Anatomical and Clinical Factors Associated With Valvulopathy and Aortopathy in Mexican Patients With Bicuspid Aortic Valves.

The bicuspid aortic valve (BAV) is associated with significant aortic valve dysfunction. We aimed to study Mexican patients with BAV to assess phenotypic expressions of BAV, and associations of valvulopathy and aortopathy and their predictors. A cross-sectional, retrospective study was designed. The patients were divided according to (1) normally or minimally dysfunctional BAV, (2) predominant aortic regurgitation (AR), and (3) predominant aortic stenosis (AS). A total of 189 patients were included with a high prevalence of males (68%). The overall median age was 42 (23 to 52) years. The distribution of fused BAV phenotypes was right-left fusion (77%), right noncoronary fusion (17%) and left noncoronary fusion (6%). AS-predominant group was the oldest with a high prevalence of hypertension, type 2 diabetes mellitus (T2DM), and raphe. In multivariable analysis T2DM (odds ratio [OR] 10.5 [95% confidence interval (CI) 2.1 to 52], p <0.01) and presence of raphe (OR 2.58 [95% CI 1.02 to 6.52], p = 0.04) were independently associated with AS. The AR-predominant group was composed mostly of males with significantly fewer cardiovascular risk factors. Male gender (OR 2.84 [95%CI 121 to 6.68], p = 0.01) and aortic dilatation (OR 3.58 [95% CI 1.73 to 7.39], p <0.01) were associated with AR-predominance in multivariable analysis. Aortic dilatation was associated with age (OR 1.03 [95% CI 1.008 to 1.05], p <0.01) and AR (OR 4.31 [95% CI 2.05 to 9.06], p <0.01). Independent factors associated with the root phenotype were male gender (OR 12.4 [95% CI 1.6 to 95], p <0.01) and AR (OR 5.25 [95% CI 2.18 to 12.6], p <0.01).In conclusion, in a mestizo population, the distribution of BAV-fused phenotypes was similar to European and North American populations, the presence of raphe and T2DM were independently associated with AS-predominance, and male gender and aortic dilatation were independently associated with AR-predominance.

Atrial fibrillation in cardiac surgery.

Atrial fibrillation is the most frequent arrhythmia in the postoperative period of cardiac surgery. It is associated with heart failure, renal insufficiency, systemic embolism and increase in days of in-hospital and mortality. Atrial fibrillation in the postoperative period of cardiac surgery (FAPCC) usually appears in the first 48 h after surgery. The main mechanisms involved in the appearance and maintenance of FAPCC are the increase in sympathetic tone and the inflammatory response. The associated risk factors are advanced age, chronic obstructive pulmonary disease, chronic kidney disease, valve surgery, fraction of ejection of the left ventricle < 40% and the withdrawal of beta-blocker drugs. There are instruments that have been shown to predict the appearance of FAPCC. Prophylactic treatment with beta-blockers and amiodarone, is associated with a decrease in the appearance of FAPCC. Given its transient nature, it is suggested that the initial treatment of FAPCC be the heart rate control and only if the treatment does not achieve a return to sinus rhythm, the use of electrical cardioversion is suggested. It is unknown what should be the long-term follow-up and complications beyond this period are little known. FAPCC is not a benign or isolated arrhythmia in patients undergoing cardiac surgery, so the identification of risk factors, their prevention, and follow-up in the outpatient setting, should be part of the units dedicated to the care and care of these patients.

La fibrilación auricular es la arritmia más frecuente en el periodo posquirúrgico de la cirugía cardíaca. Se relaciona con insuficiencia cardíaca, insuficiencia renal, embolismo sistémico y más días de estancia y mortalidad. La fibrilación auricular en el periodo posquirúrgico de la cirugía cardíaca (FAPCC) suele aparecer en las primeras 48 horas. Los principales mecanismos que producen la aparición y el mantenimiento de la FAPCC son el aumento del tono simpático y la respuesta inflamatoria. Los factores de riesgo adjuntos son la edad avanzada, enfermedad pulmonar obstructiva crónica, enfermedad renal crónica, cirugía valvular, fracción de expulsión del ventrículo izquierdo menor de 40% e interrupción de fármacos bloqueadores ß. Existen instrumentos que han demostrado predecir la aparición de FAPCC. El tratamiento profiláctico con bloqueadores ß y amiodarona se relaciona con disminución de la aparición de FAPCC. Dada su naturaleza transitoria, se sugiere que el tratamiento inicial de FAPCC sea el control de la frecuencia cardíaca y sólo en caso de que el tratamiento no consiga el retorno al ritmo sinusal está indicada la cardioversión eléctrica. Se desconoce cuál debe ser el seguimiento a largo plazo y sólo se conocen en escasa medida las complicaciones más allá de este periodo. La FAPCC no es una arritmia benigna ni aislada en los pacientes sometidos a operación cardíaca, por lo que la identificación de los factores de riesgo, su prevención y el seguimiento en el ámbito ambulatorio deben formar parte de las unidades dedicadas a la atención y los cuidados de estos pacientes.

Primary Sjögren's syndrome and bronchiolitis. An unusual association. / Síndrome de Sjögren primario y bronquiolitis. Una asociación no usual.

Sjögren's syndrome (SS) is a systemic autoimmune disease that mainly affects the exocrine glands. It has been reported that the association between SS and respiratory involvement occurs in 11% and 45% of cases, and can be the initial manifestation of the disease. The diagnosis is based on the integration of clinical, immunological and histopathological criteria. This paper examines a 58-year-old man with SS, severe dyspnea and recurrent exacerbations associated with bronchiolitis-bronchiectasis. The absence of anti-Ro and anti-La antibodies associated with severe bronchiolitis is a clinical presentation that is poorly characterized in this group of patients; moreover, how to treat them remains unclear.

Fibrilación auricular en cirugía cardíaca / Atrial fibrillation in cardiac surgery

Resumen La fibrilación auricular es la arritmia más frecuente en el periodo posquirúrgico de la cirugía cardíaca. Se relaciona con insuficiencia cardíaca, insuficiencia renal, embolismo sistémico y más días de estancia y mortalidad. La fibrilación auricular en el periodo posquirúrgico de la cirugía cardíaca (FAPCC) suele aparecer en las primeras 48 horas. Los principales mecanismos que producen la aparición y el mantenimiento de la FAPCC son el aumento del tono simpático y la respuesta inflamatoria. Los factores de riesgo adjuntos son la edad avanzada, enfermedad pulmonar obstructiva crónica, enfermedad renal crónica, cirugía valvular, fracción de expulsión del ventrículo izquierdo menor de 40% e interrupción de fármacos bloqueadores β. Existen instrumentos que han demostrado predecir la aparición de FAPCC. El tratamiento profiláctico con bloqueadores β y amiodarona se relaciona con disminución de la aparición de FAPCC. Dada su naturaleza transitoria, se sugiere que el tratamiento inicial de FAPCC sea el control de la frecuencia cardíaca y sólo en caso de que el tratamiento no consiga el retorno al ritmo sinusal está indicada la cardioversión eléctrica. Se desconoce cuál debe ser el seguimiento a largo plazo y sólo se conocen en escasa medida las complicaciones más allá de este periodo. La FAPCC no es una arritmia benigna ni aislada en los pacientes sometidos a operación cardíaca, por lo que la identificación de los factores de riesgo, su prevención y el seguimiento en el ámbito ambulatorio deben formar parte de las unidades dedicadas a la atención y los cuidados de estos pacientes.

Abstract Atrial fibrillation is the most frequent arrhythmia in the postoperative period of cardiac surgery. It is associated with heart failure, renal insufficiency, systemic embolism and increase in days of in-hospital and mortality. Atrial fibrillation in the postoperative period of cardiac surgery (FAPCC) usually appears in the first 48 h after surgery. The main mechanisms involved in the appearance and maintenance of FAPCC are the increase in sympathetic tone and the inflammatory response. The associated risk factors are advanced age, chronic obstructive pulmonary disease, chronic kidney disease, valve surgery, fraction of ejection of the left ventricle less 40% and the withdrawal of beta-blocker drugs. There are instruments that have been shown to predict the appearance of FAPCC. Prophylactic treatment with beta-blockers and amiodarone, is associated with a decrease in the appearance of FAPCC. Given its transient nature, it is suggested that the initial treatment of FAPCC be the heart rate control and only if the treatment does not achieve a return to sinus rhythm, the use of electrical cardioversion is suggested. It is unknown what should be the long-term follow-up and complications beyond this period are little known. FAPCC is not a benign or isolated arrhythmia in patients undergoing cardiac surgery, so the identification of risk factors, their prevention, and follow-up in the outpatient setting, should be part of the units dedicated to the care and care of these patients.

Síndrome de Sjögren primario y bronquiolitis. Una asociación no usual / Primary Sjögren's syndrome and bronchiolitis. An unusual association

El síndrome de Sjögren (SS) es una enfermedad sistémica autoinmune que afecta principalmente a las glándulas exocrinas. Se ha reportado que la asociación entre SS y compromiso respiratorio ocurre entre el 11 y el 45% de los casos. El diagnóstico se basa en la integración de criterios clínicos, inmunológicos e histopatológicos. Se presenta el caso de un masculino de 58 años, con SS, disnea grave y exacerbaciones recurrentes de la vía respiratoria, asociado a bronquiolitis-bronquiectasias. La ausencia de anticuerpos anti-Ro y anti-La, relacionados con la gravedad de la bronquiolitis, es una forma de presentación poco caracterizada en este grupo de pacientes, más aún, su tratamiento óptimo no está establecido

Sjögren's syndrome (SS) is a systemic autoimmune disease that mainly affects the exocrine glands. It has been reported that the association between SS and respiratory involvement occurs in 11% and 45% of cases, and can be the initial manifestation of the disease. The diagnosis is based on the integration of clinical, immunological and histopathological criteria. This paper examines a 58-year-old man with SS, severe dyspnea and recurrent exacerbations associated with bronchiolitis-bronchiectasis. The absence of anti-Ro and anti-La antibodies associated with severe bronchiolitis is a clinical presentation that is poorly characterized in this group of patients; moreover, how to treat them remains unclear

Pérdida recurrente del embarazo e hipertensión pulmonar idiopática / Recurrent pregnancy loss and idiopatic pulmonary hypertension

Resumen La pérdida recurrente del embarazo ocurre cuando una mujer tiene 2 ó más pérdidas de embarazos clínicos antes de las 20 semanas de gestación. Existen múltiples factores de riesgo relacionados con este padecimiento, entre ellos, la presencia de Hipertensión Pulmonar (HP) se vincula con elevada mortalidad (30-56% de los casos) y riesgo de abortos entre las semanas 9 y 12 de gestación. No se conoce con precisión la frecuencia de asociación entre las condiciones clínicas referidas. Presentamos el caso de una mujer de 31 años de edad que ingresó al hospital con un aborto en evolución, en el periodo posterior al legrado evidencian Hipoxemia Grave e Insuficiencia Cardiaca Derecha; durante el abordaje diagnóstico se confirma que la causa primaria de la recurrencia de abortos se encuentra asociada con la presencia de Hipertensión Pulmonar Idiopática.

Abstract Recurrent pregnancy loss occurs whenever a woman has 2 or more miscarriages of their clinical pregnancy before 20 weeks of gestation. There are multiple risk factors relates to this condition, among, them, the presence of pulmonary hypertension (PH) is linked with high mortality (30-56% of cases) and risk of miscarriages between 9 weeks and 12 of gestation. The prevalence of both conditions are not well known. Here, we present the case of a 31 year-old women who was admitted to the hospital with an abortion in evolution, immediately after the curettage, the patient exhibit severe hypoxemia in association with Right Heart Failure; the medical approach established that the primary cause of recurrent abortions was an uncontrolled idiopathic pulmonary hypertension.