[Percutaneous implantation of an aortic prosthetic valve on a degenerated mitral bioprosthesis. Report of one case]. / Implantación percutánea transeptal de válvula protésica aórtica sobre bioprótesis mitral degenerada.

Reintervention of a mitral degenerated bioprosthesis has a high surgical risk, especially in elderly patients with multiple comorbidities. We report a 74 years old female with two previous cardiac surgical procedures and a new structural mitral bioprosthesis deterioration with severe mitral regurgitation. Considering her high-surgical risk, a fully percutaneous treatment was performed with a balloon-expandable aortic valve in mitral position (valve-in-valve) through a transseptal approach with a favorable outcome. This technique is an attractive and effective option with a relatively low rate of complications that could solve this challenging and complex disease.

Implantación percutánea transeptal de válvula protésica aórtica sobre bioprótesis mitral degenerada / Percutaneous implantation of an aortic prosthetic valve on a degenerated mitral bioprosthesis. Report of one case

Reintervention of a mitral degenerated bioprosthesis has a high surgical risk, especially in elderly patients with multiple comorbidities. We report a 74 years old female with two previous cardiac surgical procedures and a new structural mitral bioprosthesis deterioration with severe mitral regurgitation. Considering her high-surgical risk, a fully percutaneous treatment was performed with a balloon-expandable aortic valve in mitral position (valve-in-valve) through a transseptal approach with a favorable outcome. This technique is an attractive and effective option with a relatively low rate of complications that could solve this challenging and complex disease.

[Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension]. / Angioplastía con balón para el tratamiento de la hipertensión arterial pulmonar por enfermedad tromboembólica crónica. Resultados hemodinámicos y clínicos inmediatos.

BACKGROUND: Balloon pulmonary angioplasty (BPA) is a therapeutic alternative for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). AIM: To report the initial experience with the "refined BPA technique" with the use of intravascular images. PATIENTS AND METHODS: Between June 2015 and June 2016 we selected fourteen patients with CTEPH who were considered candidates for BPA. Lesions targeted for treatment were further analyzed using intravascular imaging with optical frequency domain imaging (OFDI). We report the immediate hemodynamic results and four weeks of follow-up of the first eight patients of this series. RESULTS: We performed 16 BPA in eight patients aged 61 ± 14 years (88% women). Mean pulmonary artery pressure (PAPm) was 48.6 ± 5.8 mmHg. Success was achieved in seven patients (88%). A mean of 2.3 segments per patient were intervened in 11 sessions (1.6 sessions/ patient). Only one patient developed lung reperfusion injury. No mortality was associated with the procedure. After the last BPA session, PAPm decreased to 37.4 ± 8.6 mmHg (p=0.02). Pulmonary vascular resistance (RVP) decreased from 858,6 ± 377,0 at baseline to 516,6 ± 323,3 Dynes/sec/cm-5 (p<0.01) and the cardiac index increased from 2.4±0.6 at baseline to 2.8±0.3 L/min/m2 (p=0.01). At 4 weeks after the last BPA, WHO functional class improved from 3.3±0.5 to 2.5±0.5 (p<0,01) and six minutes walking distance from 331±92 to 451±149 m (p=0.01). CONCLUSIONS: BPA guided by OFDI for the treatment of inoperable CTEPH patients is a safe alternative with excellent immediate hemodynamic and clinical results.

Angioplastía con balón para el tratamiento de la hipertensión arterial pulmonar por enfermedad tromboembólica crónica. Resultados hemodinámicos y clínicos inmediatos / Balloon pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension

Background: Balloon pulmonary angioplasty (BPA) is a therapeutic alternative for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Aim: To report the initial experience with the "refined BPA technique" with the use of intravascular images. Patients and Methods: Between June 2015 and June 2016 we selected fourteen patients with CTEPH who were considered candidates for BPA. Lesions targeted for treatment were further analyzed using intravascular imaging with optical frequency domain imaging (OFDI). We report the immediate hemodynamic results and four weeks of follow-up of the first eight patients of this series. Results: We performed 16 BPA in eight patients aged 61 ± 14 years (88% women). Mean pulmonary artery pressure (PAPm) was 48.6 ± 5.8 mmHg. Success was achieved in seven patients (88%). A mean of 2.3 segments per patient were intervened in 11 sessions (1.6 sessions/ patient). Only one patient developed lung reperfusion injury. No mortality was associated with the procedure. After the last BPA session, PAPm decreased to 37.4 ± 8.6 mmHg (p=0.02). Pulmonary vascular resistance (RVP) decreased from 858,6 ± 377,0 at baseline to 516,6 ± 323,3 Dynes/sec/cm−5 (p<0.01) and the cardiac index increased from 2.4±0.6 at baseline to 2.8±0.3 L/min/m2 (p=0.01). At 4 weeks after the last BPA, WHO functional class improved from 3.3±0.5 to 2.5±0.5 (p<0,01) and six minutes walking distance from 331±92 to 451±149 m (p=0.01). Conclusions: BPA guided by OFDI for the treatment of inoperable CTEPH patients is a safe alternative with excellent immediate hemodynamic and clinical results.

Válvula aórtica cuadricúspide: caso clínico y discusión / Ouadricuspid aortic valve

The quadricuspid aortic valve is a rare congenital anomaly, usually presenting as an isolated malformation causing aortic regurgitation in the faith or sixth decades of life. The first reported cases were found at autopsy or became evident by surgical findings. However, the emergence of new imaging modalities currently allows an earlier diagnosis, including in asymptomatic patients. Hereby the case of a 60-year-old woman with quadricuspid aortic valve diagnosed by echocardiography is presented. A brief discussion of the disease is included.

[Survival of patients with pulmonary arterial hypertension after the advent of specific pulmonary vasodilator therapies]. / Sobrevida a mediano plazo en los pacientes con hipertensión arterial pulmonar en la era de terapias vasodilatadoras específicas del territorio vascular pulmonar.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare and progressive disease. Long-term survival remains poor despite of advances in specific vasodilator therapy. AIM: To describe the survival rate in a cohort of PAH patients in two referral centers in Chile. PATIENTS AND METHODS: One hundred fifteen patients aged 43 ± 15.6 years (85% females) with PAH qualified for this study. Their median pulmonary artery pressure was 55.4 ± 14 mmHg and their six minutes walking capacity was 368 ± 119 m. They were followed for 58 ± 0.4 months and their actual survival rates were compared with the estimated survival using the equation proposed by the French registry of PAH. RESULTS: One, two and three year survival rates were 97, 94 and 89%, respectively. The observed survival rates were greater than the estimated survival. CONCLUSIONS: The improvement in survival rates observed in this cohort of patients is similar to what has been described in literature.

Sobrevida a mediano plazo en los pacientes con hipertensión arterial pulmonar en la era de terapias vasodilatadoras específicas del territorio vascular pulmonar / Survival of patients with pulmonary arterial hypertension after the advent of specific pulmonary vasodilator therapies

Background: Pulmonary arterial hypertension (PAH) is a rare and progressive disease. Long-term survival remains poor despite of advances in specific vasodilator therapy. Aim: To describe the survival rate in a cohort of PAH patients in two referral centers in Chile. Patients and Methods: One hundred fifteen patients aged 43 ± 15.6 years (85% females) with PAH qualified for this study. Their median pulmonary artery pressure was 55.4 ± 14 mmHg and their six minutes walking capacity was 368 ± 119 m. They were followed for 58 ± 0.4 months and their actual survival rates were compared with the estimated survival using the equation proposed by the French registry of PAH. Results: One, two and three year survival rates were 97, 94 and 89%, respectively. The observed survival rates were greater than the estimated survival. Conclusions: The improvement in survival rates observed in this cohort of patients is similar to what has been described in literature.

Prevalence of seven cardiovascular-related genetic polymorphisms in a Chilean mestizo healthy population.

OBJECTIVE: Among the genetic factors associated with cardiovascular disease (CVD), determining polymorphic genotypes could help to understand the appearance of the illness. Ethnic differences in these polymorphisms could explain population variability in susceptibility to CVD. The main goal of this research is to study the presence of more relevant genetic variants of ApoE, CETP, ACE, PAI-1, MTHFR, FII and FVL of the coagulation cascade, to describe the presence of cardiovascular-related variants in a mestizo group of the Chilean people. METHODS AND RESULTS: The studied population comprised 146 unrelated subjects from the general population, diagnosed as healthy, who were genotyped through conventional and/or real-time PCR. The allele frequencies for the Chilean population were: Apo E, ε2: 0.036, ε3: 0.875 and ε4: 0.089; CETP, B1: 0.51 and B2: 0.49; MTHFR, C: 0.52 and T: 0.48; ACE, I: 0.603 and D: 0.397; PAI-1, 4G: 0.381 and 5G: 0.619; FII, G: 0.97 and A: 0.03, and FV Leiden, G: 0.97 and A: 0.03. CONCLUSIONS: This study contributes to establish a first picture in the Chilean mestizo population about the frequencies of these variants, which could act as single or complementary risk factors to trigger CVD. The obtained allele frequencies show great differences in relation to other South American populations.

Miocardiopatía periparto: caso clínico / Per partum cardiomyopathy: case report

Se presenta el caso clínico de una mujer de 20 años que presenta insuficiencia cardíaca de rápida instalación, asociada a síntomas de infección respiratoria viral, 9 semanas post parto. Previamente había presentado hipertensión en el puerperio precoz. Se demostró una severa disfunción sistólica (FE 12 por ciento). Se recuperó con medidas convencionales del tratamiento de Insuficiencia cardíaca y finalmente recibió bromocriptina basado en reportes favorables de la literatura respecto del uso de este fármaco. En el control al año de su alta, se mantenía asintomática pero persistía severa disminución de la FE (18 por ciento) y dilatación de cavidades izquierdas. Se revisa la información acerca de esta patología.

A 20 year old woman developed rapidly progressive heart failure 9 weeks after delivery. For a few weeks she was hypertensive. A severe systolic dysfunction with an EF of 12 percent was shown on echocardiography. She recovered on conventional treatment of congestive heart failure. Eventually she received bromocriptine con the basis of favorable literature reports. A follow up control at one year showed an asymptomatic patient, however severe systolic dysfunction with EF 18 percent was still present.

El trasplante intracoronario de células mononucleares de médula ósea se asocia a mejoría la función ventricular izquierda, en pacientes con cardiopatía dilatada de diferente etiología: Proyecto INNOVA Chile N°205-4350 / Autologous bone marrow cell transplantation improves ejection fraction in patients with dilated cardiomyopathy of diverse etiologies: Proyecto innova chile n° 205-4350

Introducción: Estudios recientes indican que el trasplante intracoronario de células mononucleares de médula ósea (BMCs) autólogas, mejoran la fracción de eyección (FEVI) y otros marcadores clínicos en pacientes con insuficiencia cardíaca (IC). Objetivo: Evaluar la seguridad y eficacia de la administración intracoronaria de BMCs autólogas, en pacientes con insuficiencia cardíaca (IC) en fase dilatada, de diferente etiología y en óptimas condiciones de tratamiento médico. Método: De 23 pacientes consecutivos que cumplieron con los criterios de inclusión, 12 fueron asignados a trasplante intracoronario de BMCs autólogas, recibiendo una dosis media de 8.19+/-4.43 x 10(6) células CD34+ (Grupo trasplantado). Los pacientes restantes sólo recibieron terapia estándar (Grupo control). Todos los pacientes fueron evaluados mediante Electrocardiograma, Ecocardiografía, Holter ECG, RMN Cardíaca, Test de esfuerzo, Potenciales Ventriculares Tardíos, Variabilidad de Frecuencia Cardíaca y evaluación clínica a los 0, 3, 6 y 12 meses. La capacidad funcional (CF) fue evaluada clínicamente y por cuestionarios de calidad de vida. Elanálisis estadístico fue realizado mediante Test Anova, y test de Bonferroni. Resultados: El grupo trasplantado presentó un aumento significativo de la FEVI a los 6 meses (26.75+/-4.85 vs 37.82+/-6.97 por ciento, p=0.001) mejoría que se mantuvo a los 12 meses (26.75+/-4.85 vs 37.27+/-7.51 por ciento, p=0.002). Hubo una mejora significativa de la CF en el grupo trasplantado a los 6 y 12 meses (p<0.001). No hubo cambios significativos en los volúmenes de ventrículo izquierdo, así como en las restantes variables estudiadas. En el grupo control no observamos cambios de estas variables. No hubo complicaciones en relación al trasplante de BMCs. Conclusión: En pacientes con IC severa y baja FEVI, el trasplante intracoronario de células BMCs au-tólogas, se asoció a una mejoría significativa de la FEVI y la CF, a los 6 y 12 meses. Adicionalmente, no observamos ...

Background: Recent studies indicate that intra-coronary delivery of autologous bone marrow mono-nuclear cells (BMCs) improves the ejection fraction (LVEF) and other clinical markers in patients with heart failure (HF). Aim: To evaluate the safety and efficacy of intraco-ronary delivery of autologous BMCs in patients with HF in dilated phase under optimal medical treatment. Method: Of 23 consecutive patients who met the inclusion criteria, 12 were assigned to autologous BMCs intracoronary transplantation, receiving a mean dose of 8.19+/-4.43 x 106 CD34+ cells (BMCs group). The remaining patients received only standard therapy (control group). All patients were evaluated by Electrocardiogram, Echocardiography, Holter Monitoring, Cardiac Magnetic Resonance Imaging, Stress Testing, Ventricular Late potetials, Heart Rate Variability, and regular clinical examination at baseline and at follow-up (3, 6 and 12 months). Repeated measures ANOVA and Bonferroni testing were used for statistic analysis. Results: The BMCs group presented a significant increase in EF at sixth months (26.75+/-4.85 vs. 37.82+/-6.97 per cent, p=0.001) and 12 months post-transplant (26.75+/-4.85 vs. 37.27+/-7.51 per cent, p=0.002). There was a significant improvement in functional (NYHA) in the transplanted group at 6 and 12 months (p<0.001). There were no significant changes concerning left ventricular volumes, heart rate variability and exercise stress testing. We observed no improvement of these variables in the control group. There were no complications related to the BMCs transplant. Conclusions: Intracoronary infusion of auto-logous BMCs, in addition to standard therapy, was associated with significant improvement of left ventricular function at 12 months in patients with HF. We observed no complications relative to the procedure.

[Contemporary practice of the coronary angioplasty in Chile. Final report of the Chilean National Coronary Angioplasty Registry (RENAC) 2001-2002]. / Práctica contemporánea de la angioplastia coronaria en Chile. Informe final del Registro Nacional de Angioplastia Coronaria (RENAC) 2001-2002.

BACKGROUND: Coronary angioplasty was introduced in Chile in 1982, but only after the introduction of stents it became commonplace. However the results of this procedure at the national level remain largely unknown. AIM: To assess the results and characteristics of coronary angioplasty and develop a national registry in Chile (RENAC). PATIENTS AND METHODS: All centers performing angioplasty were invited to contribute prospectively with the clinical, angiographic, procedural characteristics and results of all consecutive coronary angioplasty procedures attempted between June 2001 and October 2002. RESULTS: In 10 centers, 1768 lesions were treated in 1484 procedures (22.98% in women). Mean age was 60.8 +/- 11.3 years old. Diabetes was found in 21.8%, hypertension in 60.2%, dyslipidemia in 52.0%, active smoking in 40.0%, renal failure in 6.2%. Myocardial infarction was recent in 28.4% and acute in 19.7%. Forty eight percent of patients had unstable angina and 15.5% had stable angina. Fifty three percent of patients had single vessel disease and 71%, normal left ventricular eyection fraction. One vessel was treated in 90.6% of patients and 81.7% of lesions were treated with stents, 17.9% only with baloon and in 0.4% with atherectomy. Angiographic success was obtained in 95.2%. Clinical success was obtained in 92.2%, and 95.1% In patients without acute myocardial infarction. Overall inhospital death was 2.2%. In patients without myocardial infarction, the figure was 1.1%. CONCLUSIONS: Coronary angioplasty in Chile is performed mostly for the treatment of acute coronary syndromes. Stents are the most frequently used devices. The high success, low mortality and complications observed are comparable to North American registries.

Eventos coronarios tardíos post angioplastía con y sin stent / Late coronary events post angioplasty with and without stent

La angioplastia coronaria transluminal percutánea ha probado ser más efectiva que el tratamiento médico para el control de la cardiopatía coronacia. El uso de stents asociado a angioplastia ha permitido disminuir la reestenosis y los eventos a largo plazo en poblaciones seleccionadas de pacientes, sometidos a angioplastia con y sin stent. Entre agosto de 1993 y julio de 1997, se realizaron 147 angioplastias. El procedimiento fue considerado exitoso en 104 pacientes (70,7 por ciento) los que se separaron en dos grupos: 39 con stent y 65 sin stent. El seguimiento clínico se prolongó por 6,18 meses en promedio con un rango de 1 a 27 meses. Para el análisis estadístico se uso el cuociente de tasa de incidencia (CTI) y regresión de Cox. La incidencia total de eventos coronarios fue de 15,4 por ciento (10,2 por ciento en los pacientes con angioplastia más stent versus 18 por ciento en los pacientes con angioplastia sola (CTI=2,0; p=ns). El evento más frecuente fue la angina inestable (68,7 por ciento). El 31,2 por ciento de los pacientes con eventos requirieron de nueva revascularización. No se registraron muerte ni infartos durante el período de seguimiento. La incidencia de eventos tardíos fue más frecuente en mujeres (22 por ciento) que en hombres (10 por ciento), luego de ajustar por sexo, edad y presencia de diabetes. El uso de stent se asocia a una disminución no estadísticamente significativa de eventos coronarios al largo plazo en casuística de pacientes no seleccionados

Prolapso valvular mitral o enfermedad de Barlow / Prolapse of the mitral valve or Barlow's disease

El prolapso valvular mitral es la herniación de uno o ambos velos mitrales hacia la aurícula izquierda durante la sístole. Se presenta en el 5% de la población general, siendo más frecuente en la mujer y entre los 20 y 50 años. La mayoría de los casos son asintomáticos y sin repercusión hemodinámica. El diagnóstico se plantea por signos auscultatorios (Click y soplo sistólico mitrálico de regurgitación) y se objetiva ecocardiograficamente. La sintomatología es muy variable e inespecífica. Las principales complicaciones del prolapso valvular mitral son la insuficiencia mitral, la endocarditis infecciosa, los accidentes vasculares embólicos cerebrales y oculares y la muerte súbita producida por trastornos del ritmo. El tratamiento es fundamentalmente médico (antiarrítmicos, hipotensores, prevención de endocarditis bacteriana y de tromboembolismos). El reemplazo valvular está indicado cuando fracasa el tratamiento médico y existe insuficiencia mitral importante con dilatación significativa de ventrículo izquierdo