmHg), se utilizó t-student y Chi cuadrado. Resultados: 1281 pacientes cumplieron criterio de AVA<1.0 cm2. Edad 71.8±13 años, mujeres 51.4%, hombres el 48.6%. FEVI 68.71 ± 14.62%, FEp 89,2%, Características grupo GM Bajo: Edad 81.66 ± 6.56 años, Mujeres 56.3%, fibrilación auricular (FA) 14.1%. Grupo GM Alto. 68.08 ± 13.21 años, mujeres 47.6%, FA 8%. Presencia de DAG 42.5%. Factores asociados a bajo gradiente con FEp fueron: edad avanzada (>70 años), mujer y fibrilación auricular. Conclusiones: La EAS en nuestro medio se observa en personas mayores con FEp. La presencia de DAG es frecuente y el principal factor asociado en presencia de FEp es la FA.

Introduction: Aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries. Symptomatic severe AS requires surgical intervention, and its echocardiographic criteria encompass: Aortic valve area (AVA) < 1.0 cm2, aortic mean gradient (MG) > 40 mmHg, peak aortic jet velocity > 4 m/s. Usually there is agreement among these criteria, but several reasons can cause up to 40% discordant results, mainly between AVA an MG, casting doubt about severity in the setting of preserved left ventricular ejection fraction (pLVEF). Objectives: Characterize patients with severe AS. Assess prevalence and factors related to AG discordance (AGD) in patients with pLVEF. Methods: Cross-sectional study, that included all patients with an AVA <1.0 cm2 during the last 17.5 years in UC health network. Bio-demographic and echocardiographic variables were registered. Patients with severe AS and pLVEF where allocated in 2 subgroups according to the MG as low (<40 mmHg) and high (>40 mmHg), 2 sides t-student and chi-squared test were performed. Results: 1281 patients fulfill criteria of AVA<1.0 cm2. Age 71.8±13 years, women 51.4%, male 48.6%, LVEF 68.71 ± 14.62%. pLVEF 89.2%. Low MG group: Age 81.66 ± 6.56 y, women 56.3%, atrial fibrillation (AF) 14.1%. High MG group: Age 68.08 ± 13.21 y, women 47.6%, AF 8%. AGD prevalence was 42.5%. Factors related to low MG with pLVEF were; advance age (>70 y), women and AF. Conclusions: Severe AS occurs mainly in advance age patients with pLVEF. AGD is frequent and the foremost related factor is AF.

Insuficiencia aórtica sistólica: un fenómeno singular / Systolic aortic regurgitation: a remarkable event

La insuficiencia aórtica consiste en el reflujo diastólico de sangre desde la aorta hacia el ventrículo izquierdo, sus mecanismos son múltiples y su magnitud queda determinada por: el área del orificio regurgitante, el gradiente diastólico entre la aorta y el ventrículo izquierdo y la duración de la diástole. En contraposición a esto la insuficiencia aórtica sistólica (IAS) es un fenómeno inusual, con escasos reportes y con una fisiopatología particular. Reportamos tres casos clínicos que ilustran los mecanismos de la IAS. CASO 1: Hombre 54 años, consulta por palpitaciones y disnea, la ecocardiografía transtorácica (ETT) objetiva hipertrofia ventricular izquierda leve con buena función y una valvulopatía aórtica degenerativa con insuficiencia leve, durante el examen se registran ex-trasístoles ventriculares aislados asociado a IAS. CASO 2: Hombre de 61 años con diagnóstico de miocardiopatía dilatada no isquémica en estadio D. Su ETT basal evidencia severa dilatación y disfunción ventricular izquierda (FEVI 19%, DTD 90 mm), insuficiencia mitral funcional severa e insuficiencia aórtica leve. Por dependencia a infusión de inótropos se implanta en Marzo del 2016 un dispositivo de asistencia ventricular izquierda HeartWa-re, en control ambulatorio el dispositivo funcionaba normalmente y el ETT objetiva una significativa disminución de los diámetros del ventrículo izquierdo (DTD 70 mm) una válvula aórtica con apertura intermitente asociado a una IAS en rango leve a moderado. CASO 3: Mujer de 82 años con insuficiencia cardíaca y severa disfunción y dilatación ventricular izquierda, se hospitaliza por infección respiratoria, un ETT muestra insuficiencia mitral funcional severa asociado a IAS moderada.

Aortic regurgitation is a diastolic event in which blood from the aorta regurgitates back to the left ventricle, with several possible mechanisms. Its magnitude is determined by: the regurgitant orifice area, the diastolic gradient between the aorta and the left ventricle and the duration of diastole. In contrast, systolic aortic regurgitation (SAR) is an unusual phenomenon with few cases reported in the literature and with a particular pathophysiology. We report three cases of SAR that illustrate its mechanisms. CASE 1: 54 years-old hypertensive male, refers dyspnea associated with irregular heartbeatsTrans-thoracic echocardiography (TTE) revealed a mild left ventricular hypertrophy with normal function along with a degenerative aortic valve that presented mild regurgitation, isolated premature ventricular contractions were frequently observed associated with mild SAR. CASE 2. 61 years-old diabetic male, with a long history of stage D dilated non ischemic cardiom-yopathy. His last TTE was remarkable for a severe left ventricular dilatation and dysfunction (LVEF 19%, EDD 90 mm), severe functional mitral regurgitation, mild aortic regurgitation and pulmonary hypertension (SPAP 60 mmHg) along with right ventricular dysfunction. Because of inotrope infusion dependency a left ventricular assist device (LVAD) Heartware was implanted. At six months outpatient control, LVAD presented normal function parameters and TTE showed significant reduction in left ventricle diameters (EDD 70 mm) along with mild to moderate SAR. CASE 3: 82 year-old female, longstanding heart failure with severe LV dilatation and dysfunction (LVEF 15%), admitted for a respiratory infection, TTE showed moderate SAR along with functional severe mitral regurgitation.

[Survival of patients with pulmonary arterial hypertension after the advent of specific pulmonary vasodilator therapies]. / Sobrevida a mediano plazo en los pacientes con hipertensión arterial pulmonar en la era de terapias vasodilatadoras específicas del territorio vascular pulmonar.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare and progressive disease. Long-term survival remains poor despite of advances in specific vasodilator therapy. AIM: To describe the survival rate in a cohort of PAH patients in two referral centers in Chile. PATIENTS AND METHODS: One hundred fifteen patients aged 43 ± 15.6 years (85% females) with PAH qualified for this study. Their median pulmonary artery pressure was 55.4 ± 14 mmHg and their six minutes walking capacity was 368 ± 119 m. They were followed for 58 ± 0.4 months and their actual survival rates were compared with the estimated survival using the equation proposed by the French registry of PAH. RESULTS: One, two and three year survival rates were 97, 94 and 89%, respectively. The observed survival rates were greater than the estimated survival. CONCLUSIONS: The improvement in survival rates observed in this cohort of patients is similar to what has been described in literature.

Sobrevida a mediano plazo en los pacientes con hipertensión arterial pulmonar en la era de terapias vasodilatadoras específicas del territorio vascular pulmonar / Survival of patients with pulmonary arterial hypertension after the advent of specific pulmonary vasodilator therapies

Background: Pulmonary arterial hypertension (PAH) is a rare and progressive disease. Long-term survival remains poor despite of advances in specific vasodilator therapy. Aim: To describe the survival rate in a cohort of PAH patients in two referral centers in Chile. Patients and Methods: One hundred fifteen patients aged 43 ± 15.6 years (85% females) with PAH qualified for this study. Their median pulmonary artery pressure was 55.4 ± 14 mmHg and their six minutes walking capacity was 368 ± 119 m. They were followed for 58 ± 0.4 months and their actual survival rates were compared with the estimated survival using the equation proposed by the French registry of PAH. Results: One, two and three year survival rates were 97, 94 and 89%, respectively. The observed survival rates were greater than the estimated survival. Conclusions: The improvement in survival rates observed in this cohort of patients is similar to what has been described in literature.

Reparación de una perforación valvular mitral como secuela de endocarditis, aporte de la ecocardiografía tridimensional / Mitral leaflet perforation repair after healed endocarditis, advantage of three-diminesional echocardiography

Resumen Reportamos un caso de reparación de perforación valvular mitral en un joven de 18 años que consulta por disnea de esfuerzos y con el antecedente remoto de una artritis séptica de rodilla tratada. En el examen físico se encontró un soplo holosistólico 4/6 en el foco mitral. Se realizó un ecocardiograma transtorácico (ETT) que objetivó una insuficiencia mitral severa, con un jet de recorrido muy excéntrico originado desde anterior, sospechando una perforación del velo anterior, sin lograr caracterizarla por dicha técnica. Se complementó el estudio con un ecocardiograma transesofágico (ETE) en una plataforma EPIQ 7 cv (PHILIPS), que identificó en el cuerpo del segmento 2 del velo anterior mitral (A2) una posible perforación. El análisis de la válvula mediante ETE tridimensional (3D), confirmó una perforación circular de bordes netos, de dimensiones máximas 6x6 mm, localizada en el cuerpo de A2. El análisis 3D aportó valiosa información para programar la reparación valvular, la cual se efectuó mediante un parche de pericardio autólo-go fresco (sin fijación en glutaraldehido) y una anu-loplastía con un anillo rígido, con óptimo resultado y sin complicaciones.

An 18 year-old man presented with shortness of breath and a remote history of a septic arthritis of the knee. Physical examination revealed a holosystolic mitral valve murmur. Transthoracic echocardiography showed a severe mitral regurgitation originating from de anterior mitral valve leaflet, but the exact mechanism was unclear. Transesophageal echocardiography (EPIQ 7v, Philips) suggested a perforation of the medial scallop of the anterior mitral valve leaflet (A2). 3-D trans esophageal echocardiography confirmed a 6x6 mm perforation at the A2 sector of the anterior leaflet. 3-D echo was also very helpful in guiding the surgical repair of this lesion, using a pericardial patch and rigid mitral valve ring.

Remodelado auricular derecho y niveles plasmáticos de galectina-3 se relacionan con la capacidad funcional de pacientes con hipertensión arterial pulmonar / Right atrial remodeling and plasma leves of galectin-3 are related to functional capacity in patiensts with pulmonary artery hypertension

Introducción: En pacientes con hipertensión arterial pulmonar (HAP) Galectina- 3, biomarcador de fibrosis miocárdica, se ha asociado a marcadores ecocardiográficos de remodelado ventricular derecho. La relación entre Galectina- 3, remodelado auricular derecho (AD) y capacidad funcional (CF) en pacientes con HAP no ha sido explorado. El objetivo fue medir niveles de Galectina-3 y su relación con CF y remodelado AD en pacientes con HAP Metodos: Estudio prospectivo observacional en que se incluyeron 14 pacientes con HAP En todos los pacientes se midieron los niveles de Galectina-3, proBNP, se evaluó la CF mediante test de caminata 6 minutos (TC6M) y se evaluó remodelado AD. Se consideraron para el análisis dos grupos según la distancia caminada en TC6M (> 200 m vs. ≤ 200 m). Resultados: La edad promedio fue 43 ± 10 años, el 84% mujeres. Los niveles de Galectina-3 fueron 16,1 ± 7,4 ng/mL y el TC6M fue 371 ± 142 mts. Los pacientes con TC6M< 200 m presentaron mayores niveles de Galectina-3 (27,3 ± 4,6 vs 13,7 ± 3,8; p=0,006) y mayor volumen AD (151 ± 21 vs 94 ± 43; p=0,04). Además, se observó una correlación inversa entre el área AD y TC6M (-0,71; p=0,03). Conclusión: Niveles elevados de Galectina-3 y parámetros de remodelado adverso en AD se relacionan con una menor CF en pacientes con HAP. Estos hallazgos apuntan a una mejor caracterización de pacientes con HAP y eventualmente la búsqueda de nuevos objetivos terapéuticos.

Background: Galectin-3 is a biomarker of myo-cardial fibrosis and has been associated with echocar-diographic markers of right ventricular remodeling in patients with pulmonary artery hypertension (PAH). The association among Galectin-3 level, right atrial (RA) remodeling and functional capacity (FC) has not been explored. The objective was to measure plasma Galectin-3 concentrations and its relation with RA remodeling and FC in PAH patients. Methods: This is a prospective observational study and 14 PAH patients were included. Galectin-3 and proBNP levels were measured in all patients. FC was estimated by the 6-minute walk test (6MWT) and used to define 2 groups of subjects (≤200m or >200m). RA area and volume were measured by echocardiography from a 4 chamber view. Results: The average age was 43±10 years, 84% of patients were female. Galectin-3 levels were 16.1±7.4 ng / mL and 6MWT was 371±142 m. We observed an inverse correlation between RA area and 6MWT (-0.71;p=0.03). Conclusions: Higher Galectin-3 concentrations and RA adverse remodeling are related to a decreased FC in PAH patients. These findings may lead to a better characterization of PAH patients and eventually new therapeutic targets.