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|1 RESULTADOS AL AÑO DEL INTERVENCIONISMO CORONARIO PERCUTÁNEO MULTIARTERIAL / One year follow-up outcome in multivessel percutaneous coronary intervention, Abel Y. Leyva Quert, Martín A. Arguedas Alcázar, Manuel A. Valdés Recarey, Javier Almeida Gómez, José L. Mendoza Ortíz, Joel Brooks Tamayo y Ricardo A. García Hernández
Introduction: Percutaneous coronary intervention in multivessel disease is a valid option for revascularization. Objective: To assess the outcomes of multivessel percutaneous coronary intervention in patients with multivessel disease; and to identify variables that are predictors of major adverse cardiac events. Method: A retrospective cohort and long-term survival study at the Hermanos Ameijeiras Hospital. Minimum follow-up was one year. The survival function was estimated by the Kaplan-Meier analysis, and univariate and multivariate analysis were used to identify predictors of major adverse cardiac events. Results: A total of 191 lesions were treated in 87 patients, 11.5% of them had three-vessel disease. The procedure was successful in 97.7% of cases, and radial access was the most commonly used (67.8%). The left anterior descending artery was the most frequently treated one (41%) and 77% of lesions treated were complex lesions (B2 and C). Some type of major adverse cardiac events occurred in 14.9% of the patients; 3.4% of them died from cardiac causes, 2.3% suffered a nonfatal acute myocardial infarction and 10.3% required repeat revascularization. The rate of adverse event-free survival at one year was 89.16%.Three-vessel disease was the only variable that predicted, independently, the occurrence of major adverse cardiac events at one year [p = 0.01, OR 5.03 (1.18 to 21.3, 95% CI)]. Conclusions: Multivessel percutaneous coronary intervention, in properly selected cases, leads to good results one year after surgery. Three-vessel disease was associated, independently, with the occurrence of major adverse cardiac events during the follow-up.
|2 CORRELACIÓN CLÍNICO-PATOLÓGICA DEL TROMBOEMBOLISMO PULMONAR EN LA CIRUGÍA CARDIOVASCULAR / Clinical-pathological correlation of pulmonary thromboembolism in cardiovascular surgery, Lisvet Triana Triana, Ileana Puig Reyes, Rudy Hernández Ortega, Osvaldo González Alfonso, Juan M. Rodríguez Álvarez, Oliviert Nazco Hernández, Leonel Fuentes Herrera, Alina Ceballos Álvarez, Omaida J. López Bernal, Yuri Medrano Plana, Alain Moré Duarte, Jean L. Chao García, Emma M. González Rivera and Marilyn Ramírez Méndez
Introduction: Pulmonary thromboembolism is the condition generated by the interruption of the blood supply to a portion of the lung by a blockage of an afferent vessel. Objective: To compare the clinical-pathologic correlation of the diagnosis of pulmonary thromboembolism in patients undergoing surgery and to describe some related variables. Method: A descriptive-retrospective study was conducted. The sample consisted of 26 patients who had clinical or post-mortem diagnosis of pulmonary thromboembolism. Results: All patients (100%) had tachycardia and tachypnea. Bronchopneumonia and chronic obstructive pulmonary disease (40% respectively) were the main causes of misdiagnosis. In the majority of cases (45.4%), the involvement was at the level of the thin branches. Clinical diagnosis was confirmed in 34.8% of patients. The main risk factors that were identified included: major surgery, the need for prolonged bed rest (81.8% respectively), the use of cardiopulmonary bypass and the occurrence of shock (72.7% respectively). Among patients with confirmed diagnosis, 72.7% had an adequate therapeutic dose of heparin. Conclusions: Pulmonary thromboembolism was a rare complication in cardiovascular surgery, and clinical suspicion exceeded the actual existence of the disease, therefore the clinical-pathological correlation was poor.
|3 EJERCICIO FÍSICO Y DIABETES MELLITUS TIPO 2 / Physical exercise and type 2 diabetes mellitus, Juan A. Andrade Flores, Rolando E. Rogés Machado, Lázara M. Pérez Yánez, Ricardo A. García Hernández and Feliciana N. García Roblejo
Introduction: Type 2 diabetes mellitus is considered to be an epidemic in the 21st century. The beneficial effect produced by physical exercise in the management of these patients is well known. Objective: To determine the effect of physical exercise in type 2 diabetes mellitus patients who were included in a rehabilitation program, characterize the evolution of the associated risk factors and modify some biochemical and exercise test parameters. Method: An intervention study was conducted in 50 diabetic patients who were included in a rehabilitation program. Each patient underwent physical examination; and blood glucose, cholesterol and triglycerides tests were performed at the beginning of the program and every 6 months during a 24-month period. At the end of each semester, an exercise test was performed according to the Bruce protocol. Results: There was a predominance of female patients (29/50, 58%), white skin patients (48%) and those aged 35-59 years (60.0%). Control of hypertension was achieved in all affected cases, as well as elimination of the sedentary lifestyle. Smoking decreased from 34 to 8.2%. In addition, there was a significant reduction in the average blood glucose levels (5.8 ± 1.0), glycosylated hemoglobin (5.9 ± 1.0) and triglycerides (1.7 ± 0.4). Conclusions: In the diabetic patients of the study, the control of the disease and its associated risk factors improved; and some parameters of the exercise test also improved.
|4 DETECCIÓN PRECOZ DE CARDIOTOXICIDAD INDUCIDA POR ANTRACICLINAS / Early detection of anthracycline-induced cardiotoxicity, Geoffrey Chibuzor Nwuruku, Juan A. Prohías Martínez, Ángela M. Castro Arca, Oyantay Mérida Álvarez, Joel Brooks Tamayo and Ricardo A. García Hernández
Introduction: Cancer is the most dreaded disease known to mankind. Cardiotoxicity is a complication of antineoplastic treatment, which can be detected early by echocardiogram. Objective: To identify echocardiographic variables related to the occurrence of cardiotoxicity by anthracycline. Method: A descriptive, prospective and longitudinal study was conducted with all patients admitted to the Hematology Department of Hermanos Ameijeiras Surgical Clinical Hospital, from January 2010 to January 2012. 28 patients who received chemotherapy with anthracyclines were studied. The general information of each patient, as well as the information concerning the transthoracic echocardiogram, was obtained during hospitalization, at one, 6 and 12 months. Results: 69.3% of patients who developed cardiotoxicity were older than 45 years and there was a predominance of males (76.9%). 56.8% had cardiotoxicity at a dose lower than 550 mg/m2 (p = 0.032). Strain rate/? values in patients who developed cardiotoxicity were significantly reduced at one month [0.8638/0.2 (p = 0.043) and 13.77/4.1 (p = 0.031)]; while LVEF remained normal [54.6 ± 4 (p = 0.036)]. Regarding volume/pressure of the left atrium, there was an increase in the reference values (21.13 ± 5.08 ml and 10.91 ± 0.57 mmHg), although without statistical significance (p = 0.217 and p = 0.728). Conclusions: Strain rate/? technique has been helpful for early diagnosis of cardiotoxicity.
|5 EL MÉTODO CLÍNICO Y LA CRECIENTE PRESENCIA TECNOLÓGICA EN LA CARDIOLOGÍA. ¿RELACIÓN EXCLUYENTE? / The clinical method and the growing technological presence in cardiology: Are they mutually exclusive?, Suilbert Rodríguez Blanco, Javier Almeida Gómez, Jeddú Cruz Hernández and Daniel Martínez Ávila
Hippocrates was the one who gave life to the clinical method, by insisting on the supreme value of observing the patients and the accumulation of experience by the physician to make a correct diagnosis of diseases. Obtaining clinical information and its interpretation are two moments of the process of medical care, which are closely related. From them, some components are derived, such as the doctor-patient relationship, anamnesis, physical examination and medical history. Together with this, there is a technological modernism in medical sciences, which is inevitable given its progress; but it should not involve an abandonment of the clinical method, because it would violate the ethical and medical principles that have been in place since the time of Hippocrates. Some thoughts on the components of the clinical method, the technological presence in modern cardiology and the relationship between them are expressed, based on the unquestionable validity and importance of this method and the duty of health professionals to put it into practice.
|6 VARIABILIDAD CLÍNICA, IMAGENOLÓGICA Y QUIRÚRGICA DEL PSEUDOANEURISMA POSTQUIRÚRGICO DE LA AORTA ASCENDENTE. INFORME DE TRES CASOS / Clinical, imaging and surgical variability of postoperative pseudoaneurysm of the ascending aorta: Report of three cases, Osvaldo Valdés-Dupeyrón, Manuel Nafeh-AbizReck, Alejandro Villar- Inclán, Raiza Hernández-Núñez, Rolando N. Carballo-Hidalgo, Katina Rodríguez-Rey and Jean L. Chao García
The postoperative pseudoaneurysms of the ascending aorta present varied clinical symptoms, and range from asymptomatic forms to severe toxic infectious cases or a rupture. They also show diversity with regard to location, time of occurrence after the first surgery and surgical findings. Three cases of patients who underwent surgery at the Department of Cardiovascular Surgery of the Hermanos Ameijeiras Hospital over a four-year period are reported. The first case is that of a patient who underwent atrial septal defect surgery and days after the surgical closure presented with a fever. The second case was a patient who was diagnosed with pseudoaneurysm three months after an aortic valve replacement surgery, with the only antecedent of repeated febrile episodes; and the third is a patient who had undergone aortic coarctation surgery and the following year underwent aortic valve replacement, then, 17 years later, presented with chest pain, fatigue and loss of consciousness. The postoperative aortic pseudoaneurysms are a challenge for all cardiology and cardiovascular surgery departments as they show a great variety in their forms of clinical-surgical presentation.
|7 ALTERNANCIA DEL ST INDUCIDO POR PROPAFENONA. FENÓMENO USO-DEPENDENCIA DE FRECUENCIA DEMOSTRADO EN LA PRÁCTICA CLÍNICA / ST alternans induced by propafenone. Use-dependence of heart rate phenomenon demonstrated in clinical practice
, Ginner O. Rizo Rivera
ST alternans reflects changes in action potential duration with increased electrical heterogeneity proportional to the alternation intensity. Although the mechanisms of ST and T alternans are still largely unknown, four mechanisms have been proposed: a) calcium overload, b) effect of chemicals from sustained ischemia, c) stimulation of the 5-HTreceptor and d) inhomogeneous blockade of sodium channels. Propafenone is a class IC sodium channel blocker, frequently used in the pharmacological cardioversion of atrial fibrillation, and has a use-dependence of heart rate phenomenon that can induce a Brugada pattern and electrical alternans. In this article, a clinical case demonstrating these two phenomena is presented.
|8 INFARTO AGUDO DE MIOCARDIO COMO PRIMERA MANIFESTACIÓN DE SÍNDROME ANTIFOSFOLÍPIDO / Acute myocardial infarction as the first manifestation of antiphospholipid syndrome
, Rogelio López Alférez, Esmeralda García Padilla, Eder N. Flores López, David L. Aguilar De la Torre and Luis C. Álvarez Torrecilla
Antiphospholipid syndrome is an autoimmune disease characterized by the combination of venous and arterial thrombosis, whose presentation is very diverse. Acute myocardial infarction is one of the more unusual presentations. This article presents a case with this diagnosis and intracavitary thrombus as presentation form of antiphospholipid syndrome.
|9 COMPORTAMIENTO DE LA MORTALIDAD POR DISECCIÓN AÓRTICA EN CUBA / Behavior of mortality due to aortic dissection in Cuba
, Osvaldo Valdés Dupeyrón, José Hurtado de Mendoza Amat, Teresita de J. Montero González, Reynaldo Álvarez Santana, Antonio de Arazoza Hernández and Jean L. Chao García.
Introduction: Aortic dissection is a disease of poor prognosis, with a high mortality rate, even when it is diagnosed early and the adequate surgery is performed. Objective: To describe some characteristics of the patients who died due to aortic dissection in Cuba. Method: A retrospective cross-sectional study was conducted. It included 888 deceased patients with a diagnosis of aortic dissection, who were registered in the Automated Registration and Control System of Anatomical Pathology (SARCAP, for its acronym in Spanish) in Cuba, from 1962 to 2004. Results: The age groups from 65 to 74 and from 75 to 84 years predominated, with 266 (30.0%) and 210 (23.6%) deaths, respectively. The largest number of deaths [496 (55.9%)] occurred in the first 24 hours. Stanford type A aortic dissection was the most frequent type [535 diagnoses were made (61.1%)]. The most common underlying cause of death was aortic dissection itself (61.6 %) and the most common direct cause of death was hemopericardium (43.9%). The rate of diagnostic agreement was 33.5 % in the underlying cause and 28.8 % in direct cause. Conclusions: During the 42 years covered by the study, the patients who died from aortic dissection in Cuba predominantly had Stanford type A dissections, were over 55 years of age and had a hospital stay of less than 2 months. The largest number of deaths occurred in the first 24 hours and the rate of diagnostic agreement was low.
|10 DIAGNÓSTICO Y TRATAMIENTO INTERVENCIONISTA EN LOS PACIENTES DEL HOSPITAL GENERAL CALIXTO GARCÍA / Diagnosis and interventional treatment in patients of the General Calixto Garcia Hospital, Vanessa Peña Bofill, Ista A. Arjona Rodríguez, Kirenia Espronceda Sánchez, Leonardo H. López Ferrero and Lidia M. Rodríguez Nande
Introduction: The diagnosis and interventional treatment is a distance service in the developing world, in hospitals that do not have interventional cardiology services. This is the case of the Calixto Garcia Hospital, where patients are referred to two nearby hospitals. Objective: To characterize the interventional treatment of patients admitted to the coronary care ward of the above hospital. Method: A descriptive cross-sectional study was conducted from January 2003 to December 2009. The medical records and the databases of the Cardiac Catheterization and Interventional Cardiology Departments from the Institute of Cardiology and Cardiovascular Surgery and the Carlos J. Finlay Military Hospital were reviewed. Results: 841 coronary angiograms were performed. There was a predominance of males with 559 cases (66.5 %), the mean age was 58 years, the most common risk factors included hypertension 613 (72.9%), smoking 277 (32.9%), dyslipidemia 164 (19.5%) and diabetes mellitus 138 (16.4%). Angiographically significant lesions were found in 65% of patients; 272 patients (32.3%) had 1-vessel disease and 276 (32.8%) had 2 and 3-vessel disease. A total of 327 (38.9%) coronary angioplasties were performed, predominantly in men 239 (73%), with a similar behavior of the risk factors. The most common clinical diagnoses in this group included acute coronary syndrome without ST segment elevation 145 (44.3%), chronic stable angina 106 (32.4%) and acute coronary syndrome with ST segment elevation 61 (18.7 %). The most affected and treated artery was the left anterior descending artery. The 3.0 x 18 mm metal stent Apolo was the most used stent. The procedure was successful in 95.7 % of cases. Conclusions: Percutaneous treatment is a valid option for patients admitted to centers that do not have the interventional cardiology service.
|11 FACTORES DE RIESGO DE MORBILIDAD LUEGO DE LA DERIVACIÓN CAVOPULMONAR TOTAL / Morbidity risk factors after total cavopulmonary shunt
, Alfredo M. Naranjo Ugalde, Eugenio Selman-Housein Sosa, Luis E. Marcano Sanz, Maritza Oliva Pérez, M. Teresa Consuegra Chuairey and Eutivides Aguilera Sánchez
Introduction: Arrhythmia, ventricular dysfunction and decreased functional capacity appear in the surgical outcome of patients with total cavopulmonary shunt. Detection of risk factors for this morbidity is essential to improve outcomes. Objective: To identify these risk factors in patients with intraatrial and extracardiac total cavopulmonary shunt. Method: A prospective cohort study was conducted from January 1992 to January 2012 at William Soler Cardiology Hospital. Frequency distributions and contingency tables were built. The association between qualitative variables was analyzed by Ji-square test of independence, for quantitative, with the Student t test. The binary logistic regression was used to identify risk factors. Results: 74 patients were studied at an average follow-up time of 8 years. Thirteen patients had arrhythmias and it was identified as a risk factor for postoperative occurrence of moderate or severe atrioventricular failure. Eleven patients developed moderate or severe ventricular dysfunction. Association with ventricular mass variation was detected. Decreased functional capacity was detected in 33 patients with associated ventricular dysfunction. Conclusions: Atrioventricular failure that appears after total cavopulmonary shunt should be treated since it is a risk factor for new arrhythmias. The decrease in ventricular mass in evolutionary studies should guide the diagnosis and treatment of ventricular dysfunction and decreased functional capacity in patients operated with total cavopulmonary shunt.
|12 ADAPTACIONES MORFOFUNCIONALES EVALUADAS POR ECOCARDIOGRAMA EN DEPORTISTAS MASCULINOS DE ÉLITE EN TRIATLÓN / Morphofunctional adjustments assessed by echocardiogram in male elite triathlon athletes
, Comlan Géoffroy Agbélélé, Juan A. Prohías Martínez, Ángela M. Castro Arca, Oyantay Mérida álvarez and Ricardo A. García Hernández
Introduction: Cardiovascular adjustments of elite athletes allow predicting the adequacy of the physical training they undergo. The atrial changes, which have not been studied much, are established earlier than the ventricular ones. Objective: To evaluate the left ventricular and atrial morphofunctional changes in elite triathlon athletes at different stages of training. Method: A prospective, longitudinal and descriptive study was conducted by performing two-dimensional and M-mode echocardiography, with pulse tissue Doppler and color tissue Doppler, to obtain the specific variables involved in the study of all members of the men's national triathlon team. The universe consisted of six athletes. The study was performed bimonthly for a period of one year, to cover different training stages. Results: Athletes were 20 to 24 years of age and had a mean body surface area of 1.89 m2. The septal and posterior wall thickness, and left ventricular end-diastolic volume increased significantly (p
|13 FACTORES DE RIESGO DE FIBRILACIÓN AURICULAR POSOPERATORIA EN CIRUGÍA CARDÍACA / Risk factors for postoperative atrial fibrillation in cardiac surgery
, Elizabeth Rodríguez Rosales, Antonio de Arazoza Hernández, Francisco Vázquez Castro and Francisco L. Moreno-Martínez
Introduction: The advent of new techniques of percutaneous intervention, the optimization of pharmacological behavior and the use of new surgical techniques (conventional, minimally invasive and video-assisted) have resulted in ever more difficult cases being treated in the operating room with an increase in the incidence of postoperative atrial fibrillation. Objective: To analyze the association among some variables and the incidence of this arrhythmia in cardiovascular surgery. Method: A retrospective analysis was conducted with the last 100 patients of both sexes, aged 18 and over, operated in the Cardiovascular Surgery Service of CIMEQ Cardiology Hospital, between October 2008 and February 2010. 27 variables arranged in four groups were analyzed and their relationship with postoperative atrial fibrillation was determined. Results: 37% of the patients analyzed presented this type of atrial fibrillation, which was more frequent in patients with mixed (80%) and double valve disease (66.66 %). Of the clinical variables only previous atrial fibrillation, mitral valve disease, age over 65, hemodynamic instability, previous myocardial infarction and III or IV functional class were significant. None of the studied electrocardiographic variables were significantly associated with the occurrence of postoperative atrial fibrillation. All echocardiographic variables (dilated left ventricle and atrium, dilated right atrium and ejection fraction below 55 %), and six of the variables that are typical of surgery (cardiopulmonary bypass, recovery from cardiac arrest in atrial or ventricular fibrillation, use of amines in trans or postoperative period, over 120 minutes of aortic clamping, double valve disease and mixed cases) were significantly associated with the occurrence of this arrhythmia. Conclusions: The clinical variables highly associated with atrial fibrillation are less significant than the variables typical of surgery, in the case of postoperative atrial fibrillation.
|14 PAPEL DEL ESTRÉS OXIDATIVO EN LA PATOGÉNESIS DE LA HIPERTENSIÓN ARTERIAL / Role of oxidative stress in the pathogenesis of hypertension
, Yosit Ponce Gutiérrez, Arik Ponce Gutiérrez, Arnaldo Rodríguez León and Katherin Cabrera García
The increased production of reactive oxygen species has been involved in several chronic diseases, including hypertension. Oxidative stress is, in turn, cause and consequence of this hypertension. The enzyme NADPH oxidase is the major source of reactive species of cardiovascular, renal and neural oxygen. Oxidative stress is associated with endothelial dysfunction, inflammation, hypertrophy, apoptosis, cell migration, fibrosis and angiogenesis; important processes involved in vascular remodeling of hypertension. Despite the large amount of data that involve oxidative stress as a causative factor of experimental hypertension, results in humans are less conclusive. The aim of this review is to describe the role of oxidative stress in the pathophysiology of hypertension. A better understanding of these mechanisms will allow a more comprehensive behavior to this common disease.
|15 DISECCIÓN DE ARTERIA PULMONAR. A PROPÓSITO DE UN CASO / Pulmonary artery dissection. Case report
, Ángela M. Castro Arca, Carlos Ramos Emperador, Oyantay Mérida Álvarez, Zoinez Sotto García, Ricardo A. García Hernández and Alan Santana Leyva
The dissection of the pulmonary artery is an extremely rare disease that is related to the presence of severe pulmonary hypertension of long evolution, in the course of congenital heart diseases or primary pulmonary hypertension. This is the case of a woman with a history of ostium secundum type atrial septal defect that refused to undergo surgical treatment and presented suprasystemic pulmonary hypertension secondary to Eisenmenger´s syndrome, in the course of its natural evolution, and comes to our hospital complaining of chest pain and dyspnea at rest, and where pulmonary artery dissection was diagnosed.
|16 UN CASO DE SÍNDROME DE KOUNIS EN SAGUA LA GRANDE / A case of Kounis syndrome in Sagua La Grande
, Yamir Santos Monzón, Jesús A. Pérez González, Antonio Mata Cuevas, Yonielis Rivero Nóbrega and Jesús J. Roque Corzo
Allergic acute coronary syndrome, also known as Kounis syndrome, is currently underdiagnosed as a result of its low disclosure. The case of a 29-year-old man is reported. He was stung by a wasp and developed an acute coronary syndrome with ST segment elevation related to the allergic process. After an appropriate treatment, the patient improved. The case is reported with the aim of raising awareness about a recently described disease that should be consider as a differential diagnosis in the presence of an acute coronary syndrome.
|17 RELACIÓN DE VARIABLES PREOPERATORIAS Y EVOLUCIÓN POSTQUIRÚRGICA PRECOZ EN PACIENTES CON CIRUGÍA DE SUSTITUCIÓN VALVULAR MITRAL / Relationship between preoperative variables and early postoperative outcome in patients with mitral valve replacement surgery
, Jean L. Chao García, Francisco J. Vázquez Roque, Roger Mirabal Rodríguez, Gustavo J. Bermúdez Yera, Leonel Fuentes Herrera, Alina Ceballos Álvarez, Vielka González Ferrer, Álvaro L. Lagomasino Hidalgo and Francisco L. Moreno-Martínez
Introduction: Preoperative variables in mitral valve replacement surgery allow an objective preoperative assessment of each patient. Objective: To determine the influence of preoperative risk factors on mortality and major complications occurring in mitral valve replacement surgery. Method: Analytical, longitudinal, prospective follow-up study of 158 patients who underwent surgery for mitral valve disease at the Cardiocentro Ernesto Che Guevara of Villa Clara, from 2007 to 2010. A bivariate study was conducted for each independent variable. Mortality and major complications were the dependent variables. Results: The mean age was 65.2 years, female patients predominated. Smoking, ventilatory disorders, pulmonary hypertension and atrial fibrillation were the most important risk factors. Most patients underwent surgery electively, in functional class II, with left ventricular ejection fraction greater than 50% and predominance of mitral stenosis. The variables that were associated with the risk of major complications were: heart failure, age over 50 years, emergency surgery, the use of hemoderivatives, atrial fibrillation, ventilatory disorders in spirometry and pulmonary acceleration time. Those related to death were: reduced left ventricular ejection fraction, pulmonary acceleration time, heart failure, the use of hemoderivatives, creatinine > 1.5 mg/dl, cardiomegaly and atrial fibrillation. Conclusions: The relationship between preoperative variables and postoperative mor-bidity and mortality behaved indistinctly in each surgical center.
|18 PREDICTORES ECOCARDIOGRÁFICOS DE DISFUNCIÓN SUBCLÍNICA DE VENTRÍCULO DERECHO SISTÉMICO / Echocardiographic predictors of subclinical systemic right ventricular dysfunction
, Giselle Serrano Ricardo, Adel E. González Morejón, Luis E. Marcano Sanz, Michel Cabrera Ortega, Alfredo M. Naranjo Ugalde and Jesús F. Carballés García
Introduction: Transposition of the great arteries with physiological surgical correction predisposes to dysfunction of systemic right ventricle. It is believed that asymptomatic patients have a subclinical dysfunction of this ventricle. Transthoracic echocardiography is sensitive to assess right ventricular function. To date, medical treatment is started when the patient begins with symptoms suggestive of ventricular dysfunction. Objective: To estimate echocardiographic predictors of subclinical dysfunction of systemic right ventricle. Method: Observational prospective study from May 2011 to December 2012. The sample (n= 65) was divided into two groups: asymptomatic (n = 33) and symptomatic (n = 32), according to the absence or presence of clinical symptoms suggestive of right ventricular dysfunction. Results: The two groups were homogeneous in terms of age and surgical time. In both hypertrophy of the right ventricle anterior wall was showed, although lower in the asymptomatic group (p < 0.001). Subclinical systolic dysfunction in the asymptomatic group was evident. There were no differences in diastolic function between the two groups. There were correlations between the tricuspid annular plane systolic excursion and the right ventricular ejection fraction, both in the asymptomatic (r = 0.68, CI 95 % 0.44 to 0.83, p < 0.0001) and symptomatic groups (r = 0.77, CI 95 % 0.59 to 0.88, p < 0.0001). Echocardiographic predictors of subclinical systemic right ventricular dysfunction were identified. Conclusions: Age, right ventricle anterior wall thickness, surgical time, and diastolic and systolic diameters of the right ventricle are echocardiographic predictors of subclinical systemic right ventricular dysfunction, useful for the timely initiation of medical treatment.
|19 SOBREVIDA, ESTADO CLÍNICO Y CALIDAD DE VIDA AL AÑO DE LA CIRUGÍA CARDIOVASCULAR / Survival, clinical status and quality of life one year after cardiovascular surgery
, Antonio de Arazoza Hernández, Elizabeth Rodríguez Rosales, Miguel Á. Carrasco Molina and Dania Valera Pérez
Introduction: Hospital outcomes of cardiac surgery have been well studied and reported at national and international levels, but survival data is not abundant in our country. Objective: To establish survival and determine social functioning of patients one year after cardiovascular surgery. Method: An observational, descriptive, cross-sectional study was conducted with patients who underwent surgery over the last three years at the Cardiovascular Surgery Department of the CIMEQ Hospital. Patients were interviewed at the cardiovascular surgery consultation and their medical records were analyzed in order to incorporate the study variables (demographics, survival, functional classification, social functioning, reoperations, complications, and other non-cardiac surgeries). Results: 186 patients were included, who had a survival of 95.17 % at one year, with a clinical improvement over 96 %, in additional testing and functional class. The level of overall social functioning of these patients increased from "neutral or indifferent" to "very satisfied or satisfied" in 85.9 % of cases. Conclusions: Survival figures at one year, patients’ return to working life, the level of social functioning, and the clinical improvement in additional testing after cardiovascular surgery that have been reached by the CIMEQ Hospital are at the level of those shown by hospital which are leaders in developed countries of Europe and America.
|20 FACTORES ASOCIADOS A LA PREHIPERTENSIÓN ARTERIAL EN JÓVENES DE 20 A 25 AÑOS DE EDAD / Factors associated with prehypertension in young adults between 20 and 25 years of age
, Samuel I. Merino Barrera, Guillermo A. Pérez Fernández, Merlin Garí Llanes, Vielka González Ferrer, Beyda González Camacho, Francisco L. Moreno-Martínez and Juan J. Flores Molina
Introduction: Hypertension is a major health problem worldwide. Prehypertension is a category that has been little studied in young adults. Objective: To determine the factors associated with prehypertension in young adults between 20-25 years of age. Method: A descriptive cross-sectional study was conducted in a universe consisting of 257 second-year medical students. A total of 134 young adults, between 20-25 years of age, were selected by simple random sampling in the academic year 2009-2010. Results:The prevalence of prehypertension was 27.6 %. Males (51.5 %) and white skin subjects (59.7 %) were the most affected. Home environment, a personal history of low birth weight (OR=2.3; p=0.179) and gestational age less than 37 weeks (OR=2.5; p=0.187) did not influence the possibility of having prehipertensives figures in the subjects of this sample. Conclusions: The high body mass index (OR=34.1; p
|21 VALORACIÓN CLÍNICA Y ANGIOGRÁFICA DE LA REESTENOSIS DEL STENT CORONARIO CONVENCIONAL / Clinical and angiographic assessment of coronary bare-metal stent restenosis
, Max G. Sánchez Manzanares, Francisco L. Moreno-Martínez, Iguer F. Aladro Miranda, Luis F. Vega Fleites, Rosendo S. Ibargollín Hernández, José R. Nodarse Valdivia, Norge R. Lara Pérez, Alejandro Agüero Sánchez, Reinaldo C. Gavilanes García, Lill D. Vega Plá, Leonardo Pérez González, Maribel I. Noda Valledor, Ricardo Oroz Moreno and Wanda Báez La Rosa
Introduction: Ischemic heart disease is the leading cause of death in Cuba. Coronary angioplasty with stenting is an excellent treatment option, but restenosis overshadows its prognosis and is more common with the use of bare metal stents. Objective: To characterize restenosis after coronary bare metal stent from the clinical and angiographic points of view. Method: A descriptive cross-sectional study was conducted in 59 patients with a diagnosis of restenosis after coronary bare metal stent confirmed by angiography in the Interventional Cardiology Unit of Cardiocentro Ernesto Che Guevara of Villa Clara, Cuba, from February 2010 to April 2012. The variables analyzed were age, sex, coronary risk factors, previous history of angina or heart attack, vessel involved, type of restenosis and treated lesion, vessel diameter and lesion length. Results: Predominance of male patients (76.27 %), aged 60-69 years (40.66 %). The most common risk factors were hypertension (76.27 %), smoking (37.28 %) and type II diabetes mellitus (33.89 %). The most affected vessel was the left anterior descending (28.81 %), arterial diameters were predominantly ? 2.5 mm (54.2%) and lesion length > 20 mm (65, 97). Type B injuries (52.5) and focal restenosis (57.62 %) were more frequent. Conclusions: Patients with restenosis were predominantly male, between 60-69 years old, with a history of hypertension, smoking and diabetes mellitus type II. Left anterior descending disease, diameter ? 2.5 mm, lesion length > 20 mm, type B coronary lesion and focal restenosis were more frequent.
|22 COMPORTAMIENTO DE LA ENDOCARDITIS INFECCIOSA EN EL CARDIOCENTRO PEDIÁTRICO "WILLIAM SOLER" DE 2000 A 2012 / Behavior of infective endocarditis at the Pediatric Cardiocentro William Soler from 2000-2012
, Hiram Tápanes Daumy, Elsa Fleitas Ruisánchez, Eliobert Díaz Bertot, Andrés Savío Benavides and Maylín Peña Fernández
Introduction: Infective endocarditis is a rare disease in children. There are few publications that include large numbers of patients and discuss their risk factors. Objective: To describe the clinical and epidemiological characteristics of pediatric infective endocarditis. Method: A retrospective descriptive study was performed in the 33 patients admitted for infective endocarditis (who met the Duke criteria) at the Pediatric Cardiocentro William Soler in Havana, Cuba, from January 2000 to July 2012. Medical records were reviewed to obtain the primary data. Variables were stored and analyzed with SPSS version 15.0. Absolute and relative frequencies were determined and for the association between qualitative variables the Chi Square Test of Independence was used. Results: Infective endocarditis predominated in female students (20/ 33 patients), the most frequent heart diseases were ventricular septal defect (50%) and tetralogy of Fallot (18.2%). Dental procedures (36.4% p < 0.01) and the use of intravascular catheters (36.4 % p < 0.05) were the most relevant risk factors. In 78.8 % of cases the presentation was subacute and in 57.6 %, nosocomial. Blood cultures were positive in 25 of 33 patients; in 14 of them (56 %) staphylococcal species were isolated. 46 complications were found, 30.4 % were congestive heart failure, followed by cerebral (21.8%) and lung embolisms, and pneumonia (10.9%). Conclusions: Infective endocarditis was more frequent in children with congenital heart disease, and was significantly associated with defined risk factors, had a subacute clinical presentation and germ acquisition was nosocomial. Most common isolated germs were staphylococcal species and regarding complications heart failure and heart embolisms predominated.
|23 PERCEPCIÓN DE LOS BENEFICIOS DE LA TENENCIA DE ANIMALES DE COMPAÑÍA EN PACIENTES CON ENFERMEDADES CARDIOVASCULARES / Perception of the benefits of pet ownership in patients with cardiovascular disease
, Beatriz Hugues Hernandorena, Aimée Álvarez Álvarez, Loraine Ledón Llanes, Madelin Mendoza Trujillo, Liset Castelo Elías-Calles and Emma Domínguez Alonso
Introduction: Pets have played an important role in the life of human beings. In dissimilar studies a beneficial effect in the prevention and recovery of physical and mental health has been shown. Objective: To describe the perception of the benefits of pet ownership in patients with cardiovascular disease. Method: A descriptive cross-sectional exploratory study was conducted with 37 people that suffer from cardiovascular disease and brought their pets to the main clinic of affective pets in Havana between September and December 2012. A questionnaire was made in which the necessary aspects and socio-demographic data were assessed. Results: The mean age was 102 years old, females were predominant with 15 patients (75%) and 50% had white skin color. The most prevalent coronary risk factor was hypertension (40%); diabetes mellitus type 2, dyslipidemia, and smoking followed in this order. Centenarians had preserved systolic function of the left ventricle (90%) with little tendency to supernormality, one patient had segmental contractility disorders in the underside, which corresponded to a history of myocardial infarction. Four centenarians had normal filling pattern, 11 had impaired ventricular relaxation and five pseudonormal patterns. Conclusion and recommendations: In the group studied there is a perception that pet ownership exerts beneficial effects on the physical and psycho-emotional health of the owner, and it was recommended to continue and expand research related to the topic, cover other sectors and increase the sample.
|24 ARRITMIAS VENTRICULARES MALIGNAS EN PACIENTES CON CARDIODESFIBRILADOR IMPLANTABLE: SIGNOS ELÉCTRICOS PREDICTORES DE RECIDIVAS / Malignant ventricular arrhythmias in patients with implantable cardioverter-defibrillators: electrical signals which are predictors of recurrence
, Ailema A. Alemán-Fernández, Margarita Dorantes-Sánchez, Jesús Castro Hevia, Lisbeth González González, Yoel Coto Hernández and Marcos A. Rodríguez García
Introduction: There is a growing number of patients with implantable cardioverter-defibrillators. Recurrences are frequent and electrical shocks are the main factor affecting the quality of life. Objective: To identify the electrocardiographic predictors of the recurrence of malignant ventricular arrhythmias in these patients. Method: From a universe of 76 patients, who had undergone cardioverter-defibrillator implantation, 46 patients were selected and two groups were formed. Group A consisted of 27 patients with at least one episode of malignant ventricular arrhythmias after device implantation; and group B consisted of 19 subjects without recurrences. Measurements (prolonged QTc, abnormal QT dispersion, Tpeak-Tend interval and its abnormal dispersion) were averaged over three consecutive heartbeats in each lead, manually, by two independent observers. Results: In group A, there was a predominance of structural heart disease and an ejection fraction less than 35%. The fragmentation of the QRS complex, bimodal T wave and early repolarization pattern were also present. There were significant differences in the mean values of the QT interval (428 vs. 390 ms), p=0.004; the corrected QT (476 vs. 436 ms), p=0.011; and Tpeak-Tend interval (108 vs. 87 ms), p=0.006. There were no significant differences in QT dispersion (51 vs. 48 ms), the Tpeak-Tend dispersion (35 vs. 27 ms), or QRS duration (121 vs. 105 ms). Conclusions: QT, QTc and Tpeak-Tend intervals are electrocardiographic predictors of the recurrence of ventricular arrhythmias in patients with implantable cardioverter-defibrillators.
|25 UNA APROXIMACIÓN A LAS DIMENSIONES CARDÍACAS EN EL EMBRIÓN HUMANO DEL ESTADIO 22 DE CARNEGIE / An approximation of cardiac dimensions in the human embryo at Carnegie stage 22, María A. Vila Bormey, Yanely Surí Santos, Omar Hernández Trimiño and Oscar Cañizares Luna
Introduction: Cardiac prenatal growth has been a topic of research, and it has allowed establishing the normal curve of fetal heart volume. Objective: To obtain, in a novel way in our country, the volume of the embryonic heart at Carnegie stage 22, at week 8 of development. Method: Two human embryos from this stage were studied at the embryo gallery of the Faculty of Medicine of Villa Clara. The two specimens were processed by paraffin technique, their cuts were digitized and the heart areas were measured in all serial sections of the heart. To calculate the volume, the thickness of the cut was multiplied by the sum of partial areas. Results: Volumes of 6.137 mm3 and 6.004 mm 3 were obtained in both specimens. Conclusions: The results provide a scientific approximation of the actual dimensions of the heart at this stage of development.
|26 BIOALBERIC ¿UNA ALTERNATIVA PARA LA HIPERCOLESTEROLEMIA? / BioAlberic: an alternative for hypercholesterolemia?
, Carmen del R. Guardado Orille, Lizet Castelo Elías-Calles and Jesús A. Ramírez López
Introduction: Despite the progress made in the diagnosis and treatment of dyslipidemias, therapeutic goals are often not reached due to noncompliance of medical indications by some patients or to the presence of adverse reactions to lipid lowering drugs. The use of the BioAlberic method can be another therapeutic alternative. Objective: To assess the effectiveness of the method in the treatment of hypercholesterolemia. Method:A controlled, randomized, open-label pilot study was designed. The sample was composed of 60 patients with hypercholesterolemia. Patients were divided into three groups of 20 each: group I treated with coltricé 1, Group II treated with coltricé 2 and group III to whom 20 mg of atorvastatin were administered. Treatment consisted of the oral administration of the BioAlberic product, used in drinking water over a period of 90 days, with a monthly monitoring. At the beginning of the research the serum levels of cholesterol, triglycerides, glutamic pyruvic transaminase and oxaloacetic, uric acid, creatinine, and glucose were determined. Total plasma cholesterol and triglycerides were assessed monthly for three months, and levels at the beginning and end of the research were compared. Results: Cholesterol was normalized in 12 patients with the use of coltricé (between 9.6 and 6.02 mmol / L), 11 reached borderline levels (from 10.43 to 5.9 mmol / L) and there was no response in 17. Conclusions:Administration of coltricé could be another therapeutic option in the treatment of hypercholesterolemia.
|27 EL INTERVALO QT, SU ORIGEN E IMPORTANCIA DEL CONOCIMIENTO DE FÓRMULAS PARA SU MEDICIÓN EN DIFERENTES CIRCUNSTANCIAS CLÍNICAS / The QT interval, its origin and importance of the knowledge of formulas for its measurement in different clinical circumstances
, Elibet Chávez González
The long QT syndrome is an arrhythmogenic channelopathy characterized by severe alterations in ventricular repolarization, electrocardiographically translated as a QT interval prolongation. The involvement of various ion channels in the genesis of cardiac action potential causes that alterations in their structure and function lead to the so-called syndrome and to the presence of malignant ventricular arrhythmias. In 1920, Bazett adapted the formula of the cardiac electrical systole duration to the QT interval of the electrocardiogram, and proposed normal values of QT for a given heart rate. After Bazett´s description, several formulas were described in different clinical situations to calculate the corrected QT interval. The knowledge about how to measure the QT interval and about its correction as a tool for the diagnosis of arrhythmogenic conditions and prevention of primary or secondary malignant ventricular arrhythmias is of vital importance for its clinical use.
|28 CONSIDERACIONES ACTUALES ACERCA DE LA ENFERMEDAD HIPERTENSIVA DEL EMBARAZO Y EL PUERPERIO / Current issues on hypertensive disorders of pregnancy and puerperium
, Alain Cruz Portelles, Idaer M. Batista Ojeda, Ernesto Medrano Montero and Alfredo Ledea Aguilera
Hypertensive disorders of pregnancy complicate 5 to 7% of all pregnancies and are one of the leading causes of maternal morbidity and mortality worldwide. These disorders vary from mild hypertension to severe preeclampsia. Recently, there have been major advances in the study of these disorders; however, many aspects need to be resolved, mainly concerning pathogenesis, prevention and management. This review is based on the latest available evidence on hypertensive disorders of pregnancy. Aspects related with classification, diagnosis and management of hypertension in pregnancy and its main complications are discussed in this article.
|29 FASE HOSPITALARIA DE LA REHABILITACIÓN CARDIACA. PROTOCOLO PARA EL SÍNDROME CORONARIO AGUDO / Hospitalization phase of cardiac rehabilitation: protocol for acute coronary syndrome
, Susana Hernández García, José Á. Mustelier Oquendo and Eduardo Rivas Estany
The hospitalization phase of cardiac rehabilitation has evolved and has been shortened considerably over the years. On the one hand, the rise of therapeutic percutaneous coronary intervention and, on the other, the fundamental purpose of reducing the harmful effects of prolonged rest have been aspects that have motivated the update the physiotherapy intervention program during this phase in our hospital. Action guidelines were established in each stage of the program, as well as an exercise schedule according to the stage of the patient, the use of controls in the fitness session and aspects of psychological intervention. The benefits of a prompt and adequate physiotherapy intervention for continuing into convalescence and the patient´s consequent social and labor return were considered when updating the action protocol, which would help to unify criteria and working strategies in the hospitalization phase of the Cuban National Program for Cardiac Rehabilitation.
|30 SUSTITUCIÓN VALVULAR AÓRTICA MÍNIMAMENTE INVASIVA. PRIMEROS CASOS REALIZADOS EN CUBA / Minimally invasive aortic valve replacement surgery. First cases performed in Cuba
, Antonio de Arazoza Hernéndez, Elizabeth Rodríguez Rosales, Fausto L. Rodríguez Salgueiro, Miguel A. Carrasco Molina and Dania Valera Pérez
Aortic valve diseases, primarily of rheumatic cause in the past, are now mostly degenerative. The arrival of new therapeutic strategies, technological developments and increased life expectancy have led to an increase in the incidence of this disease and also to the fact that the patients we treat are increasingly of older ages. Thus minimally invasive cardiac surgery has been developed and aims to provide a new possibility of surgical treatment for the increasingly growing number of patients. A report of the first 2 aortic valve replacements performed in Cuba using this minimally invasive surgery is presented in this article. This technique has been successful in reducing the risk of infection and bleeding, need of transfusions, postoperative pain and postoperative intubation and mechanical ventilation times, as well as hospital stay and total cost of surgery.
|31 ENFERMEDAD CORONARIA MULTIVASO, DISFUNCIÓN ENDOTELIAL Y ANGIOPLASTIA EN LA DIABETES MELLITUS. A PROPÓSITO DE UN CASO / Multivessel coronary artery disease, angioplasty and endothelial dysfunction in diabetes mellitus. Case Report
, Suilbert Rodríguez Blanco, Javier Almeida Gómez and Juan Carlos Pérez Guerra
Coronary heart disease is the leading cause of morbidity and mortality in patients with diabetes mellitus, and causes changes in the endothelium and vascular smooth muscle. This endothelial dysfunction is a precursor of atherogenic lesions. This article describes the case of a diabetic patient with left main trunk disease who was successfully treated with percutaneous coronary intervention and showed rapid progression of atherosclerotic disease in other vessels, so she needed new percutaneous revascularization. Angiographic images are presented and aspects of endothelial dysfunction in diabetes mellitus and its percutaneous treatment are commented. It is important to early identify and treat endothelial dysfunction in diabetic patients. The choice of the revascularization method should be individualized.
|32 HALLAZGO FORTUITO DE FÍSTULA ARTERIOVENOSA CORONARIA IZQUIERDA EN ESCOLAR DE 6 AÑOS / Incidental finding of a left coronary arteriovenous fistula in a 6-year-old schoolgirl
, Lysmara Senra Reyes, Hiram Tápanes Daumy, Francisco Díaz Ramírez, Maylin Peña Fernández and Eliobert Díaz Bertot
Coronary fistulas are congenital or acquired abnormalities in which there is direct communication between a coronary artery and any of the cardiac chambers or other vessels. An interesting case of a child with a left coronary arteriovenous fistula draining into the right atrium is reported. The diagnosis was made by an echocardiographic finding that was confirmed by cardiac catheterization. Angiographic images are shown, and the literature on this topic is reviewed in order to discuss some aspects of its epidemiology, clinical presentation, diagnostic possibilities, and the final conduct to face this disease.
|33 FASE HOSPITALARIA DE LA REHABILITACIÓN CARDÍACA. PROTOCOLO PARA LA CIRUGÍA CARDÍACA / Hospitalization phase of cardiac rehabilitation. Protocol for cardiac surgery
, Susana Hernández García, Elisabeth Prendes Lago, José A. Mustelier Oquendo and Eduardo Rivas Estany
Cardiac rehabilitation in the hospitalization phase, in patients scheduled for surgery, has progressed over the years. Based on the knowledge and scientific evidence that a more dynamic physiotherapy intervention favors a quicker recovery from surgery, and reduces postoperative complications and hospital stay, it is the aim of this paper to update the physiotherapy intervention protocol of our hospital. Educational and informational aspects were established in the preoperative stage, as well as the teaching of techniques and breathing exercises, and a psychological intervention. Also, an exercise routine is presented according to the different stages, and the use of variables to control the physical fitness session. Updating the action protocol from the preoperative stage to the moment of hospital discharge will help unify work strategies and criteria in the hospital phase of the national rehabilitation program for cardiac surgery.