[Breast feeding and systemic blood pressure in infants]. / La alimentación al seno materno y la presión arterial sistémica en el lactante.

INTRODUCTION: Blood pressure levels in childhood influence these levels in adulthood, and breastfeeding has been considered such as a cardioprotective. We evaluated the association between blood pressure levels and feeding type in a group of infants. MATERIAL AND METHODS: We conducted a comparative cross-sectional study in term infants with appropriate weight at birth, to compare blood pressure levels in those children with exclusively breastfeeding, mixed-feeding and formula feeding. The comparison of groups was performed using ANOVA and multiple regression analysis was used to identify variables associated with mean arterial blood pressure levels. A p value < 0.05 was considered significant. RESULTS: We included 20 men and 24 women per group. Infant Formula Feeding had higher current weight and weight gain compared with the other two groups (p < 0.05). Systolic, diastolic and mean blood pressure levels, as well as respiratory and heart rate were higher in the groups of exclusively formula feeding and mixed-feeding than in those with exclusively breastfeeding (p < 0.05). Multiple regression analysis identified that variables associated with mean blood pressure levels were current body mass index, weight gain and formula feeding. CONCLUSIONS: Infants in breastfeeding show lower blood pressure, BMI and weight gain.

[Frequency and clinical outcome of odontogenic cervicofacial infection]. / Frecuencia de infección cervicofacial odontógena que requiere hospitalización.

OBJECTIVE: To measure frequency, mortality, hospitals stay and the requirement of attention in the intensive care unit (ICU) of patients with cervical infections. METHODS: A descriptive, observational and transversal study was carried out. We analyzed the database of patients admitted to Emergency Room of High Specialty Hospital, with cervical and facial infection with odontogenic origin, during a year period. RESULTS: In three cases were ambulatory and 19 where hospitalized; only three required ICU attention. The average of hospital stay was 6.3 days and the mortality of 8.3%. CONCLUSIONS: The mortality is significant in patients who require ICU and whose age is older than 60 years. Therefore this group of patients required a rapid multidisciplinary care to improve their expectations for survival expectancy.

Extensive demethylation of normally hypermethylated CpG islands occurs in human atherosclerotic arteries.

Global DNA hypomethylation potentially leading to pro-atherogenic gene expression occurs in atherosclerotic lesions. However, limited information is available on the genomic location of hypomethylated sequences. We present a microarray-based survey of the methylation status of CpG islands (CGIs) in 45 human atherosclerotic arteries and 16 controls. Data from 10,367 CGIs revealed that a subset (151 or 1.4%) of these was hypermethylated in control arteries. The vast majority (142 or 94%) of this CGI subset was found to be unmethylated or partially methylated in atherosclerotic tissue, while only 17 of the normally unmethylated CGIs were hypermethylated in the diseased tissue. The most common functional classes among annotated genes adjacent to or containing differentially methylated CGIs, were transcription (23%) and signalling factors (16%). The former included HOX members, PROX1, NOTCH1 and FOXP1, which are known to regulate key steps of atherogenesis. Expression analysis revealed differential expression of all CGI-associated genes analysed. Sequence analysis identified novel DNA motifs with regulatory potential, associated with differentially methylated CGIs. This study is the first large-scale analysis of DNA methylation in atherosclerosis. Our data suggest that aberrant DNA methylation in atherosclerosis affects the transcription of critical regulatory genes for the induction of a pro-atherogenic cellular phenotype.

Improvement of diastolic function after regression of left ventricular hypertrophy / Mejora de la función diastólica tras regresión de la hipertrofia ventricular izquierda

OBJECTIVE: To evaluate the diastolic function after regression of left ventricular hypertrophy, in mild to moderate hypertension treated with angiotensin converting enzyme(ACE) inhibitor and, if necessary, with a diuretic. METHODS: Ninety-eight hypertensive patients with left ventricular hypertrophy (LVH) and abnormal left ventricle diastolic function indexes received captopril (Capotena) 50 to 200 mg/day plus chlortalidone during 12 months to reach blood pressure control, defined as a diastolic blood pressure < or =90 and systolic blood pressure < or =140 mm Hg. Left ventricular (LV) mass index was calculated by M mode and two-dimensional echocardiography, and left ventricular diastolic function was assessed by transmitral pulsed Doppler ultrasound every 3 months. RESULTS: Sixty-three patients were women and 35 were men, mean age was 53.4 +/- 8.4 years (range 34-70). Thirty-six patients had mild (36.7%) and 62 (63.3%) moderate hypertension. Treatment reduced significantly both systolic pressure from 165 +/- 13 to 137 +/- 12.9 mm Hg (p<0.05) and diastolic pressure from 99 +/- 8.6 to 86 +/- 6.37 mm Hg (p<0.05). LV mass index decreased from 155.4 +/- 32.9 to 121.7 +/- 29.14 g/m2 (p<0.05). Late diastolic filling velocity (A wave) and the ratio of E/A waves improved (p<0.05), but early diastolic filling velocity (E wave) and isovolumetric relaxation time did not change with treatment. CONCLUSIONS: Some indexes of diastolic function improved after regression of left ventricular hypertrophy and good blood pressure control with captopril and chlortalidone.

[Factors associated to heavy bleeding during heart surgery with cardiopulmonary bypass]. / Factores relacionados con hemorragia mayor durante la cirugía cardíaca bajo circulación extracorpórea.

OBJECTIVE: To evaluate the risk factors related to bleeding in patients subjected to cardiac surgery using an extracorporeal circulation pump. MATERIAL AND METHODS: A study of cases and controls was designed performed in adults, matched by age and gender with indication of elective cardiac surgery using an extracorporeal circulation pump. Those patients with hepatic failure or blood coagulation disorders were excluded. Results were analyzed by Student t test, chi-square, and logistic regression analysis, considering p values significant at <0.05. RESULTS: The patients with functional class III or IV of the CCS presented more bleeding (p = 0.006), although there were no differences when comparing the ejection fraction in both. Obesity, dyslipidemia, and arterial hypertension were identified as risk factors. The coronary artery bypass graft, multivessels bypass surgery, and prolonged surgical times are associated to the complication (p < 0.05). According to the discriminant function analysis, the cardiopulmonary derivation time, weight, aortic clamp time, and heparin doses are the factors that better discriminate the possibility of hemorrhage. CONCLUSIONS: Heavy bleeding is related to ischemic patients, longer cardiac surgery time, overweight, and heparin doses during surgery.

[Revascularization surgery through left off-pump thoracotomy is a viable alternative for coronary bypass re-operation]. / La cirugía de revascularización per toracotomía izquierda sin circulación extracorpórea, es una alternativa viable en la re-operación de puentes coronaries.

BACKGROUND: Despite substantial advances in treatment, coronary atherosclerosis is a progressive disease, for this reason a second surgery is frequent. The left anterior small thoracotomy operation on a beating heart is an alternative with less morbidity and mortality than the conventional surgery. CASES REPORT: We report two cases of coronary surgery with limited access. The first corresponds to a 72-year-old man with diabetes, hypertension, dyslipidemia, obesity, with myocardial damage and bypass surgery to anterior descendent coronary artery and first diagonal coronary artery with saphenous vein graft performed 13 years ago. Due to unstable angina and positive test for myocardial ischemia, we performed bypass surgery of minimal access to the anterior descendent coronary artery and obtuse marginal coronary artery. The second case corresponds to a man with hypertension, diabetes, obesity, previous bypass surgery of two vessels performed 4 years ago, complicated with perioperative inferior myocardial infarction. Due to unstable angina and positive test for myocardial viability, we performed a re-do coronary artery bypass graft surgery to the left anterior descending artery and first diagonal coronary arteries through a minimal access incision. In both the clinical evolution was satisfactory, they were discharged 7 days after surgery and remain asymptomatic at one year of follow-up. CONCLUSION: The antero-lateral thoracotomy off-pump coronary bypass surgery is an alternative indicated in high risk patient with coronary revascularization.

La cirugía de revascularización per toracotomía izquierda sin circulación extracorpórea, es una alternativa viable en la re-operación de puentes coronaries / Revascularization surgery through left off-pump thoracotomy is a viable alternative for coronary bypass re-operation

Despite substantial advances in treatment, coronary atherosclerosis is a progressive disease, for this reason a second surgery is frequent. The left anterior small thoracotomy operation on a beating heart is an alternative with less morbidity and mortality than the conventional surgery. CASES REPORT: We report two cases of coronary surgery with limited access. The first corresponds to a 72-year-old man with diabetes, hypertension, dyslipidemia, obesity, with myocardial damage and bypass surgery to anterior descendent coronary artery and first diagonal coronary artery with saphenous vein graft performed 13 years ago. Due to unstable angina and positive test for myocardial ischemia, we performed bypass surgery of minimal access to the anterior descendent coronary artery and obtuse marginal coronary artery. The second case corresponds to a man with hypertension, diabetes, obesity, previous bypass surgery of two vessels performed 4 years ago, complicated with perioperative inferior myocardial infarction. Due to unstable angina and positive test for myocardial viability, we performed a re-do coronary artery bypass graft surgery to the left anterior descending artery and first diagonal coronary arteries through a minimal access incision. In both the clinical evolution was satisfactory, they were discharged 7 days after surgery and remain asymptomatic at one year of follow-up. CONCLUSION: The antero-lateral thoracotomy off-pump coronary bypass surgery is an alternative indicated in high risk patient with coronary revascularization.

Factores relacionados con hemorragia mayor durante la cirugía cardíaca bajo circulación extracorpórea / Factors associated to heavy bleeding during heart surgery with cardiopulmonary bypass

OBJECTIVE: To evaluate the risk factors related to bleeding in patients subjected to cardiac surgery using an extracorporeal circulation pump. MATERIAL AND METHODS: A study of cases and controls was designed performed in adults, matched by age and gender with indication of elective cardiac surgery using an extracorporeal circulation pump. Those patients with hepatic failure or blood coagulation disorders were excluded. Results were analyzed by Student t test, chi-square, and logistic regression analysis, considering p values significant at <0.05. RESULTS: The patients with functional class III or IV of the CCS presented more bleeding (p = 0.006), although there were no differences when comparing the ejection fraction in both. Obesity, dyslipidemia, and arterial hypertension were identified as risk factors. The coronary artery bypass graft, multivessels bypass surgery, and prolonged surgical times are associated to the complication (p < 0.05). According to the discriminant function analysis, the cardiopulmonary derivation time, weight, aortic clamp time, and heparin doses are the factors that better discriminate the possibility of hemorrhage. CONCLUSIONS: Heavy bleeding is related to ischemic patients, longer cardiac surgery time, overweight, and heparin doses during surgery.

Improvement of diastolic function after regression of left ventricular hypertrophy.

OBJECTIVE: To evaluate the diastolic function after regression of left ventricular hypertrophy, in mild to moderate hypertension treated with angiotensin converting enzyme(ACE) inhibitor and, if necessary, with a diuretic. METHODS: Ninety-eight hypertensive patients with left ventricular hypertrophy (LVH) and abnormal left ventricle diastolic function indexes received captopril (Capotena) 50 to 200 mg/day plus chlortalidone during 12 months to reach blood pressure control, defined as a diastolic blood pressure < or =90 and systolic blood pressure < or =140 mm Hg. Left ventricular (LV) mass index was calculated by M mode and two-dimensional echocardiography, and left ventricular diastolic function was assessed by transmitral pulsed Doppler ultrasound every 3 months. RESULTS: Sixty-three patients were women and 35 were men, mean age was 53.4 +/- 8.4 years (range 34-70). Thirty-six patients had mild (36.7%) and 62 (63.3%) moderate hypertension. Treatment reduced significantly both systolic pressure from 165 +/- 13 to 137 +/- 12.9 mm Hg (p<0.05) and diastolic pressure from 99 +/- 8.6 to 86 +/- 6.37 mm Hg (p<0.05). LV mass index decreased from 155.4 +/- 32.9 to 121.7 +/- 29.14 g/m2 (p<0.05). Late diastolic filling velocity (A wave) and the ratio of E/A waves improved (p<0.05), but early diastolic filling velocity (E wave) and isovolumetric relaxation time did not change with treatment. CONCLUSIONS: Some indexes of diastolic function improved after regression of left ventricular hypertrophy and good blood pressure control with captopril and chlortalidone.

Estenosis aórtica pura y resonancia magnética en el adulto / Pure aortic stenosis and magnetic resonance in adult patients

OBJECTIVE: To evaluate the utility of the cardiovascular magnetic resonance imaging (cMRI) for quantify the aortic area in adult patients with pure aortic stenosis (AS). METHOD: Comparative cross-sectional study, blinded, in patients with AS, without another valvular pathology associated. A transthoracic echocardiogram (TTE) and cMRI were performed, in all of them. Results were analyzed by Student t test and ji-square, considering significant values p < 0.05. Bayesian analysis and ROC curve, for the determination of the disease severity. RESULTS: No were significant differences with respect to quantification of the speed of transvalvular flow between both methods (TTE 4.593 +/- 0.9114 m/s vs. cMRI 4.233 +/- 0.6894 m/s, p = 0.080), nor the ejection fraction (TTE 54.27 +/-16.451 vs. cMRI 48.40 +/-17.332, p = 0.760). The cMRI seems to underestimate the maximum and medium gradients compared with the TTE, in 12.53 mm Hg and 10.07 mm Hg respectively. The sensitivity for the diagnosis of severe aortic stenosis is 90% with specificity 80%. CONCLUSIONS: The cMRI is a useful diagnostic method for the evaluation of patients with pure aortic valve stenosis, as good as TTE. cMRI can to be a diagnostic alternative in cases with limitations to TTE.

[Cardiovascular magnetic resonance evaluation of left-to-right shunts due to cardiac septal defects in patients with pulmonary arterial hypertension]. / Resonancia magnética cardiovascular en la cuantificación de los cortocircuitos de izquierda a derecha en los defectos septales cardiacos con hipertensión arterial pulmonar.

INTRODUCTION AND OBJECTIVES: As cardiac septal defects are frequently associated with pulmonary arterial hypertension, hemodynamic assessment is essential before deciding on surgery. The aim of this study was to evaluate the use of cardiovascular magnetic resonance imaging for assessing cardiac shunts and for quantifying pulmonary artery systolic pressure in patients with cardiac septal defects. METHODS: This cross-sectional study involved patients with cardiac septal defects and clinically suspected severe pulmonary arterial hypertension who had an indication for cardiac catheterization and in whom magnetic resonance imaging was not contraindicated. Each test's results were evaluated independently by two expert radiologists and interventional cardiologists who were blinded to the results of the other test. The procedures were compared using confidence limits and intraclass correlation coefficients. RESULTS: The study involved 29 patients (18 female and 11 male) aged from 30 days to 18 years; seven had an atrial septal defect, 14 had a ventricular septal defect, and eight had an atrioventricular septal defect. The correlation coefficients for measurements made using the two procedures were 0.80, 0.75, 0.81 and 0.58 for pulmonary output, systemic output, flow ratio, and systolic pressure in the pulmonary artery, respectively. Cardiovascular magnetic resonance tended to underestimate systemic output by 0.80 L/min, pulmonary output by 1.35 L/min, left-to-right shunt flow by 0.12 L/min, and systolic pressure in the pulmonary artery by 16.5 mmHg. The complication rate with cardiac catheterization was 31% compared with 3.4% with cardiovascular magnetic resonance imaging. CONCLUSIONS: The evaluation of patients with cardiac septal defects and pulmonary arterial hypertension should initially be performed using noninvasive diagnostic techniques.

Resonancia magnética cardiovascular en la cuantificación de los cortocircuitos de izquierda a derecha en los defectos septales cardiacos con hipertensión arterial pulmonar / Cardiovascular magnetic resonance evaluation of left-to-right shunts due to cardiac septal defects in patients with pulmonary arterial hypertension

Introducción y objetivos. Los defectos septales cardiacos con frecuencia se asocian con hipertensión arterial pulmonar, por lo que es indispensable su evaluación hemodinámica previa a la decisión quirúrgica. Llevamos a cabo un estudio para comparar la cuantificación del cortocircuito y de la presión sistólica de la arteria pulmonar mediante resonancia magnética cardiovascular en pacientes con defectos septales cardiacos. Métodos. Se diseñó un estudio transversal en pacientes con defectos septales cardiacos y sospecha clínica de hipertensión arterial pulmonar grave, con indicación de cateterismo cardiaco, sin contraindicación de resonancia magnética. La valoración de los resultados de cada prueba fue realizada por dos expertos radiólogos y hemodinamistas, de manera independiente y que desconocían los hallazgos en la otra prueba. La comparación entre los procedimientos se llevó a cabo mediante los límites de concordancia y el coeficiente de correlación intraclase. Resultados. Se incluyó a 29 pacientes, 18 mujeres y 11 varones, de 30 días a 18 años de edad, 7 con comunicación interauricular, 14 con comunicación interventricular y 8 con canal auriculoventricular completo. La correlación intraclase entre ambos procedimientos fue 0,80; 0,75; 0,81 y 0,58 para el gasto pulmonar, el gasto sistémico, la relación de flujos y la presión sistólica de la arteria pulmonar, respectivamente. La resonancia tiende a subestimar en 0,80 l/min el gasto sistémico, 1,35 l/min el gasto pulmonar, 0,12 l/min el desvío de flujo QP:QS y 16,5 mmHg la presión sistólica de la arteria pulmonar. La incidencia de complicaciones inherentes al cateterismo fue del 31% y de la resonancia del 3,4%. Conclusiones. La evaluación de los pacientes con defectos septales cardiacos e hipertensión pulmonar deberá realizarse, en primera instancia, con métodos de diagnóstico no invasivos (AU)

Introduction and objetives. As cardiac septal defects are frequently associated with pulmonary arterial hypertension, hemodynamic assessment is essential before deciding on surgery. The aim of this study was to evaluate the use of cardiovascular magnetic resonance imaging for assessing cardiac shunts and for quantifying pulmonary artery systolic pressure in patients with cardiac septal defects. Methods. This cross-sectional study involved patients with cardiac septal defects and clinically suspected severe pulmonary arterial hypertension who had an indication for cardiac catheterization and in whom magnetic resonance imaging was not contraindicated. Each test's results were evaluated independently by two expert radiologists and interventional cardiologists who were blinded to the results of the other test. The procedures were compared using confidence limits and intraclass correlation coefficients. Results. The study involved 29 patients (18 female and 11 male) aged from 30 days to 18 years; seven had an atrial septal defect, 14 had a ventricular septal defect, and eight had an atrioventricular septal defect. The correlation coefficients for measurements made using the two procedures were 0.80, 0.75, 0.81 and 0.58 for pulmonary output, systemic output, flow ratio, and systolic pressure in the pulmonary artery, respectively. Cardiovascular magnetic resonance tended to underestimate systemic output by 0.80 L/min, pulmonary output by 1.35 L/min, left-to-right shunt flow by 0.12 L/min, and systolic pressure in the pulmonary artery by 16.5 mmHg. The complication rate with cardiac catheterization was 31% compared with 3.4% with cardiovascular magnetic resonance imaging. Conclusions. The evaluation of patients with cardiac septal defects and pulmonary arterial hypertension should initially be performed using noninvasive diagnostic techniques (AU)

[Pure aortic stenosis and magnetic resonance in adult patients]. / Estenosis aórtica pura y resonancia magnética en el adulto.

OBJECTIVE: To evaluate the utility of the cardiovascular magnetic resonance imaging (cMRI) for quantify the aortic area in adult patients with pure aortic stenosis (AS). METHOD: Comparative cross-sectional study, blinded, in patients with AS, without another valvular pathology associated. A transthoracic echocardiogram (TTE) and cMRI were performed, in all of them. Results were analyzed by Student t test and ji-square, considering significant values p < 0.05. Bayesian analysis and ROC curve, for the determination of the disease severity. RESULTS: No were significant differences with respect to quantification of the speed of transvalvular flow between both methods (TTE 4.593 +/- 0.9114 m/s vs. cMRI 4.233 +/- 0.6894 m/s, p = 0.080), nor the ejection fraction (TTE 54.27 +/-16.451 vs. cMRI 48.40 +/-17.332, p = 0.760). The cMRI seems to underestimate the maximum and medium gradients compared with the TTE, in 12.53 mm Hg and 10.07 mm Hg respectively. The sensitivity for the diagnosis of severe aortic stenosis is 90% with specificity 80%. CONCLUSIONS: The cMRI is a useful diagnostic method for the evaluation of patients with pure aortic valve stenosis, as good as TTE. cMRI can to be a diagnostic alternative in cases with limitations to TTE.