Archivos del Instituto de Cardiologia de Mexico最新文献

A case of direct communication between right pulmonary artery and left atrium is reported. The diagnosis was made before surgical correction. A surgical ligation of the fistula resolved the cyanosis of the patient. Selective angiocardiogram of the right pulmonary artery 4 months after surgery revealed no residual shunt. This very rare malformation should be considered in the clinical setting of unexplained cyanosis. This is the number 50 case reported in the literature.

We present the initial experience of closing of patent ductus arteriosus (PDA) with a new device; Gianturco-Grifka, at the General Hospital of The Medical Center "La Raza". The patient was a 4 year's old girl, in whom we detected continuous murmur in the second intercostal space, echocardiography showed a long conical patent ductus arteriosus 4.9 mm of diameter, systolic pressure of the pulmonary artery was 35 mm Hg with QP/QS 1.6:1. Hemodynamic study revealed a long conical ductus arteriosus 5 mm of diameter, type A1 from Krichenko classification. We proceeded to occlude the PDA with a Gianturco-Grifka device of 7 mm. Immediately after the PDA occlusion the shunt disappeared, there were no complications during the procedure. More cases are needed to determine long term benefits and limitations, of this procedure. However we conclude that technically it is easy to use. There is greater decrease of residual shunt that the one reported with other devices.

Unlabelled: Primary and secondary prevention trials have demonstrated that niacin improves the lipid profile and reduces coronary morbidity and mortality.

Objective: To investigate the safety and efficacy of niacin in daily doses of 1.5 and 3.0 g in patients with ischemic heart disease and dyslipidemia.

Patients and methods: Sixty one male and female patients, aged 30 to 70 years were included. Thirty two patients were later excluded; 18 for adverse events and 14 for causes not related to niacin.

Results: In the 29 patients that finished the study, niacin in a dose-dependent manner, significantly reduced the levels of total cholesterol, LDL-cholesterol, triglycerides, apoB and LDL-C/HDL-C ratio, and significantly increased HDL-Cholesterol concentrations; a decrease in lipoprotein(a) was observed with both dosages, but the change was significant only with the 3.0 g/day. In 11 patients (38%) lipids and lipoproteins reached ideal concentrations. In 15 patients (52%) C-LDL/C-HDL was lower than or equal to 3.5 at the end of the study.

Conclusions: Our results suggest that niacin is well tolerated by 62% of the patients. Niacin is a safe, effective and a low cost alternative in the treatment of patients with ischemic heart disease and dyslipidemia.

This article describes the first case in Mexico city that received a three chamber pacing system. A 40 year-old man with dilated cardiomyopathy with variant cardiac rhythm and bradycardia. The three leads were introduced by right subclavian approaches. The right chamber leads were placed in atrial's appendage and in the right ventricular outflow tract and the last one was placed in the great cardiac vein. The two ventricular lead were connected a Y-connector to the ventricular channel of a standard bipolar DDDR pacemaker. The right ventricular lead was connected to the distal pole (anode) and the left ventricular lead to the proximal pole (cathode). Eight days later, the patient's clinical status improved, his functional class improved from IV to II and his left ventricular ejection fraction increased from 30% to 35% by conventional ventriculography. In this type of patients the improvement in cardiac output is this result an of increase in left ventricular filling, reduced mitral and tricuspid regurgitation a better synchronization of ventricular contraction. Multisite pacing has added a mayor complexity to contemporary pacing and a modification of the standard pacer-maker code should be considered to accommodate multisite pacing. The letter in the first and second position might be T (three) or F (four) according to number of pacing chamber and also the letter "t" may be suitable to designate trigger in the third position. We conclude that implant of three chamber pacing in patients with dilated cardiomyopathy is technically feasible. An improvement in the patient's condition may be obtained and a modification in standard pacemaker code is necessary.

Unlabelled: To obtain more information about the role of the pericardium in the setting of acute right ventricular infarction (ARVI) we studied the behaviour of the ventricular function curves (VFC) and the relationship of the ventricular end-diastolic pressures (R-VEDP-RV:LV) in two groups of dogs. Group A. (n = 12) Control (C), ARVI, Pericardiectomy (P). A parabolic behaviour of the C VFC was noted (r2 = 071) and it's flexion point (FP) was found in 13. +/- 2 mmHg. After the ARVI the right (R) VFC was shifted downwards and to the right and the FP was documented in 18 +/- 2 mmHg (p < 0.05) in relation to C VFC. After P the RVFC was displaced upwards and to the left in relation to ARVIC RVFC (p < 0.05). The C R-VEDP-RV:LV = 0.75 and only a trend to equalization after the ARVI and after P were noted (0.91, 0.84, respectively) (p = ns). Group B (n = 12). Control (C), P, ARVI. The RVFC after P was shifted up and to the left in relation to the C RVFC (p < 0.05) and the FP = 10 +/- 2 mmHg. After P in the setting of ARVI the RVFC was shifted downward and to the right in relation to P RVFC (p < 0.05). After P the R-VEDP-RV:LV = 0.45 and statistical significant equalized in the condition of ARVI without pericardium (0.95, p < 0.05).

Conclusion: Ours results support a partial restrictive role of the pericardium in the origin of the low cardiac output (LCO) in ARVI. Because, equalization of the R-VEDP-RV:LV is not only due to the restraining pericardial effect but is also due to right ventricular myocardial ischemia. The FP (18. +/- 2 mmHg) found seems to be the top value of RVEDP for volume infusion in experimental ARVI. Hemodynamic finding that could be useful in the preload volume management for humans with ARVI and LCO or systemic hypotension.

We report the results obtained of 23 patients in whom 25 intracoronary stents (SAQ) were placed. All had atherosclerotic coronary artery disease with different clinical types of presentation, such as stable angina, unstable angina, myocardial infarction. In others cases the reason for the procedure was postangioplasty complications. The majority of cases had complex lesions: total occlusion, long plaques and patients in critical and unstable state. The immediate results were considered satisfactory due to the fact that there was angiographic improvement compared to just conventional angioplasty, the final flow was TIMI-3 in 23 and TIMI-2 en two others, in these cases the initial flow was TIMI-0. The arterial diameter improved compared to prior angioplasty. Acute thrombosis occurred in one case and was resolved with repeated dilatation, in two cases the atherosclerotic plaque protruded within the stent, in both cases the occlusion was considered non significant, without modifications in the flow. All patients had a 3 months follow up with treadmill test. In 10 cases angiography was indicated, in 4 due to positive treadmill. Restenosis was resolved in three cases, in another coronary arterial by-pass was necessary. In all other cases angiographic findings were normal, included one patient with two stents.