Academic and professional profile of cardiology fellowship graduates of National Institute of Cardiology Ignacio Chávez from 2000 to 2015.

BACKGROUND: The Ignacio Chávez National Institute of Cardiology (NIC) has positioned itself as an international benchmark in cardiovascular medical education, standing out for its high academic standards and human quality. OBJECTIVE: This study aims to identify the employment and academic profile of cardiology fellowship graduates from the National Institute of Cardiology of Mexico (NIC). METHODS: A cross-sectional and retrospective study was conducted, involving 473 graduates from the period 2000-2015. Data was collected through an electronic survey. RESULTS: A total of 221 graduates agreed to participate, accounting for 46.7% of the total number of graduates. Among the participants, 85.2% were male. The majority of graduates (82.4%) held Mexican nationality, while the remaining individuals represented various Latin-American nationalities. Following the completion of the cardiology fellowship, 89% of graduates pursued further postgraduate degrees. Within this group, 95.4% completed at least one additional fellowship, while 4.6% pursued a master's or PhD program. The most popular fellowship program chosen was Interventional Cardiology. On average, NIC graduates dedicate 10.8 hours per day to their work, with 6.4 hours dedicated to cardiology and 4.3 hours to their other postgraduate degree. Those employed in both public and private health systems allocate 6.1 hours and 5.2 hours per day, respectively. Additionally, 75% of graduates are involved in teaching activities. Currently, 84% of graduates are employed in Mexico. CONCLUSION: The majority of NIC graduates are physicians who further their academic training by pursuing additional postgraduate programs. They work longer hours per day compared to the general Mexican population, with a significant focus on clinical cardiology. Graduates actively seek opportunities to share their expertise through various academic activities.

ANTECEDENTES: El Instituto Nacional de Cardiología Ignacio Chávez (INC) se ha posicionado como un referente internacional en la educación médica cardiológica, destacándose por su alto nivel académico y calidad humana. OBJETIVO: El objetivo de este estudio fue identificar el perfil laboral y académico actual de los egresados del Instituto Nacional de Cardiología Ignacio Chávez (INC). MÉTODOS: Se llevó a cabo un estudio transversal y retrospectivo que incluyó a 473 egresados del INC graduados entre 2000 y 2015. Se utilizó una encuesta electrónica para recopilar los datos. RESULTADOS: Un total de 221 egresados aceptaron participar en el estudio, lo que representa el 46.7% del total de egresados. El 85.2% de los participantes son hombres. La mayoría de los egresados son de nacionalidad mexicana (82.4%), mientras que el resto se distribuye en varios países de Latinoamérica. El 89% de los egresados completó otro posgrado después de cardiología. De este grupo, el 95.4% realizó al menos una alta especialidad, mientras que el 4.6% obtuvo una maestría o doctorado. La especialidad más comúnmente elegida fue Cardiología Intervencionista. Los egresados del INC trabajan en promedio 10.8 horas al día, de las cuales 6.4 horas se dedican a la cardiología clínica y 4.3 horas al otro posgrado. Aquellos que trabajan en el sector público y privado dedican 6.1 horas y 5.2 horas al día, respectivamente. Además, el 75% de los egresados desempeña actividades de enseñanza. El 84% de los egresados trabajan en México. CONCLUSIÓN: En su mayoría, los egresados del INC son médicos especialistas que continúan su formación académica a través de la realización de otros posgrados. Trabajan más horas al día en comparación con el resto de la población mexicana, y dedican la mayor parte de su tiempo al ejercicio de la cardiología clínica. También buscan transmitir sus conocimientos a través de actividades académicas y de enseñanza.

Aneurisma del seno de Valsalva roto a la aurícula derecha resuelto con intervencionismo / Rupture of sinus of Valsalva aneurysm to the right atrium resolved with interventionism

Resumen Se presenta un caso de aneurisma del seno de Valsalva derecho roto a la aurícula derecha, que en el transcurso de tres meses desarrolló insuficiencia cardiaca global y fue resuelto del todo por medio de intervencionismo, colocando un dispositivo oclusor en el sitio de la fístula. Se discute su etología, así como las pautas para el diagnóstico clínico y el tratamiento.

Abstract We present a case of a ruptured right sinus of Valsalva aneurysm to the right atrium that developed global heart failure over the course of three months, and which was completely resolved through cardiac catheterism, placing an occlusive device at the site of the fistula. Its ethology is discussed, as well as the guidelines for clinical diagnosis and treatment.

Rupture of sinus of Valsalva aneurysm to the right atrium resolved with interventionism.

We present a case of a ruptured right sinus of Valsalva aneurysm to the right atrium that developed global heart failure over the course of three months, and which was completely resolved through cardiac catheterism, placing an occlusive device at the site of the fistula. Its ethology is discussed, as well as the guidelines for clinical diagnosis and treatment.

Se presenta un caso de aneurisma del seno de Valsalva derecho roto a la aurícula derecha, que en el transcurso de tres meses desarrolló insuficiencia cardiaca global y fue resuelto del todo por medio de intervencionismo, colocando un dispositivo oclusor en el sitio de la fístula. Se discute su etología, así como las pautas para el diagnóstico clínico y el tratamiento.

The rescue of medical education crippled by the COVID-19 pandemic.

BACKGROUND AND OBJECTIVE: The ravages caused by the COVID-19 pandemic have affected medical education by losing the tutorial teaching that we carried out in out Institution. METHOD: The strategies implemented through information and communication technologies are described in this article. RESULTS: With the strategies carried out, it was possible to continue with all the theoretical education virtually at a distance, including the daily hospital rounds, the presentation of clinical cases, the remote analysis of laboratory and cabinet methods, as well as the teaching of the physical examination and the acquisition of diagnostic aid methods. In addition, the number of attendants for the weekly academic general session of the institute increased from 100 in-person attendants to 500 virtual attendants (average), with approximately 5000 reproductions of the recorded sessions. The advantages and disadvantages of these new techniques and the challenges for the future are discussed in this manuscript. CONCLUSIONS: Undoubtedly, the pandemic has caused damage to the teaching of two generations of medical students during 2020 and 2021, and we are still afraid that, in 2022, it will persist. Therefore, in our opinion, the medical education implemented by us is not ideal, but, at least, it constitutes a good palliative for the harm that the pandemic caused to medical education.

ANTECEDENTES Y OBJETIVO: Los estragos causados por la pandemia COVID-19 alcanzaron también la educación médica perdiéndose la enseñanza tutorial que ejercíamos en nuestro Instituto. MÉTODO: Se implementaron estrategias a través de las tecnologías de la información y de la comunicación que se describen en este artículo. RESULTADOS: Con las estrategias llevadas a cabo se pudo continuar con toda la educación teórica de manera virtual a distancia, incluyendo el pase cotidiano de visita a los enfermos, la presentación de casos clínicos, el análisis a distancia de los métodos de laboratorio y gabinete, así como la enseñanza de la exploración física y la adquisición de los métodos de ayuda diagnóstica de los gabinetes. El número de asistentes a la sesión general semanaria del Instituto incremento de 100 asistentes presenciales a 500 virtuales (promedio) con reproducciones de las mismas en un promedio de 5,000. Se discuten las ventajas e inconvenientes de estas nuevas técnicas y cuáles son los desafíos para el futuro. CONCLUSIONES: Sin duda alguna, la pandemia ha causado daño a la enseñanza de dos generaciones de estudiantes de la medicina en los años 2020 y 2021 y aún seguimos temerosos de que en el 2022 persista. A nuestro juicio la educación médica implementada por nosotros no es lo ideal, pero por lo menos constituye un buen paliativo del daño que la pandemia produjo en la educación médica.

Bone Morphogenetic Protein-2 and Osteopontin Gene Expression in Epicardial Adipose Tissue from Patients with Coronary Artery Disease Is Associated with the Presence of Calcified Atherosclerotic Plaques.

PURPOSE: It has been proposed that the cardiovascular effects of obesity are related to epicardial adipose tissue (EAT), which seems to play an active role on the development and calcification of atherosclerotic plaques, but the mechanisms are still unknown. Therefore, the aim of this study was to determine whether the EAT expresses the genes of calcifying factors and whether such expression is associated with the body mass index (BMI) and with the presence of coronary artery calcium (CAC) in patients with coronary artery disease (CAD). PATIENTS AND METHODS: Forty-three patients with CAD were enrolled specifically for this study, and their CAC score and EAT volume were determined by computed tomography. As the group of comparison, 41 patients with aortic valve stenosis and CAC = 0 were included (control group). A representative subgroup of 16 CAD patients and 23 controls were selected to obtain EAT biopsies during the chirurgical procedure from the atrio-interventricular groove. The mRNA expression of bone morphogenetic protein-2 and -4 (BMP-2, BMP-4), osteopontin (OPN), osteonectin (ON), and osteoprotegerin (OPG) in EAT was determined by qPCR. RESULTS: The gene expression of OPN and BMP-2 was 70% and 52% higher in the EAT from CAD patients than that in controls, respectively, whereas the expression of OPG, ON, and BMP-4 was similar in both groups. The EAT volume positively correlated with OPG and with the BMI, suggesting a relationship of obesity with local higher expression of calcifying genes in the coronary territory. The logistic regression analysis showed that high levels of both OPN and BMP-2 increased about 6 and 8 times the odds of coronary calcification (CAC score > 0), respectively. CONCLUSION: EAT correlated with BMI and expressed the mRNA of calcifying genes but only OPN and BMP-2 expression was higher in CAD patients. Higher levels of both OPN and BMP-2 statistically determined the presence of calcium in coronary arteries of CAD patients.

Ten-year clinical and echocardiographic follow-up of patients undergoing percutaneous mitral commissurotomy with Inoue balloon.

Percutaneous mitral commissurotomy (PMC) has emerged as an effective nonsurgical technique for the treatment of patients with symptomatic mitral stenosis. This report highlights the immediate and long-term follow-up results of this procedure in an unselected cohort of patients with rheumatic mitral stenosis from a single center. PMC with Inoue balloon was performed in 70 patients in a 2-year period (1993-1994). Age of patients ranged from 18 to 67 years (mean 38 +/- 11). Atrial fibrillation was present in 18 (30%) patients. A detailed clinical and echocardiographic (two-dimensional, continuous-wave Doppler and color-flow imaging) assessment was done at follow-up. The procedure was technically successful in 61 (85%) patients with an increase in mitral valve area (MVA) from 0.96 +/- 0.2 to 1.7 +/- 0.28 cm2 (P < .001) and a reduction in mean trans-mitral gradient from 14.3 +/- 4.8 to 6.0 +/- 2.8 mmHg (P < .01). Mitral regurgitation appeared or worsened in 25 (30%) patients, of which 3 (4%) developed severe mitral regurgitation. Urgent mitral valve replacement was performed in these 3 patients. Data of 52 patients followed over a period of 105 +/- 10 months revealed MVA of 1.4 +/- 0.4 cm. Elective mitral valve replacement was done in 14 (23%) patients. Mitral restenosis diagnosed with echocardiography was seen in 24 (50%) patients, of which 14 were having recurrence of class III or more symptoms and were treated with surgery. Thus, percutaneous mitral commissurotomy is an effective and safe procedure and over 2/3 of the patients were event-free at the end of follow-up. The benefits are sustained in most of these patients on long-term follow-up.

Ten-year clinical and echocardiographic follow-up of patients undergoing percutaneous mitral commissurotomy with Inoue balloon / Comisurotomía mitral percutánea con balón de Inoue: seguimiento clínico y ecocardiográfi co a 10 años

Percutaneous mitral commissurotomy (PMC) has emerged as an effective nonsurgical technique for the treatment of patients with symptomatic mitral stenosis. This report highlights the immediate and long-term follow-up results of this procedure in an unselected cohort of patients with rheumatic mitral stenosis from a single center. PMC with Inoue balloon was performed in 70 patients in a 2-year period (1993-1994). Age of patients ranged from 18 to 67 years (mean 38 +/- 11). Atrial fibrillation was present in 18 (30%) patients. A detailed clinical and echocardiographic (two-dimensional, continuous-wave Doppler and color-flow imaging) assessment was done at follow-up. The procedure was technically successful in 61 (85%) patients with an increase in mitral valve area (MVA) from 0.96 +/- 0.2 to 1.7 +/- 0.28 cm2 (P < .001) and a reduction in mean trans-mitral gradient from 14.3 +/- 4.8 to 6.0 +/- 2.8 mmHg (P < .01). Mitral regurgitation appeared or worsened in 25 (30%) patients, of which 3 (4%) developed severe mitral regurgitation. Urgent mitral valve replacement was performed in these 3 patients. Data of 52 patients followed over a period of 105 +/- 10 months revealed MVA of 1.4 +/- 0.4 cm. Elective mitral valve replacement was done in 14 (23%) patients. Mitral restenosis diagnosed with echocardiography was seen in 24 (50%) patients, of which 14 were having recurrence of class III or more symptoms and were treated with surgery. Thus, percutaneous mitral commissurotomy is an effective and safe procedure and over 2/3 of the patients were event-free at the end of follow-up. The benefits are sustained in most of these patients on long-term follow-up.

[Secondary prevention in patients treated with coronary intervention]. / Prevención secundaria en pacientes tratados con intervencionismo coronario.

Percutaneous coronary interventions have been growing rapidly in recent years for their favorable outcome. Coronary artery disease, however, is caused by a diffuse atherosclerotic process involving the whole coronary artery tree and commonly other vascular territories. In recent years, evidence has accumulated that several classes of secondary preventive drugs are clinically effective. The statins are the cornerstone for lipid-lowering therapy and reduce morbidity and mortality in patients with ACS and treated with interventional cardiology. The highest risk of a recurrent event in patients with acute coronary syndromes (ACS) occurs in the first month, with the rates of reported events ranging from 10-25%. More recent data from several trials show that statin therapy can reduce cardiovascular risk in unstable disease. In the MIRACL trial, early initiation of atorvastatin after an episode of unstable angina or non-Q-MI reduced events along the ensuing 16 weeks. The Third Report of the Expert Panel Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) recommends that lipid lowering drug therapy be initiated at hospital discharge in patients with acute coronary syndromes and patients treated with percutaneous coronary interventions.

Treatment of a giant coronary aneurysm with a novel technique: scaffolding (tunnel) stenting to support PTFE-covered stents: insights from intravascular ultrasound.

This report describes a patient with progressive angina and a giant coronary aneurysm in the right coronary artery. Percutaneous treatment was performed using a novel technique consisting of implantation of a long stent that provided scaffolding or bridge for the subsequent implantation of two polytetrafluoroethylene-covered stents. Complete closure of the aneurysm was successfully achieved. In the angiogram performed 3 months later for recurrent angina, a localized narrowing at the distal stent edge (corresponding to severe underexpansion of the stent struts on intravascular ultrasound) was observed. This was successfully treated with balloon angioplasty. The technical details of this new technique are described.

[Pacemaker stimulation in dilated and hypertrophic myocardiopathies: should its use be stratified?]. / Estimulación con marcapasos en las miocardiopatías dilatada e hipertrófica: se debe estratificar su indicación?

New indications for permanent cardiac pacing have been developed in recent years, with numerous studies demonstrating improved clinical outcomes in many disorders. These techniques have been used in hypertrophic obstructive cardiomyopathy and dilated cardiomyopathy, and many physiological bases and clinical studies justify their application. In dilated cardiomyopathy and heart failure with intraventricular conduction delay, abnormal electrical depolarization of the heart results in mechanical asynchrony of the ventricles. Tricameral pacing (atrial-based biventricular) offers an alternative and conditions ventricular synchronization. The MUSTIC study, a controlled, randomized, crossover study, showed promising results, significantly improving exercise tolerance and quality of life, and increasing in diastolic ventricular filling period. Several ongoing randomized, controlled clinical trials should provide more definitive data on safety, efficacy, and decreased mortality. Hypertrophic obstructive cardiomyopathy has many therapeutic approaches such as, medical treatment, dual chamber pacing, surgery, and transcatheter septal ablation. Dual chamber pacing has been shown to improve symptoms and hemodynamic variables in patients severely symptomatic. However, randomized clinical trials (PIC and M-PATHY) have not shown conclusive evidence regarding the long-term benefit from pacing in these patients. Moreover, relationship between reduction in the intraventricular gradient and improvement of symptoms is controversial; there might be a significant placebo effect. Cardiac pacing is an alternative therapy for selected patients with hypertrophic cardiomyopathy, but very careful screening of patients is mandatory.

The impact of right atrial ischemia on inferior myocardial infarction with extension to right ventricle: transesophageal echocardiographic examination.

BACKGROUND: The role of the right atrium in adaptation to the hemodynamic changes produced by extension of myocardial infarction (MI) of the left ventricular inferior wall to the right ventricle is fundamental. HYPOTHESIS: The aim of this study was analyze a group of patients with MI with extension of right chambers, and particularly right atrial alterations, by transesophageal echocardiography and to correlate it with clinical and angiographic variables. METHODS: Thirty patients with right ventricular (RV) MI involving obstruction of the right coronary artery without stenosis of the left coronary artery were included; 18 underwent early reperfusion. Transesophageal echocardiography was performed on all within 5 days of coronary angiography. Follow-up was continued from hospitalization to the present. RESULTS: When patients with right atrial ischemia were compared with those with normal right atrium, the RV wall movement score was significantly greater in the group with right atrial ischemia, severe RV dilatation was more frequent, and association with proximal occlusion of the artery responsible for the MI, as well as absence of right atrial branches and poor collateral circulation, were significant. Hospitalization was more prolonged in this group, and there was a higher incidence of arrhythmias, complete atrioventricular block, and mortality. CONCLUSIONS: Right atrial ischemia associated with RV infarction leads to a higher incidence of complications and higher mortality. Transesophageal echocardiography is a safe, reproducible technique that provides detailed anatomic information about right chambers and aids in the determination of prognosis and therapeutic decisions.

Myocardial perfusion scintigraphy (spect) in the evaluation of patients in the emergency roo with precordial pain and normal or doubtful ischemic ECG. Study 60 cases

Objetivos: Evaluar la utilidad diagnóstica de la centelleografia de perfusión miocárdica con SPECT y Gated-SPECT (GSPECT), en el diagnóstico del síndrome coronario agudo (SCA) en pacientes con dolor precordial y ECG normal o dudoso, dentro de las 6 horas del último episodio de dolor precordial. Métodos: Sesenta pacientes con estas características fueron incluidos. Se realizó en todos los pacientes estudio de perfusión miocárdica con SPECTy Gated SPECT empleando 2 protocolos distintos. Todos los pacientes fueron sometidos a prueba de estrés farmacológico. En 30 casos se realizó angiografía coronaria. Resultados: La perfusión miocárdica en reposo fue anormal o positiva en 25 pacientes (42 por ciento) y normal o negativa en 35 pacientes (58 por ciento). En estos últimos la perfusión se tornó anormal en 15 pacientes (43 por ciento) bajo la prueba de estrés con dipiridamol, y en 19 (54º/0) la perfusión permaneció normal. Este subgrupo se mantuvo libre de eventos coronarios 12 meses posteriores al alta hospitalaria. En el grupo de 25 pts con perfusión positiva en reposo se diagnosticó infarto agudo del miocardio en 7 pacientes, isquemia en 12 y reversibilidad-inversa en 6. La centelleografia de perfusión miocárdica mostró en la fase de reposo una sensibilidad del 61 por ciento (IC 95 por ciento, 39-74 por ciento) y VPN del 71 por ciento (IC 95 por ciento, 58-82 por ciento). En la fase de estrés, la utilidad de la prueba se incrementa en forma significativa alcanzando una sensibilidad del 97 por ciento (IC 95 por ciento,83-99 por ciento), una especificidad del 79 por ciento (IC 95 por ciento, 57-92 por ciento) y lo más sobresaliente, un VPN del 95 por ciento (IC 95 por ciento, 73 por ciento-99 por ciento). Conclusiones El estudio de perfusión miocárdica tiene una sensibilidad del 97 por ciento para identificar a los pacientes con SCA, dolor precordial y ECG de reposo normal o dudoso. En los pacientes con síndrome coronario agudo con riesgo intermedio o bajo en estas técnicas no invasivas de perfusión miocárdica, se obtiene un alto grado de precisión diagnóstica y seguridad, se reducen los internamientos innecesarios así como los costos