[A tribute to the memory of the illustrious maestro and academic Dr. Rafael Méndez Martínez, pioneer in the pharmacological studies of digitalis and digitalis glycosides]. / Breve historia de la digital y los digitálicos. Homenaje a la memoria del ilustre maestro y académico Dr. Rafael Méndez Martínez, pionero de los estudios farmacológicos sobre la digital y los glucósidos digitálicos.

Since the end of the XVIII century, digitalis glycosides were employed in heart failure. They were considered initially as diuretics and later as cardiotonic agents or as positive inotropics. At the present time there are varied groups of positive inotropic agents, which have a beneficial action on the failing human myocardium. For example, the beta adrenergics, the phosphodiesterase III inhibitors such as milrinone, or the sensibilizers of myocardial proteins to Ca++ such as levosimendan and omecamtiv mecarbil. However, following the opinion of distinguished cardiologists, in the case of heart failure associated to atrial fibrillation, digitalis cannot be substituted.

On New Spain and Mexican medicinal botany in cardiology.

Towards the middle of the XVI century, the empirical physician Martín de la Cruz, in New Spain, compiled a catalogue of the local medicinal herbs and plants, which was translated into Latin by Juan Badiano, professor at the Franciscan college of Tlatelolco. On his side, Dr. Francisco Hernández, the royal physician (protomédico) from 1571 until 1577, performed a systematic study of the flora and fauna in this period. His notes and designs were not published at that time, but two epitomes of Hernández' works appeared, respectively, in 1615 in Mexico and in 1651 in Rome. During the XVIII century, two Spanish scientific expeditions arrived to these lands. They were led, respectively, by the Spanish naturalist Martín Sessé and the Italian seaman, Alessandro Malaspina di Mulazzo, dependent from the Spanish Government. These expeditions collected and carried rich scientific material to Spain. At the end of that century, the Franciscan friar Juan Navarro depicted and described several Mexican medicinal plants in the fifth volume of his botanic work. In the last years of the colonial period, the fundamental works of Humboldt and Bonpland on the geographic distribution of the American plants were published. In the modern age, the first research about the Mexican medicinal botany was performed in the laboratory of the Instituto Médico Nacional [National Medical Institute] under the leadership of Dr. Fernando Altamirano, who started pharmacological studies in this country. Later, trials of cardiovascular pharmacology were performed in the small laboratories of the cardiological unit at the General Hospital of Mexico City, on Dr. Ignacio Chávez' initiative. The Mexican botanical-pharmacological tradition persists alive and vigorous at the Instituto Nacional de Cardiología and other scientific institutions of the country.

How electricity was discovered and how it is related to cardiology.

We relate the fundamental stages of the long road leading to the discovery of electricity and its uses in cardiology. The first observations on the electromagnetic phenomena were registered in ancient texts; many Greek and Roman writers referred to them, although they provided no explanations. The first extant treatise dates back to the XIII century and was written by Pierre de Maricourt during the siege of Lucera, Italy, by the army of Charles of Anjou, French king of Naples. There were no significant advances in the field of magnetism between the appearance of this treatise and the publication of the study De magnete magneticisque corporibus (1600) by the English physician William Gilbert. Scientists became increasingly interested in electromagnetic phenomena occurring in certain fish, i.e., the so-called electric ray that lived in the South American seas and the Torpedo fish that roamed the Mediterranean Sea. This interest increased in the 18th century, when condenser devices such as the Leyden jar were explored. It was subsequently demonstrated that the discharges produced by "electric fish" were of the same nature as those produced in this device. The famous "controversy" relating to animal electricity or electricity inherent to an animal's body also arose in the second half of the 18th century. The school of thought of the physicist Volta sustained the principle of a single electrical action generated by metallic contact. This led Volta to invent his electric pile, considered as the first wet cell battery. Toward the middle of the XIX century, the disciples of the physiologist Galvani were able to demonstrate the existence of animal electricity through experiments exploring the so-called current of injury. On the path of Volta's approach, many characteristics of electricity were detailed, which ultimately led to their usage in the industrial field. The route followed by Galvani-Nobili-Matteucci led to the successes of Waller, Einthoven, etcetera, enabling the modern conquests of electro-vectorcardiography.

[Electro-histological comparison in a case of Chagasic chronic cardiomyopathy]. / Cotejo electro-histológico en un caso de miocardiopatía chagásica crónica.

The case of a 50 years old man, coming from an endemic Chagas' disease zone, is reported. This patient came with a dilated cardiomyopathy, likely of Chagasic etiology, and heart failure. He died in our Institute, were it was possible to register an ECG, and perform the necropsy, on the same day of his death. The ECG showed signs of heart chambers dilatation, inactive myocardium in subendocardial anterolateral regions of the left ventricle, and extensive subepicardial injury. The anatomical study demonstrated the four heart chambers dilatation, and a subendocardial fibrosis essentially located in anterolateral portions of the left ventricle. The histological examination proved that the distribution of injured zones corresponded to location of the inflammatory foci. Furthermore, Trypanosoma cruzi inoculation in mice produced inflammatory foci, predominantly located in the ventricular epicardial and subepicardial regions.

[On the epistemological approaches to medicine]. / Algunos enfoques epistemológicos en medicina.

The doctrine of correct reasoning was developed in the Western World as logic. This is an activity of the intellect that apparently began with Zeno of Elea, being formalized by Aristotle, and which received its name from the Stoic philosopher Chrysippus. It corresponds to the structure or anatomy of thought. Logic empiricism introduced systematic use of the logistic language into epistemology. The latter discipline designates the philosophy of science, i.e., the critical foundation of its principles, hypotheses, methods, and results. Strictly speaking, it does not constitute an analysis of the scientific method, which is rather the object of methodology, nor anticipation or synthesis of scientific results. It can be considered that, concerning science, epistemology constitutes the second step with a primary activity. In other words, it is a reflection on science, considering the latter as an element to be respected and not as a domain to be ruled. Dr. Hermann Boerhaave was the first physician to challenge problems of an epistemologic character in a coherent and systematic manner (XVIII Century). Others followed him in this direction during the subsequent centuries. In the light of Popper's critical rationalism, construction of a medical instrument, conception of a therapeutic procedure, development of a useful model in biology or medicine could also be considered as epistemologic problems. The corresponding examples that follow are worthwhile mentioning: Riva-Rocci's sphygmomanometer; metabolic therapeutics for ischemic heart disease, and elaboration of theoretical models. In turn, epistemology suggests that assessment of a fact, perceivable by the senses, is generally more difficult that elaboration of a hypothesis.

[200 years of the smallpox vaccine]. / Doscientos años de la vacunación antivariolosa.

The expression "inoculation of smallpox" was first employed by Emanuele Timone, native of Chios island and graduated from the Universities of Padua and Oxford. He learned about this procedure in Constantinople. This method was introduced in North America, during the great epidemic outbreak of 1721, by two Bostonian citizens: Cotton Mather and Zabdiel Boylston. The French physician Henri Etienne Morel introduced the procedure into New Spain during the smallpox epidemic of 1779. Nevertheless only in 1798 the English physician Edward Jenner published the results of his observations and experience concerning the "vaccination" in his book "Inquiry into the cause and effects of the variolae vaccinae." After some initial oppositions, this method rapidly spreaded to the rest of Europe. It arrived to Spain in 1801 and thence was transferred to Spanish America and Philippine Islands with the expedition leaded by Francisco Xavier Balmis. Along the XIX century the methods for obtaining and keeping the vaccine were notably improved. Both Jenner and Balmis are worthy of remembrance as great humanity benefactors.

[Physicians and surgeons during the inquisition in new Spain]. / Cirujanos y médicos frente a la Inquisición Novohispana.

The origins of New Spain Inquisition whose jurisdiction extended also to Philippine Islands, are related herein. Physicians and surgeons who worked as Inquisition officers are discussed, from the first Dr. Juan de la Fuente who was appointed on May 9, 1572, to Dr. Pedro del Castillo, appointed on September 24, 1644. Likewise, physicians and surgeons judged by the Holy Office are mentioned. During the XVI century, those judged were few and insignificant personages, the first was the Irish Protestant William Corniels a barber surgeon, who arrived with the John Hawkins' pirate fleet in 1568 and settled in Guatemala. Some physicians and surgeons were judged as "Judaizers" during the first half of the XVII century. Many physicians and surgeons were prosecuted in Mexico, as well as in the Philippine Islands, in the second half of the XVIII century because they were Freemasons or supporters of French Revolution ideology. Among those was the unfortunate Dr. Enrique Esteban Morel, who introduced into Mexico the method of antivariolar inoculation at the time of the great epidemic out-break of 1779. It should be a gesture of justice to build a memorial in the ancient Inquisition Palace to honor this Public Health's worthy physician.

[Professional ethics of physicians]. / En torno a la ética profesional del médico.

Socrates is considered the great classic moralist, although he was not the first to take care of man and morality. Aristotle instituted ethics as an autonomous science and clearly defined its fields, its methods and its purposes, formulating the concept of "happy medium". In the Aristotelian methodology we find traces of Hippocrates, who believed that the physician must always consider the peculiar aspects and that the individual characteristics' determinations can be reached by sensitivity. Once these particularities have been proved, the physician must rely on the "happy medium". Only Stoics could discover, and gradually elaborate, the concept of natural law. Apparently they were the first to establish the classic distinction between the theorical or ideal morality and the practical morality, which is accessible to all people. They refused to compare wisdom, entirely turned inward, with the medical art, which does not constitute an aim by itself. Modern authors assert that, with stoicism, the notion we can denominated wisdom's humanism rised. Today it is admitted that "medicine is more than simply learning medical data.... Physicians must have a wisdom learned from human finitude. They will need this wisdom to tackle the health care policy debates in the next decades". This would be a major cultural undertaking.

[On Academics and Academicians. Historical sketch]. / De academias y académicos. Bosquejo histórico.

First Academies originated in Italy at the beginnings of the Renaissance. Their works were of encyclopedic extent. Regarding to scientific academies, the first was the "Accademia dei Lincei" founded in Rome on August 17, 1603, due to the initiative of four young men; three naturalists and a physician. Later, several distiguished scientists were admitted, such as Giambattista della Porta, inventor of the dark chamber (1610) and Galileo Galilei (1611). This Academy sponsored the publication of a compendium of Francisco Hernández manuscripts, prepared by the Italian physician Antonio Nardo Recchi. Many years later, other scientific academies arose, such as the "Accademia del Cimento", established in 1657 in Florence and inspired by Galilean thought. In 1662, the "Royal Society" of London, was formally recognized, following Bacon's empirical line, and in 1666 the "Académie Royale des Sciences" was created in Paris, which followed the mechanicist orientation of Descartes. These scientific societies aspired to become centers of information and exchange ideas. Therefore, the "Philosophical Transactions" in London and the "Journal des Savants" in Paris began to be published in 1665. Both publications often included medical articles and notes. Regarding New Spain, the worthy "Academia médico-quirúrgica" of Puebla, mentioned since 1802, must be considered. In independent Mexico, two successive medical academies were established that paved the way for our National Academy of Medicine (1864). This society, since its birth, has been publishing the "Gaceta Médica de México", dean of the Mexican medical journals.

[Notes on ancient Islamic medicine]. / Notas sobre la medicina del antiguo Islam.

Arab medicine arose as a consequence of the assimilation and breeding of Hellenistic medicine, particularly of Galenic medicine. It reached its high point between the X and XII centuries and, after the XIII century, lost all creative capabilities. Nevertheless, it achieved the status of being an incentive for European medieval medicine. Some aspects of the medical teaching and publications of the most distinguished Moslem physicians, such as Rhazes (865-932), Avicenna (980-1037), and Averroës (1126-1198) are described. The main characteristics of Moslem medical institutions such as guilds, hospitals, and organizations of professional practice also are discussed. Although Arab medicine essentially constituted a transmission vehicle of master ideas of ancient medical thought, this medicine awoke the interest and initiative of the medieval physicians of western Europe, for example, those at the medical school of Salerno.

[On the origins of modern science]. / En torno a los orígenes de la ciencia moderna.

The Renaissance savants essentially repelled the scholastic translations and commentaries of the ancient writings. Nevertheless, they did not reach a modern vision of experimental science. Moreover, education at the universities was not credited for the development of science. In fact, academic training of students was rather precarious. The first professional associations, such as the "Royal College of Physicians" of London, were not any better. Regarding the hermetic influence on Renaissance thought, the cultured and philosophical reformed magic (so-called white magic) was the equivalent of science at the time. Once the animistic universe, operated by magic, was transformed into the mathematical universe operated by mechanics, the era of science came into being. This movement began during the post-Renaissance age and gradually progressed following the physical-mathematical orientation of Galileo and his pupils: Borelli; Fabrizi; Santorio; Harvey, etc. They initiated physiological studies and introduced the quantitative method into the research field. Harvey's doctrine was the first adequate explanation of an organic phenomenon and a starting point for the way toward experimental physiology. However, the English physician did not completely leave the pre-scientific era, as can be inferred from his monography on animals reproduction. In this work, some points suggesting the birth of modern scientific reasoning alternate with confused, vague, and capricious assertions. In fact, modern science did not arise suddenly, but was elaborated and sustained slowly starting in the XVII century: Galileo's century.

[An overview of the history of electro-vectorcardiography. Tribute to the memory of the unforgettable Dr. Gustavo A. Medrano Castro]. / Un excursus en la historia de la electrovectocardiografía. Homenaje a la memoria del inolvidable Dr. Gustavo A. Medrano Castro.

The history of the investigations about of the so-called irritability of animal tissues showed by English physician Francis Glisson in the 17th century, is summarized. During the 18th century, reliable studies on the bioelectric properties of these tissues began, due to the Swiss scientist Albrecht von Haller and continuated by the Italian naturalist Felice Fontana. In the second half of this century, multiple controversies of the partisans of the animal electricity against the partisans of the contact electricity took place. The Danish scientist Oersted in 1820 proved the close relation of magnetism to electricity, which led to construction of electrometers. These instruments allowed to register and measure record of the electric current. On this way, at middle 21st century, the true animal electricity was identified as the injury current. Later it was possible to record the electric current, risen in the myocardium, out the thorax first by means of the Lippmann' capillary electrometer and later thanks to the Einthoven's string galvanometer at the beginning of the 20th century. So the modern electro-vectorcardiography took off, due to English Thomas Lewis, the North-American Frank N. Wilson and the Mexican Demetrio Sodi Pallares. The last one allowed to rationalize the electro-vectorcardiographic exploration on experimental bases.

[Gradual knowledge of the structure and function of the cardiovascular system]. / Orígenes del conocimiento de la estructura y función del sistema cardiovascular.

The first anatomical lexicon was established in old Egypt, Alexandría by the priests who ritually offered all the parts of the human corpses to their gods. About 500 years b. C. studies of comparative anatomy began due to the physician Alcmeon of Croton, author of the text seriously starting the history of scientific pathology according to Laín Entralgo. It was only during the III century b. C. that dissections of human corpses began at the famous Alexandrian School of Medicine in Ptolemaic Egypt. During the Roman era and in high Middle Ages, physicians carried out anatomical studies in humans in order to dismiss or confirm poisoning suspicions or to extrapolate their flindings in animals (monkeys, pigs, etc) to humans. However, in low Middle Ages (XIV century), direct studies in human corpses were performed once again. These studies reached their pinnacle in the XVI century allowing the discovery of the lesser blood circulation and later of the greater blood circulation. The XVII century saw the coming of microscopic anatomy and the XVIII century witnessed the zenith of pathological anatomy. These studies developed during the following century into clinical-anatomical comparison. Today the help of technological studies is mandatory.

About the specialized myocardial conducting tissue.

The chronological succession of discoveries on the location and structure of the atrio-ventricular conducting system are described. The starting point of this system is located in the sinus atrial node, identified by the English scientists A. Keith and M. W. Flack in 1907. The atrioventricular conducting system was pointed out by the Swiss physician Wilhelm His Jr. in 1893. The atrioventricular node (AV) was first identified by the Japanese pathologist Sumao Tawara and his German professor Ludwig Aschoff in 1906. Likewise the structure and routes of the three internodal bundles are described. These bundles include: Bachmann's bundle (1916) connecting the right with the left atrium and the AV node; the middle Wenckebach's bundle (1910) and the posterior or Thörel's bundle (1910), extending from the region of the sinus atrial node towards the posterior margin of the AV node. Lastly, the ventricular left and right conduction systems are detailed. These include the main trunk and their peripheral subdivisions with respective networks. Regarding the controversial existence of the left middle subdivision, it can exist in animal and human hearts. Nevertheless, an intermediate left septal network of specialized fibers seems to act as a functional equivalent of this subdivision.

[Atrioventricular defect with 2 valves associated with absence of the pericardium. Report of a case]. / Defecto de la tabicación atrioventricular con 2 válvulas asociado a ausencia del pericardio. Informe de un caso.

We present a case of a patient with a cardiac malformation that represents a form of embryo-anatomical transition of an atrioventricular septal defect between a 2 valves form to a common valve form. This entity was associated with pericardium absence. Throughout several studies we have precisely established a diagnostic sequence by determining the adequate contribution of each method and we have been able to clear out the proper nomenclature of the atrioventricular cushion defect.

Un excursus en la historia de la electrovectocardiografía: Homenaje a la memoria del inolvidable Dr. Gustavo A. Medrano Castro / An overview of the history of electro-vectorcardiography: Tribute to the memory of the unforgettable Dr. Gustavo A. Medrano Castro

Se resume la historia de los estudios acerca de la llamada irritabilidad de los tejidos animales, señalada en el siglo XVII por el médico inglés Francis Glisson. Estudios sustentables sobre las propiedades bioeléctricas de dichos tejidos se iniciaron en el siglo XVIII por el científico suizo Albrecht von Haller y se continuaron por el naturalista italiano Felice Fontana. Durante ese siglo arreció la polémica entre los partidarios de la llamada electricidad animal y los de la electricidad de contacto. La demostración por el danés Oersted en 1820 de la íntima relación existente entre magnetismo y electricidad llevó a la preparación de los electrómetros. Con estos fue posible detectar y medir el flujo eléctrico. Se llegó así, a mediados del siglo XIX, a la identificación de la verdadera electricidad animal en forma de corriente de lesión. Más tarde fue posible registrar la corriente eléctrica, originada en el miocardio, también al exterior de la caja torácica primero con el electrómetro capilar de Lippmann y después con el galvanómetro de cuerda construido por el holandés Willem Einthoven a principios del siglo XX. Despegó así la moderna electrocardiografía por obra del investigador inglés Thomas Lewis, del norteamericano Frank N. Wilson y del mexicano Demetrio Sodi Pallares. Este último trató de racionalizar la exploración electrovectocardiográfica mediante una base experimental.

The history of the investigations about of the so-called irritability of animal tissues showed by English physician Francis Glisson in the 17th century, is summarized. During the 18th century, reliable studies on the bioelectric properties of these tissues began, due to the Swiss scientist Albrecht von Haller and continuated by the Italian naturalist Felice Fontana. In the second half of this century, multiple controversies of the partisans of the animal electricity against the partisans of the contact electricity took place. The Danish scientist Oersted in 1820 proved the close relation of magnetism to electricity, which led to construction of electrometers. These instruments allowed to register and measure record of the electric current. On this way, at middle 21st century, the true animal electricity was identified as the injury current. Later it was possible to record the electric current, risen in the myocardium, out the thorax first by means of the Lippmann' capillary electrometer and later thanks to the Einthoven's string galvanometer at the beginning of the 20th century. So the modern electro-vectorcardiography took off, due to English Thomas Lewis, the North-American Frank N. Wilson and the Mexican Demetrio Sodi Pallares. The last one allowed to rationalize the electro-vectorcardiographic exploration on experimental bases.

Orígenes del conocimiento de la estructura y función del sistema cardiovascular / Gradual knowledge of the structure and function of the cardiovascular system

El léxico anatómico más antiguo se estableció por los sacerdotes egipcios, quienes ofrecían de forma ritual a los dioses todas las partes del cuerpo del difunto. Hacia el año 500 a. c. se iniciaron estudios de anatomía comparada por el médico Alcmeón de Crotona, autor del texto que, según Laín Entralgo, inicia formalmente la historia universal de la patología científica. Solamente en el siglo III a. C. en el Egipto tolemaico comenzaron a efectuarse disecciones en cadáveres humanos. En la época romana y en la Alta Edad Media, los médicos realizaban estudios anatómicos en humanos para descartar o confirmar sospechas de envenenamiento y en animales (monos, cerdos, etcétera) para extrapolar sus hallazgos al hombre. Pero en la Baja Edad Media (siglo XIV), se volvió al estudio directo del cuerpo humano. Dicho estudio alcanzó un gran auge en el siglo XVI, lo que llevó al descubrimiento de la circulación menor y, más tarde, de la circulación mayor de la sangre. En el siglo XVII llegó el estudio de la anatomía microscópica y, en el siglo XVIII, la sistematización de la anatomía patológica. En el siglo siguiente se impuso el cotejo anatomoclínico y, actualmente, se impone el auxilio de procedimientos tecnológicos de gabinete.

The first anatomical lexicon was established in old Egypt, Alexandria by the priests who ritually offered all the parts of the human corpses to their gods. About 500 years b. C. studies of comparative anatomy began due to the physician Alcmeon of Croton, author of the text seriously starting the history of scientific pathology according to Laín Entralgo. It was only during the III century b. C. that dissections of human corpses began at the famous Alexandrian School of Medicine in Ptolemaic Egypt. During the Roman era and in high Middle Ages, physicians carried out anatomical studies in humans in order to dismiss or confirm poisoning suspicions or to extrapolate their flindings in animals (monkeys, pigs, etc) to humans. However, in low Middle Ages (XIV century), direct studies in human corpses were performed once again. These studies reached their pinnacle in the XVI century allowing the discovery of the lesser blood circulation and later of the greater blood circulation. The XVII century saw the coming of microscopic anatomy and the XVIII century witnessed the zenith of pathological anatomy. These studies developed during the following century into clinical-anatomical comparison. Today the help of technological studies is mandatory.

About the specialized myocardial conducting tissue / Acerca del tejido miocárdico especializado de excitoconducción

The chronological succession of discoveries on the location and structure of the atrio-ventricular conducting system are described. The starting point of this system is located in the sinus atrial node, identified by the English scientists A. Keith and M. W. Flack in 1907. The atrioventricular conducting system was pointed out by the Swiss physician Wilhelm His Jr. in 1893. The atrioventricular node (AV) was first identified by the Japanese pathologist Sumao Tawara and his German professor Ludwig Aschoff in 1906. Likewise the structure and routes of the three internodal bundles are described. These bundles include: Bachmann's bundle (1916) connecting the right with the left atrium and the AV node; the middle Wenckebach's bundle (1910) and the posterior or Thorel's bundle (1910), extending from the region of the sinus atrial node towards the posterior margin of the AV node. Lastly, the ventricular left and right conduction systems are detailed. These include the main trunk and their peripheral subdivisions with respective networks. Regarding the controversial existence of the left middle subdivision, it can exist in animal and human hearts. Nevertheless, an intermediate left septal network of specialized fibers seems to act as a functional equivalent of this subdivision.

Se describe, en orden cronológico, la sucesión del descubrimiento de la localización y la estructura de los componentes del sistema de conducción auriculoventricular. El haz de conducción AV fue descrito por el médico suizo Wilhelm His Jr. en 1893. El punto de origen de dicho sistema se halla en el nodo sinoauricular, identificado por los ingleses A. Keith y M.W. Flack en 1907. El nodo auriculoventricular (AV) fue identificado por el patólogo japonés Sunao Tawara y su maestro, el alemán Ludwig Aschoff, en 1906. Asimismo se relatan la estructura y los recorridos de los 3 haces internodales: el anterior o de Bachmann (1916), que conecta la aurícula derecha con la izquierda y el nodo AV; el medio o haz de Wenckebach (1910) y el posterior o haz de Thórel (1910), que se dirige desde la región del nodo sinoauricular hacia la aurícula izquierda y el margen de atrás del nodo AV. Se presentan asimismo, de forma esquemática, los sistemas de conducción ventricular izquierdo y derecho, que comprenden el tronco principal y las subdivisiones periféricas con sus respectivas redes de Purkinje. Respecto a la controvertida existencia de un fascículo izquierdo medio, éste sí puede existir en corazones humanos y de animales. Pero la red septal intermedia de fibras especializadas parece ser un equivalente funcional de dicho fascículo.

Defecto de la tabicación atrioventricular con 2 válvulas asociado a ausencia del pericardio: Informe de un caso / Atrioventricular defect with 2 valves associated with absence of the pericardium: Report of a case

Presentamos el caso de una paciente con una malformación cardiaca que representa una forma de transición anatomoembriológica del defecto de la tabicación atrioventricular entre la forma de 2 válvulas y la que tiene una válvula común. Esta entidad además se asoció con ausencia de pericardio. A través de los diferentes estudios se ha establecido con precisión la secuencia diagnóstica, determinando cuál fue la aportación de cada método y aclarando además la nomenclatura del defecto de la tabicación atrioventricular.

We present a case of a patient with a cardiac malformation that represents a form of embryo-anatomical transition of an atrioventricular septal defect between a 2 valves form to a common valve form. This entity was associated with pericardium absence. Throughout several studies we have precisely established a diagnostic sequence by determining the adequate contribution of each method and we have been able to clear out the proper nomenclature of the atrioventricular cushion defect.