[Mechanical mitral valve prosthesis dysfunction in pregnant women. Report of 2 cases]. / Disfunción de prótesis mitral mecánica en embarazadas. Informe de dos casos.

We present two cases of pregnant women associated with mechanical mitral valve prostheses dysfunction, treated between October 1998 and September 2000, in congestive heart failure, functional class III, without fetal distress. Emergency surgery consisted in cesarean procedure immediately followed for mitral prostheses removal and implantation of new mechanical heart valve prostheses was realized in both patients. In each case a single live infant was obtained with good Apgar evaluation. Both patients had successful surgical procedures. In both patients were found thrombi in the mechanical heart valves. Actually patients and their children have good evolution, without any problem.

[Myxoma of the left auricle and ischemic cardiopathy. Report of a case]. / Mixoma de aurícula izquierda y cardiopatía isquémica. Informe de un caso.

Myxoma is most frequent tumor of the heart, and usually appears isolated. This case involves a 64-year-old female with left atrial myxoma and associated ischemic heart disease. The patient was surgically treated with excision of the myxoma and coronary artery bypass grafting with internal mammary artery to left anterior descending artery. There were no perioperative complications, and the patient is asymptomatic at present. In conclusion, when there exists evidence of associated pathology to a cardiac myxoma, the case must be integrally evaluated in order to effect a complete treatment.

[De novo neoplasms in transplant patients]. / Neoplasias de novo en pacientes trasplantados.

To identify the number of patients with de novo tumors in organ transplant recipients, we collected the information from eleven hospitals of the Instituto Mexicano del Seguro Social with organ transplant programs. During a period of 9 years, we found only five cases of neoplasia. The median age was 26 years. All tumor occurred in renal transplant recipients. All patients received cyclosporine, azathioprine and steroids. One breast tumor, one renal carcinoma, two Kaposi's sarcoma and one angioleiomyosarcoma were found. The frequency of tumors in these patients is lower than reported by other authors, probably due, in our series to the fact that the patients were younger and the existence of a recently created transplant program with a short period of follow-up.

[Stents: experience at the Cardiology Hospital of the 21st century National Medical Center]. / Stents: Experiencia en el Hospital de Cardiología del Centro Médico Nacional Siglo XXI.

UNLABELLED: From february 1995 to february 1997 we implanted 157 stents in 105 patients. Age ranged from 38 to 81 years (mean 58), there were 83 males and 22 females. In 62.8% cases we implanted one stent and in 39 (37.2%) cases 2 to 6. Eighty three were Palmaz/Schatz (P/S), 27 ACT-ONE, 18 Wiktor (W), 9 Gianturco Rubin (GR), 8 Wallstent, 6 XT-Bard and 6 microstent. Indication were de novo in 23.8%, 87.5% post failure PTCA and in 13.3% late PTCA restenosis. Implant was successful al 96.1% of the patients. The first 32 patients received oral anticoagulation, the last 72 received aspirin and ticlopidine only. COMPLICATIONS: 4.7% acute thrombosis, 0.9% sub-acute thrombosis, three of them (2.5%) developed myocardial infarction, 0.9% emergency surgical treatment, 2.8% vascular complications and death in 2.8%. During follow-up (1 to 18 months, mean 7.7) we repeated angiography and 35 patients two to 14 months (m = 5.6), 12 of them had restenosis, during dilation two cases had dissection of the main left coronary artery and were send to surgery, the others were dilated without complications. One case had restenosis of the stent with obstructive lesions in other vessels and was send to elective surgery. The reminded patients are symptom free and had negative stress test. We conclude that this technology is an excellent alternative to percutaneous myocardial revascularization. Larger trials with long term follow-up is necessary to determine the true incidence of restenosis with the different types of stents.

[Tutorial training in cardiology and cardiothoracic surgery. Preliminary report]. / Enseñanza tutelar en cardiología y cirugía cardiotorácica. Informe preliminar.

INTRODUCTION AND OBJECTIVES: Personal contact has been lost in medical training due to the increase in numbers of medical students but not of teachers. This fact has impaired training in medical specialties. This is the reason that the Hospital for Cardiology has developed a program of tutelary training. In this paper we present our initial evaluation of this program. METHODS: The inclusive criteria for tutors and students have been defined as have the procedures to develop the program. After three months, 20 residents involved in the tutelary training program were randomly analyzed. Academic activities, clinical practice, research activities and extra-academic activities were evaluated. RESULTS: Currently there are 14 tutors. 50% of residents have developed research projects, 60% has increased academic activities, 50% has improved clinical practice and 65% has defined their postgraduate research projects. CONCLUSIONS: It was concluded that tutelary training in Cardiology and Cardiothoracic Surgery is a useful alternative to improve quality of graduates in these specialties.

[Transcatheter closure of patent ductus arteriosus with Rashkind's occluder. Experience during 3.7 years]. / Cierre transcateterismo del conducto arterioso (CTCA) con oclusor de Rashkind. Experiencia de 3.7 años.

Thirty eight transcatheter umbrella closure (TUC) of a persistently patent ductus arteriosus using the Rashkind umbrella occluder (USCI), were attempted in thirty four patients. Mean age 8.5 +/- 9.0 years (range 1.5 to 31). Internal diameter of ductus arteriosus (DA) average 4.0 +/- 1.5 mm (range 2 to 9 mm). Successful implantation was achieved in 36 procedures (94.7%). Complete closure immediately postimplantation was achieved in 15 (45.4%), 12 (36.3%) had trivial and 6 (18.1%) severe residual shunt. In four cases we implanted successfully a second device. At the follow-up (average 24 months) in 31 patients, 87.0% (n = 27) had complete closure and 96.7% (n = 30) did not need another intervention. Device embolization to distal left pulmonary artery occurred in two cases (5.2%), one was retrieved by surgery and in the other case it was allowed to remain. No mortality was observed. This results confirm the efficacy, with low morbidity and no mortality of TUC, especially in those with smaller PDA (< 4 mm).

[Residual shunts after application of the Rushkind occlusion system in closure of persistent ductus arteriosus. Insertion of a second device]. / Fuga residual postcolocación de oclusor de Rashkind para cierre del conducto arterioso persistente via percutánea. Colocación de un segundo dispositivo.

From May 1991 to August 1994, we performed transcatheter closure of patent ductus arteriosus with Rashkind umbrella system in 25 patients. In one, the device had embolism, to the right pulmonary artery and was operated 24 hs afterwards without complications. Seven had residual shunts, two had subsequent surgery, two are being followed (one for mild and one for moderate residual shunt). In the other three cases we inserted a second device. We used a 12 mm device in two cases and a 17 mm device in the other. Two cases had total occlusion 24 hrs after and in one had mild residual shunt without clinical repercussion. There were no complications. All had electrocardiographic and clinical improvement, take no medication, and their cardiomegaly had decreased (Cardiac index pre 61 vs post 54%). In conclusion the insertion of a second device is safe and effective alternative for residual shunt after first Rashkind occluder.

[Observer variation in diagnostic procedures related to cardiothoracic surgery]. / Variabilidad de observador en procedimientos diagnósticos afines a la cirugía cardiotorácica.

The results reliability is a predominant condition in the validity of clinical research. The observer agreement determination is a useful procedure in the confirmation of the obtained results in clinical research. The present work is a presentation of the basis about observer agreement and a review of national publications in cardiology, pneumology and cardiothoracic surgery between january 1980 and july 1993, where we found just two publications with the application of observer agreement determination in echocardiography, electrocardiography, microscopy and hemodynamics. It was concluded that is necessary the increase in determination of observer agreement and inform this results in our publications, excluding the variability attributed to patients, diagnostics equipment or the circumstances.

The intraaortic counterpulsation balloon in cardiac surgery. The importance of opportune indication.

The results with the use of this device in patients who develop Low Cardiac Output Syndrome after cardiac surgery with extracorporeal circulation are analyzed. Special emphasis is given to the development of the opportune indication of this procedure, on the basis of a comparison of the results of the first few years to the most recent ones. Finally, the advantages of the prophylactic use of the Intraaortic Balloon Pump are commented.