Correction to: A systematic review on the role of MSC­derived exosomal miRNAs in the treatment of heart failure.

BACKGROUND: Heart failure (HF) is a deeply serious clinical problem that remains unsolved. Many reports highlight the cardioprotective properties of mesenchymal stem cells (MSCs), the factors contained in their secretome being particularly important for this function; these include the exosomal miRNAs (exo-miRNAs) secreted with or without stimulus which can modulate various biological processes. In search of new paradigms in heart failure, we wondered whether MSC-derived exosomal microRNAs could play a role in the management of clinical patients. METHODS: To analyze whether there is sufficient evidence to support this hypothesis we designed a systematic review of studies on exo-miRNAs in heart diseases causing HF during the last decade. RESULTS: The cardioprotective functions of twenty-four exo-miRNAs derived from bone marrow MSCs (BM-MSCs) are known and the functions of exo-miRNAs from other MSC sources such as adipose tissue, trophoblasts, amniotic fluid, and endometrium were also determined. Inhibition of apoptosis is the most reported biological function and the targets for thirty exo-miRNAs are known. CONCLUSIONS: The results from this systematic review support the initial hypothesis and encourage us to test it in future experimental research works but more importantly, we seek to encourage other researchers in the field to propose other hypotheses aimed at the possible use of exo-miRNAs in HF secondary to cardiac disease.

A systematic review on the role of MSC-derived exosomal miRNAs in the treatment of heart failure.

BACKGROUND: Heart failure (HF) is a deeply serious clinical problem that remains unsolved. Many reports highlight the cardioprotective properties of mesenchymal stem cells (MSCs), the factors contained in their secretome being particularly important for this function; these include the exosomal miRNAs (exo-miRNAs) secreted with or without stimulus which can modulate various biological processes. In search of new paradigms in heart failure, we wondered whether MSC-derived exosomal microRNAs could play a role in the management of clinical patients. METHODS: To analyze whether there is sufficient evidence to support this hypothesis we designed a systematic review of studies on exo-miRNAs in heart diseases causing HF during the last decade. RESULTS: The cardioprotective functions of twenty-four exo-miRNAs derived from bone marrow MSCs (BM-MSCs) are known and the functions of exo-miRNAs from other MSC sources such as adipose tissue, trophoblasts, amniotic fluid, and endometrium were also determined. Inhibition of apoptosis is the most reported biological function and the targets for thirty exo-miRNAs are known. CONCLUSIONS: The results from this systematic review support the initial hypothesis and encourage us to test it in future experimental research works but more importantly, we seek to encourage other researchers in the field to propose other hypotheses aimed at the possible use of exo-miRNAs in HF secondary to cardiac disease.

Changes in miR 21 and 23b expression in postnatal hypertrophic heart derived from gestational diabetes precede dilated cardiomyopathy.

Gestational diabetes mellitus (GDM) increases the risk of fetal congenital ventricular hypertrophic cardiomyopathy (HCM). We explored the effects and mechanisms of the postnatal progression of fetal hypertrophic failure in rat pups with STZ-induced Gestational Diabetes (GD). The hearts of rat pups (newborn [NB], 8, 15, 25 and 35 days postnatal) were obtained. Histological characteristics and expression of collagen were evaluated. In-gel-gelatin zymography for MMP-9 activation was performed. Adrenergic receptors (α2AR and ß3AR), myosins (Myc6 and Myc7), Bcl-2 and Bax mRNA expression were quantified by qRT-PCR. Fetal hypertrophy of the left ventricular lateral wall (LVLW) in rat pups with DG persists until day 8, although this process appears to be reversed during the postnatal stage. The temporal continuity of the study demonstrated a thinning of the ventricular wall, similar to dilated cardiomyopathy (DCM). This ventricular remodeling process is associated with the expression of ß3 adrenergic receptors and miR-21, -23b. The Bax/Bcl2 ratio was significantly reduced only at early ages. In addition, the increase in interstitial space in all ages, as well as the predominance of early ages expression of Col2 and increased expression of Col3, MMP-9 and Cx43 in late ages, is the result of an active extracellular remodeling in the hearts of rat pups with GD.

Identification, clinical manifestation and structural mechanisms of mutations in AMPK associated cardiac glycogen storage disease.

BACKGROUND: Although 21 causative mutations have been associated with PRKAG2 syndrome, our understanding of the syndrome remains incomplete. The aim of this project is to further investigate its unique genetic background, clinical manifestations, and underlying structural changes. METHODS: We recruited 885 hypertrophic cardiomyopathy (HCM) probands and their families internationally. Targeted next-generation sequencing of sudden cardiac death (SCD) genes was performed. The role of the identified variants was assessed using histological techniques and computational modeling. FINDINGS: Twelve PRKAG2 syndrome kindreds harboring 5 distinct variants were identified. The clinical penetrance of 25 carriers was 100.0%. Twenty-two family members died of SCD or heart failure (HF). All probands developed bradycardia (HRmin, 36.3 ±â€¯9.8 bpm) and cardiac conduction defects, and 33% had evidence of atrial fibrillation/paroxysmal supraventricular tachycardia (PSVT) and 67% had ventricular preexcitation, respectively. Some carriers presented with apical hypertrophy, hypertension, hyperlipidemia, and renal insufficiency. Histological study revealed reduced AMPK activity and major cardiac channels in the heart tissue with K485E mutation. Computational modelling suggests that K485E disrupts the salt bridge connecting the ß and γ subunits of AMPK, R302Q/P decreases the binding affinity for ATP, T400N and H401D alter the orientation of H383 and R531 residues, thus altering nucleotide binding, and N488I and L341S lead to structural instability in the Bateman domain, which disrupts the intramolecular regulation. INTERPRETATION: Including 4 families with 3 new mutations, we describe a cohort of 12 kindreds with PRKAG2 syndrome with novel pathogenic mechanisms by computational modelling. Severe clinical cardiac phenotypes may be developed, including HF, requiring close follow-up.

Ontogeny of the facial phenotypic variability in Mexican patients with 22q11.2 deletion syndrome.

BACKGROUND: 22q11.2 deletion syndrome is a medical condition that results from genomic loss at chromosome 22. Affected patients exhibit large variability that ranges from a severe condition to mild symptoms. In addition, the spectrum of clinical features differs among populations and even within family members. The facial features related to this syndrome are not an exception, and although part of its variation arises through development, few studies address this topic in order to understand the intra and inter-population heterogeneities. Here, we analyze the ontogenetic dynamics of facial morphology of Mexican patients with del22q11.2 syndrome. METHODS: Frontal facial photographs of 37 patients (mean age = 7.65 ± 4.21 SE) with del22q11.2DS and 200 control subjects (mean age = 7.69 ± 4.26 SE) were analyzed using geometric morphometric methods. Overall mean shape and size differences between patients and controls were analyzed, as well as differences in ontogenetic trajectories (i.e. development, growth, and allometry). RESULTS: We found that Mexican patients show typical traits that have been reported for the Caucasian population. Additionally, there were significant differences between groups in the facial shape and size when all the ontogenetic stages were considered together and, along ontogeny. The developmental and allometric trajectories of patients and controls were similar, but they differed in allometric scaling. Finally, patients and controls showed different growth trajectories. CONCLUSION: The results suggest that the typical face of patients with del22q11.2DS is established prenatally; nonetheless, the postnatal ontogeny could influence the dysmorphology and its variability through size-related changes.

Prevalencia y espectro de las enfermedades que predisponen a la muerte súbita cardiaca en niños mexicanos: una muestra obtenida del Hospital Infantil de México Federico Gómez / Prevalence and spectrum of diseases that predispose to sudden cardiac death in Mexican children: a sample obtained from The Federico Gomez Children's Hospital of Mexico

Resumen Objetivo: Determinar la prevalencia y espectro de las enfermedades que predisponen la muerte súbita cardiaca en niños mexicanos e identificar los principales signos y síntomas tempranos que pueden permitir al personal de salud sospechar acerca de estas enfermedades y referir a los pacientes a un hospital de tercer nivel de manera temprana. Métodos: La incidencia, prevalencia y prevalencia de periodo, así como los primeros síntomas, los datos clínicos y el seguimiento, se describen en todos los niños con enfermedades que predisponen a la muerte súbita cardiaca en el Hospital Infantil de México. Resultados: Cincuenta y nueve pacientes de 8 ± 5 años, 40 con miocardiopatías y 19 con enfermedades arritmogénicas hereditarias. La prevalencia del periodo fue de 9.5/1,000 pacientes/año. Los primeros síntomas más comunes fueron disnea, palpitaciones y síncope. En 9 casos se encontró un patrón de herencia mendeliana. Tres pacientes fallecieron de muerte súbita cardiaca durante el periodo de estudio. Conclusión: Las enfermedades que predisponen a la muerte súbita cardiaca en los niños no son muy conocidas por la comunidad médica y general. Todo niño con disnea, palpitaciones y/o síncope debe referirse para la búsqueda intensiva de estas enfermedades. Una evaluación cardiológica completa en todos los miembros de la familia está indicada.

Abstract Objective: To determine the prevalence and spectrum of diseases that predispose to sudden cardiac death in Mexican children, and to identify the main early signs and symptoms that can enable the health personnel to suspect these diseases and to refer the patients to a tertiary hospital in a timely manner. Methods: Incidence, prevalence, and period prevalence, as well as early symptoms, clinical data, and follow-up were recorded on all children found with diseases that predispose to sudden cardiac death in The Children's Hospital of Mexico. Results: The study included 59 patients, with a mean age of 8 ± 5 years old, with 40 cardiomyopathies, and 19 with inherited arrhythmogenic diseases. The period prevalence was 9.5/1,000 patients/year. The most common early symptoms were dyspnoea, palpitations, and syncope. A Mendelian inheritance pattern was found in 9 cases. Three patients died of sudden cardiac death during the period of the study. Conclusion: Diseases that predispose to sudden cardiac death in children are not very well known by the general medical community. Every child with dyspnoea, palpitations and/or syncope, should be referred for the intensive search of these diseases. A complete cardiological evaluation in all members of the family is indicated.

Maternal Obesity as a Risk Factor for the Development of Total Anomalous Pulmonary Venous Connection in Their Offspring.

The incidence of total anomalous pulmonary venous connection (TAPVC) in the Caucasian population is 2.5/100,000 live births (LB), and the incidence in the Hispanic population is 19.8/100,000 LB. Without knowing the exact etiology for the development of congenital heart disease, our objective was to determine the maternal factors associated with the development of TAPVC. METHODS: 55 mother-child binomials with isolated TAPVC (group I) and 152 healthy mother-child binomials (group II) were included. Both groups had no maternal history of addiction, pre-eclampsia, or type 1, 2 or gestational diabetes mellitus. Complete clinical histories were obtained for the women in both groups and perinatal and birth data were recorded. In addition, genealogies across three generations were constructed to determine affected first- or second-degree relatives with complex congenital heart disease. RESULTS: Among the maternal characteristics analyzed, women in group I had a higher number of pregnancies before gestation of the index case (p = <0.05), and the Body Mass Index (BMI) before pregnancy was higher compared to Group II (p < 0.05), with an adjusted risk of OR = 3.6 (p = 0.011). The family history showed a higher prevalence in the group of patients with TAPVC compared to healthy children (p < 0.05). CONCLUSION: Maternal obesity before pregnancy is a risk factor for the development of CATVP in children in the Mexican population.

[Prevalence and spectrum of diseases that predispose to sudden cardiac death in Mexican children: a sample obtained from The Federico Gomez Children's Hospital of Mexico]. / Prevalencia y espectro de las enfermedades que predisponen a la muerte súbita cardiaca en niños mexicanos: una muestra obtenida del Hospital Infantil de México Federico Gómez.

OBJECTIVE: To determine the prevalence and spectrum of diseases that predispose to sudden cardiac death in Mexican children, and to identify the main early signs and symptoms that can enable the health personnel to suspect these diseases and to refer the patients to a tertiary hospital in a timely manner. METHODS: Incidence, prevalence, and period prevalence, as well as early symptoms, clinical data, and follow-up were recorded on all children found with diseases that predispose to sudden cardiac death in The Children's Hospital of Mexico. RESULTS: The study included 59 patients, with a mean age of 8 ± 5 years old, with 40 cardiomyopathies, and 19 with inherited arrhythmogenic diseases. The period prevalence was 9.5/1,000 patients/year. The most common early symptoms were dyspnoea, palpitations, and syncope. A Mendelian inheritance pattern was found in 9 cases. Three patients died of sudden cardiac death during the period of the study. CONCLUSION: Diseases that predispose to sudden cardiac death in children are not very well known by the general medical community. Every child with dyspnoea, palpitations and/or syncope, should be referred for the intensive search of these diseases. A complete cardiological evaluation in all members of the family is indicated.

Arco aórtico derecho con subclavia izquierda aberrante y divertículo de Kommerell. Una causa de anillo vascular / Right-side aortic arch with aberrant left subclavian artery and Kommerell's diverticulum. A cause of vascular ring

Resumen: El arco aórtico derecho puede estar asociado a subclavia izquierda aberrante, en algunos casos esta se origina de una dilatación aneurismática que se conoce como divertículo de Kommerell. Se presentan 2 casos de anillo vascular formado por un arco aórtico derecho, subclavia izquierda anómala con divertículo de Kommerell y persistencia del conducto arterioso izquierdo con una revisión de la literatura acerca del desarrollo embriológico y los métodos de imagen que ayudan al diagnóstico de esta rara anomalía vascular.

Abstract: The right-side aortic arch may be associated with aberrant left subclavian artery, in some cases this artery originates from an aneurismal dilation of the aorta called Kommerell's diverticulum. A report is presented on 2 cases of vascular ring formed by a right-side aortic arch, anomalous left subclavian artery, Kommerell's diverticulum and left patent ductus arteriosus. A review the literature was also performed as regards the embryological development and the imaging methods used to help in the diagnosis of this rare vascular anomaly.

[Right-side aortic arch with aberrant left subclavian artery and Kommerell's diverticulum. A cause of vascular ring]. / Arco aórtico derecho con subclavia izquierda aberrante y divertículo de Kommerell. Una causa de anillo vascular.

The right-side aortic arch may be associated with aberrant left subclavian artery, in some cases this artery originates from an aneurismal dilation of the aorta called Kommerell's diverticulum. A report is presented on 2 cases of vascular ring formed by a right-side aortic arch, anomalous left subclavian artery, Kommerell's diverticulum and left patent ductus arteriosus. A review the literature was also performed as regards the embryological development and the imaging methods used to help in the diagnosis of this rare vascular anomaly.

Velocardiofacial syndrome in Mexican patients: Unusually high prevalence of congenital heart disease.

INTRODUCTION: Velocardiofacial syndrome (VCFS) is the most common microdeletion syndrome with an incidence of 1:4000 live births. Its phenotype is highly variable with facial, velopharyngeal, cardiac, endocrine, immunologic and psychiatric abnormalities. It is caused by a microdeletion in chromosome 22q11.2. OBJECTIVES: We present 7 years of experience evaluating patients with VCFS regarding their main clinical characteristics. MATERIAL AND METHODS: The patients included were multidisciplinary evaluated and had a positive FISH analysis for del22q11.2. RESULTS: A total of 62 patients were assessed, a 34 female/28 male ratio was observed with ages ranging from 9 days to 16 years, all but one patient had typical facial features. A diagnosis of congenital heart disease was established in 97% of the patients; other clinical characteristics were identified with different percentages such as cleft palate, and hypocalcaemia. Three cases had a familial presentation. DISCUSSION: While the clinical findings of this study were in general terms in keeping with the literature, it is interesting the unexpectedly high percentage of congenital heart disease identified in Mexican children with VCFS that also was the main cause for clinical referral.

Persistencia del quinto arco aórtico asociado a persistencia del conducto arterioso / Persistent fifth aortic arch with patent ductus arteriosus

La persistencia del quinto arco aórtico es una rara anomalía congénita vascular que consiste en la presencia de una comunicación entre la aorta ascendente y la aorta descendente a través de un conducto arterial; se diagnostica de manera incidental. Informamos de un caso asociado a persistencia de conducto arterioso.

Persistent fifth aortic arch is a rare congenital vascular anomaly, with no clinical impact, so diagnosis is usually an incidental finding ocasionally associated with other congenital heart defects. We report a case of persistent fifth aortic arch associated with patent ductus arteriosus.

[Persistent fifth aortic arch with patent ductus arteriosus]. / Persistencia del quinto arco aórtico asociado a persistencia del conducto arterioso.

Persistent fifth aortic arch is a rare congenital vascular anomaly, with no clinical impact, so diagnosis is usually an incidental finding occasionally associated with other congenital heart defects. We report a case of persistent fifth aortic arch associated with patent ductus arteriosus.

Polymorphism 677C → T MTHFR gene in Mexican mothers of children with complex congenital heart disease.

Congenital heart defects (CHD) are the third leading cause of death in children <1 year of age in Mexico where there is a high prevalence of the 677C → T polymorphism of the MTHFR gene. This is important because the homozygous 677T/T MTHFR gene and deficiency of folic acid (FA) intake have been associated with CHD. Our objective was to analyze the possible association between the genotype 677T/T of the MTHFR gene and supplementation of FA in Mexican women with the presence of complex CHD in their children. We analyzed genotypes of 31 mothers of children with complex CHD (group I) and 62 mothers of healthy children (group II) and investigated FA supplementation during pregnancy in both study groups. Allele frequencies in group I were 41.9 % for C and 58.1 % for T and 22.6 % for genotype frequencies CC, 38.7 % for CT, and 38.7 % for TT. Allele frequencies in group II were 63.7 % for C and 36.3 % for T and 38.7 % for genotype frequencies CC, 50 % for CT and 11.3 % for TT. Both populations are in Hardy-Weinberg equilibrium. Odds ratio for having a child with a complex CHD was 5.9, p = 0.008 (95 % CI 1.67; 20.63) for the TT genotype. FA supplementation at any time during pregnancy was 90.3 and 87.9 % in groups II and I respectively (p > 0.05). Association was found between the maternal genotype (677/TT MTHFR) with the presence of complex CHD in their offspring. No differences in FA supplementation during any stage were found between groups.

Pentalogy of Cantrell: Forty-two Years of Experience in the Hospital Infantil de Mexico Federico Gomez.

Pentalogy of Cantrell is a rare disease. Approximately 185 cases have been reported around the world. The authors performed a retrospective study that reviewed the clinical files and pathological samples of 22 cases of pentalogy of Cantrell treated at the Hospital Infantil de México Federico Gómez. Thirteen patients had ectopia cordis associated with pentalogy of Cantrell (group I), and there were 9 cases without ectopia cordis (group II). In group I, the following types of congenital heart disease were found: single ventricle (4), double-outlet right ventricle (4), ventricular septal defect (3), aortic coarctation (1), and atrial septal defect (1). In group II, the following types of congenital heart disease were found: double-outlet right ventricle (3), double-inlet left ventricle (2), ventricular septal defect (2), tetralogy of Fallot (1), and hypoplastic right ventricle syndrome (1). Nine cases had a ventricular diverticulum (40%). Ten patients (45%) had some other congenital anomaly associated with pentalogy of Cantrell. Thirteen patients underwent surgery (59%), which included cardiac surgery in 10 cases (45%). Sixteen patients died (73%): 11 from group I and 5 from group II (P < .05). Little more than 50 years since it was first described, pentalogy of Cantrell remains a disease with high mortality, especially in patients with associated ectopia cordis.

[Left ventricular function in children after successful repair of aortic coarctation]. / Función ventricular izquierda en niños después de la reparación exitosa de la coartación aórtica.

INTRODUCTION AND OBJECTIVES: Lifetime prognosis following successful repair of aortic coarctation can be affected by a number of late complications. The objective of this study was to assess left ventricular function in these patients and to identify factors that predispose to functional abnormalities. METHODS: The study involved patients who had undergone repair of aortic coarctation and who had a pressure gradient pound 15 mmHg after repair and normal systemic blood pressure. Echocardiographic data collected before repair and the results of the most recent postoperative left ventricular function studies were analyzed. RESULTS: The study involved 40 patients and 31 controls. Their mean age at repair was 6.9 years and the mean follow-up period was 4.25 years. During follow-up, the ejection fraction and the shortening fraction were observed to increase in 82.5% and 67.5% of patients, respectively. The myocardial performance index was abnormal in 47.5% of patients. The highest myocardial performance indices were observed in patients with arterial hypertension at diagnosis, in those who were aged over 4 years when they underwent repair, and in those with the most abnormal left ventricles before repair. CONCLUSIONS: Measurement of the myocardial performance index showed that global left ventricular function was abnormal in 47.5% of patients after successful repair of aortic coarctation despite functional parameters being normal or elevated.

Función ventricular izquierda en niños después de la reparación exitosa de la coartación aórtica / Left ventricular function in children after successful repair of aortic coarctation

Introducción y objetivos. El pronóstico para la vida después de una corrección exitosa de coartación aórtica puede verse afectado por varias complicaciones tardías. Nuestro objetivo fue evaluar la función del ventrículo izquierdo en este grupo de pacientes y tratar de identificar factores que predisponen a anomalías circulatorias. Métodos. Se incluyó a pacientes con reparación de coartación aórtica que tuvieron un gradiente en la zona de reparación £ 15 mmHg y presión arterial normal. Se analizaron sus ecocardiogramas antes de la corrección y se estudió la función ventricular izquierda al postoperatorio actual. Resultados. Se estudió a 40 pacientes y 31 controles. La edad de la reparación fue 6,9 años, con 4,25 años de seguimiento. La fracción de eyección y la fracción de acortamiento se encontraron aumentadas en el 82,5 y el 67,5% de los casos, respectivamente, durante el seguimiento. El índice de rendimiento miocárdico fue anormal en el 47,5% de los pacientes. Los pacientes que tenían hipertensión arterial al momento del diagnóstico, los que se corrigieron después de los 4 años y los que tenían un ventrículo izquierdo más anormal antes de la corrección tuvieron índices de rendimiento miocárdico más elevados. Conclusiones. La función ventricular izquierda general evaluada con el índice de rendimiento miocárdico fue anormal en el 47,5% de los casos después de una corrección de coartación aórtica exitosa, pese a tener índices endocárdicos normales o aumentados (AU)

Introduction and objectives. Lifetime prognosis following successful repair of aortic coarctation can be affected by a number of late complications. The objective of this study was to assess left ventricular function in these patients and to identify factors that predispose to functional abnormalities. Methods. The study involved patients who had undergone repair of aortic coarctation and who had a pressure gradient £15 mm Hg after repair and normal systemic blood pressure. Echocardiographic data collected before repair and the results of the most recent postoperative left ventricular function studies were analyzed. Results. The study involved 40 patients and 31 controls. Their mean age at repair was 6.9 years and the mean follow-up period was 4.25 years. During follow-up, the ejection fraction and the shortening fraction were observed to increase in 82.5% and 67.5% of patients, respectively. The myocardial performance index was abnormal in 47.5% of patients. The highest myocardial performance indices were observed in patients with arterial hypertension at diagnosis, in those who were aged over 4 years when they underwent repair, and in those with the most abnormal left ventricles before repair. Conclusions. Measurement of the myocardial performance index showed that global left ventricular function was abnormal in 47.5% of patients after successful repair of aortic coarctation despite functional parameters being normal or elevated (AU)

Evaluación del flujo de las venas pulmonares con ecocardiografía transtorácica en niños con cardiomiopatía dilatada / Pulmonary venous flow in children with dilated cardiomyopathy using transthoracic echocardiography

OBJECTIVE: To evaluate the pulmonary venous flow in children with dilated cardiomyopathy and to establish its correlation with mitral Doppler flow and with the functional class. METHODS: It is a descriptive and transversal study in which we evaluated the pulmonary venous flow and its correlation with mitral Doppler flow and the functional class in 14 children with dilated cardiomyopathy. RESULTS: Nine patients were female. The mean age was 5.58 years and the mean follow up was 17 months. The functional class was I in 7 patients, II in 4 and III in 3. When diastolic function was evaluated using mitral Doppler flow it was abnormal in 9 of 14 patients, while the pulmonary venous flow was altered in all 14 patients since S/D ratio was abnormal in all. S wave was reduced in 12 patients; D wave was elevated in 8 patients, A reverse wave was elevated in 4 patients and in 8 the A reverse wave length was higher than mitral A wave length. CONCLUSIONS: Systolic function of the left ventricle is reduced in children with dilated cardiomyopathy. Diastolic function is also frequently abnormal in this group of patients. Pulmonary venous flow identifies better the abnormal diastolic function and correlates better with functional class than mitral Doppler flow.

[Pulmonary venous flow in children with dilated cardiomyopathy using transthoracic echocardiography]. / Evaluación del flujo de las venas pulmonares con ecocardiografía transtorácica en niños con cardiomiopatía dilatada.

OBJECTIVE: To evaluate the pulmonary venous flow in children with dilated cardiomyopathy and to establish its correlation with mitral Doppler flow and with the functional class. METHODS: It is a descriptive and transversal study in which we evaluated the pulmonary venous flow and its correlation with mitral Doppler flow and the functional class in 14 children with dilated cardiomyopathy. RESULTS: Nine patients were female. The mean age was 5.58 years and the mean follow up was 17 months. The functional class was I in 7 patients, II in 4 and III in 3. When diastolic function was evaluated using mitral Doppler flow it was abnormal in 9 of 14 patients, while the pulmonary venous flow was altered in all 14 patients since S/D ratio was abnormal in all. S wave was reduced in 12 patients; D wave was elevated in 8 patients, A reverse wave was elevated in 4 patients and in 8 the A reverse wave length was higher than mitral A wave length. CONCLUSIONS: Systolic function of the left ventricle is reduced in children with dilated cardiomyopathy. Diastolic function is also frequently abnormal in this group of patients. Pulmonary venous flow identifies better the abnormal diastolic function and correlates better with functional class than mitral Doppler flow.