Hipertensión pulmonar y embarazo / Pulmonary hypertension and pregnancy

A 36 year old woman, with an 18 year history of syncope, became pregnant shortly after a cardiac catheterization demonstrated a high pulmonary arterial pressure and resistance and a low cardiac output. During pregnancy she remained stable at NYHA FC III, on nifedipine, apresoline, isosorbide, aspirin and bed rest. At 28 weeks, catheterization showed a decreased pulmonary pressure and an increased cardiac output. At 38 weeks, she was submitted to an elective caesarean section, and delivered a healthy newborn of 2820 g. After 5 months, her catheterization showed a pulmonary artery pressure similar to the pre-pregnancy study. Her condition deteriorated, leading to death 10 months later. Urinary 6-keto-PGF1, nitrates/nitrites, kallikrein and angiotensin-(1-7) were increased from 13 to 33 weeks, to drop in week 35 of pregnancy. The safe maternal and fetal outcome, and the intragestational hemodynamic improvement are attributed to a close multidisciplinary surveillance, and to the effects of the endogenous vasodilators of pregnancy on the reversible component of the pulmonary hypertension. Reports in the literature show a decrease in maternal mortality rate, from 56 percent for the period previous to 1963, to 34 and 30 percent for those spanning between 1978-1996 y 1997-2001 respectively

Efectos cardiovasculares del acortamiento del intervalo AV mediante estimulación eléctrica del corazón en miocardiopatía dilatada / Cardiovascular effects of AV interval shortening with heart electric stimulation in dilated cardiomyopathy

Patients and methods: Nine patients with dilated cardiomyopathy were studied. Hemodynamic and tissular perfusion values, echocardiographic and radioisotopic ventricular function parameters were measured before and after six hours of AV interval shortening with electrical stimulation of the heart. Results: After electrical stimulation, cardiac output increased from 3.38 ñ 0.8 to 32.87 ñ 0.79 l/min (p < 0.05). Pulmonary capillary pressure decreased from 23.8 ñ 8.9 to 19.8 ñ 9.2 mm Hg (p = NS). There were no significant changes in ventricular function parameters or in systemic and pulmonary pressures. Conclusions: Electrical shortening of AV interval in patients with dilated cardiomyopathy increases cardiac output but does not change ventricular function parameters

Tromboendarterectomía pulmonar: tratamiento quirúrgico del tromboembolismo pulmonar crónico bajo paro circulatorio con hipotermia profunda en un caso / Pulmonary thromboendarterectomy: surgical treatment of chronic pulmonary thromboembolism under circulatory arrest and with deep hypothermia in 1 case

Pulmonary thromboendarterectomy under circulatory arrest and deep hypothermia is presently a curative treatment for pulmonary hypertension secondary to chronic pulmonary artery thromboembolic occlusion, but is still not frequently performed around the world. We report here the first successful pulmonary thromboendarterectomy under circulatory arrest performed in Chile. The patient was a 37 years old white man, high school teacher, with a 5 months history of effort dyspnea and cough. Pulmonary hypertension secondary to chronic pulmonary thromboembolism was confirmed by angiography and echocardiography. The patient was operated on april 27, 1995. After the operation the patient had an enmediate and maintained normalization of his pulmonary hemodynamics. He presented periods of delirium that postponed mechanical ventilation disconnection until the 7th postoperative day, after which he had an uneventful neurological recovery. Before hospital discharge a control angiography showed complete patency of the pulmonary artery system with no evidence of residual thrombi. Presently he is enjoying a normal life and back to his teaching activities