Archivos Peruanos de cardiologia y cirugia cardiovascular最新文献

Objective: To determine the clinical characteristics, therapeutic and in-hospital mortality of patients with mechanical complications post myocardial infarction.

Materials and methods: Observational, descriptive and retrospective study. We included patients >18 years old with a diagnosis of mechanical complication post myocardial infarction hospitalized at the Instituto Nacional Cardiovascular- INCOR in Lima -Peru, from January 1, 2017 to December 31, 2021. Variables like clinical characteristics, treatments, complications, and in-hospital mortality were studied.

Results: We found 37 cases, with a predominance of males (73.0%) and a median age of 73 years old. The location of the myocardial infarction was 51.4% in the anterior wall and 43.2% in the inferior wall. The patients received reperfusion therapy with fibrinolysis in 5 cases (13.5%), coronary angioplasty in 5 (13.5%), and 73% received only medical management prior to the diagnosis of mechanical complications. Of the 37 patients, 13 (35.1%) presented isolated ventricular free wall rupture, 12 (32.4%) isolated interventricular septum rupture, 10 (27.0%) the combination of ventricular free wall rupture and interventricular septum, and 2 (5.4%) papillary muscle rupture. In-hospital mortality was 51.4%.

Conclusions: The ventricular free wall rupture was the most frequent complication, patients with mechanical complications after myocardial infarction still maintain high intra-hospital mortality rates, mainly in those who did not have adequate surgical treatment.

Objective: To characterize compliance with the annual curricular program of second and third-year cardiology residents in hospital of Lima-Peru during the COVID-19 pandemic.

Materials and methods: A cross-sectional study was conducted, through a questionnaire applied to seventy-eight cardiology residents from the second and third year of specialty. We evaluated the compliance with rotations in clinical fields, individual compliance with the annual program, and the achievement of minimum training standards.

Results: Compliance with rotations in clinical fields was highly variable (from 7.9% in Cardiac Rehabilitation for the second year to 90.9% for imaging in cardiology). Regarding individual compliance, 98.7% did not manage to comply with the annual program. Finally, only the standard of evaluation by radionuclides of myocardial function and perfusion was achieved by all residents, concerning the scope of the other achievements, variations are reported from 4.4% for performing stress tests to 75.8% in the to participate in interventional cardiology procedures. Associations were found between compliance with rotations with the type of health organization and type of university.

Conclusions: The COVID-19 pandemic has considerably affected the training of cardiology residents, mainly due to non-compliance with the annual curriculum.

Objective: This study aims to describe the clinical, electrophysiological and therapeutic characteristics of pediatric patients with supraventricular tachycardia undergoing radiofrequency ablation.

Materials and methods: Observational, descriptive, retrospective study of children admitted for supraventricular tachycardia treatment at the Instituto Nacional de Salud del Niño during 2018 to 2021.

Results: Data from 62 procedures were collected, corresponding to 59 patients (mean age: 9.91 years, 61% male), 23% of procedures were performed in patients under 15kg, and two were in patients under 5kg. 63% of patients had a structurally normal heart, while 37% had some type of congenital heart disease, the most common being Ebstein's anomaly. The most widely used group of drugs were beta-blockers, mainly propranolol. Among the arrhythmias treated, 21.7% had preexcitation Syndrome, 33.3% had at least one hidden accessory pathway, 5% corresponded to permanent reciprocating junctional tachycardia, 5% intranodal tachycardia, 11.7% atrial tachycardia, 10 % atrial flutter, 5% had other types of tachycardia and in 5 cases no tachycardia was induced. Of the total procedures, 76% corresponded to electrophysiological study and ablation, four patients recurred.

Conclusions: The most common supraventricular tachycardia substrate in children was the presence of some accessory pathway. Radiofrequency catheter ablation could be applied in children with a high success rate and a low complication rate.

Homozygous familial hypercholesterolemia (HFH) is a rare and life-threatening disease that can manifest as coronary artery disease or severe aortic stenosis before twenties. We present the case of a male adolescent who was hospitalized with a clinical diagnosis of HFH and severe aortic stenosis. He underwent aortic valve replacement with mechanical prosthesis and aortic annulus enlargement, and two aortocoronary bypasses were implanted due to an intraoperative complication. The patient evolved favourably and was discharged with combination therapy with high-intensity statins and ezetimibe.

Objectives: During acute infection by the SARS-CoV-2 virus, myocardial involvement has been demonstrated; it is unknown if cardiovascular sequelae in patients recovered from this infection and if these are associated with global morbidity and mortality. The objective of this study was to compare myocardial deformation in patients recovered from mild SARS-CoV-2 virus infection with healthy controls.

Materials and methods: This was a cross-sectional observational study that included 33 subjects recovered from mild SARS-CoV-2 infection, who were diagnosed in the previous three to six months, and 31 healthy volunteers, both groups free of cardiovascular risk factors. The study of myocardial deformation was performed using echocardiography with the speckle tracking modality. Clinical and anthropometric variables were compared.

Results: The 2D global longitudinal strain of the left ventricle was lower in the subjects recovered from mild SARS-CoV-2 infection than the controls (-20.2% ± 2.6 v -21.6% ± 2.4; p: 0.036). Both groups presented differences in the three ventricular levels, significant at the apical level (-21.2 ± 4.0 vs -23.4% ± 4.2; p: 0.044). The effect by levels shows an inverse Takotsubo pattern. The left ventricular ejection fraction was preserved in both groups (p: 0.153).

Conclusions: Left ventricular myocardial deformation is affected in subjects recovered from mild SARS-CoV-2 infection, while the ejection fraction was found in normal ranges. Our study shows a potential role of global longitudinal strain in the detection of subclinical myocardial alterations in patients who had SARS-CoV-2.

The ankle-brachial index (ABI) is the relationship between the systolic blood pressure taken at the ankle level and the brachial artery. A pathological ABI (<0.90 or >1.40) indicates the presence of peripheral artery disease (PAD). Many studies indicate the great utility of this test in the diagnosis of PAD due to its ease of use, reproducibility, low cost, and high cost-effectiveness. This evaluation can be directly correlated with cardiovascular morbidity and mortality; however, it has recently been confirmed that a low ABI can be a predictor of major cardiovascular events, as it is related to diabetes mellitus, chronic coronary disease, stroke, and more. The objective of this work was to review the current evidence on the importance of ABI in the diagnosis of PAD and its main role as a predictor of cardiovascular morbidity and mortality.

Hypertrophic cardiomyopathy is the more commonly (60 to 70 percent) genetically determined disease of the heart muscle caused by mutations in one of several sarcomere genes that encode components of the heart's contractile apparatus. It is characterized by disproportionate hypertrophy in the absence of a secondary cause. The clinical presentation is variable, ranging from asymptomatic to heart failure or sudden cardiac death. Hypertrophy and abnormal ventricular configuration can result in dynamic left ventricular outflow obstruction in most cases. The goal of therapeutic interventions is largely to reduce dynamic obstruction, with different therapeutic options encompassing risk stratification for sudden death, genetic screening, lifestyle modifications, and drugs. A case of hypertrophic septal cardiomyopathy, a fairly frequent and under-diagnosed entity, is discussed below.

The presence of decompensated heart failure continues to be a condition with high rates of hospitalization, impact on the health system, and quality of life for those who suffer it. The mainstay of treatment in these cases are diuretics. However, the resistance to this pharmacological group may occasionally occur, generating an inadequate negative fluid balance and persistence of congestion with negative clinical outcomes. Hypertonic saline solution with high doses of diuretic emerges as a therapeutic option for this group of patients with probable physiological, and clinical benefits on hospitalization and re-admission rates due to heart failure decompensation. A review of the most relevant aspects and benefits of this combination is discussed in this article.

Pentalogy of Cantrell is a rare entity characterized by a combination of alterations, among which the following stand out: defects of the pericardium, heart, diaphragm, lower third of sternum and abdominal wall. On the other hand, congenital cardiac diverticulum is a rare malformation whose presentation is associated with Cantrell's pentalogy in some cases. We present the case of a child with Cantrell's pentalogy who, during follow-up, was diagnosed with left ventricular diverticulum, which required surgical management with a favorable outcome. Addressing these conditions requires the use of cardiovascular images that allow timely decision-making by the treating team.