[Fast pathway for heart surgery]. / Vía rápida para cirugía cardiaca.

The increasing demographic and life expectancy rates, together with the vertiginous technological development during the last two decades, have raised the number of cardiac patients requiring surgical treatment. Therefore, several institutions have been forced to give priority to advanced or more serious cases and to postpone those that do not demand an urgent surgery. This analysis was made from June 15, 1999 to June 15, 2000 and demonstrates the results obtained from maintaining a fast track at the National Institute of Cardiology "Ignacio Chávez". This has favored the practice of surgeries in cases with noncomplex pathologies, null mortality, and low morbidity rates. The analysis also compares results from patients who had been subjected to surgery for the same type of pathologies but following the usual course of admittance and surgery scheduling, proving to be cost-efficient. It also demonstrates the high incidence of inter-auricular communication and the Von Willebrand disease that exist in our environment. Based on the results, we propose to maintain and increase this type of surgeries, addressing their limitations.

[Converting enzyme inhibitors or AT1 receptor blockers]. / Inhibidores de enzima convertidora o bloqueadores de receptores AT1.

The arrival of angiotensin converting enzyme inhibitors (ACE), and AT1 angiotensin selective receptors blockers, has changed the panorama of systemic high blood pressure and cardiac insufficiency treatments. These inhibitors and blockers have also been useful in cases of left asymptomatic ventricular dysfunction, myocardial infarction and post-infarction and various nephropathies--not only diabetes dependent but due to other etiologies as well. Furthermore, its application in primary prevention of coronary cardiopathies has started to become evident. The main advantages of this new group of drugs are their relative harmlessness and lesser undesirable side effects, as those caused by other antihypertensives agents. The AT1 receptor inhibitors of angiotensin have actually not proven to be superior than the ACE inhibitors (although the latter are not worse) but are better tolerated and protect a greater period of time with a single dosage. A greater number of macro studies with selective AT1 receptor blockers is necessary to know its right place in therapeutics.

[Myocardial bridging. The role of microcirculation, coronary reserve and systolic endothelial injury]. / Puentes miocárdicos. Papel de la microcirculación, reserva coronaria y daño endotelial sistólico.

BACKGROUND: The relationship between myocardial bridging (MB) and ischemic heart disease is still controversial. However, a recent new evidence suggests that this relation is not by chance. PURPOSE: The purpose of our study was to review in a critical manner, the evidence for the relationship between MB and myocardial ischemia and its possible consequences. METHODS: We present 2 cases of our series and review the medical literature from January 1966 to January 1998 published and included in Medline and Current Contents. RESULTS AND CONCLUSIONS: The principal findings after this review were: 1) MB is not a normal variant; 2) The clinical impact of MB depends on its anatomical extension and degree of compressive effect; 3) The MB muscle is not similar to myocytes from other cardiac areas; 4) The environment surrounding coronary artery may be a crucial factor in determining whether the MB influences the induction of heart disorders or not; 5) The overshoot due to compressive effect on coronary artery might determine endothelial injury in the microcirculation post-MB; 6) In some cases, the systolic endothelial injury may contribute to release factors that are able to reduce the coronary reserve, resulting in myocardial ischemia; 7) The possible role of PTCA in this disorder still has to be proven. Surgical treatment should be considered when important myocardial ischemia had been demonstrated, even in those asymptomatic cases.

[Primary mesothelioma of the pericardium. Report of 2 cases and review of the literature]. / Mesotelioma primario del pericardio. Comunicación de dos casos y revisión de la literatura.

We described two adult females with primary pericardial mesothelioma. There was not history of asbestos exposure. The clinical picture suggested pericardial constriction, with predominantly right sided heart failure. Anatomically; one case was of a nodular type, being the other diffuse. On histology both cases were of the fibrous type. The second case was less differentiated; it perforated the right atrial wall creating an intracavitary mass. A review of the literature is made.

[Mitral insufficiency after a penetrating thoracic wound. Report of a case]. / Insuficiencia mitral secundaria a herida penetrante de tórax. Informe de un caso.

It is communicated an isolated mytral insufficiency case, secondary to thorax's penetrative wound by steel arm. There are commented the clinic discoveries, phonomechanocardiographic, echocardiographic, haemodynamic and operation results of a unique orifice in the mytral's septal valve with important overflow. When perforation was sutured it was necessary reoperate it in order to suture's dehiscence and valve's substitution by a Bjork-Shilley's prothesis. The patient persists asymptomatic 35 months after intervention.