Cardiorespiratory Phase Synchronization increases during certain mental stimuli in healthy subjects.

Several neurological and mechanical non-linear mechanisms relate the respiratory and cardiovascular systems to one another. Besides the well-known modulation of heart rate by respiration, another form of non-linear interaction between both systems is Cardiorespiratory Phase Synchronization (CRPS). In this study we investigated CRPS on a group of 27 healthy individuals subject to a stimulation protocol with five different mental states: a basal state, a videogame, a comedy video, a suspense video and a reading state. Acontinuous measure of CRPS was calculated from the phase synchrogram between respiratory and electrocardiographic signals. Periods of CRPS were characterized by their average duration (AvDurSync) and by the percentage of synchronized time (%Sync) within each mental state. These measures were studied considering two thresholds: a minimum amplitude and a minimum duration for synchronization. Each subject exhibited a particular pattern of phase locking ratios along the different mental states. We observed that, in all states, %Sync decreased and AvDurSync increased in proportion to the minimum duration threshold. Both measures were inversely proportional to the minimum amplitude threshold.uring the videogame, subjects showed a significantly higher %Sync as compared to any other mental stimulus, irrespective of the minimum duration threshold. Mental stimulation can be an alternative approach to enhance cardiorespiratory coupling when subjects have difficulties to perform aerobic exercise, such as in patients with Chronic Obstructive Pulmonary Disease or Chronic Heart failure.

Endocarditis infecciosa de alto riesgo embolígeno durante el embarazo: ¿manejo conservador o quirúrgico? / High risk infective endocarditis embolism during pregnancy: Medical or surgical management?

Presentamos el caso de una paciente de 22 años de edad con embarazo de 14 semanas y endocarditis infecciosa de válvula mitral nativa con una vegetación de 15 mm con amplia movilidad, acompañada de insuficiencia valvular severa. Inicialmente, y pese al riesgo embolígeno, se dio tratamiento antibiótico durante 4 semanas. Por persistencia del tamaño de la vegetación se decide llevar a cirugía para reparación mitral y remoción de la lesión en la semana 18 de gestación, considerando que el balance entre el riesgo fetal y materno estaba a favor del procedimiento quirúrgico. Se usaron técnicas de protección fetal intraoperatoria y se colocó una prótesis biológica previo intento de reparación. La evolución postintervención fue satisfactoria, lográndose parto por cesárea a las 30 semanas.

A 22-year-old pregnant woman was seen at 14 weeks of pregnancy for infective endocarditis with a vegetation of 15 mm and wide mobility, which affected the native mitral valve accompanied by severe valvular insufficiency. Antibiotic treatment was given for 4 weeks despite the embolism risk. Due to persistence of vegetation size and after considering the fetal and maternal risk, the surgical procedure was favored. We decided to perform valvuloplasty and removal of lesion at 18 weeks of pregnancy. Fetal protection techniques were used and a bioprosthesis was placed before attempting a repair. The postoperative follow-up was satisfactory, achieving a successful birth by cesarean section at 30 weeks.

[High risk infective endocarditis embolism during pregnancy: Medical or surgical management?]. / Endocarditis infecciosa de alto riesgo embolígeno durante el embarazo: ¿manejo conservador o quirúrgico?

A 22-year-old pregnant woman was seen at 14 weeks of pregnancy for infective endocarditis with a vegetation of 15 mm and wide mobility, which affected the native mitral valve accompanied by severe valvular insufficiency. Antibiotic treatment was given for 4 weeks despite the embolism risk. Due to persistence of vegetation size and after considering the fetal and maternal risk, the surgical procedure was favored. We decided to perform valvuloplasty and removal of lesion at 18 weeks of pregnancy. Fetal protection techniques were used and a bioprosthesis was placed before attempting a repair. The postoperative follow-up was satisfactory, achieving a successful birth by cesarean section at 30 weeks.