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Left bundle branch block (LBBB) is a frequent finding in patients with heart failure (HF), particularly in those with dilated cardiomyopathy (DCM). LBBB has been commonly described as a consequence of DCM development. However, a total recovery of left ventricular (LV) function after cardiac resynchronization therapy (CRT), observed in patients with LBBB and DCM, has led to increasing acknowledgement of LBBB-induced dilated cardiomyopathy (LBBB-iDCM) as a specific pathological entity. Its recognition has important clinical implications, as LBBB-iDCM patients may benefit from an early CRT strategy rather than medical HF therapy only. At present, there are no definitive diagnostic criteria enabling the universal identification of LBBB-iDCM, and no defined therapeutic approach in this subgroup of patients. This review compiles the main findings about LBBB-iDCM pathophysiology and the current proposed diagnostic criteria and therapeutic approach. Resumo: O bloqueio de ramo esquerdo (BRE) é encontrado frequentemente em doentes com insuficiência cardíaca (IC), particularmente naqueles com miocardiopatia dilatada (MCD). O BRE tem sido descrito sobretudo como uma consequência no decorrer da história natural de alguns doentes com MCD. No entanto, a observação de uma recuperação total da função do ventrículo esquerdo (FVE) após terapia de ressincronização cardíaca, tem contribuído para o reconhecimento crescente da MCD induzida por BRE como uma entidade patológica específica. Esta definição tem implicações clínicas importantes, uma vez que os doentes com este diagnóstico podem beneficiar de uma estratégia precoce de terapia de ressincronização, além da terapêutica médica estabelecida para a IC. Até ao momento, não existem critérios de diagnóstico específicos que permitam uma identificação universal de doentes com MCD induzida por BRE, nem uma abordagem terapêutica definida. Esta revisão sumariza a evidência existente acerca das principais caraterísticas da fisiopatologia da MCD induzida por BRE, bem como os critérios de diagnóstico que têm sido propostos para a sua identificação e estratégias de abordagem terapêutica.

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Objetivo: Revisar los mecanismos fisiopatológicos a través de los cuales se presenta la insuficiencia cardíaca en pacientes con hipertiroidismo. Métodos: Se realizo una revisión narrativa de la literatura sobre sobre el efecto del hipertiroidismo en el corazón y los mecanismos fisiopatológicos que se relacionan con insuficiencia cardíaca. Resultados: El aumento de las hormonas tiroideas ejercen un efecto sobre la frecuencia cardíaca, la función contráctil y la conducción eléctrica del corazón, que se relaciona con la aparición de insuficiencia cardíaca de alto gasto y tardíamente puede observarse la presencia de miocardiopatía dilatada, hallazgos potencialmente reversibles con el tratamiento de la patología de base. Conclusiones: La insuficiencia cardíaca relacionada con el hipertiroidismo es una enfermedad heterogénea, potencialmente reversible con el tratamiento de la enfermedad endocrinológica de base.

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Left bundle branch block (LBBB) is a frequent finding in patients with heart failure (HF), particularly in those with dilated cardiomyopathy (DCM). LBBB has been commonly described as a consequence of DCM development. However, a total recovery of left ventricular (LV) function after cardiac resynchronization therapy (CRT), observed in patients with LBBB and DCM, has led to increasing acknowledgement of LBBB-induced dilated cardiomyopathy (LBBB-iDCM) as a specific pathological entity. Its recognition has important clinical implications, as LBBB-iDCM patients may benefit from an early CRT strategy rather than medical HF therapy only. At present, there are no definitive diagnostic criteria enabling the universal identification of LBBB-iDCM, and no defined therapeutic approach in this subgroup of patients. This review compiles the main findings about LBBB-iDCM pathophysiology and the current proposed diagnostic criteria and therapeutic approach., (Copyright © 2024 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Antecedente y objetivos: Hasta la realización de este estudio, se desconocía la evolución clínica de los pacientes receptores de trasplante cardiaco en Costa Rica. El objetivo de este trabajo fue documentar los resultados del Programa de Trasplante Cardíaco del Hospital Dr. Rafael Ángel Calderón Guardia desde el inicio de este programa en 2007 hasta 2020. Métodos: Investigación observacional retrospectiva de 33 pacientes que recibieron trasplante de corazón. Resultados: La miocardiopatía dilatada idiopática fue la indicación más frecuente de trasplante (27.3%). La mayoría de los pacientes receptores fueron hombres (63.6%). La mayoría de los receptores presentaban 5 (45.4%) ó 6 (27.2%) discordancias de HLA con el donador. El rechazo agudo celular 2R se presentó en 30% de los casos en los primeros 30 días. La sobrevida a 10 años fue de 14%. Conclusiones: Aunque los hallazgos documentados en esta investigación fueron similares a los reportados en otros centros, el rechazo agudo significativo fue mayor al esperado y la sobrevida a largo plazo fue mucho menor.

Copyright of Enfermería en Cardiologia is the property of Asociacion Espanola de Enfermeria en Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Argentina de Cardiología is the property of Sociedad Argentina de Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and Objectives: Limited information is available on the safety of pregnancy in patients with genetic dilated cardiomyopathy (DCM) and in carriers of DCM-causing genetic variants without the DCM phenotype. We assessed cardiac, obstetric, and fetal or neonatal outcomes in this group of patients., Methods: We studied 48 women carrying pathogenic or likely pathogenic DCM-associated variants (30 with DCM and 18 without DCM) who had 83 pregnancies. Adverse cardiac events were defined as heart failure (HF), sustained ventricular tachycardia, ventricular assist device implantation, heart transplant, and/or maternal cardiac death during pregnancy, or labor and delivery, and up to the sixth postpartum month., Results: A total of 15 patients, all with DCM (31% of the total cohort and 50% of women with DCM) experienced adverse cardiac events. Obstetric and fetal or neonatal complications were observed in 14% of pregnancies (10 in DCM patients and 2 in genetic carriers). We analyzed the 30 women who had been evaluated before their first pregnancy (12 with overt DCM and 18 without the phenotype). Five of the 12 (42%) women with DCM had adverse cardiac events despite showing NYHA class I or II before pregnancy. Most of these women had a history of cardiac events before pregnancy (80%). Among the 18 women without phenotype, 3 (17%) developed DCM toward the end of pregnancy., Conclusions: Cardiac complications during pregnancy and postpartum were common in patients with genetic DCM and were primarily related to HF. Despite apparently good tolerance of pregnancy in unaffected genetic carriers, pregnancy may act as a trigger for DCM onset in a subset of these women., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

A miocardiopatia dilatada é uma doença de caráter complexo e multifatorial, em que infecções virais, mecanismos auto-imunes e fatores genéticos produzem lesão miocárdica definitiva. É diagnosticada habitualmente na forma avançada, na qual determina severo comprometimento da função sistólica do ventrículo esquerdo e manifestações clínicas de insuficiência cardíaca. Pode ser identificada em forma inicial, caracterizada pela ausência de sinais congestivos e leve disfunção sistólica. Distúrbios do enchimento diastólico do ventrículo esquerdo são evidenciados em ambas as formas. A biópsia endomiocárdica identifica alterações histopatológicas, as quais não se correlacionam com o grau de comprometimento da função ventricular esquerda. Unitermos: Miocardiopatia dilatada, patogenia, função ventricular, biópsia endomiocárdica.

Dilated cardiomyopathy in pregnancy is generally of unknown origin, but in 20- 35% it is hereditary. Here is presented the case of a 22-year-old patient, 34.6 weeks of pregnancy, primipara, with a history of slight bronchial asthma, who was asymptomatic from the cardiovascular point of view, until a heart rate greater than 130 beats per minute and edema in lower limbs were found, which were the causes that bring her to the Department of Cardiology. The transthoracic echocardiogram revealed dilated cardiomyopathy with severely depressed left ventricular function, diastolic dysfunction, severe tricuspid and moderate mitral regurgitations, as well as slight pulmonary hypertension. It was considered a very high obstetric risk (group IV of the World Health Organization Classification) and, after coordinating with the national department of heart disease and pregnancy, the patient was sent to the reference center, where a cesarean section was performed without complications. [ABSTRACT FROM AUTHOR]

Dilated cardiomyopathy in pregnancy is generally of unknown origin, but in 20- 35% it is hereditary. Here is presented the case of a 22-year-old patient, 34.6 weeks of pregnancy, primipara, with a history of slight bronchial asthma, who was asymptomatic from the cardiovascular point of view, until a heart rate greater than 130 beats per minute and edema in lower limbs were found, which were the causes that bring her to the Department of Cardiology. The transthoracic echocardiogram revealed dilated cardiomyopathy with severely depressed left ventricular function, diastolic dysfunction, severe tricuspid and moderate mitral regurgitations, as well as slight pulmonary hypertension. It was considered a very high obstetric risk (group IV of the World Health Organization Classification) and, after coordinating with the national department of heart disease and pregnancy, the patient was sent to the reference center, where a cesarean section was performed without complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Dilated cardiomyopathy is the main cause of pediatric cardiac transplantation. CLINICAL CASE: We present a four months old child (preterm birth at 29-week gestational age) affected from dilated cardiomyopathy secondary to Bordetella pertussis infection. At diagnosis there are unfavorable prognostic factors (patient age, high initial proBNP figure and left ventricular ejection fraction less than 30%). However, after 6 months of immunomodulatory treatment with ciclosporine and prednisone he presents an adequate clinical evolution. CONCLUSIONS: Although dilated cardiomyopathy is an alteration that puts patients' lives at risk, it is worth noting the satisfactory clinical and analytical evolution and recovery of our case during the first year. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Myocarditis is an inflammatory disease of the myocardium, due to the low incidence and the variability of the clinical course, the diagnosis is an exclusion one. The etiology is mainly viral, although a shift of the specific agent in recent years has taken place. Treatment is controversial and the prognosis related to dilated myocardiopathy is generally bad. We present the clinical case of a patient with myocarditis due to cytomegalovirus in the cardiology department of our Hospital. We conducted a bibliographic review of the topic to help to determine the etiology, the treatment and to be able to establish a prognosis at the discharge. [ABSTRACT FROM AUTHOR]

El feocromocitoma, un tumor de baja incidencia con un comportamiento benigno en la mayoría de los casos, puede ser el responsable de extensas manifestaciones cardiovasculares.Las manifestaciones sobre el miocardio pueden ser de profundas consecuencias, pues llegan a producir una miocardiopatía dilatada con insuficiencia cardiaca severa. La exéresis del tumor suele ser curativa en el 90 % de los casos y el manejo perioperatorio muy complejo. Se presenta un paciente joven portador de un feocromocitoma , que sometido a la larga acción de las catecolaminas llegó a desarrollar una miocardiopatía dilatada con criterio de trasplante cardiaco. La cirugía adrenal fue curativa en nuestro paciente.Pheochromocytoma, a low incidence tumor of benign behavior in most of cases, can cause extensive cardiovascular manifestations. These manifestations on the myocardium can have deep consequences since they may lead to dilated myocardiopathy with severe heart failure. The excision of tumor may be the curative solution for 90 % of cases but the perioperative management is very complex. This is the case of a young patient who carries pheochromocytoma and after a long-acting catecholemine-based treatment, he developed dilated myocardiopathy, and the medical criterion was that he required heart transplantation. The adrenal surgery was successfully healing in our patient.

INTRODUCTION: Despite significant left ventricular (LV) systolic dysfunction and cardiomegaly, pulmonary congestion does not seem to be a major finding in Chagas' cardiomyopathy (CC). This study sought to identify echocardiographic parameters associated with pulmonary congestion in CC and in dilated cardiomyopathy of other etiologies, such as non-CC (NCC), and to compare pulmonary venous hypertension between the two entities. METHODS: A total of 130 consecutive patients with CC and NCC, with similar echocardiographic characteristics, were assessed using Doppler echocardiography and chest radiography. Pulmonary venous vessel abnormalities were graded using a previously described pulmonary congestion score, and this score was compared with Doppler echocardiographic parameters. RESULTS: NCC patients were older than CC patients (62.4 ± 13.5 × 47.8 ± 11.2, p = 0.00), and there were more male subjects in the CC group (66.2% × 58.5%, p = 0.4). Pulmonary venous hypertension was present in 41 patients in the CC group (63.1%) and in 63 (96.9%) in the NCC group (p = 0.0), the mean lung congestion score being 3.2 ± 2.3 and 5.9 ± 2.6 (p = 0.0), respectively. On linear regression multivariate analysis, the E/e' ratio (β = 0.13; p = 0.0), LV diastolic diameter (β = 0.06; p = 0.06), left atrial diameter (β = 0.51; p = 0.08), and right ventricular (RV) end-diastolic diameter (β = 0.02; p = 0.48) were the variables that correlated with pulmonary congestion in both groups. CONCLUSIONS: Pulmonary congestion was less significant in patients with CC. The degree of LV of systolic and diastolic dysfunction and the RV diameter correlated with pulmonary congestion in both groups. The E/e' ratio was the hallmark of pulmonary congestion in both groups.

La aparición de una insuficiencia valvular mitral funcional en el seno de una miocardiopatía isquémica o dilatada es un signo de mal pronóstico con una elevada mortalidad y morbilidad y una reducción significativa de la esperanza de vida. La válvula mitral es anatómicamente normal, sin lesiones orgánicas en sus estructuras, por lo que el mecanismo de la regurgitación valvular se explica por los cambios en la geometría que sufre el ventrículo izquierdo. La miocardiopatía isquémica produce un remodelado del ventrículo que pierde su configuración normal, produciéndose una separación de ambos músculos papilares que traccionan de los velos ocasionando un déficit de coaptación y la aparición de la insuficiencia valvular. Probablemente, el tratamiento quirúrgico es la única opción terapéutica adecuada para corregir la regurgitación valvular y normalizar el pronóstico de estos pacientes. Se han diseñado diversas estrategias quirúrgicas encaminadas a reparar la lesión valvular, por una parte, y a normalizar la geometría ventricular, por otra. No obstante, en la actualidad aún no disponemos de una solución quirúrgica definitiva que pueda ser considerada el «patrón oro».

La miocardiopatía dilatada (MCD) se caracteriza por la dilatación ventricular y la reducción del grosor miocárdico. Es una patología multifactorial con varios mecanismos biológicos que pueden explicar su fisiopatología. Entre estos mecanismos, es relevante el componente inmunitario humoral y celular con una serie de autoanticuerpos (AA) descritos, principalmente los anti-β1 adrenérgicos y los anti-m2 de la acetilcolina. Estos anticuerpos reconocen a un grupo de proteínas presentes en el tejido cardíaco, y desempeñan un papel esencial en la patogénesis de la miocardiopatía, contribuyendo a la disfunción ventricular. La eliminación de estos anticuerpos mediante la inmunoadsorción (IA) implica un beneficio hemodinámico en estos pacientes. Las experiencias piloto más recientes han demostrado que la eliminación de los anticuerpos circulantes mediante la IA mejora la función cardíaca de los pacientes con MCD y reduce la inflamación. Estos anticuerpos son mayoritariamente inmunoglobulinas G de clase 3 (IgG3). La IA mediada por los adsorbentes anti-Ig es eficaz para la eliminación, entre otras, de la IgG3, y es un método seguro y generalmente bien tolerado por los pacientes con MCD.

La miocarditis viral es resultado de una inflamación del miocardio provocada por diferentes virus. Esta enfermedad cardíaca constituye sin duda una urgencia cardiovascular en el adulto por las complicaciones que ocasiona. El cuadro clínico se caracteriza por arritmias e insuficiencia cardíaca que pueden conducir a la muerte. La secuela más frecuente de la miocarditis viral a largo plazo es la miocardiopatía dilatada. En el presente trabajo se revisa etiología, fisiopatología, sintomatología, diagnóstico y tratamiento de la miocarditis viral en el adulto.Viral myocarditis is the result of a myocardial inflammation provoked by different viruses. This cardiac disease is doubtless a cardiovascular urgency in the adult due to its complications. The clinical picture is characterized by arrhythmias and cardiac failure that may to lead to death. The more frequent long-term myocarditis sequela is the dilated myocardiopathy. In present paper etiology, pathophysiology, symptomatology, diagnosis and treatment of viral myocarditis in the adult are reviewed.

El presente trabajo constituye una revisión bibliográfica donde se reflejan los posibles mecanismos de producción de las afecciones cardíacas en pacientes con VIH positivo y con SIDA, donde se concluyó que el VIH podría ser considerado como una infección viral capaz de generar riesgo de afecciones cardíacas, al nivel del endocardio valvular y mural y desencadenar la aparición de endocarditis. El miocardio es una de las estructuras cardíacas más afectadas con la aparición de miocarditis intersticial, miocardiopatía dilatada, neoplasias cardíacas como el sarcoma de Kaposi y el linfoma inmunoblástico de células B. De todas las estructuras cardíacas la más afectada, según estudios de necropsias, es el pericardio con la presencia de pericarditis aguda, derrame pericárdico ligero, moderado y severo, el taponamiento cardíaco y la pericarditis constrictiva. Por último, al nivel del endotelio coronario se ha visto el desarrollo de aterosclerosis coronaria, secundaria a hiperlipidemias, que se atribuyen a la introducción del tratamiento antirretroviral el cual induce la aparición de un síndrome metabólico, el que podría provocar una disfunción del endotelio coronario.This paper is a bibliographic revision of the possible mechanisms of heart disease generation in HIV positive and AIDS patients, which concluded that HIV could be considered as a viral infection capable of generating risk of heart disease at the level of the valvular and mural endocardium and triggering the onset of endocarditis. The myocardium is one of the cardiac structures most frequently affected by the emergence of interstitial myocarditis, dilated cardiomyopathy, cardiac neoplasms such as Kaposi's sarcoma and immunoblastic B-cell lymphoma. Of all cardiac structures, the most frequently affected, according to autopsy studies, is the pericardium, with the presence of acute pericarditis; mild, moderate and severe pericardial effusion; cardiac tamponade and constrictive pericarditis. Finally, the development of coronary atherosclerosis secondary to hyperlipidemia has been observed at the level of the coronary endothelium, which is attributed to the introduction of antiretroviral treatment leading to the emergence of a metabolic syndrome, which could cause coronary endothelial dysfunction.

FUNDAMENTO: As técnicas de substituição mitral com preservação do aparelho subvalvar têm reafirmado sua superioridade, sendo a papilopexia cruzada uma nova opção técnica que além de permitir preservação de estruturas anatômicas, oferece suporte na contração e protege o miocárdio na diástole ventricular, necessitando de estudos que documentem seus resultados. OBJETIVO: Avaliar as funções atrial e ventricular esquerdas, através de ecodopplercardiografia, em pacientes submetidos à substituição da valva mitral com papilopexia cruzada. MÉTODOS: Foram submetidos à substituição valvar mitral 15 pacientes, sendo nove (60%) do sexo masculino, com idade média de 45,7 anos. Quanto à etiologia, nove (60%) casos eram degenerativos, três (20%) reumáticos, dois (13,3%) isquêmicos e um (6,7%) com endocardite infecciosa. Após atriotomia e avaliação anatômica do aparelho valvar o folheto anterior foi desinserido do anel e centralmente dividido, sendo cada metade com seu complexo de cordas tendíneas fixada à comissura oposta por sua extremidade medial. Foi Implantada a prótese valvar biológica (em 13 casos) ou mecânica, fixada por pontos separados, com redução do anel valvar nos casos com miocardiopatia dilatada. Foram tomadas avaliações clinicas e ecodopplercardiográficas no pré-operatório, e sexto mês de pós-operatório. RESULTADOS: Todos os pacientes receberam alta em condições clínicas estáveis. Foi demonstrada redução significativa dos diâmetros ventriculares e dos diâmetros atriais (p< 0,001) sem comprometimento das vias de entrada e saída do ventrículo esquerdo. CONCLUSÃO: As substituições da valva mitral realizadas com a técnica de papilopexia cruzada apresentaram resultados favoráveis, com efeito positivo na recuperação morfológica atrial e ventricular esquerdas.FUNDAMENTO: Las técnicas de sustitución mitral con preservación del aparato subvalvular han estado reafirmando su superioridad, siendo la resuspensión de los músculos papilares una nueva opción técnica que además de permitir la preservación de estructuras anatómicas, ofrecer soporte en la contracción y protege el miocardio en la diástole ventricular, necesitando estudios que documenten sus resultados. OBJETIVO: Evaluar las funciones atrial y ventricular izquierdas, mediante ecocardiografía Doppler, en pacientes sometidos a sustitución de la válvula mitral con resuspensión de los músculos papilares. MÉTODOS: Se sometieron a sustitución valvular mitral 15 pacientes, siendo nueve (60%) del sexo masculino, con una edad promedio de 45,7 años. En cuanto a la etiología, nueve (60%) casos eran degenerativos, tres (20%) reumáticos, dos (13,3%) isquémicos y uno (6,7%) con endocarditis infecciosa. Después de la atriotomía y evaluación anatómica del aparato valvular, el velo anterior se retiró del anillo y se dividió centralmente, siendo cada mitad con su complejo de cuerdas tendinosas fijadas a la comisura opuesta por su extremidad medial. Se implantó prótesis valvular biológica (en 13 casos) o mecánica, fijada por puntos separados, con reducción del anillo valvular en los casos con miocardiopatía dilatada. Se realizaron evaluaciones clínicas y por ecocardiografía Doppler en el preoperatorio, y sexto mes de postoperatorio. RESULTADOS: Todos los pacientes recibieron alta en condiciones clínicas estables. Se demostró reducción significativa de los diámetros ventriculares y de los diámetros atriales (p< 0,001) sin compromiso de las vías de entrada y salida del ventrículo izquierdo. CONCLUSIÓN: Las sustituciones de la válvula mitral realizadas con la técnica de resuspensión de los músculos papilares presentaron resultados favorables, con efecto positivo en la recuperación morfológica atrial y ventricular izquierdas.BACKGROUND: Techniques for mitral valve replacement with preservation of the subvalvular apparatus have proven their superiority, and crossed papillopexy is a new technical option which, besides allowing Preservation of the anatomical structures, provides contractility support and protection to the myocardium during ventricular diastole. The technique requires further studies that document its results. OBJECTIVE: To evaluate the left atrial and ventricular function by Doppler echocardiography in patients who have undergone mitral valve replacement with crossed papillopexy. METHODS: Fifteen patients underwent mitral valve replacement, 9 (60%) of them male, and the mean age was 45.7 years. As to the etiology of aortic valve disease, nine (60%) cases were degenerative, three (20%) were rheumatic, two (13.3%) were ischemic, and one patient (6.7%) had infectious endocarditis. After closure of the atriotomy and anatomical evaluation of the valvar apparatus, the anterior leaflet was detached from the annulus and centrally split in halves, each one with its complex tendinous chords attached to the opposing commissure by its medial extremity. Biological (13 cases) or mechanical prosthetic valves were implanted and secured with separate stitches. Reduction of the valvar annulus was performed in patients with dilated cardiomyopathy. Patients underwent clinical and Doppler echocardiographic examinations before surgery and six months after the procedure. RESULTS: All patients were clinically stable at discharge. A significant reduction in ventricular and atrial diameters was demonstrated (p< 0.001) without impairment of the entry and exit points of the left ventricle. CONCLUSION: Mitral valve replacements performed with the crossed papillopexy technique showed favorable results with a positive effect on the recovery of left atrial and ventricular morphology.

La insuficiencia cardiaca es un cuadro clínico frecuente y de apreciable mortalidad. A menudo de nuestra área de atracción emergen cardiópatas con diferentes grados de discapacidad, dependientes de familiares para su atención y que requieren re-hospitalizaciones y tratamientos costosos y a pesar de ello con mal pronóstico. Las autoridades sanitarias y particularmente el estado invierten anualmente mucho dinero en el tratamiento de los enfermos que la padecen y también en la cobertura de incapacidades para estos individuos. El trasplante cardiaco se ha implementado en el mundo como una excelente opción de tratamiento de los pacientes con insuficiencia cardiaca, capaz de brindar al menos 10 años de vida a pesar de lo riguroso del seguimiento, tanto para el paciente y su familia, como para el personal medico. El Hospital R. A. Calderón Guardia inició hace un año un Programa de Trasplante Cardiaco, presentamos aquí los 2 primeros pacientes y su seguimiento.Heart failure is a common clinical problem that implies pretty high mortality. From the Calderon Guardia Hospital drawing area emerge individuals with different degrees of disability, depending upon their families for their needs, requiring frequent hospitalizations and expensive treatments and still with bad prognosis. The government dedicates large amounts of money to the treatment of these patients and also to cover for their disability. Cardiac transplantation has been implemented worldwide as a viable solution for persons with heart failure, able to expand their life for at least 10 extra years, in spite of the rigorous follow up protocols for the patients and health personnel as well. One year ago the R. A. Calderon Guardia Hospital started a heart transplant program, we herein present the first 2 patients and their follow up.

La insuficiencia cardiaca es un cuadro clínico frecuente y de apreciable mortalidad. A menudo de nuestra área de atracción emergen cardiópatas con diferentes grados de discapacidad, dependientes de familiares para su atención y que requieren re-hospitalizaciones y tratamientos costosos y a pesar de ello con mal pronóstico. Las autoridades sanitarias y particularmente el estado invierten anualmente mucho dinero en el tratamiento de los enfermos que la padecen y también en la cobertura de incapacidades para estos individuos. El trasplante cardiaco se ha implementado en el mundo como una excelente opción de tratamiento de los pacientes con insuficiencia cardiaca, capaz de brindar al menos 10 años de vida a pesar de lo riguroso del seguimiento, tanto para el paciente y su familia, como para el personal medico. El Hospital R. A. Calderón Guardia inició hace un año un Programa de Trasplante Cardiaco, presentamos aquí los 2 primeros pacientes y su seguimiento.

Justificación y objetivo: Determinar la prevalencia de la enfermedad de Chagas en un grupo de pacientes con miocardiopatía dilatada, bradiarritmias y taquiarritmias ventriculares en Costa Rica. Material y métodos: Estudio observacional, descriptivo, prospectivo de una serie de casos. Se seleccionaron pacientes con diagnóstico clínico y ecocardiográfico de miocardiopatía dilatada, bloqueo atrioventricular o intraventricular documentados o con arritmia ventricular compleja, excluyéndose aquellos en quienes hubiera uno o más factores causales (enfermedad arterial coronaria o cardiopatía hipertensiva). Mediante consentimiento informado, se les realizó un estudio con 2 pruebas serológicas de diferente fuente para detectar IgG anti-Trypanosoma cruzi. Resultados: De aproximadamente 15.000 a 20.000 vistos pacientes por año en la Consulta Externa del Servicio de Cardiología del Hospital México, unos 500 se presentan con el diagnóstico de miocardiopatía dilatada. Excluidos los pacientes con causa conocida de su cardiopatía, entre febrero de 2004 y noviembre de 2005 se reclutó a 74 pacientes, 41 hombres y 33 mujeres, con edades comprendidas entre los 13 y los 87 años (promedio 47,9), de los cuales la mayoría (n=51; 68,9%) tenían miocardiopatía dilatada idiopática, con una fracción de eyección promedio del 29,2%; 18 (24,33%) se incluyeron por bloqueo atrioventricular y 5 por arritmia ventricular compleja. De los 78 pacientes, 5 (6,8%) resultaron tener serología positiva por enfermedad de Chagas; de estos: 3 con miocardiopatía dilatada, uno con bloqueo atrioventricular completo y uno con arritmia ventricular compleja. Cabe destacar que solo uno de los 3 pacientes dilatados tiene el electrocardiograma característico de la fase crónica de la enfermedad de Chagas: bloqueo AV de primer grado, bloqueo completo de rama derecha y hemibloqueo anterior izquierdo. Conclusión: Los datos obtenidos en esta investigación revelan que la prevalencia de miocarditis chagásica crónica es relativamente baja entre los pacientes cardiópatas estudiados. Esta es la primera documentación clínica y serológica de la enfermedad en el país, en este grupo de pacientes. Entre las alteraciones clínicas predomina el daño miocárdico, pero también hay casos con bloqueo atrioventricular y arritmia ventricular compleja.Aim: To determine the prevalence of Chagas´ disease in a group of patients from Costa Rica, with dilated myocardiopathy, bradiarrhythmias and ventricular tachyarrhythmias. Materials and methods: We prospectively selected patients with clinical and echocardiographic diagnosis of dilated myocardiopathy, documented atrioventricular or intraventricular block or complex ventricular arrhythmias, excluding those who already had known etiologies, for example coronary artery disease or hypertensive heart disease. After obtaining an informed consent, we performed a serologic ELISA qualitative test using anti-trypanosoma cruzi antigens obtained by two different techniques. Results: From aproximately 15,000 to 20,000 patients/year seen at the cardiology clinic of the Mexico Hospital, about 500 had dilated myocardiopathy. From February 2004 to august 2005 and excluding those patients with known causes, we recruited 74 patients, there were 41 men and 33 women with ages between 13 and 87 years (mean 47,8). Almost 70% (n=51) were included because of idiopathic dilated myocardiopathy (mean ejection fraction 29,2%), 24,3% (n=18) were included with atrioventricular block and 6,8% (n=5) with complex ventricular arrhythmia. Five patients were positive, 3 with dilated myocardiopathy, 1 with atrioventricular blockade and 1 with complex ventricular arrhythmia. Of note, only 1 patient with dilated myocardiopathy (the only 1 in the group) had the charactersitic electrocardiographic pattern of the chronic phase of the disease: first degree atrioventricular block, right bundle branch block and left anterior division block. Antiarrhythmic management of the patient with complex ventricular arrhythmia (29 years old) was challenging. Since he did not respond to ablation and underwent sympathectomy, only to die 4 months later. There were no other differences compared with the other 9 patients. Conclusion: The prevalence of chronic chagasic myocarditis is relatively low in patients with idiopathic myocardiopathy. This is the first time this subject is reported clinically and serologically in our country. In this entity myocardial compromise is predominant but there could also be atrioventricular blockade and complex ventricular arrhythmia cases.

OBJETIVO: Avaliar efeitos precoces do transplante de células de medula óssea para o miocárdio de pacientes com insuficiência cardíaca (IC) de etiologia chagásica. MÉTODOS: A amostra consistiu de 28 pacientes, idade média 52,2±9,9 anos, 24 masculinos, 25 em classe NYHA III e 3 em NYHA IV, apesar de tratamento otimizado. O procedimento consistiu na aspiração de 50ml de medula óssea, separação da fração mononuclear e injeção intracoronariana. Foram avaliados os efeitos sobre a fração de ejeção ventricular esquerda (FEVE), distância no teste de 6 minutos, qualidade de vida, classe NYHA, efeitos arritmogênicos e bioquímicos. RESULTADOS: Não houve complicações relacionadas diretamente ao procedimento. A fração de ejeção ventricular esquerda em repouso antes do transplante era 20,1±6,8% e, após 60 dias, aumentou para 23,0±9,0%, p = 0,02. Houve melhora da classe NYHA (3,1±0,3 para 1,8±0,5; pOBJECTIVE: To evaluate early effects of bone marrow cell transplantation to the myocardium of patients with heart failure (CHF) due to Chagas disease. METHODS: We studied 28 patients (mean age 52.2 ± 9.9), of whom 24 were male. Despite optimized treatment, 25 patients were in NYHA class III and three patients, in NYHA class IV. The procedure consisted of aspiration of 50 mL of bone marrow, separation of the mononuclear fraction, and intracoronary injection. Effects on left ventricle ejection fraction (LVEF), distance walked in the six-minute walking test, quality-of-life, NYHA class, arrhythmogenic and biochemical parameters, were all evaluated. RESULTS: There were no complications directly related to the procedure. Baseline left ventricular ejection fraction was 20.1 ± 6.8%, and 60 days after transplantation it increased to 23.0 ± 9.0%, p = 0.02. Significant improvements were observed in the NYHA class (3.1 ± 0.3 to 1.8 ± 0.5; p < 0.0001); quality-of-life (50.9 ± 11.7 to 21.8 ± 13.4; p < 0.0001); and distance walked in six minutes (355 ± 136 m to 443 ± 110 m; p = 0,003). The number of ventricular premature beats in 24 hours tended to increase (5,322 ± 4,977 to 7,441 ± 7,955; p = 0,062), but without increase in ventricular tachycardia episodes (61 ± 127 to 54 ± 127; p = 0.27). CONCLUSION: Our data demonstrate for the first time that intraco­ronary injection of bone marrow mononuclear cells is feasible and suggest that it may be potentially safe and effective in patients with CHF due to Chagas disease.

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Introduction: Cardiovascular diseases in HIV seropositive patients have been reported due to the epidemic that has represented this virus infection. Objectives: To assess: A) Demographic characteristics and clinical profile of the patients, B) Presence or absence of coronary disease, C) presence or absence of Ventricular dysfunction and / or Dilatation, and D) Risk Factors associated. Method: This is a descriptive record; cardiac catheterizations was performed on HIVpositive people in CECANOT. Results: The population includes 17 patients in which Cardiac Catheterization was performed in the period May 2011 to May 2016: 29.4% Females and 70.6% Males, average age of 53.7 years. 29.4% of patients presented with Stable Angina, Unstable Angina 5.8%, 23.5% with STEMI, 5.8% No STEMI, 5.8% with impaired Ventricular function, class NYHAII, 23.5% and 5.8% NYHAIII and NYHAIV respectably. 58.82% of patients had not Coronary Heart Disease; the remaining 41.18% did have it. Contractility disorders were reported in 76.4% of cases; ventricular dilation of some degree in 76.4% of cases, deterioration of ventricular function in 58.82%. The most frequent comorbidity is Hypertension in 94.11% of cases, and diabetes mellitus type 2 in 17.5% of cases. Conclusion: HIV infection and treatment is an aggravating factor and trigger for cardiovascular disease and should be better studied in a country like ours where the condition appears increasingly. [ABSTRACT FROM AUTHOR]

Heart failure is a great public health problem in the world, either by its increasing prevalence, or the cost for a proper treatment. Heart Failure is a complex problem resulting from a structural or functional disorder that impairs the ventricular filling and ejection of blood ability. It is also characterized by the presence of cardinal symptoms such as dyspnea, fatigue and fluid retention. The main causes of heart failure are ischemic heart disease, hypertensive heart disease, dilated cardiomyopathy and valvular heart disease. In the initial stages, cardiac function at rest may be regular but it does not properly increase with exercise; in advanced stages it becomes abnormal even at rest. [ABSTRACT FROM AUTHOR]

OBJETIVO: Apresentar uma proposição técnica baseada na experiência de 130 implantes utilizando técnica simplificada para cateterização do seio coronariano, baseada no componente atrial do eletrograma intracavi-tário e anatomia radiológica. MÉTODOS: De outubro de 2001 a outubro de 2004 foram realiza-dos 130 implantes de marcapasso biventricular, utilizando-se anatomia radiológica e observação de eletrograma intracavitário, com prioridade ao componente atrial. RESULTADOS: O implante do sistema, utilizando-se a estimulação do ventrículo esquerdo via seio coronariano, não foi possível em 8 pacientes. Em 12 pacientes foram observadas dificuldades na canulação do óstio coronário e em 15 pacientes observaram-se dificuldades de progressão do eletrodo através do seio coronariano. O tempo médio de utilização de radioscopia foi de 18,69 min. CONCLUSÃO: A técnica de implante, utilizando a morfologia do componente atrial do eletrograma intracavitário e anatomia radiológica, demonstrou ser pouco trabalhosa, segura e eficaz para canulação do óstio do seio coronariano, necessitando de reduzido tempo de radioscopia.OBJECTIVE: To present a technical proposal based on the experience of 130 implantations using a simplified technique for coronary sinus catheterization, based on the atrial component of the intracavitary electrogram and radiological anatomy. METHODS: From October, 2001 to October, 2004, 130 biventricular pacemaker implantations were performed, using radiological anatomy and observation of the intracavitary electrogram, focusing on the atrial component. RESULTS: The implantation of the system using left ventricular pacing via coronary sinus was not possible in 8 patients. Difficulties on the cannulation of the coronary ostium were felt in 12 patients and difficulties of lead advancement through the coronary sinus were felt in 15 patients. The mean time of radioscopy utilization was 18.69 min. CONCLUSION: The implantation technique, using the atrial component morphology of the intracavitary electrogram and radiological anatomy showed to be workless, safe and effective for the cannulation of the coronary sinus ostium requesting reduced time of radioscopy.

La miocardiopatía espongiforme es una forma infrecuente de miocardiopatía congénita, resultado de la interrupción del desarrollo embrionario endomiocárdico normal, que produce la no compactación del miocardio ventricular (miocardio no compactado). El ecocardiograma bidimensional y el doppler en color permiten el diagnóstico de la entidad, siendo sus principales características las múltiples trabeculaciones y recesos que se comunican directamente con la cavidad ventricular. Existe una alta incidencia familiar de esta enfermedad, asociada con anormalidades del cromosoma Xq28. Presentamos dos casos ilustrativos en dos hermanos jóvenes, de raza negra, diagnosticados mediante eco cardiografía doppler codificado en color, en el Hospital Regional Dr. Tony Facio Castro de Limón.

La insuficiencia mitral en la miocardiopatía dilatada y en la isquémica es una entidad que reduce de manera significativa las expectativas de supervivencia y, en consecuencia, determinados subgrupos de pacientes se pueden beneficiar de la reparación, bien mediante técnicas conservadoras, bien sustituyendo la mitral. Las indicaciones y, especialmente, el tipo de intervención son todavía motivo de controversia. Nuevas prótesis anulares pueden facilitar la reparación mitral y eventualmente asegurar una estabilidad del procedimiento hoy poco reproducible.

PURPOSE: To retrospectively evaluate the survival rate of patients that underwent dynamic cardiomyoplasty, determining the influence of pre-, intra- and post-operative factors and the evolution of left ventricle ejection fraction according to the stimulation mode. METHOD: Forty-three patients that underwent dynamic cardiomyoplasty between May 1988 and September 1997 were analyzed. Functional class III was predominant (81.4%). The mean left ventricle ejection fraction was 19.37 ± 3.48%. Hospital death was 2.2% and 39 patients who completed the conditioning period had a mean follow up of 46 ± 26 months. Twenty-eight patients were predominantly maintained under stimulation mode 1:1 and 11 under 1:2 stimulation mode. RESULTS: Survival rate at nine years of follow up was 9%. The causes of death were progression of the heart failure and sudden cardiac death. Functional class, the pulmonary vascular-resistance index and stimulation mode were identified as risk factors. The maintenance of the increase of the left ventricle ejection fraction when compared to the preoperative values was more consistent during the studied period when the graft was stimulated in the 1:2 mode. CONCLUSION: Late results of dynamic cardiomyoplasty are limited by the high incidence of deaths by progression of the heart failure and sudden cardiac death. Survival rate is influenced by the preoperative clinical condition and by the stimulation mode. Muscle graft performance is higher at late follow up with the 1:2 stimulation mode.OBJETIVO: Analisar, retrospectivamente, a sobrevivência dos pacientes submetidos a cardiomioplastia dinâmica, determinando a influência de fatores pré, intra e pós-operatório e o comportamento da fração de ejeção conforme o modo de estimulação. MÉTODO: Foram analisados 43 pacientes submetidos a cardiomioplastia dinâmica, no período de maio de 1988 a setembro de 1997. A classe funcional III foi predominante (81,4%). A fração de ejeção média do VE foi de 19,37±3,48%. A mortalidade hospitalar foi de 2,2% e 39 pacientes, que completaram o período de condicionamento, tiveram seguimento médio de 46±26 meses. Vinte e oito pacientes foram mantidos predominantemente sob estimulação em modo 1:1 e 11 pacientes foram mantidos predominantemente sob estimulação em modo 1:2. RESULTADOS: A sobrevivência foi de 9% em nove anos. As causas de óbito foram progressão da insuficiência cardíaca e morte súbita. A classe funcional, o índice de resistência vascular pulmonar e o modo de estimulação foram identificados como fatores independentes de prognóstico. A manutenção da melhora da fração de ejeção do VE em relação ao pré-operatório foi mais consistente ao longo do período estudado, quando o enxerto muscular foi estimulado em modo 1:2. CONCLUSÃO: Os resultados tardios da cardiomioplastia dinâmica são limitados pela alta incidência de morte súbita e de óbitos decorrentes da progressão da doença de base. A sobrevivência é influenciada pela condição clínica pré-operatória e pelo modo de estimulação do enxerto. O desempenho do enxerto muscular é mais satisfatório a longo prazo quando submetido à estimulação modo 1:2.

OBJETIVO: Avaliar o perfil arritmogênico ventricular de pacientes com miocardiopatia dilatada e fração de ejeção diminuída. MÉTODOS: Estudo prospectivo em 40 pacientes com fração de ejeção média ao ecocardiograma de 32,5±2,1%, obtida pela análise do Holter de 24h, do balanço autonômico cardíaco, determinado por índices de variabilidade da freqüência cardíaca (rMSSD e pNN50), do eletrocardiograma (ECG) de alta resolução (ECGAR) e do grau de dispersão da repolarização ventricular determinado no ECG de superfície. Por regressão logística determinaram-se, a partir dos resultados, os preditores de risco para morte cardíaca e morte súbita. RESULTADOS: Observou-se na população envolvida uma elevada incidência de ectopias ventriculares isoladas, pareadas e de surtos não sustentados de taquicardia ventricular. Pela análise do balanço autonômico notou-se depressão da atividade vagal cardíaca em mais da metade dos pacientes, sendo que apenas 30% apresentaram ECGAR positivo. O grau de dispersão temporal da repolarização ventricular variou de 20 a 100ms. A presença de >30 extra-sístoles isoladas por hora e de taquicardia ventricular não sustentada ao Holter foram os preditores de risco com valores mais elevados para a morte cardíaca e morte súbita, com uma razão de risco respectiva de 1,9 e 3,2 (p= 0,01 e 0,000). CONCLUSÃO: Foram observadas importantes alterações no comportamento elétrico e autonômico cardíaco, constituindo-se fatores de risco para a ocorrência de eventos arrítmicos graves ou fatais.

Introduction: Combined heart kidney Transplant was first described in 1978, in the United States in 2011, 74 combined heart kidney transplants were performed. Our hospital has begun offering this type of therapy for selected patients. Case report: We present a case of a patient who underwent to a combined heart kidney transplant, with this approach, that heart transplant was performed first, later after a perioperative period of 24 hours in the Intensive Care Unit for haemodynamic stabilization, finally the kidney transplant was performed, both organs from the same cadaveric donor. The patient evolved satisfactory. Conclusion: In the past, patients with concurrent end-stage heart and kidney disease were not considered candidates for transplantation. Combined heart-kidney transplant has become an option for those patients with associated end-stage heart and kidney failure. Combined heart-kidney transplant is increasing as a percentage of total heart transplant. [ABSTRACT FROM AUTHOR]

The diagnosis of dilated cardiomyopathy requires tests of dilation and impaired contraction of left ventricular or both ventricles. It is considered idiopathic primary and secondary causes of heart disease (e.g., myocarditis and coronary artery disease) were excluded from the assessment including history and physical examination, laboratory tests, coronary angiography (to exclude > 50% obstruction of one or more coronary arteries), echocardiography and endomyocardial biopsy when indicated. Among the causes of myocarditis is infection by enteroviruses, particularly coxsackievirus in human myocarditis. [ABSTRACT FROM AUTHOR]