[Heart transplant in "Nuevo Leon": the first 33 cases]. / Estado actual del trasplante cardíaco en Nuevo León: primeros 33 casos.

Heart failure is one of the most important causes of death worldwide. Heart transplant is the last effective alternative when the medical and surgical treatments have failed in patients with end stage heart failure, giving them an 80% one year survival rate. Unfortunately, during the outcome, the heart transplant patients can develop complications such as graft rejection and opportunistic infections because of the use of immunosuppressive therapy. In the present article we report the experience with 33 heart transplant patients. Our program not only has successfully transplanted patients with advanced age but, for the first time in Latin America we have transplanted patients assisted with the ambulatory Thoratec TLC II system. Even with limited resources, we have managed the same complications than other heart transplant programs, our 82% one year survival rate is similar than reports in medical literature.

Estado actual del trasplante cardíaco en Nuevo León: primeros 33 casos / Heart transplant in Nuevo Leon: the first 33 cases

Heart failure is one of the most important causes of death worldwide. Heart transplant is the last effective alternative when the medical and surgical treatments have failed in patients with end stage heart failure, giving them an 80% one year survival rate. Unfortunately, during the outcome, the heart transplant patients can develop complications such as graft rejection and opportunistic infections because of the use of immunosuppressive therapy. In the present article we report the experience with 33 heart transplant patients. Our program not only has successfully transplanted patients with advanced age but, for the first time in Latin America we have transplanted patients assisted with the ambulatory Thoratec TLC II system. Even with limited resources, we have managed the same complications than other heart transplant programs, our 82% one year survival rate is similar than reports in medical literature.

[Importance of tumor necrosis factor-alpha in the pathogenesis of heart failure]. / Importancia del factor de necrosis tumoral alfa en la patogenia de la insuficiencia cardíaca.

Clinical and experimental evidence demonstrating the effects of tumor necrosis factor-alpha (TNF-alpha) in patients with heart failure continues to accumulate. It is well established that high concentrations of TNF-alpha appear in the circulation of patients with heart failure and that these levels have a directly proportional correlation with the patient's functional class. TNF-alpha levels also show a linear relation with prognosis. These circulating levels are responsible for the decreased expression of myocardial TNF-alpha receptors observed in heart failure. As a result of extrapolation of findings from experimental animals, we assume that TNF-alpha is deleterious to myocardial function in humans because it induces a negative inotropic state in patients who have not undergone heart transplant. Supporting this assumption is the fact that the resolution or improvement of pressure overload (obstructive hypertrophic myocardiopathy, by ethanol ablation) and volume overload (terminal dilated myocardiopathy, by ventricular assistance) states is accompanied by a decrease in myocardial TNF-alpha expression. The use of specific antagonists of circulating TNF-alpha in patients with symptomatic heart failure has been demonstrated to be safe and possibly effective. At present, multicenter studies are under way to assess the efficacy of this antagonism in a larger number of patients. If the results of these studies are favorable, we will have new therapeutic elements for managing patients with advanced hear failure. The transplanted heart behaves differently from the native heart. From the early stages of HTx, myocardial TNF-alpha expression is greatly increased (much more than in patients with heart failure) and not associated with contractile dysfunction, in contrast with what occurs in the native heart. However, we know that the transplanted heart soon develops ventricular hypertrophy, fibrosis, diastolic dysfunction, and late graft failure, even in the presence of normal epicardial coronary arteries. Clinical evidence suggests that TNF-alpha may be involved in these processes.

Aterosclerosis y cardiopatía isquémica: notas históricas breves / Atherosclerosis and ischemic heart disease: brief historical accounts

Una revisión de algunos pasajes históricos de la medicina, revela conceptos, descripciones clínicas y pronóstico de la aterosclerosis coronaria y la cardiopatía isquémica en el pasado reciente y en la remota antigüedad. En esta revisión se exponen algunos conceptos y términos utilizados con referencia a la aterosclerosis; la documentación más antigua de aterosclerosis coronaria e infarto del miocardio en momias egipcias; el síndrome de angor pectoris en el papiro de Ebers y descripciones clínicas y de carácter pronóstico en la medicina hipocrática, respecto a posibles casos de angina, infarto y muerte súbita. Estos informes nos permiten valorar mejor la medicina primitiva del Mundo Antiguo Occidental, la evolución del concepto de aterosclerosis y la existencia de esta enfermedad en el remoto pasado de la humanidad.

Registro nacional de comisurotomía mitral percutánea. Experiencia de 8 años / National Registry of percutaneous mitral commisurotomy. An eight years experience

De abril de 1986 a junio de 1994, en un estudio multicéntrico, se realizó comisurotomía mitral percutánea a 689 pacientes con el diagnóstico de estenosis mitral de etiología reumática. La edad promedio fue de 40ñ11 años. 84.9 por ciento del sexo femenino, 2.7 por ciento con tratamiento quirúrgico previo y 1.4 por ciento cursaban con embarazo. Se utilizó el balón de Inoue en 89.4 por ciento, doble balón 9.7 por ciento y monobalón en 0.9 por ciento. El área valvular mitral (AVM) predilatación se incrementó de 0.93ñ0.20 a 1.85ñ0.37 cm² (p<0.001), la presión media de la aúricula izquierda descendió de 20.9ñ8.1 a 10.0ñ5.9 mmHg (p<0.001), el gradiente transvalvular (GTVM) descendió de 15.4ñ6.4 a 3.4ñ3.1 mmHg (p<0.001). Se completó el procedimiento sin complicaciones mayores en 93.1 por ciento. Desarrollaron insuficiencia mitral (IM) severa el 3.9 por ciento. Resultado óptimo en 82.1 por ciento, subóptimo 8.2 por ciento y se fracasó en 9.7 por ciento. Complicaciones mayores 4.7 por ciento con mortalidad de 0.9 por ciento. A 6 meses de seguimiento el área valvular disminuyó a 1.77ñ0.38 (p<0.001), manteniéndose sin cambios a 24 meses (1.78ñ0.37 p ns). El 93.3 por ciento están en clase funcional (CF) 1 a 24 meses. Los únicos predictores de resultado óptimo, fueron el AVM(> 1cm²) y la CF(I y II). La IM se desarrolló con mayor frecuencia con fibrilación auricular y puntuación ecocardiográfica >8. Nuestros resultados son comparables a lo encontrado en la literatura mundial, confirmando la seguridad de efectividad del procedimiento