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Introducción. Existen pocos datos con respecto a los efectos de la carbamacepina y sus derivados en el aparato cardiovascular; además, el mecanismo molecular y su sitio de acción celular no son claros. Objetivo. Evaluar los efectos inducidos por el derivado carbamacepina-alquino sobre la presión de perfusión, la resistencia vascular y la presión ventricular izquierda. Materiales y métodos. Los efectos de la carbamacepina y del derivado carbamacepina-alquino sobre la presión de perfusión, la resistencia vascular y la presión ventricular izquierda fueron evaluados en un modelo de corazón aislado de rata (Langendorff). Resultados. Se encontró que: 1) el derivado carbamacepina-alquino (1x10-9 mM) incrementa la presión de perfusión y la resistencia vascular en comparación con la carbamacepina (1×10-9 mM); 2) los efectos del derivado carbamacepina-alquino (1×10-9-1×10-4 M) sobre la presión intraventricular no fueron inhibidos por metoprolol o prazosina (1×10-6 mM); 3); el nifedipino (1×10-6 mM) bloquea los efectos ejercidos por el derivado carbamacepina-alquino (1×10-9-1×10-4 M) sobre la presión intraventricular, y 4) el efecto del derivado de carbamacepina (1×10-9 mM) incrementa la concentración de calcio intracelular a través del tiempo (3 a 18 minutos); sin embargo, en presencia de nifedipino (1×10-6 mM), este efecto disminuye significativamente (p=0,005). Conclusiones. La actividad ejercida por el derivado carbamacepina-alquino sobre la presión de perfusión, la resistencia vascular y la presión intraventricular, involucra la activación del canal de calcio de tipo L, lo que trae como consecuencia indirecta cambios en los niveles de calcio intracelular y, subsecuentemente, induce un efecto inotrópico positivo.

Introduction and Objectives: Pulmonary vascular remodeling is common among patients with advanced heart failure. Right heart catheterization is the gold standard to assess pulmonary hypertension, but is limited by indirect measurement assumptions, a steady-flow view, load-dependency, and interpretation variability. We aimed to assess pulmonary vascular remodeling with intravascular optical coherence tomography (OCT) and to study its correlation with hemodynamic data., Methods: This observational, prospective, multicenter study recruited 100 patients with advanced heart failure referred for heart transplant evaluation. All patients underwent right heart catheterization together with OCT evaluation of a subsegmentary pulmonary artery., Results: OCT could be performed and properly analyzed in 90 patients. Median age was 57.50 [interquartile range, 48.75-63.25] years and 71 (78.88%) were men. The most frequent underlying heart condition was nonischemic dilated cardiomyopathy (33 patients [36.66%]). Vascular wall thickness significantly correlated with mean pulmonary artery pressure, pulmonary vascular resistance, and transpulmonary gradient (R coefficient=0.42, 0.27 and 0.32 respectively). Noninvasive estimation of pulmonary artery systolic pressure, acceleration time, and right ventricle-pulmonary artery coupling also correlated with wall thickness (R coefficient of 0.42, 0.27 and 0.49, respectively). Patients with a wall thickness over 0.25mm had significantly higher mean pulmonary pressures (37.00 vs 25.00mmHg; P=.004) and pulmonary vascular resistance (3.44 vs 2.08 WU; P=.017)., Conclusions: Direct morphological assessment of pulmonary vascular remodeling with OCT is feasible and is significantly associated with classic hemodynamic parameters. This weak association suggests that structural remodeling does not fully explain pulmonary hypertension., (Copyright © 2022 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Balloon pulmonary angioplasty (BPA) for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is becoming widely accepted. Procedural refinement has reduced complications. Our primary objective was to analyze the results and complications of the first national BPA program., Methods: Observational, prospective series that included all consecutive BPA procedures in inoperable CTEPH patients between May 2013 and February 2017 performed at a single institution. We analyzed clinical and hemodynamic improvement, reperfusion pulmonary edema, and mortality., Results: We performed 156 BPA sessions in 46 patients. Pulmonary vascular resistance was reduced by 44% (10.1 ± 4.9 vs 5.6 ± 2.2 WU; P < .001) and mean pulmonary arterial pressure by 23.6% (49.5 ± 12 vs 37.8 ± 9mmHg; P < .001); cardiac index rose by 17.1% (2.3 vs 2.7 L/min/m 2 ; P = .002), N-terminal pro-B-type natriuretic peptide levels were reduced by 79.2% (1233 ± 1327 vs 255.5 ± 318 pg/dL; P < .001) and the 6-minute walk test distance improved by 74 meters (394 vs 468 m; P = .001). Reperfusion pulmonary edema developed after 9 interventions (5.8%) and 1 patient died (mortality 2.1%)., Conclusions: Due to its current refinement, BPA has become a safe and effective treatment for inoperable CTEPH that improves hemodynamics, functional status, and biomarkers with a low rate of severe periprocedural complications and mortality., (Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

We present a 45-year-old patient with Klinefelter syndrome, with a history of type 2 diabetes mellitus, obesity, dyslipidemia, obstructive sleep apnoea syndrome and masked arterial hypertension. The purpose of this presentation is to draw attention to the increased cardiovascular risk in these patients and to review the data in the literature on this risk., (Copyright © 2018 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: Psoriasis is associated to endothelial dysfunction, which causes impaired vascular functioning. TNF-α blockers have shown the ability to improve vascular functioning in psoriasis. The nailfold vessel resistance index (NVRI) assesses microvascular functioning at nailfold. The objectives of the study is to assess the effect of the TNF-α inhibition with adalimumab on NVRI., Material and Methods: Quasi-experimental study. Fifteen patients with moderate-severe psoriasis received adalimumab 40mg sc according to label information. Participants were assessed at baseline and at 12, 24 and 52 weeks after study intervention., Results: A reduction of -0.09±0.02 (P<.01) in NVRI and a -11.2±2,41ng/ml (P<.001) in E-selectin was observed at week 52., Conclusions: Adalimumab could produce a progressive and sustained reduction of vessel resistance at nailfold and E-selectin in patients with psoriasis., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

Hypertension is the main cardiovascular risk factor affecting 25% of women. Hormone changes and hypertension after menopause may lead to higher target organ damage and cardiovascular disease such as increased arterial stiffness, coronary diseases, chronic heart failure and stroke. The physiopathological mechanisms involved in the development of hypertension and cardiovascular diseases in menopausal women are controversial. There are pharmacokinetic and pharmacodynamic differences in both sexes, the women have more coughing when using the converting-enzyme inhibitors, more cramps when using thiazide diuretics and more oedema in the inferior limbs when using calcium antagonists. The aim of this review is to analyse possible physiopathological mechanisms involved in hypertension after menopause and to gain a better understanding of the biological effects mediated by vascular ageing in women when the level of oestrogen protective effect decreases over the vascular system., (Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Hypertension is a haemodynamic disorder resulting from a persistent mismatch between cardiac output and peripheral resistance. Hypertension undergoes haemodynamic progression during its natural history. Impedance cardiography is a method of evaluating the cardiovascular system that obtains haemodynamic information from beat to beat through the analysis of variations in the impedance of the thorax on the passage of an electric current. Impedance cardiography unmasks the haemodynamic deterioration underlying the increase in blood pressure as age and systolic blood pressure increases. This method may help to improve blood pressure control through individualized treatment with reduction of peripheral resistance, maintenance of cardiac output or its increase, improvement of arterial compliance and preservation of organ-tissue perfusion. It is useful in the management of patients with resistant hypertension, since a greater percentage of patients controlled with changes in the treatment in relation to the haemodynamic measurements are obtained. Impedance cardiography is important and has prognostic utility in relation to a haemodynamic deterioration pattern and increased cardiovascular events., (Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Viewing heart failure as a clinical syndrome delays treatment and impairs prognosis, which leads to the question: Is it possible to make an early diagnosis based on echocardiography studies?, Methods: It was carried out a review of medical records of asymptomatic heart disease patients, with no treatment, who were studied by echocardiogram in order to measure cardiac output (CO) and total peripheral vascular resistance (TPVR), for which mean blood pressure was calculated. It is described the hemodynamic regime on the basis of the proportion of three integrated groups according to CO and TPVR., Results: The hemodynamic regime in 200 heart disease patients was hypokinetic in 36%, hyperkinetic in 17% and eukinetic in 47%., Conclusions: Non-invasive hemodynamic study identified asymptomatic heart failure in one third of the cases.

Eisenmenger syndrome (ES) is a complex combination of cardiovascular abnormalities defined as pulmonary hypertension with investment or bidirectional flow through an intracardiac or aortopulmonary communication, usually secondary to a congenital heart disease not resolved promptly. It carries a significant risk of perioperative mortality, with an incidence close to 30% for non-cardiac surgery. We report the anaesthetic management in a ES patient undergoing breast surgery, which was successfully performed under general anaesthesia combined with thoracic analgesic blocks. The main pathophysiological implications of this syndrome are discussed, emphasizing the importance of appropriate preoperative evaluation with thorough assessment of associated risks, careful intraoperative management, and postoperative care, which should be initially performed in a critical care unit. The need to individualize and tailor the choice of drugs and anesthetic technique to the hemodynamic condition of the patient and the surgical procedure is highlighted., (Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Recent advances in genetics have led to the discovery of new genes associated with pulmonary arterial hypertension, such as TBX4 and KCNK3. The phenotype and prognosis associated with these new genes have been scarcely described and their role in the Spanish population is unknown. The aim of this study was to characterize the genetics of a Spanish cohort of patients with idiopathic and hereditary pulmonary arterial hypertension and to describe the phenotype and prognostic factors associated with BMPR2 and the new genes (KCNK3 and TBX4)., Methods: A total of 165 adult patients were screened for BMPR2, KCNK3, and TBX4 mutations, 143 with idiopathic pulmonary arterial hypertension and 22 with hereditary pulmonary arterial hypertension. Baseline characteristics and survival were compared among the different subgroups and predictors of poor outcomes were analyzed. We also performed family screening., Results: The genetic study identified a possibly associated mutation in 11.10% of the idiopathic cases (n = 16) and in 68.18% of the hereditary cases (n = 15). There were 19 mutations in BMPR2, 4 in TBX4, and 3 in KCNK3. The forms associated with TBX4 showed the highest survival rate (P < .01). Advanced functional class at diagnosis was the only factor associated with poor outcomes in the hereditary forms. In the family screening, 37.5% of relatives tested positive., Conclusions: The genetics of pulmonary arterial hypertension in the Spanish population may differ from other populations, with a lower proportion of BMPR2 causative mutations. In our cohort, TBX4-related forms of pulmonary arterial hypertension showed a more benign course and late diagnosis was the only predictor of adverse outcomes in the hereditary forms of the disease., (Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Diabetes mellitus is a chronic degenerative disease characterized by elevated hyperglycemia, triggering a series of processes and culminating in chronic, uncontrolled, cellular and vascular damage in different organs., Objective: To assess whether the elevated glycosylated hemoglobin, microalbuminuria, and the time evolution of more than 10 years of diabetes mellitus are associated with elevated resistance index of the interlobar renal arteries assessed with pulsed Doppler in patients with metabolic uncontrolled diabetes mellitus., Material and Methods: Transversal-analytical, observational, prospective study that included diabetic patients attending UMAE abdominal ultrasound in 25 of IMSS, from October 15, 2014 to November 15, 2014, which was performed for pulsed Doppler index resistance of vascular interlobar renal arteries and was collected from electronic medical records: age, sex, glycated hemoglobin, and microalbuminuria. The association between metabolic uncontrolled diabetes mellitus was analyzed with the elevation of resistance index by χ(2) test or Fisher, being significant with a value of p < 0.05, and to assess the magnitude of the association that was measured with a response magnitude of 95%., Results: 63 patients with type 2 diabetes were examined, with an average age of 52.3 ± 14.2 years, 41 were older than 50 years (65.0%), 26 with hypertension (41.2%), 32 with higher levels of glycated hemoglobin 7 (50.8%), 35 with normoalbuminuria (55.6%), 28 with microalbuminuria (44.4%), and 39 with a time evolution of diabetes of more than 10 years (61.9%). We observed a statistically significant difference between microalbuminuria and increased duration of diabetes mellitus with high resistance index., Conclusion: The alterations in renal microvasculature conditioned by the occurrence of microalbuminuria in diabetic nephropathy and the duration of diabetes are strongly associated with higher resistance index.

Introduction: Pulmonary thromboendarterectomy is the treatment of choice in chronic thromboembolic pulmonary hypertension. We report our experience with this technique., Methods: Between February 1996 and June 2014, we performed 106 pulmonary thromboendarterectomies. Patient population, morbidity and mortality and the long-term results of this technique (survival, functional improvement and resolution of pulmonary hypertension) are described., Results: Subjects' mean age was 53±14 years. A total of 89% were WHO functional class III-IV, presurgery mean pulmonary pressure was 49±13mmHg and mean pulmonary vascular resistance was 831±364 dynes.s.cm(-5). In-hospital mortality was 6.6%. The most important post-operative morbidity was reperfusion pulmonary injury, in 20% of patients; this was an independent risk factor (p=0.015) for hospital mortality. With a 31-month median follow-up (interquartile range: 50), 3- and 5-year survival was 90 and 84%. At 1 year, 91% were WHO functional class I-II; mean pulmonary pressure (27±11mmHg) and pulmonary vascular resistance (275±218 dynes.s.cm(-5)) were significantly lower (p<0.05) than before the intervention. Although residual pulmonary hypertension was detected in 14 patients, their survival at 3 and 5 years was 91 and 73%, respectively., Conclusions: Pulmonary thromboendarterectomy offers excellent results in chronic thromboembolic pulmonary hypertension. Long-term survival is good, functional capacity improves, and pulmonary hypertension is resolved in most patients., (Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.)

Introduction: Pulmonary endarterectomy (PE) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to analyze our experience in the medical and surgical management of CTEPH., Methods: We included 80 patients diagnosed with CTEPH between January 2000 and July 2012. Thirty two patients underwent PE and 48 received medical treatment (MT). We analyzed functional class (FC), six-minute walking distance (6MWD) and pulmonary hemodynamics. Mortality in both groups and periods were analyzed., Results: Patients who underwent PE were younger, mostly men, and had longer 6MWD. No differences were observed in pulmonary hemodynamics or FC at diagnosis. One year after treatment, all PE patients versus 41% in MT group were at FCI-II. At follow-up, the PE group showed greater increase in 6MWD, and greater reduction in mean pulmonary arterial pressure and pulmonary vascular resistance than the MT group (P<.05). Overall survival in the MT group at 1 and 5years was 83% and 69%, respectively. Conditional survival in patients alive 100days post-PE at 1 and 5years was 95% and 88%, respectively. Surgical mortality in operated patients in the first period (2000-2006) was 31,3%, and 6,3% in the second (2007-2012)., Conclusions: PE provides good clinical results, and improves pulmonary hemodynamics in patients who successfully overcome the immediate postoperative period. After a learning period, the current operatory mortality in our center is similar to international standards., (Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.)

Background and Objectives: Vitamin D deficiency and parathyroid hormone (PTH) are associated with an increased cardiovascular risk and arterial stiffness. The aim of our study is to compare the cardiovascular risk in subjects with low vitamin D, attending to the PTH concentration, as well as evaluating the response after administration of vitamin D., Patients and Methods: Prospective study of patients with a concentration of 25(OH)-vitamin D below 30nmol/l. We evaluated vascular risk parameters as blood pressure, arterial stiffness, lipid profile and glucose metabolism. Patients received vitamin D supplements for 3 months, after which the previous parameters were reassessed., Results: A total of 32 patients were included. Those with PTH over 65pg/ml were older, had worse renal function, higher systolic blood pressure, pulse pressure and arterial stiffness. Treatment with vitamin D showed a statistically significant trend to lower blood pressure and pulse wave velocity., Conclusions: The increase in PTH in patients with low vitamin D involves poor control of blood pressure and increased vascular stiffness. Vitamin D replacement shows a tendency to reduce these parameters., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Background: The central venous catheter prevalence as a permanent hemodialysis vascular access is growing in the last years. However, there is no consensus in the scientific community about what is the most appropriate lock solution to avoid complications., Aim: To compare the effectiveness and the cost between heparin 20 IU/ml (SH20) lock solution versus usual pattern (UP), consisted on 5% heparin/5000 IU urokinase lock solution in hemodialysis catheters with patency problems., Methodology: Experimental comparative study. Patients with a permanent hemodialysis central venous catheter with patency problems were included. Catheters were locked with SH20 during 6 sessions and with 5% heparin/5000 IU urokinase during another 6 sessions, depending on the patient., Results: Of 50 patients in our unit, 7 fulfill the inclusion criteria. 42.9% had arterial branch resistance and 57% both branches resistance. Blood flow and venous pressure was similar in both periods. Blood lines reversal percentage was 15.85% using SH20 and 20.61% for UP, not statistically significant in all cases. The lock cost was 1 Euro/session with SH20 and 2.78 Euro/session with UP., Conclusions: 20 IU/ml heparin as a lock solution for hemodialysis catheters is as effective as the usual patterns but involves less systemic risk to the patient, reduced workload for nurses and lower cost per session.

Cardiovascular failure is a common disorder in critical care medicine. When admitted to the ICU, patients with hemodynamic deterioration should be examined rapidly to correctly assess the main determinants of cardiovascular function (preload, afterload and contractility). This review examines the assessment of contractility and afterload involving the combined use of several hemodynamic monitors, which allows different approaches to the same problem, with a view to improving the efficiency of management and treatment in critically ill patients., (Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.)

Introduction: This study has aimed to assess the hemodynamic parameters, Renal Resistive Index (RI), Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV) and Blood Flow of the Renal Artery (FR) by Doppler Ultrasound for diagnosis and monitoring postsurgical partial chronic obstructive uropathy., Material and Methods: Fifty pigs were used. The experiment was divided into three phases. Phase I consisted of a duplex-Doppler evaluation of the both kidneys to determine the parameters under study. The ratio of each index is calculated as the difference between the value of study kidney and the contralateral. After, a fluoroscopic examination was performed by compressive cystography, excretory urography and retrograde ureteropyelography. Finally, a model of partial right ureteral obstruction was created. After six weeks of the obstructive model, Phase II was begun with the diagnosis of the uropathy, by means of the aforementioned diagnostic methods and the endourological treatment was completed. Phase III is a follow-up performed at 6 months of treatment using the same methods as in the previous phases., Results: Of the parameters studied, the EDV and its ratio showed greater sensitivity and specificity as a diagnostic marker of obstructive uropathy. In the postoperative monitoring, it was observed that the RI and the EDV returned to baseline levels, with the baseline values., Conclusions: The ΔEDV and its ratio is the parameter that shows the greater efficacy for the diagnosis of chronic partial obstructive uropathy, however, it is insufficient to avoid conventional diagnostic techniques. All the parameters, mainly the EDV, have proven useful as complementary tests for monitoring after endourologic resolution of obstructive uropathy., (Copyright © 2011 AEU. Published by Elsevier Espana. All rights reserved.)

Objective: To analyze the relationship between pulse wave velocity (PWV) and central blood pressure evaluated by augmentation index (AIx) in hypertensive patients with kidney disease., Methods: 406 hypertensive patients with normal renal function and 72 with kidney disease. Arterial stiffness was estimated with the PWV and the AIx. We followed the 2007 European Guidelines of Hypertension criteria to assess the presence or absence of kidney disease., Results: PWV was 8.98 ± 2.15 and 10.17 ± 3.01 m/s (p <0.05) and AIx 30.06% ± 12.46 and 30.23% ± 12.56 (p >0.05) in hypertensive patients with normal renal function and kidney disease, respectively. Multiple regression analysis showed the renal function as an important determinant of PWV, but not AIx., Conclusion: In hypertensive patients with renal disease PWV is increased, but not the AIx. We believe that the AIx is not a reliable measure of arterial stiffness in hypertensive patients with kidney disease.

Background and Objectives: Pulmonary thromboendarterectomy (PTE) is considered the potential curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH). We analysed the results of the PTE application in our institution., Patients and Methods: From February 1996 to December 2007, 30 patients with CTEPH underwent video-assisted PTE. Preoperative hemodynamic data were: systolic pulmonary artery pressure (SPAP) 87+/-17mmHg, mean pulmonary artery pressure (MPAP) 51+/-11mmHg, pulmonary total resistance 1067+/-485dynes x s x cm(-5), pulmonary vascular resistance 873+/-389dynes x s x cm(-5) and cardiac index 2.2+/-0.5l/min/m(2). We analysed the influence of several factors on hospital mortality and survival, and we performed partial analysis of mortality since 2004., Results: PTE resulted in significant improvements in SPAP (P<0.001), MPAP (P=0.001) and cardiac index (P<0.001). Hospital mortality was 17% (5/30) (95% confidence interval, 6%-35%). From 2004, it dropped to 5% (1/20) (95% confidence interval, 0%-25%). Hospital mortality was influenced by preoperative pulmonary total resistance, preoperative pulmonary vascular resistance, postoperative SPAP, reduction of SPAP, reduction of MPAP, reperfusion pulmonary oedema and residual postoperative pulmonary hypertension (P=0.036; P=0.018;P=0.013; P=0.050; P=0.050; P=0.030; P=0.045). Survival after PTE, including hospital mortality, was 76+/-9% at 10 years. Through long-term follow-up, functional status (P=0.001), 6min walking distance (P=0.001), end-diastolic right ventricle size (P<0.001), and tricuspid regurgitation (P<0.001) significantly improved., Conclusions: PTE effectively reduces pulmonary hypertension and offers CTEPH patients a substantial improvement in survival and quality of life.

The term pulmonary vascular resistance [PVR] describes, in part, the forces opposing the flow across the pulmonary vascular bed. The equation traditionally used is based on the assumption that the pulmonary capillaries, as well as some others vessels in series behave like a Poiseuille resistance. This assumption implies a laminar type of flow of a homogeneous Newtonian fluid, however blood is not a Newtonian fluid and flow is pulsatile in the pulmonary circulation. Neglecting these factors [which only slightly undermines the application of the equation] and others as well [like distension and recruitment of the vessels], will, however, not give us a true clinically practical solution for the calculation of PVR, because the concept of the equation is only true or partially true for part of the pulmonary circulation. In other parts of the lung, flow depends mainly on the behaviour of capillaries as a Starling resistor. If we considered always pulmonary venous pressure [measured clinically as left atrial pressure or pulmonary wedge pressure] as the effective downstream pressure for the calculation of PVR and we ignore or disregard the existence of a significant "critical closing pressure" [whatever the cause] in the lung it will lead to additional erroneous concept regarding PVR calculations and, in addition for the real hemodynamic conditions of the pulmonary vascular bed. Because, at least two different models of perfusion exist in the lung it is inadmissible from a theoretical point of view to calculate PVR, based on only in one of these models. According to the present knowledge of the pulmonary circulation hemodynamics, an improved definition for the PVR could be obtained: 1. by a multipoint pulmonary vascular pressure/flow plot at high flows and 2. with the use of the pulmonary artery occlusion pressure [PAOP] in addition to the determination of the pulmonary wedge pressure technique [PWP], in order to establish the estimated downstream pressure of the pulmonary circulation at zero flow. Therefore, pulmonary hemodynamic determinations of the PVR are better defined with the analysis of the pressure-flow relationships in addition to the information derived from the PAOP/PWP measurements. However, if none of the previous pressure-flow relationships [in order to obtain the slope = PVR at high flows] or the effective downstream pressure measurements [in order to estimate the critical closing pressure at zero flow] are applied for the analysis of the pulmonary circulation, a cautious interpretation of the measured variables [mean pulmonary artery pressure and cardiac output] is preferable to wrong conclusions made from a meaningless variable, the "calculated PVR".

Objective: The study was focused on determining the effectiveness and reliability of using the renal resistance index as a method of diagnosing and monitoring the evolution of obstructive uropathy treatment. For this purpose, we conducted an experimental study on a homogenous group of animals that all had the same level of obstruction., Material and Methods: 15 healthy female pigs were used. The experiment was divided into three phases: phase I consisted of a study prior to unilateral pyeloureteral junction obstruction, performing retrograde ureteropyelography, renal B-mode ultrasound and duplex-Doppler (of both kidneys) at a level of the arcuate arteries. Then, the obstruction was performed on the animals. Phase II commenced by diagnosing the lesion, 6 weeks after the previous phase, by means of the aforementioned diagnostic methods. Finally, the endourological treatment was completed. Animals were monitored (Phase III) 15 weeks after the endopyelotomy, using the same methods as in the study, by assessing the urinary tract (fluoroscopy) and both kidneys by determining the renal resistance index and ratio., Results: All the animals in the study showed signs of urinary obstruction on radiology and renal ultrasound 6 weeks after ureteral ligature. After treatment and follow-up, all animals showed signs of having recovered from the obstructive uropathy. Values of deltaRI during the 3 phases are detailed below. Fase I deltaIR = 0.01, Fase II deltaIR = 0.11, Fase III deltaIR = 0.02., Conclusion: RI determination using duplex-Doppler is effective for distinguishing obstructive dilatation using non-invasive techniques. However, this parameter provides very slight differences and it can also be influenced by too many direct and indirect factors (observational, patient age, anaesthesia, haemodynamic parameters, etc.), to supplant the classic diagnostic methods.

Vasoplegia is a frequent complication in post-operative heart surgery and determines a significant increase in morbidity-mortality. When vasoplegia persists in spite of optimized fluid therapy with the use of Swan-Ganz catheter, we have a safe, effective and economical alternative, methylene blue. We present the case of a patient who developed vasoplegia refractory to treatment and shock in the scheduled post-operative period of myocardial revascularization. The use of a single dose of methylene blue resolved the hemodynamic instability and allowed for total discontinuation of vasoactive drugs. Thus, we present this new indication of methylene blue, still not approved by the corresponding bodies, for which no national publications have been found and its clinical management and the absence of adverse effects after its use.

Introduction: Portal hypertension is associated with splanchnic vasodilatation and baroreceptors activation with secondary renal vasoconstriction., Objective: To measure the pulsatility and resistance index in the renal arteries: Segmentaries and arcuates of both kidneys in cirrhotic patients Child-Pugh A, B, C classes and compared them with healthy controls., Patients and Methods: Thirty patients with cirrhosis were included: Ten patients Child A, 10 were Child B and 10 Child C class and 10 healthy patients, we measured the resistance index (RI = [systolic peak velocity-minimum diastolic velocity]/systolic peak velocity) and the pulsatility index (PI = [systolic peak velocity-minimum diastolic velocity]/medium velocity) with Doppler spectral analysis., Results: The RI in controls had an average of 0.55 +/- 0.11. In child A: 0.79 +/- 0.114, in Child B 0.77 +/- 0.104 and in Child C 0.85 +/- 0.037. For the pulsatility index the values were: 0.98 +/- 0.21, 1.4 +/- 0.105, 1.72 +/- 0.206, and 2.04 +/- 0.346, respectively. The resistances and pulsatility index were higher in patients with cirrhosis at the time to be compared with healthy controls, which represent a diminishment in blood flow. At the time to compare each one of the Child stages with controls, both index resulted higher in cirrhotic patients, but when we compared the cirrhotic patients between them, only difference for RI in child B vs. C was evident. The differences in PI were evident between each one of the Child classes., Discussion: The present study proved that a non invasive method like Doppler ultrasound is useful in the evaluation of the renal hemodynamic changes in cirrhotic patients with a good correlation between Child class and IP.

Cardiogenic shock (CHC) associated to acute myocardial infarct has high mortality and their manifestations are heterogenous. In our institution historical mortality, was 98%, but with different methods of reperfusion, its reduced to 53%. In other hand, with opportune clinical stratification is useful to improve the treatment strategy. This stratification on basis in clinical signs: age, infarction location, cardiac frequency and systemic arterial pressure, and hemodynamical valuation with the use of right catheterism with quantification miocardial work parameters like "Cardiac power" that is the product of flow and arterial pressure and that is of utility to know the "Miocardial reserve". In our experience after reperfusion procedure patients with CHC and cardiac power less than 1.0 had highly mortality.

It is now well established that portal hypertension is not a purely mechanical phenomenon. Primary hemodynamic alterations develop in the hepatic and systemic circulatory systems; these alterations in combination with mechanical factors contribute to the development of portal hypertension. In the hepatic circulation, these hemodynamic alterations are characterized by vasoconstriction and impaired hepatic vasodilatory responses, whereas in the systemic circulation, particularly in the splanchnic bed, vessels are hyperemic with increased flow. Thus, an increase in intrahepatic resistance in conjunction with increased portal venous inflow, mediated through splanchnic dilation, contributes to the development of portal hypertension. The ensuing development of elevated flow and transmural pressure through collateral vessels from the hypertensive portal vasculature into the lower pressure systemic venous circulation accounts for many of the complications, such as bleeding esophageal varices, observed with portal hypertension. The importance of the primary vascular origin of portal hypertension is emphasized by the utility of current therapies aimed at reversing these hemodynamic alterations, such as nitrates, which reduce portal pressure through direct intrahepatic vasodilatation, and ,B blockers and octreotide, which reduce splanchnic vasodilatation and portal venous inflow. New evidence concerning relevant molecular mechanisms of contractile signaling pathways in hepatic stellate cells and the complex regulatory pathways of vasoactive molecules in liver endothelial cells makes a better understanding of these processes essential for developing further experimental therapies for portal hypertension. This article examines the current concepts relating to cellular mechanism that underlie the hemodynamic alterations that characterize and account for the development of portal hypertension.

Background: The pathophysiological hallmark of the hepatorenal syndrome (HRS) is renal vasoconstriction. Doppler ultrasonography can be used to assess the vascular resistance in small renal intraparenchymal vessels through analysis of the Doppler waveform by a parameter termed Resistive Index (RI). We postulated that the RI could be important for the diagnosis and prognosis of HRS., Aims: To assess the RI in cirrhotic patients with ascites, with and without HRS., Patients and Methods: We studied 48 cirrhotics with ascites, of whom 12 were with and 36 without HRS and other 23 were normal subjects. We measured the intrarenal arterial RI (Resistive index = Peak systolic velocity - Minimum diastolic velocity/Peak systolic velocity) with color Doppler ultrasonography after visualization of interlobular or arcuate arteries. It was considered abnormal when higher than 0.70., Results: The RI values, mean and SD) were: normal subjects: 0.58 +/- 0.05, cirrhotics with ascites: 0.65 +/- 0.05 and cirrhotics with ascites and HRS: 0.78 +/- 0.11. Patients with HRS had significantly higher values than those without HRS (p < 0.001). The Relative Risk of developing the HRS in patients with a RI > or = 0.70 were 3.32 (CI 95% = 1.79-6.2), Conclusions: The RI was useful in patients with cirrhosis and ascites for the prognosis of HRS and could suggest diagnosis of HRS with values of 0.78 or higher, if other clinical conditions that produce renal vasoconstriction are excluded.

Aim: To assess renal hemodynamics by Doppler analysis of resistive index (RI) in small intrarenal arteries in patients with chronic liver diseases at different stages, and to analyze renal RI in patients with cirrhosis as a function of the absence or presence of ascites and the response to diuretic therapy., Methods: Prospective cross-sectional study of 24 patients with chronic hepatitis, 39 with compensated cirrhosis, and 34 with ascites. The last group was divided into two subgroups: 1) responders to sodium restriction and a low dose of diuretics, and 2) patients with refractory ascites or those requiring high-dose therapy., Results: Renal RI was increased in patients with cirrhosis and ascites (0.68 +/- 0.06) in comparison with patients with compensated cirrhosis (0.63 +/- 0.03, p < 0.01). Renal RI in the latter group was higher than in patients without cirrhosis (0.61 +/- 0.04, p < 0.05). Renal RI in patients with ascites was lower in subgroup 1 than in subgroup 2 (0.65 +/- 0.05 vs 0.72 +/- 0.06, p < 0.01)., Conclusions: Renal RI increases as liver disease progresses. Patients with cirrhosis and ascites and increased RI require high-dose treatment or do not respond. Further studies are needed to demonstrate the predictive value of renal RI in assessing the effectiveness of diuretic therapy.

Introduction and Development: The regulation of cerebral blood flow (CBF) is a determinant factor amongst the mechanisms involved in the development of neonatal brain lesions. Therefore it has been the main objective of many investigators in recent decades, seeking reliable techniques for measurement of cerebral haemodynamic parameters. However, the use of different techniques to assess brain haemodynamics has been limited by various factors including: harmlessness of the technique, its ease of use and accuracy of measurement. In this paper we aim to show how, using these techniques, together with sufficient understanding of neonatal pathophysiology, we can obtain better understanding of antenatal and perinatal factors responsible for cerebral damage, and the effect of this lesion on development. Besides using these findings to prevent specific disorders, we will obtain the advantage of an appropriate medical and neurosurgical treatment, with lower risk of neurological sequelae.

In order to evaluate the presence of nuchal cord entanglement and to measure resistance index with Doppler color ultrasonography, a prospective, observational, cross-sectional study was carried out, 132 low risk term pregnant women were included, 50 of them had umbilical cord encirclement (37%), the sensitivity, specificity, positive predictive and negative predictive values were 92%, 87%, 81% and 95%, respectively. McNemar'test for discordance had a p = 0.121 in comparing ultrasonography result with the gold standard. Patients with nuchal cord entanglement had higher frequency of cesarean section (70%, p < 0.05) than those without it. On the other hand, normal vaginal delivery was more common (46%, p < 0.05) in patients without nuchal coiling of the umbilical cord. There were no significant difference in evaluating acute fetal distress, meconium stained amniotic fluid, newborn Apgar scores at one and five minutes, birth weight, neonatal intensive care unit admissions and intrapartum stillbirths. In our patients with nuchal cord entanglement the resistance index average values were 0.59 and those without nuchal cord were 0.60 (p = 0.712). We concluded that color flow Doppler ultrasonography is a reliable tool to detect nuchal coiling of the umbilical cord, and therefore Doppler color waveforms assessment in nuchal cord entanglements might helpful for clinicians to decide a closer surveillance in labor by using intrapartum cardiotocography.

Garlic has been used for centuries, and even nowadays is part of popular medicine in many cultures. New data have increased the interest in garlic and its role in normalization and treatment of cardiovascular disease risk factors. Recent studies have shown the complex composition of garlic, containing many compounds, that present potential positive effect in the field of health. The aim of the present paper was to review results of some studies that have found a relationship between garlic and cardiovascular diseases. From some of them it can be summarized that garlic can normalize plasma lipid, check lipid peroxidation, stimulate fibrinolytic activity, inhibit platelet aggregation, smooth the thickening and structural changes of artery wall related to aging and atherosclerosis, and decrease blood pressure. However, some other studies do not support these benefits. The positive effects found have promoted many study projects, nevertheless, the extract lability and the lack of result consensus call for a moderate consumption of garlic and garlic extracts. The composition variation due to gathering and aging together with the changes occurring in canning and industrial treatment makes necessary the application of some norms in the production and consumption of this functional food in order to guarantee its use in adequate form and doses.

Background: It is known that the sympathetic varicosities co-store and co-release norepinephrine (NE) together with adenosine S-triphosphate (ATP) and neuropeptide Y (NPY)., Aim: To describe the chemical characterization of stored and released NPY from the varicosities of sympathetic nerve terminals surrounding segments of the human saphenous vein, and the vasomotor activity of rings electrically depolarized or contracted by the exogenous application of the co-transmitters., Material and Methods: Saphenous vein tissues were obtained from patients undergoing elective cardiac revascularization surgery., Results: The chromatographic profile of NPY extracted from biopsies is identical to a chemical standard of human NPY. Upon electrical depolarisation of the perivascular sympathetic nerve terminals, we demonstrated the release of NPY to the superfusion media, which did not exceed a 1% of its stored content. The release of the peptide is sensitive to guanethidine, and to extracellular calcium, suggesting that the mechanism of its release is exocytotic in nature. The electrically evoked release of NPY is dependent on the frequency and duration of the electrical pulses. Phenoxybenzamine reduces the electrically evoked release of NPY. Exogenous application of NE and ATP contract saphenous vein rings; the simultaneous application of NE plus ATP causes a synergic response, effect which is further potentiated by the joint co-application of 10 nM NPY., Conclusions: Present results highlight the role of NPY as a sympathetic co-transmitter in the regulation of human vascular tone.

The testicular infarction can be a rare complication of the orchiepididymitis. The ultrasonography appearance of the partial infarctions creates confusion with expansive intratesticular processes. We present three cases of focal testicular infarction associated with orchiepididymitis, stressing the usefulness of the Color doppler sonography for detecting the avascular nature o these lesions. The determination of de indeces of resistance (IR) in the doppler spectrum of intratesticular arteries showed a highly increased vascular resistance in respect of the healthy testicle. In patients with grave orchiepididymitis vein drainage can be affected due to compressive edema or to thrombosis, causing the raising of the resistance indeces. Acknowledging the avascular resistance of the focal post-orchiepididymitis infarction we can prevent unnecessary orchiectomy.

To determine whether endogenous production of nitric oxide (NO) increases during one-lung lung ventilation (OLV) and to observe its possible influence on pulmonary vascular resistance (PVR). The experimental group consisted of 19 patients undergoing chest surgery with OLV, with monitoring by Swan-Ganz catheter. Hemodynamic parameters were measured and peripheral venous blood samples were taken at the start of surgery and 10 minutes after starting OLV. The control group consisted of 13 patients with comparable clinical characteristics undergoing chest surgery with conventional lung ventilation. In this group samples of peripheral venous blood were taken at the start of surgery and at a moment comparable to the sampling of the experimental group. NO was assessed by quantitative colorimetry as the concentration of nitrites in venous blood. Nitrite concentration in the experimental group was higher during OLV (12.7 +/- 10.1 muMol/ml) than initially (7.1 +/- 5.4 muMol/ml) (p < 0.05). Nitrite concentration was similar at the two moments sampled in the control group (8.7 +/- 2.8 muMol/ml at the start of surgery and 8.1 +/- 3.2 muMol/ml in the second sample taken). Mean percent increase in nitrite concentration in the experimental group was 93.7 +/- 117%; mean percent change in the control group was 3.9 +/- 23% (p < 0.001). PVR during OLV (134 +/- 45 din.s.cm-5) is lower than at the start of surgery (163 +/- 37 din.s.cm-5, p < 0.05). During OLV endogenous production of NO, measured as nitrite concentration in plasma, increases. PVR decreases, possibly because of the increase in nitrite concentration.

Shock occurs when the circulatory system fails to maintain adequate cellular perfusion, with widespread reduction in delivery of oxygen and other nutrients to tissues. Irreversible cellular injury and multisystem organ failure develop if the condition is not promptly remedied. In cardiogenic, hypovolemic and vascular obstructive shock, systemic vascular resistance is elevated and pulmonary artery oxygenation is decreased. Distributive shock is caused primarily by vasomotor dysfunction resulting in excessive venous pooling, loss of arteriolar tone, and redistribution of blood flow. Cardiac output and intravascular volume may be low, normal or increased in the presence of hypotension in distributive shock. The characteristic pattern of cardiac performance of septic shock is reduced left and right ventricular ejection fractions, increased end-diastolic and end-systolic volumes of both ventricles and normal stroke volumes.

Objectives: The incidence of arterial hypertension post-renal transplantation has been reported to be 48.6%. The present study investigated the usefulness of echo Doppler in detecting renal artery stenosis and the effects of arterial pressure control and hypotensive agents on the vascular resistance of the renal graft., Methods: A total of 234 echo Doppler studies were done in 110 patients. The pulsatility index (PI), resistance index (RI), acceleration and mean velocity (MV), maximum systolic (SVMX) and minimum diastolic (DVMN) velocities of the external iliac, renal, segmental, interlobar and arcuate arteries were determined., Results: In the stenotic segment, an elevation of SVMX was observed, followed by turbulent flow in the post-stenotic segment in 73% of the cases with arterial stenosis. The hypertensive patients had a higher external iliac artery RI than the normotensives. The beta-blockers reduced the RI in large vessels (external iliac), the vasodilators in medium-sized extraparenchymal vessels (segmental) and the calcium antagonists changed the PI in the smaller caliber intraparenchymal vessels (interlobar and arcuate)., Conclusions: Evaluation by echo Doppler is the first diagnostic approach in patients suspected as having arterial stenosis of the renal graft. It permits evaluating blood flow changes from hypertension and hypotensive agents.

Objectives: To assess the relation between changes in pulmonary shunt and minute volume induced by blood loss, using an animal model with anesthetic maintenance by isoflurane CAM 1., Material and Methods: Eight dogs were given balanced anesthesia with pancuronium and isoflurane. Variables monitored were systemic and pulmonary arterial pressures, central venous and pulmonary capillary pressures and minute volume. Arterial and mixed venous blood gas measurements were taken from the pulmonary artery catheter, and blood samples were analyzed for hemoglobin in order to calculate pulmonary shunt (Qs/Qt). Two levels or stages of hypovolemia were studied: a) level I = loss of 20% blood volume and b) level II = loss of 30%., Results: A significant decrease of 35% (139 +/- 43 to 90 +/- 24 ml/min-1/kg-1; p < 0.001) in minute volume was observed at the first level of hypovolemia; a 52% (139 +/- 43 to 69 +/- 23 ml/min-1/kg-1; p < 0.001) decrease was found at the second. This decrease was accompanied by similar drops in Qs/Qt of 34% (18.2 +/- 5% to 12.1 +/- 5%; p < 0.01) and 47% (18.2 +/- 5% to 9.2 +/- 5%; p < 0.01) at the first and second levels, respectively. Linear regression analysis showed a direct relation between changes in Qs/Qt with changes in minute volume., Conclusions: The data reported in this study indicate that changes in Qs/Qt are directly related to those of minute volume in the presence of isoflurane.