Comparison of Early and Mid-Term Outcomes After Classic and Modified Morrow Septal Myectomy in Patients with Hypertrophic Obstructive Cardiomyopathy.

INTRODUCTION: The aim of our study is to compare the early and mid-term outcomes of patients with hypertrophic obstructive cardiomyopathy who underwent classic and modified Morrow septal myectomy. METHODS: Between 2014 and 2019, 48 patients (24 males; mean age 49.27±16.41 years) who underwent septal myectomy were evaluated. The patients were divided into two groups - those who underwent classic septal myectomy (n=28) and those who underwent modified septal myectomy (n=20). RESULTS: Mitral valve intervention was higher in the classic Morrow group than in the modified Morrow group, but there was no significant difference (P=0.42). Mortality was found to be lower in the modified Morrow group than in the classic Morrow group (P=0.01). In both groups, the mean immediate postoperative gradient was significantly higher than the mean of the 3rd and 12th postoperative months. The preoperative and postoperative gradient difference of the modified Morrow group was significantly higher than of the classic Morrow group (P<0.001). CONCLUSION: Classic Morrow and modified Morrow procedures are effective methods for reducing left ventricular outflow tract obstruction. The modified Morrow procedure was found to be superior to the classic Morrow procedure in terms of reducing the incidence of mitral valve intervention with the reduction of the left ventricular outflow tract gradient.

Comparison of Early and Mid-Term Outcomes After Classic and Modified Morrow Septal Myectomy in Patients with Hypertrophic Obstructive Cardiomyopathy

ABSTRACT Introduction: The aim of our study is to compare the early and mid-term outcomes of patients with hypertrophic obstructive cardiomyopathy who underwent classic and modified Morrow septal myectomy. Methods: Between 2014 and 2019, 48 patients (24 males; mean age 49.27±16.41 years) who underwent septal myectomy were evaluated. The patients were divided into two groups - those who underwent classic septal myectomy (n=28) and those who underwent modified septal myectomy (n=20). Results: Mitral valve intervention was higher in the classic Morrow group than in the modified Morrow group, but there was no significant difference (P=0.42). Mortality was found to be lower in the modified Morrow group than in the classic Morrow group (P=0.01). In both groups, the mean immediate postoperative gradient was significantly higher than the mean of the 3rd and 12th postoperative months. The preoperative and postoperative gradient difference of the modified Morrow group was significantly higher than of the classic Morrow group (P<0.001). Conclusion: Classic Morrow and modified Morrow procedures are effective methods for reducing left ventricular outflow tract obstruction. The modified Morrow procedure was found to be superior to the classic Morrow procedure in terms of reducing the incidence of mitral valve intervention with the reduction of the left ventricular outflow tract gradient.

Morfología de las paredes ventriculares en fetos humanos con defectos septales

Introducción: las cardiopatías congénitas constituyen defectos estructurales y/o funcionales del corazón y los grandes vasos, como consecuencia de un error en la embriogénesis de estas estructuras. Los defectos septales suelen ser las cardiopatías congénitas más frecuentes. Objetivo: identificar la asociación entre la morfología de las paredes ventriculares y los defectos septales en fetos humanos. Materiales y métodos: se realizó un estudio observacional, descriptivo y transversal en la Facultad de Ciencias Médicas de Pinar del Río Dr. Ernesto Guevara de la Serna y el Departamento de Anatomía Patológica del Hospital General Docente Abel Santamaría Cuadrado, en el período de enero de 2019 a diciembre de 2020, con 54 fetos producto de interrupciones de embarazo indicadas por genética. Resultados: predominaron los defectos de septación en el sexo masculino. La comunicación interventricular fue el defecto de septación más frecuente. El grosor del ventrículo derecho mostró diferencias lineales y estadísticas significativas en relación con la edad gestacional en los tres defectos estudiados. Similares características presentó el grosor del tabique interventricular en los defectos troncoconales. Conclusiones: ante la presencia de defectos septales se observan modificaciones del grosor de los tabiques cardiacos.

Introduction: congenital heart diseases are structural and/or functional defects of the heart and large vessels, as a consequence of an error in the embryogenesis of these structures. Septal defects are usually the most common congenital heart diseases. Objective: to identify the association between ventricular walls morphology and septal defects in human fetuses. Materials and methods: an observational, descriptive and cross-sectional study was carried out in the Medical Sciences Faculty of Pinar del Rio Dr. Ernesto Guevara de la Serna and the Department of Pathological Anatomy of the General Teaching Hospital Abel Santamaría Cuadrado, in the period from January 2019 to December 2020, with 54 fetuses resulting from pregnancy interruptions indicated by genetics Results: septation defects predominated in males. Interventricular communication was the most frequent septation defect. The thickness of the right ventricle showed significant linear and statistical differences in relation to gestational age in the three studied defects. Similar characteristics showed the thickness of the inter-ventricular septum in truncoconal defects. Conclusions: in the presence of septal defects, modifications of the heart septum thickness are observed.

Factores asociados a hipertrofia sigmoidea en personas adultas que habitan en altura / Factors associated with sigmoidea hypertrophy in adults who live in altitude

RESUMEN Objetivo: Determinar los factores asociados con hipertrofia sigmoidea (HS) en adultos que habitan en la altura. Material y métodos: Estudio observacional, analítico, de casos y controles. Se realizó en el laboratorio de Ecocardiografía del Hospital Regional Docente Clínico Quirúrgico Daniel Alcides Carrión de Huancayo, entre enero del 2017 y julio del 2019. La muestra estuvo conformada por 74 personas que viven a más de 3000 m.s.n.m. Para el diagnóstico de HS se consideró el incremento del grosor septal basal (> 13 mm en varones y > 12 mm en mujeres), y tener el grosor > a 50% de la pared septal media. Los datos se recolectaron mediante un cuestionario. Se realizó el análisis estadístico con X2, t-student, y regresión logística considerándose significativo p<0,05. Resultados: Se incluyeron 74 pacientes. El promedio de edad fue 63 ± 16 años (rango: 23-94), 41 (55,4 %) fueron mujeres. La HS tipo 2 fue dos veces más frecuente que el tipo 1. Se conformaron dos grupos: n1=37 casos y n2=37 controles. En el análisis multivariado se encontró que la diabetes mellitus (OR=23,76 IC 95%: 1,61-350,7); la edad de 60 a más años (OR=9,97; IC 95%: 1,93-51,48) y la hipertensión arterial (OR=5,18 IC 95%: 1,19-22,59) estuvieron asociados con la mayor frecuencia de presentación de HS (p<0.05). Conclusiones: Se concluye que en el poblador que habita en la altura la diabetes mellitus, la edad avanzada y la hipertensión arterial son factores asociados a HS.

SUMMARY Objective: To determine factors associated to sigmoidal hypertrophy (SH) in adults living at high altitude. Methods: A case-control study was carried-out in the Ultrasound laboratory at Hospital Regional Docente Clínico Quirúrgico Daniel Alcides Carrión, Huancayo from January 2017 to July 2019. 74 persons were included who lived at altitudes above 3000 m.a.s.l. SH was defined considering the septal thickening (> 13 mm for males and > 12 mm for females) and having a septal median thickening > a 50%. Data were collected in a questionnaire, chi-square and student´s t-test were performed and a logistic regression analysis was carried-out including variables with statistical significance at <0.05. Results: Mean age was 63 ± 16 years (range: 23-94); 41 (55.4%) were females. SH type 2 was twice more common than SH type 1; 37 patients were cases and 37 were controls. The multivariate analysis found that diabetes mellitus (OR=23.76; 95% CI: 1.61-350.7); age above 60 years old (OR=9.97; 95% CI: 1.93-51.48) and blood hypertension (OR=5.18; 95% CI: 95%: 1.19-22.59) were associated with HS (p<0.05). Conclusions: In people living at high altitude, diabetes mellitus, advanced age and blood hypertension are associated to SH.

Defecto ventricular septal aislado. Reporte de un caso / Isolated ventricular septal defect. A case report / Isolated ventricular septal defect. A case report

RESUMEN Las cardiopatías congénitas son las anomalías congénitas más frecuentes. El defecto ventricular septal (DVS) es la cardiopatía congénita más común en los recién nacidos que afecta entre 25 y 30% de los neonatos con defecto cardiaco; los de tipo medio muscular son más comunes que los perimembranosos. La incidencia de anomalías cromosómicas con DVS aislado es relativamente baja. El cierre espontáneo del DVS aislado ocurre en aquellos que son pequeños, y el DVS muscular medio es el que más comúnmente se cierra comparado con el membranoso o perimembranoso. El diagnóstico de DVS muscular aislado sin otra anomalía puede ser considerado un hallazgo benigno.

ABSTRACT Congenital heart disease is the most common congenital anomaly. Ventricular septal defect (VSD) is a frequent congenital heart disease in newborns, affecting 25 to 30% neonates with cardiac defects. Muscular VSDs are more frequent than perimembranous VSDs. The association of cases with chromosomal anomalies and isolated VSD is relatively low. Spontaneous closure of isolated VSD is higher with small VSD cases, and the muscular VSD is more likely to close spontaneously than the membranous or perimembranous types. Therefore, diagnosis of isolated muscular VSD with no other anomalies can be considered a benign finding.

Utilización del "balón con cuchillas" para ampliación de comunicación interauricular restrictiva en lactantes menores de 6 meses: resultados inmediatos y a mediano plazo / Blade Balloon Septostomy to Enlarge a Restrictive Atrial Septal Defect in Infants under 6 Months: Immediate and Medium-Term Outcomes

Los pacientes con cardiopatías congénitas complejas requieren con cierta frecuencia una comunicación interauricular no restrictiva para mantener una saturación de oxígeno arterial y un gasto cardíaco adecuados. En este trabajo se describen seis pacientes menores de 6 meses con cardiopatías congénitas cianóticas graves, en los cuales se realizó dilatación de una comunicación interauricular restrictiva utilizando un balón con cuchillas. Se presentan los resultados inmediatos y a mediano plazo. En todos los pacientes se logró un incremento importante y duradero del tamaño del defecto interauricular y una mejoría clínica sostenida posprocedimiento. Se resalta la utilización de la ecocardiografía intraprocedimiento para guiar y evaluar los resultados. Consideramos que, utilizada con cautela en casos seleccionados, la ampliación de una CIA restrictiva con balón con cuchillas en lactantes menores de 6 meses es una alternativa segura y eficaz, con resultados satisfactorios. La monitorización ecocardiográfica es muy importante para el éxito del procedimiento.

A nonrestrictive atrial septal defect is mandatory in order to maintain adequate arterial oxygen saturation and cardiac output in patients with complex congenital heart defects. We describe six patients under 6 months with severe cyanotic congenital heart defects in whom blade balloon septostomy was performed to enlarge a restrictive atrial septal defect. Immediate and medium-term outcomes are presented. The procedure was successful in all patients, producing a larger and long-lasting atrial septal defect and sustained clinical improvement. The use of intraprocedure echocardiography to guide and evaluate the results is highlighted. We consider that balloon septostomy is a safe and effective option to enlarge a restrictive ASD in carefully selected cases in infants less than 6 months old, with satisfactory outcomes. Echocardiography guidance is very important to warrant success of the procedure.

Estudo ecocardiográfico pré-natal da redundância do septum primum e sua relação com a gênese de extra-sístoles atriais no feto / Prenatal echocardiographic study of septum primum redundancy and its relationship to the genesis of atrial extrasystole in the fetus

PURPOSE--To test the hypothesis that the redundancy of the septum primum is more pronounced in fetuses with atrial premature beats than in normal fetuses. METHODS--Twenty-five consecutive fetuses with atrial premature beats detected by prenatal echocardiography as the sole alteration at a mean gestational age of 34 +/- 3.3 (26 to 38) weeks and a mean maternal age of 27 +/- 6.5 (18 to 39) years made up the study group. The control group was formed by 50 consecutive fetuses without rhythm disturbances and normal prenatal echocardiography, examined at a mean gestational age of 33.9 +/- 3 (26 to 39) weeks and a mean maternal age of 31 +/- 5.8 (18 to 43) years. A redundancy index (RI) was obtained as a ratio between the maximal septum primum excursion and the maximal left atrium diameter during atrial diastole, at the 4-chamber projection. Statistical analysis utilized the unpaired Student-Fisher's "t" test. RESULTS--The RI in the study group varied from 0.50 to 1.00 (mean = 0.758 +/- 0.127) and in the control group in ranged from 0.29 to 0.67 (mean = 0.449 +/- 0.080). These differences were statistically significant for p < 0.0001. CONCLUSION--Septum primum is more redundant in fetuses with atrial premature beats than in those with normal regular rhythm. Although it is still speculative that this feature may have a cause-effect relationship, the measurement of the RI during routine fetal echocardiography may allow detection of a potential risk factor FOR developing atrial arrhythmias.