In female rat heart mitochondria, oophorectomy results in loss of oxidative phosphorylation.

Oophorectomy in adult rats affected cardiac mitochondrial function. Progression of mitochondrial alterations was assessed at one, two and three months after surgery: at one month, very slight changes were observed, which increased at two and three months. Gradual effects included decrease in the rates of oxygen consumption and in respiratory uncoupling in the presence of complex I substrates, as well as compromised Ca2+ buffering ability. Malondialdehyde concentration increased, whereas the ROS-detoxifying enzyme Mn2+ superoxide dismutase (MnSOD) and aconitase lost activity. In the mitochondrial respiratory chain, the concentration and activity of complex I and complex IV decreased. Among other mitochondrial enzymes and transporters, adenine nucleotide carrier and glutaminase decreased. 2-Oxoglutarate dehydrogenase and pyruvate dehydrogenase also decreased. Data strongly suggest that in the female rat heart, estrogen depletion leads to progressive, severe mitochondrial dysfunction.

Evaluación postquirúrgica por ecocardiografía del paciente sometido a cambio valvular aórtico: ¿Se aplican las recomendaciones de las guías? / Echocardiographic evaluation of patients after aortic valve replacement: Do we follow the guidelines?

Objetivo: Determinar la metodología de evaluación ecocardiográfica empleada en el Instituto Nacional de Cardiología (hospital de tercer nivel) en pacientes operados de cambio valvular aórtico. Método: Se incluyeron a todos los pacientes consecutivos mayores de 18 años con estenosis aórtica que fueron llevados a cirugía de cambio valvular aórtico en el Instituto Nacional de Cardiología "Ignacio Chávez", durante el periodo de enero del 2011 a junio del 2012. Se determinó la fecha de cirugía, tipo de prótesis y el número y fecha de ecocardiogramas realizados después del evento quirúrgico. Resultados: Se encontró que en el 81% de los pacientes el primer ecocardiograma postquirúrgico se realizó durante su internamiento. Esta primera evaluación fue realizada dentro de las primeras 24 a 48 horas a 42 pacientes (51.8%); entre los 3 y los 7 días a 27 pacientes (33.3%); entre los 8 y los 14 días a 7 pacientes (8.6%) y posterior a los 14 días a 5 pacientes (6.1%). A 19 pacientes no se les realizó ecocardiograma. Conclusiones: En el Instituto Nacional de Cardiología "Ignacio Chávez", se realiza una evaluación y seguimiento ecocardiográfico de los pacientes operados de cambio valvular aórtico distinto a las recomendaciones internacionales.

Objective: To determine the methodology for the echocardiographic evaluation of patients with aortic valve replacement at the Instituto Nacional de Cardiología. Method: We included all consecutive patients, 18 years old or more with aortic valve replacement secondary to aortic stenosis at the Instituto Nacional de Cardiología "Ignacio Chávez", between January 2011 and June 2012. We described the date of the surgery, type of prosthetic valve and the number and date of the echocardiograms after the valve replacement. Results: Between January 2011 and June 2012, 100 patients underwent aortic valve replacement. In 81% the first echocardiogram was made during hospitalization. The first evaluation was made within the first 24-48 hours in 42 patients (51.8%), between the 3rd and 7th day in 27 patients (33.3%), between the 8th and the 14th day in 7 patients (8.6%) and after 14 days in 5 patients (6.1%). No echocardiogram was made in 19 patients. Conclusions: At the Instituto Nacional de Cardiología "Ignacio Chávez" we made an echocardiographic evaluation and follow up different from the international recommendations for patients with valve replacement.

[Aortic valve calcification evaluated by echocardiography associated with baseline conduction abnormalities as a predictor for pacemaker placement after aortic valve replacement]. / La extension de la calcificación aórtica evaluada mediante ecocardiografia asociada a trastornos de la conducción como predictors de marcapasos dedinitivos en el postoperatorio de cambio valvular aórtico.

INTRODUCTION: Aortic valve replacement in patients with severe aortic stenosis may be complicated by complete atrioventricular block (CAVB), requiring a permanent pacemaker (PPM) implantation. Predicting this complication could help to plan the surgical. OBJECTIVE: Determine whether electrocardiography and echocardiography are useful methods for predicting the need for PPM. MATERIAL AND METHODS: A retrospective, observational and transversal study was performed. An echocardiography based semi-quantitative classification was implemented to graduate the extent of calcification of the aortic valve. RESULTS: We included 95 patients; 10 of them required PPM implantation (10.52%). In the pre-surgical basal electrocardiogram we observed that 90% of patients that required PPM had conduction abnormalities as opposed to only 24.7% in the other group, p = 0.001. A 1st and 2nd degree AV block (AVB 1 and 2) was identified in 8 patients that subsequently needed PPM (80%) vs. 5 patients (5.9%), in the group that did not required it, p = 0.001.OR 41.7, IC 95% 6.5-68. We found a grade 3 calcification extent in 80% of patients who required PPM implant compared with only 17.6% of patients in the other group, p = 0.04, OR 4.8, IC 95% 0.76-29. The AVB 1 and 2 were the single predictor in multivariate analysis but the calcification 3 + AVB 1 and 2, increased sensibility. CONCLUISON: In patients with aortic stenosis in whom aortic valve replacement was performed, identifying AVB 1 and 2 on the basal electrocardiogram is a useful tool in order to identify requirement of PPM. The grade 3 of calcification extent increased the sensibility of this prediction.

Inhibir la contractilidad sin provocar necrosis: ¿sería útil en miocardiopatía hipertrófica? Modelo experimental de administración intramiocárdica de toxina botulínica y de wortmanina / Inhibiting contractility without necrosis: Would it be helpful for hypertrophic cardiomyopathy? Experimental model of intramyocardial botulinum toxin and wortmannin

En este artículo se presenta una idea original: inhibir la contracción miocárdica en forma regional y selectiva sin inducir necrosis. Se propone como una posible opción terapéutica en miocardiopatía hipertrófica asimétrica obstructiva, y se plantean 2 modelos farmacológicos basados en la administración intramiocárdica de toxina botulínica y de wortmanina.

The purpose of this paper is to introduce a new idea: local inhibition of contractility without necrosis. It's potential usefulness in hypertrophic cardiomyopathy treatment is discussed and 2 pharmacological models, administrating botulinum toxin and wortmannin directly in the myocardium are disclosed.

[Inhibiting contractility without necrosis: would it be helpful for hypertrophic cardiomyopathy? Experimental model of intramyocardial botulinum toxin and wortmannin]. / Inhibir la contractilidad sin provocar necrosis: ¿sería útil en miocardiopatía hipertrófica? Modelo experimental de administración intramiocárdica de toxina botulínica y de wortmanina.

The purpose of this paper is to introduce a new idea: local inhibition of contractility without necrosis. It's potential usefulness in hypertrophic cardiomyopathy treatment is discussed and 2 pharmacological models, administrating botulinum toxin and wortmannin directly in the myocardium are disclosed.

[Echocardiographic diagnosis of obstructive intermittent dysfunction of a mitral disc prosthetic valve]. / Diagnóstico ecocardiográfico de disfinción por obstrucción intermitente de prótesis de disco mitral.

Echocardiographic findings in six patients with obstructive intermittent dysfunction of mechanical disc prosthetic mitral valve (OIPD) are described. All with a clinical picture of gradual installation and progressive dyspnea of several weeks of evolution. TTE with Bd recordings were performed in all of them with "oriented" M mode from apical 4/C view. The findings were compared with a control group of 14 patients with normal prosthetic valves. In the group of OIDP, all patients displayed a variable delay in the opening of the prosthetic disc, registered as a "protodiastolic step" in M mode. In three patients, the dysfunction was due to a thrombus. In two, due to pannus. Three were operated. One with thrombolysis. In two, the treatment consisted of heparin and increased oral anticoagulation. None die during the acute handling of the intermittent dysfunction. Two patients died: one seven months later due to cardiac failure and the other a year later due to prosthetic rethrombosis. In patients with mechanical prosthetic valve in mitral valve position and progressive dyspnea, the presence of a variable delay in the opening of the prosthesis is diagnostic of OIDP and requires urgent handling with thrombolysis or surgery.

Diagnóstico ecocardiográfico de disfunción por obstrucción intermitente de prótesis de disco mitral / Echocardiographic diagnosis of obstructive intermittent dysfunction of a mitral disc prosthetic valve

Se describen los hallazgos Ecocardiográficos en seis pacientes con disfunción por obstrucción intermitente de prótesis (DOIP) mecánica de disco en posición mitral. Todos con cuadro clínico de instalación gradual, con disnea progresiva de varias semanas de evolución. Se les practicó ETT con registros Bd y de modo M "orientado" desde apical 4/C y se compararon los hallazgos con un grupo control de 14 pts con prótesis normo-funcionante. En el grupo de DOIP, todos presentaban un retardo variable en la apertura de la prótesis, registrada como un "escalón" protodiastólico en el modo M. En la mitad la disfunción fue por trombos. En dos porpannus. Tres se operaron. Uno se trombolizó. En dos se incrementó el tratamiento con heparina IV y con anticoagulante oral. Ninguno falleció durante el manejo agudo de la disfunción intermitente. Dos fallecieron: uno siete meses después en insuficiencia cardíaca y otro, un año después por retrombosis protésica. En pacientes con prótesis mecánica en posición mitral y disnea progresiva, la presencia de un retardo variable en la apertura de la prótesis, es diagnóstica de DOIP y requiere manejo urgente con trombólisis o cirugía.

Echocardiographic findings in six patients with obstructive intermittent dysfunction of mechanical disc prosthetic mitral valve (OIPD) are described. All with a clinical picture of gradual installation and progressive dyspnea of several weeks of evolution. TTE with Bd recordings were performed in all of them with "oriented" M mode from apical 4/C view. The findings were compared with a control group of 14 patients with normal prosthetic valves. In the group of OIDP, all patients displayed a variable delay in the opening of the prosthetic disc, registered as a "protodiastolic step" in M mode. In three patients, the dysfunction was due to a thrombus. In two, due to pannus. Three were operated. One with thrombolysis. In two, the treatment consisted of heparin and increased oral anticoagulation. None die during the acute handling of the intermittent dysfunction. Two patients died: one seven months later due to cardiac failure and the other a year later due to prosthetic rethrombosis. In patients with mechanical prosthetic valve in mitral valve position and progressive dyspnea, the presence of a variable delay in the opening of the prosthesis is diagnostic of OIDP and requires urgent handling with thrombolysis or surgery. (Arch Cardiol Mex 2005; 75: 141-147).

[Aortic valve complications associated with subarterial infundibular ventricular septal defect. Echocardiograpic follow-up]. / Alteraciones aórticas asociadas a comunicación interventricular infundibular subarterial. Seguimiento ecocardiográfico.

INTRODUCTION AND OBJECTIVES: Interventricular fibromuscular septal defects of the outlet tract are subarterial infundibular ventricular septal defects (VSDs). This anatomical situation predisposes to aortic cusp prolapse (AoP) and/or regurgitation (AoR). METHODS: In order to determinate the frequency of VSDs and the presence or development of aortic valve alterations detected by two-dimensional echocardiography, we studied 35 patients with VSDs. The defect area and presence, severity, and evolution of AoP and/or AoR were evaluated. Ten anatomic specimens were studied to verify the echocardiographic correlation. RESULTS: Subarterial infundibular defect was present in 6.9% of all ventricular septal defects. The average age at time of diagnosis was 5,8 years. VSDs diameter and gradient did not change during follow-up. At time of diagnosis, 30 patients (87%) did not have AoR, but during an average follow-up of 8 years, 11 (32%) developed it. By the end of the study, 46% had AoR. When the time to progression of AoR was compared in the group that developed it versus the group that did not, the median values were similar in both groups. There was a greater tendency to development and/or progression of regurgitation in small VSDs. The echo-anatomic correlation was precise. CONCLUSIONS: Aortic valve damage was a frequent finding in VSD. Most cases did not progress to more severe AoR. Small VSDs developed more severe regurgitation in less time. Surgery must be considered when AoR is detected. Regular evaluation by echocardiography is important in follow-up.

Alteraciones aórticas asociadas a comunicación interventricular infundibular subarterial. Seguimiento ecocardiográfico / Aortic valve complications associated with subarterial infundibular ventricular septal defect. Echocardiograpic follow-up

Introducción y objetivos. Los defectos septales interventriculares fibromusculares de la porción de salida constituyen las comunicaciones interventriculares infundibulares subarteriales (CIVI). Este sustrato anatómico condiciona el desarrollo de prolapso (PAo) y/o insuficiencia aórtica (IAo). El objetivo fue determinar la frecuencia de CIVI y la presencia o desarrollo de alteraciones en la válvula aórtica y su evolución ecocardiográfica. Métodos. Se analizaron 35 pacientes estudiados con ecocardiografía transtorácia (se valoró el área de la CIVI y presencia, gravedad y evolución de PAo y/o IAo) y 10 especímenes anatómicos para su correlación ecocardiográfica. La CIVI representó el 6,9 por ciento de los defectos septales ventriculares. La edad promedio al diagnóstico fue de 5,8 años. Resultados. El diámetro y el gradiente de CIVI no cambiaron durante el seguimiento. En el diagnóstico, 30 pacientes (87 por ciento) no tenían IAo y durante el seguimiento (promedio de 8 años) la desarrollaron 11 pacientes (32 por ciento); al finalizar el estudio el 46 por ciento presentó insuficiencia. Al comparar el tiempo de progresión de la IAo con el del grupo que no la desarrolló, la mediana fue similar en ambos grupos. En las CIVI de diámetro pequeño se encontró una mayor tendencia de desarrollo de IAo y/o progresión. La correlación ecoanatómica fue precisa. Conclusiones. El daño valvular aórtico en CIVI es frecuente; la mayoría de los casos permanecen con el mismo grado de IAo; sin embargo, las CIVI pequeñas evolucionan a grados más graves en menor tiempo. La cirugía debe considerarse cuando se observa IAo. La evaluación con ecocardiografía transtorácica es importante en el seguimiento de estos pacientes (AU)