A theoretical study of the photochemistry of 1,3-cyclopentadiene and its cyano derivatives bound to a water dimer: Assessing reactivity of ionized clusters and possible photoproducts.

We theoretically investigate the photoionization scenarios of molecular complexes involving cyclopentadiene and cyanocyclopentadiene bound to water dimers. Using electronic structure calculations within density-functional theory (DFT) and time dependent DFT (TD-DFT), we explore the potential photochemical pathways following ionization, and determine the charge transfer excitations related to the possible subsequent reactions. Our findings suggest that the investigated photochemical pathways of the hydrated complexes take place in two well-defined ultraviolet regions: (i) 8.2-9.5 eV for the cyclic compounds and (ii) 11.2-11.4 eV for the bound water dimer. We quantify how H-bonding effects can influence the photoionization channels. Before forming possible photoproducts, we also examine the regiospecificity of OH addition to 1,3-cyclopentadiene and its cyano derivatives We analyze our results in light of photoionization studies of jet-cooled molecular complexes and possible implications in astrochemical environments.

Influence of Solvents and Halogenation on ESIPT of Benzimidazole Derivatives for Designing Turn-on Fluorescence Probes.

This work reports a theoretical investigation of the solvent polarity as well as the halogenation of benzimidazole derivatives during excited state intramolecular proton transfer (ESIPT). It details how the environment and halogen substitution may contribute to the efficiency of ESIPT upon keto-enol tautomerism and exploits this effect to design fluorescence sensing. For this purpose, we first examine the conformational equilibrium of benzimidazole derivatives containing different halogen atoms, which results in intramolecular proton transfer, using density-functional theory (DFT) combined with the polarizable continuum model (PCM). Then we evaluate the fluorescence of the benzimidazole derivatives in different dielectric constants within time-dependent DFT (TD-DFT) approaches. Our results quantitatively allow the determination of large Stokes shifts in nonpolar solvents around 100 nm. These theoretical results are in agreement with experimental solvatochromism studies of benzimidazoles. The effect of halogenation, with fluorine, chlorine, and bromine, is less important than solvent polarization when ESIPT takes place. Thus, halogenation can be properly chosen depending on the interest of the synthesis of benzimidazole-based turn-on fluorescence in appropriate solvents.

Predicting pressure-dependent rate constants for the furan + OH reactions and their impact under tropospheric conditions.

In this work, we have evaluated the influence of temperature and pressure on the mechanism of furan oxidation by the OH radical. The stationary points on the potential energy surface were described at the M06-2X/aug-cc-pVTZ level of theory. In the kinetic treatment at the high-pressure limit (HPL), we have combined the multistructural canonical variational theory with multidimensional small-curvature tunneling corrections and long-range transition state theory. The system-specific quantum Rice-Ramsperger-Kassel theory was employed to estimate the pressure-dependent rate. In the HPL, the OH addition on the α carbon is the dominant pathway in the mechanism, producing a product via the ring-opening process, also confirmed by the product branching ratio calculations. The overall rate constant, obtained by a kinetic Monte Carlo simulation, reads the form koverall=5.22×10-13T/3001.10⁡exp1247(K/T) and indicates that the furan oxidation by OH radicals is a pressure-independent reaction under tropospheric conditions.

Regioselectivity in the Nitration of Eugenol Is Independent of Inorganic Reagents: An Experimental and Theoretical Investigation with Synthetic and Mechanistic Implications.

In this study, we reinvestigated the straightforward nitration of eugenol using traditional reagents and bismuth nitrate. NMR analysis of the obtained products revealed that the regioselectivity of eugenol nitration was independent of the inorganic nitrating reagent used, consistently resulting in the formation of 6-nitroeugenol. This contradicts previous literature reports because the elusive synthesis of 5-nitroeugenol using Bi(NO3)3·5H2O was not achievable through straightforward methods; instead, this isomer could only be prepared via the well-established three-step synthesis. Theoretical investigations using DFT calculations, considering both the dielectric constant of the medium and explicit water molecules, substantiated this regioselectivity. It was found that hydration water played a critical role in the formation of a Zundel cation, shifting the thermodynamic equilibrium toward the exclusive production of 6-nitroeugenol. These results imply that all biological studies involving eugenol derivatives synthesized via direct nitration with Bi(NO3)3·5H2O should be reviewed, as they dealt with 6-substituted eugenol derivatives rather than the previously assumed 5-substituted eugenol.

Effects of breed on preferential intake of hydroxychloride and sulfate sources of trace minerals in growing beef heifers.

This study evaluated the effects of breed on voluntary preferential intake of two sources of Cu, Mn, and Zn when added to white salt-based trace mineral supplement (days 0 to 55; experiment 1) and protein supplement (days 56 to 112; experiment 2). On day 0, Nelore and ½ Angus × ½ Nelore heifers (n = 20/breed) were stratified by breed, body weight (BW = 347 ±â€…82 kg), and age (12 to 30 mo), and randomly allocated into 1 of the 40 drylot pens (1 heifer/pen). Both experiments were divided into washout (days 0 to 27 in experiment 1 and days 56 to 83 in experiment 2) and preferential intake periods (days 28 to 55 in experiment 1 and days 84 to 112 in experiment 2). During the respective preferential intake period, heifers were provided simultaneous free-choice access to sulfate (SUL) and hydroxychloride (HYD) sources of Cu, Mn, and Zn mixed into salt-based trace mineral supplements from days 28 to 55 (experiment 1) and then protein supplements from days 84 to 112 (experiment 2). Heifers were provided free-choice access to Tifton 85 (Cynodon sp.) hay from days 0 to 112. Effects of breed × source × day of the study were detected (P ≤ 0.05) for daily trace mineral intake from days 28 to 56 and days 84 to 112. Angus × Nelore heifers consumed a greater amount of SUL vs. HYD supplements on days 31 to 33 (P = 0.02) and HYD vs. SUL supplements on days 37 to 42 (P ≤ 0.02), whereas Nelore heifers consumed more HYD vs. SUL supplements on days 31 to 33 and 43 to 51 (P ≤ 0.05). Both breeds consumed (P ≤ 0.05) a greater amount of protein supplement containing HYD vs. SUL from days 84 to 112, but the differences in protein supplement intake increased (P ≤ 0.04) in greater magnitude for Nelore vs. Angus × Nelore heifers. Supplement intake coefficient of variation (CV) from days 28 to 41 and days 84 to 97 tended (P = 0.06) to be greater for Nelore vs. Angus × Nelore heifers. Effects of breed × source were detected (P = 0.02) for supplement intake CV from days 84 to 112. Intake CV of supplements added with HYD did not differ (P ≥ 0.40) between Nelore vs. Angus × Nelore heifers but was greater (P < 0.01) for Nelore vs. Angus × Nelore heifers fed SUL supplements. Overall, Nelore heifers had greater preferential intake for mineral and protein supplements containing hydroxychloride vs. sulfate sources compared to Angus × Nelore heifers. Hydroxychloride sources encouraged voluntary intake and reduced variation in supplement consumption compared to SUL sources of the same metals.

Photoabsorption of Microhydrated Naphthalene and Its Cyano-Substituted Derivatives: Probing Prereactive Models for Photodissociation in Molecular Clouds.

We investigate the photoionization pathways of naphthalene, 1-cyanonaphthalene, and 2-cyanonaphthalene upon complexation with the water dimer, aiming to understand the photodissociation process under conditions of the interstellar medium (ISM). We analyze the intermolecular bonding pattern, equilibrium rotational properties, energy complexation, far-IR spectra, and ionic trends of the possible photoproducts using dispersion-corrected density functional theory (DFT-D) and time-dependent DFT (TD-DFT). For the different configurations, we evaluate the possible charge-transfer (CT) excitations near the photoionization limit. Our results indicate that, in high-radiation regions of the ISM (>8.0 eV), CT excitations occur from localized occupied molecular orbitals (MOs) in the aromatic molecules to mixed unoccupied MOs in the complexes, favoring cationic aromatic species in these conditions. We notice that the photoabsorption spectra depend on the type of intermolecular interaction (H-bonds or O-H···π bonds) in the complexes, as well as the presence and position (1 or 2) of the cyano-functional group in naphthalene. For hydrated naphthalene, the O-H···π complexes assume a more relevant role for photodissociation. In the case of the cyano-substituted derivatives, the H-bonded structures are more favorable to be considered as prereactive models. However, the cyano group at position 2 indicates that CT excitations toward the water dimer are more likely to occur.

Stability and Rupture of an Ultrathin Ionic Wire.

Using a combination of in situ high-resolution transmission electron microscopy and density functional theory, we report the formation and rupture of ZrO_{2} atomic ionic wires. Near rupture, under tensile stress, the system favors the spontaneous formation of oxygen vacancies, a critical step in the formation of the monatomic bridge. In this length scale, vacancies provide ductilelike behavior, an unexpected mechanical behavior for ionic systems. Our results add an ionic compound to the very selective list of materials that can form monatomic wires and they contribute to the fundamental understanding of the mechanical properties of ceramic materials at the nanoscale.

Aparición de melanina como pigmento protector en el encéfalo de xenopus laevis para protegerlo de los efectos de la radiación ultravioleta / Emerging melanin protective pigment in the brain of xenopus laevis to protect from the effects of uv radiation

Con el fin de proteger al organismo de condiciones estresantes, tales como cambios de osmolaridad y de temperatura, además de actuar como pantalla protectora en contra de los rayos ultravioleta (UV). Se ha observado que ciertos anfibios han desarrollado pigmentación en su encéfalo como una posible protección ante el aumento de la radiación UV, causada por el daño en la capa de ozono, la cual estaría alterando al ecosistema. En este trabajo se describe la presencia de pigmentación en el encèfalo de X. laevis durante el desarrollo larvario y su posible función protectora frente a la radiación UV. Para ello, se recolectaron individuos de diferentes estados larvarios, los que fueron obtenidos de distintas localidades de la región de Valparaíso (V región, Chile), para ser procesados con el método corriente H-E y el método de Lillie. En los análisis se pudo evidenciar que la pigmentación correspondía a melanina, que se encontraría en la membrana denominada leptomeninge, la cual recubre al encéfalo y estaría actuando como un filtro protector para evitar daños a nivel del desarrollo en el sistema nervioso de estos anuros. En suma, los rayos UV como agentes deletéreos estarían estimulando la producción de eumelanina en la leptomeninge de estos anfibios, para proteger parte del SNC (encéfalo), como al individuo en sí de posibles alteraciones teratogénicas y/o mutagénicas.

It has been observed that certain amphibians have developed pigmentation in brain as a possible increased protection against UV radiation, caused by damage to the ozone layer, which would alter the ecosystem. In this paper we describe the presence of pigment in the brain of X. laevis during larval development and possible protective function against UV radiation. To do this, we collected individuals at various larval stages, which were obtained from different locations in Valparaiso (V Region, Chile), to be processed with HE and the method of Lillie. In the analysis it was evident that pigmentation corresponded to melanin, which would be in the membrane called leptomeninges, which covers the brain and would be acting as a protective filter to prevent damage to the level of development in the nervous system of these frogs. In addition, UV rays would be deleterious agents stimulating production of eumelanin in the leptomeninges of these amphibians, to protect the CNS (brain), and the individual itself of potential teratogenic or mutagenic alterations.

Anestesia/analgesia epidural cervical en mastectomía de paciente con antecedentes familiares de hipertermia maligna / Epidural cervical anesthesia/analgesia for mastectomy in a pa tient with family history of malignant hypertermia

Introducción: La hipertermia maligna es un síndrome frecuentemente he redado, caracterizado por un estado hipermetabólico agudo tras la exposición a determinados fármacos, como relajantes musculares despolarizantes y anestésicos volátiles. Entre los signos y síntomas de una crisis se incluyen, el aumento del anhídrido carbónico espirado, taquicardia, taquipnea, rigidez de la musculatura esquelética, aumento rápido y gradual de la temperatura con alto riesgo de fallecimiento. Este cuadro es consecuencia de una alteración de la homeostasis del calcio en la fibra muscular esquelética. Material y métodos. Resultados: Paciente de 47 años propuesta para intervención quirúrgica por tumoración mamaria izquierda en cuadrantes supero-externos. Entre sus antecedentes resalta el fallecimiento de dos familiares por hipertermia maligna en el transcurso de anestesias generales. Se propone anestesia epidural cervical por el sistema de la gota pendiente, usando ropivacaína 0,5 por ciento y colocando un catéter para analgesia en el intra y postoperatorio de la intervención quirúrgica de glandulectomía segmentaria. Valoramos el dolor por la escala analógico visual, nivel de sedación y parámetros hemodinámicos. Con posterioridad la paciente es sometida a una mastectomía bilateral junto a vaciamiento axilar izquierdo completo, procediéndose a una nueva anestesia epidural cervical con idéntica técnica y valoraciones. Conclusiones: La paciente presentó una adecuada anestesia para el procedimiento quirúrgico realizado junto a una excelente analgesia en el intraoperatorio como en el postoperatorio inmediato y a las 24 horas. Los antecedentes familiares de la paciente con el peligro potencial de hipertermia maligna hace aconsejable el uso de una técnica regional versus anestesia general (AU)

Tyrphostin AG825 triggers p38 mitogen-activated protein kinase-dependent apoptosis in androgen-independent prostate cancer cells C4 and C4-2.

Prostate cancer (PCa) progression is aided by abnormal autocrine growth factor loops. We screened for small cell-permeable inhibitors of receptor tyrosine kinases that could block their signaling and trigger cell death in PCa cell lines. We found that the human epidermal growth factor receptor (HER)-2/neu inhibitor tyrphostin AG825 is preferentially toxic to PCa cells that are phenotypically androgen independent. These effects were dose and time dependent in the human LNCaP, C4, and C4-2 cell line models of progression and correlated with the inhibition of HER-2/neu phosphoactivation and its down-regulation. In addition, we show that the inhibition of HER-2/neu signaling with AG825 triggers an imbalance between extracellular signal-regulated kinase 1/2 and p38 mitogen-activated protein kinase activation, which leads to p38-dependent apoptosis. Inhibition of HER-1 with Compound 56 had no effect. These findings suggest that the androgen-independent C4 and C4-2 cells can be killed by selectively inhibiting their HER-2/neu signaling pathway and provide insights into the mechanism of action of AG825 in PCa cells.

Role of PI3K signaling in survival and progression of LNCaP prostate cancer cells to the androgen refractory state.

The mechanisms by which prostate cancer (PCa) cells progress to a hormone refractory state are poorly understood. The progression process under androgen ablation conditions involves the survival of at least a portion of malignant cells and their eventual proliferation in an androgen-independent manner. The goal of this study was to investigate the role of PI3K signaling in such a progression. Using an in vitro model of androgen ablation, we show that after removal of androgen support, the human PCa cell line LNCaP initially arrested in G(1) and trans-differentiated into neuroendocrine-like cells that eventually resumed androgen-independent proliferation. Both acute and chronic androgen ablation resulted in an increase in basal levels of PI3K and Akt activity, which were sustained throughout the progression process. Under these conditions, inhibition of PI3K, pharmacologically or with ectopic expression of PTEN, arrested cell proliferation and blocked progression to the androgen-independent state. In contrast, LNCaP cells in the presence of androgens were marginally sensitive to PI3K inhibition. During the chronic stage of androgen deprivation, androgen-independent proliferation correlated with diminished p27(kip1) protein levels, whereas PI3K and Akt activity remained elevated. At this stage, PI3K inhibition rapidly triggered accumulation of p27(kip1), cell cycle arrest, and cell death. PI3K modulated p27(kip1) levels at least in part by regulating its rate of degradation. Taken together, these data show that androgen ablation alone can increase PI3K-Akt activation, which supports survival after acute androgen ablation and proliferation during chronic androgen deprivation. Successful progression to the androgen-independent state in the LNCaP cell line model requires intact PI3K signaling.

[Low molecular weight heparin in pregnancy. Report of three cases with pure mitral stenosis]. / Heparina de bajo peso molecular y embarazo. Tres pacientes con estenosis mitral pura.

Three pregnant women with 5 +/- 1.7 weeks of pregnancy and mitral stenosis are described. Their valve area were < 1.0 cm2. They received medical treatment with little improvement and were included in our valvotomy percutaneous mitral (VPM) program with Inoue technique before their 30th week of pregnancy. Before they were treated with low molecular weight heparin (LMWH), Enoxiparin) as prophylaxis of intracavitary thrombus formation transthoracic and transesophageal echocardiogram demonstrated the absence of thrombus. We used 40 mgs. subcutaneous injection once a day during 16 weeks. Repeated transthoracic and transesophageal echocardiogram during VPM showed no evidence of intracavitary thrombus. Complete blood count and coagulation parameters remained within normal limits. The three cases delivered a healthy products. In conclusion, although this series is small, we show that the LMWH can be used in the first trimester of pregnancy as prophylactic treatment instead of oral anticoagulant treatment.

[Percutaneous mitral commissurotomy in patients with mitral valve stenosis and thrombosis of the left atrium]. / Comisurotomía mitral percutánea en pacientes con estenosis mitral y trombos en la orejuela izquierda.

UNLABELLED: Mitral percutaneous valvotomy (MPV) is an effective therapeutic alternative in the treatment of patients with mitral stenosis (MS) and thrombus in the left atrium have been an absolute contraindication to this procedure. The aim of our study is to evaluate the safety of MPV in patients with MS and thrombus in the appendix of the left atrium (ALA). Between September 1996 and April 1997, we performed ten procedures of MPV with Inoue's technique in patients with MS and thrombus in ALA. Nine females and 1 male were included. Their were 41 +/- 7.6 years old. The Wilkins score in our patients were 8 +/- 1.2. All were treated with oral anticoagulants between three and twelve months but the thrombus did not resolved. With transesophagic echocardiogram and fluoroscopic control we avoided the contact between wires and Inoue's catheter with ALA. Results were positive. Mitral valve area increased from 0.8 +/- 0.2 cm2 to 1.95 +/- 0.3 cm2. There was no case of systemic embolism or others major complications during the MVP and during following one year. CONCLUSION: MPV is a safe and efficient therapeutic alternative in the treatment of selected patients with MS and thrombus in ALA.

[Uterine leiomyomatosis in the female in late menopause]. / Miomatosis uterina en la mujer en la posmenopausia tardía.

Leiomyomatosis is less frequent in old woman, and its clinical and histological characteristic in late postmenopause are unknown. Uterine leiomyomas were confirmed histologically in 14 out of 69 patients (20.2%) who were 65 or older and in whom a vaginal hysterectomy was performed. Another group without myomas was paired by age to the study group. In both groups, the uterine volume and the minor diameter of the uterus were compared, as well as age at menarche, menopause and duration of the menstrual life. Statistical analysis was done with ANOVA. It was observed, as expected, that uterine volumes of women with leiomyomatosis were significantly greater (p < 0.01) than those of women that did not have myomas; however, the smaller uterine diameters were not significantly different between the two groups, which is an important finding for surgical treatment of these patients. In addition, the menstrual life of patients with myomas was significantly greater (p < 0.04) than that of women without leiomyomatosis. In conclusion, one fifth women 65 years old or older can present myomas and consequently an increase in uterine volume, but without increase in minor diameters. Furthermore, the greater menstrual life span must be recognized as possible risk factor for the presence of leiomyomatosis.

Immediate results of the Inoue mitral valvotomy in patients with previous surgical mitral commissurotomy. Preliminary report.

BACKGROUND: The objective of this study is to evaluate the immediate result of the percutaneous mitral valvotomy in patients with previous surgical mitral commissurotomy, compared with patients considered ideal for the performance of the procedure. METHODS: The authors of this paper compared the immediate results of the percutaneous mitral valvotomy (PMV) performed on two groups of patients. Group I included 20 patients who were good candidates for PMV, with an echocardiographic score of < or = 8, without evidence of left atrial thrombus, and with no recent embolic event. Group II included seven patients with previous mitral commissurotomy (MC). RESULTS: According to the Wilcoxon non-parametric t test analysis, the hemodynamic variables changed significantly in the patients of group I: the mitral area increased from 1.21 +/- 0.41 to 2.62 +/- 0.75 cm2 (P = < 0.001); the mean left atrial pressure decreased from 17.2 +/- 7.2 mmHg to 9.2 +/- 4.5 mmHg (P = < 0.001), and the pressure transmitral gradient decreased 12.4 +/- 6.8 to 3.3 +/- 1.26 mmHg (P = < 0.001). No statistically significant difference in the hemodynamic changes of the patients of group II after the PMV was found: the mitral area increased from 1.2 +/- 0.2353 to 1.96 +/- 0.57 cm2; the mean left atrial pressure decreased from 17.42 +/- 10.35 to 12.42 +/- 7.3 mmHg, and the pressure mitral gradient decreased from 11.47 +/- 6.5 to 5.7 +/- 4.8 mmHg. The mitral area determined by echocardiographic procedure showed the same tendency in patients with previous MC. CONCLUSIONS: In spite of this tendency, during the follow-up after PMV the NYHA functional class decreased from II-IV to I in the patients with previous MC. Because a second surgical MC results in higher mortality, PMV is indicated in patients with previous MC, delaying or avoiding a second MC or valve replacement.

Cholera and myocarditis--a case report.

The authors describe the case of a fifty-nine-year-old white man, previously in good health, who initiated his present illness with acute episode of enterocolitis characterized by mild fever and, in the next eight hours, twenty-four episodes of watery diarrhea, nausea and vomiting, as well as generalized sweating and severe weakness secondary to hypovolemia and electrolyte disorder. These complications were corrected in seventy-two hours in the intensive care unit. Two days later, when the patient was stable hemodynamically, under cardiac monitoring and with normal laboratory studies including serum electrolytes, he developed electrocardiographic changes characterized by trifascicular block (prolonged P-R interval, complete right bundle branch block [CRBBB] and left posterior hemiblock [LPH]) with a cardiac rate of thirty beats per minute, for which a temporary pacemaker was inserted. Endomyocardial biopsy showed histopathologic signs of myocarditis and the immunologic study of the cardiac tissue revealed positive polymerize chain reaction (PCR+) with the presence of antitoxine choleric antibodies (AcTCA). After three weeks, the same conduction disturbances remained, for which a permanent pacemaker was inserted. On top of intravenous fluid replacement and electrolyte supplements, the patient was managed with tetracycline 2 g a day for one week and sulfamethoxazole-trimethoprim 800/160 mg a day for two weeks. The purpose of this study is to present a rare and very well-documented myocarditis by cholera in a patient with enteric disease, in whom several cardiac complications occurred.

[Identification and treatment of coronary atherosclerosis, before resection of abdominal aortic aneurysm]. / Reconocimiento y tratamiento de la enfermedad aterosclerosa coronaria, previos a la resección de aneurisma aortoabdominal.

Atherosclerotic aortic aneurysm, is frequently associated to coronary atherosclerosis. When myocardial ischemia is asymptomatic, aortic surgery commonly is deferred because unexpected ischemic cardiopathy. To diminish the risk of aortic surgery, aortocoronary bypass must be installed before the aortic graft. Percutaneous transluminal coronary angioplasty is an alternative treatment of coronary atherosclerosis, principally in elderly patients. We present the case of a male patient with an abdominal aortic aneurysm and myocardial silent ischemia secondary to right coronary artery stenosis treated by mean the percutaneous transluminal coronary angioplasty (PTCA) before aortic surgery, with the objective of decreasing surgical risk and its possible complications (myocardial infarction, cardiogenic shock, death, etc.). Nine months after the PTCA, the patient is asymptomatic and stress test on treadmill is negative.

[Transrectal recatheterization under echocardiography control]. / Recateterismo transeptal bajo control ecocardiográfico.

We present the case of a 36 years-old woman, in whom antegrade mitral intraluminal valvulotomy was performed under transesophageal echocardiography control. Inadvertently, we retired the Inoue's catheter to the right atrium from the left atrium, before the dilation of the mitral valve was accomplished. Under echocardiographic control we reintroduced the transseptal catheter across the former septal orifice, avoiding a new septal puncture, and its possible complications. Now a days, the antegrade intraluminal mitral valvulotomy is easy performed, because the transesophageal echocardiography monitoring. The transesophageal echocardiography has modified the transseptal catheterization contraindications.

[Percutaneous mitral commissurotomy using Inoue's balloon during pregnancy]. / Comisurotomía mitral percutánea con balón de Inoue durante el embarazo.

The authors present three cases of pregnant women with symptomatic severe mitral stenosis with a mean age of 28.6 +/- 2.3 years, and during 27.6 +/- 1.52 weeks of pregnancy. Two patients were in class III and one in class IV of the New York Heart Association (NYHA). All patients had a mitral valvular area equal or less than 1 cm2, with a Wilkins score of 7 to 9 and mitral insufficiency grade I in two cases; two, had severe pulmonary arterial hypertension (mean > 50 mm Hg). After Percutaneous Mitral Valvuloplasty (PMV) the mitral valve measured by 2D echocardiography increased form 0.83 +/- 0.2 cm2 to 1.8 +/- 0.15 cm2; the mean transmitral gradient diminished from 13 +/- 3.4 mm Hg to 3.6 +/- 1.15 mm Hg; the degree of mitral insufficiency was no modified in neither case. Hemodynamic results revealed increasing of the mitral valve from 0.83 +/- 0.18 cm2 to 2.23 +/- 0.3 cm2; the mean mitral gradient decreased from 21.6 +/- 9 to 4.3 +/- 0.5 mm Hg; the mean left atrial pressure from 30 +/- 12 to 12.3 +/- 4 mm Hg; the mean pressure of the pulmonary artery diminished suddenly from 44.3 +/- 16 to 25.6 +/- 11 mm Hg. The average fluoroscopic time was 15.3 +/- 3 minutes. There were no complications. The patients were discharged 48 hours after the procedure and continued their pregnancies in class I NYHA, which resolved in a non complicated vaginal delivery with normal products. We conclude that PMV is a safe and useful therapy in pregnant patient with severe mitral stenosis refractory to medical treatment.

Coronary fistula associated with double mitral valve disease. A case report.

The authors report a case of a 54-year-old white male with a coronary fistula associated with double mitral valve disease. The patient was studied by invasive and non-invasive cardiac methods including coronary angiogram in order to reach the correct diagnosis and to define the successful surgical treatment that included the closure of the fistula, partial resection of the left atrium and insertion of a mechanical mitral valve prosthesis. It is concluded that this case represents a very rare association between coronary fistula and double mitral valve disease.