Archivos de cardiologia de Mexico最新文献

Objectives: Patients with congenital heart disease with ductus arteriosus-dependent pulmonary flow have as a palliative procedure the placement of a Blalock-Taussig-Thomas fistula (BTTF) or ductal stent (DSt) and subsequently undergoing to definitive palliation or repair. BTTF has been associated with increased morbidity and mortality. The objective of this research is to compare the morbidity and mortality of BTTF versus DSt, as well as their short- and medium-term outcomes.

Methods: The study population was patients undergoing BTTF or DSt placement from January 2012 to December 2022.

Results: 164 patients were identified, 128 with BTTF and 36 with DSt. 87.5% of the BTTF group presented complications, and 22.2% of the DSt group (p < 0.001). The OR for BTTF for development of complications was 19.58 (95%CI: 7.79-51.17). Intensive care unit stay was shortzer in DSt compared to FBTT (MD: -4.69 days; 95%CI: -7.30 to -2.07; I2 = 80%; p = 0.0004). The relative risk of FBTT patients for death was 2.32 (95%CI: 0.755-7.149), but there was no statistically significant difference for mortality (p = 0.135).

Conclusions: Mortality presented a lower tendency in patients with DSt. However, in other variables such as morbidity, hospital stay and reintervention were less frequent in the DSt group and were statistically significant. This evidence is the first in Latin-America and supports DSt as the safest and most effective option compared to FBTT in our setting.

Objective: To analyze the clinical characteristics and natural history of pediatric patients with a diagnosis of vascular ring.

Method: We retrospectively studied the records of 110 patients of pediatric age, from January 2014 to December 2022, with the following variables: age, clinical manifestations, associated cardiac lesions, diagnostic method and surgical approach.

Results: Of the total, 60 (55%) were female and 50 (45%) were male. Diagnosis was made, on average, at 47 months of life. The vascular rings found were aberrant subclavian artery (82.8%), circumflex aorta (8.1%), double aortic arch (6.3%) and left pulmonary artery sling (1.8%). Ninety percent of the cases were associated with other congenital heart disease, mainly tetralogy of Fallot, pulmonary valve atresia and ventricular septal defect. Forty-five percent of the cases produced compression of structures and 77% of the patients were asymptomatic. Twenty-one percent of the patients received surgical treatment of which 35% presented postoperative complications: sepsis (26%), mediastinitis (4.3%) and cardiogenic shock (4.3%). Postoperative mortality was 17%. Within the natural history of symptomatic patients who remained in expectant management, 100% resolved their symptoms.

Conclusions: In this series, the most frequent type of vascular ring was aberrant subclavian artery. Diagnosis is late due to the lack of specificity of its symptoms, being mainly respiratory. The symptoms of mild involvement resolve in most cases, associated with the growth of the affected structures and their laxity.

Objective: To compare body mass index (BMI), waist circumference (WC) and WC-BMI in predicting elevated pulse pressure and to examine how these associations vary by age and sex.

Method: A cross-sectional analysis used data from the Peru Demographic and Health Survey (2018-2023). Poisson regression models with robust variance were employed to evaluate the association between anthropometric measures and elevated pulse pressure (≥ 50 mmHg), adjusting for sociodemographic and lifestyle factors.

Results: WC-BMI showed the most consistent and robust association with elevated pulse pressure compared to BMI and WC. The strength of the association was more significant in adults under 60 years and women. An attenuation of the effect was observed in individuals over 60 years for all anthropometric measures. WC-BMI presented a more linear and stable relationship across different population subgroups.

Conclussions: WC-BMI predicts elevated pulse pressure more precisely than BMI or WC alone. The attenuation of the effect in older adults and the differences by sex highlights the importance of considering demographic factors in evaluating cardiovascular risk.

Objectives: The aim was to determine the relationship between the elevation of ultrasensitive troponin T (hs-cTnT) after percutaneous atrial septal defect (ASD) closure with deficient aortic rim and with standard and specific maneuvers of the intervention.

Method: Baseline hs-cTnT was measured and repeated 6 hours after the procedure. To determine the influence of independent variables with the dependent variable (change in hs-cTnT), a generalized linear mixed model was used.

Results: The total cohort consisted in 106 patients. The median age was 8 years, and 22 patients (21%) were older than 18 years. The hs-TnT before the procedure was 3.7 pg/ml and 6 hours after the intervention was finalized was 72.5 pg/ml. The hs-TnT at 6 hours was similar in patients with sufficient vs. deficient aortic rim. A generalized linear mixed model demonstrated a direct relationship between hs-cTnT change and ASD diameter (β: 2.8; CI: 0.8 to 4.9; p < 0.01) and fluoroscopy time (β: 2.7; CI: 0.6 to 4.7; p < 0.01) and an inverse relationship between hs-cTnT change and patient weight (β: -0.7; CI: -1.1 to -0.3; p < 0.01).

Conclusions: The increase in hs-cTnT after percutaneous ASD treatment was directly related to ASD diameter and the fluoroscopy time and inversely to the patient weight. Aortic rim deficit was not associated with elevation of hs-cTnT.

Objective: The objective is to determinate the association between the degree of aortic valve calcification and the presence of paravalvular leakage (PVL) in Mexican patients who underwent transcatheter aortic valve replacement (TAVR).

Methods: We conducted a retrospective, analytic, cohort. Pooled data were retrospectively analyzed from the patient's files from January 2014 to July 2022. With a median follow-up of 6 months.

Results: We included 83 patients. 31 (37.3%) developed residual PVL. Several factors as male gender (men 58.1% versus women 41.9% p = 0.01), higher gradients previous TAVR (mean 57 mmHg in the group with versus mean 53 mmHg in the group without PVL, p = 0.01), bigger annulus diameters and perimeters as well as reduce left ventricular ejection fraction and a degree of aortic regurgitation previous TAVR were present more frequently in the group of residual PVL. Aortic valve calcification was the only predictor after the bivariate and multivariate analysis that showed an association with the presence of PVL after TAVR. The calculated cut-off value of calcium score was 2970 Agatston units, with a sensitivity of 70% and a specificity of 60% as a predictor for PVL.

Conclusions: The results are consistent with the previous data and there are no greater differences in the Mexican population. The severity of the aortic valve calcification is an independent predictor of PVL in patients who underwent TAVR.