Insuficiencia mitral de etiología poco usual

We communicate a case of a 8-month breastfed sent by her pediatrician to cardiology consultation after finding a heart murmur on physical examination. Echocardiography showed left ventricle dilatation with severe mitral regurgitation due to restricted posterior leaflet movement, together with a diastolic flow on pulmonary artery suggestive of anomaly of coronary arterial origin. CT coronary angiogram confirmed diagnosis. The patient underwent surgery with left coronary artery reimplantation on ascending aorta, mitral valve plication, and posterior leaflet closure of pseudo-cleft of posterior leaflet evidenced during intervention, with good results.Se presenta un caso de lactante de 8 meses, que fue enviado por su pediatra para una consulta cardiovascular después de auscultar un soplo en el examen físico. La ecocardiografía demostró el ventrículo izquierdo dilatado con regurgitación mitral grave debido a movimiento restringido de la valva posterior, junto a un flujo diastólico en la arteria pulmonar sugestivo de una anomalía con origen en la arteria coronaria. La angiografía coronaria por tomografía computarizada confirmó el diagnóstico. El paciente fue sometido a cirugía de reimplante de la arteria coronaria izquierda a la aorta ascendente, más plicatura de valva mitral y cierre de la hendidura de la valva posterior evidenciado ya durante la intervención buenos resultados

Mixoma de características atípicas: un simulador en tiempos de COVID-19

We present a case of a 55-year-old woman with an atypical myxoma in the left atrium. She was admitted for one month history of fever, cough and dyspnea associated with radiological alveolar infiltrates in the chest X-ray. Echocardiography revealed the existence of a heterogeneous mass in the left atrium dependent on the interatrial septum with a large cystic content prolapsing through mitral valve and causing significant obstruction. Its echocardiographic morphological characteristics suggested myxoma or sarcoma as two possible etiological diagnoses. Urgently surgical intervention was practiced and the intraoperative biopsy confirmed the existence of atrial myxoma.Se presenta el caso de una mujer de 55 años con un mixoma en aurícula izquierda de morfología atípica. Fue ingresada por un cuadro de fiebre, tos y disnea de 1 mes de evolución asociado con la aparición de infiltrados alveolares en la radiografía de tórax. La ecocardiografía reveló la existencia de una masa en aurícula izquierda dependiente del septo interauricular, heterogénea y con un gran componente quístico, que prolapsaba a través de la válvula mitral causando obstrucción significativa. Sus características morfológicas ecocardiográficas hicieron pensar en un mixoma o un sarcoma como dos posibles diagnósticos etiológicos. Fue intervenida de forma urgente y la biopsia intraoperatoria confirmó la existencia de un mixoma auricular

Reparación percutánea borde a borde mitral en insuficiencia mitral degenerativa compleja: ¿es realmente una contraindicación?

Transcatheter edge to edge repair (TEER) represents an effective alternative to valve repair surgery in patients with severe primary mitral regurgitation in whom surgical risk is unacceptable. Adequate prior echocardiographic study is essential for the success of the therapy.  Different prognostic scores and criteria have been published to guide the patient selection. We report the case of a 77-year-old woman admitted to our hospital with acutely decompensated heart failure in whom a severe primary mitral regurgitation with a complex valvular anatomy was effectively treated by TEER.El tratamiento percutáneo borde a borde (TPBB) es una alternativa eficaz a la cirugía de reparación valvular en los pacientes con insuficiencia mitral primaria severa y riesgo quirúrgico prohibitivo.  Para el éxito de la terapia, es fundamental un adecuado estudio ecocardiográfico previo. Existen diferente scores pronósticos y criterios que son útiles en la selección del paciente. Se presenta una mujer de 77 años que ingresa en nuestro hospital por un cuadro de insuficiencia cardiaca aguda secundaria a una insuficiencia mitral primaria severa con anatomía valvular compleja tratada de forma eficaz mediante TPBB

The Assessment of Myocardial Longitudinal Strain in a Paediatric Spanish Population Using a New Software Analysis

Two-dimensional speckle-tracking echocardiography (2DSTE) has been present for years. However, it is underutilized due to the expertise and time requirements for its analysis. Our aims were to provide strain values in a paediatric Spanish population and to assess the feasibility and reproducibility of a new strain software analysis in our environment. Methods: A cross-sectional study of 156 healthy children aged 6 to 17 years. Longitudinal strain (LS) analysis of the left ventricle, right ventricle, and left atrium was performed. Feasibility and reproducibility were assessed. The associations of clinical and echocardiographic variables with strain values were investigated by multivariate analysis. Results: Mean age was 11 ± 3 years (50% female). Feasibility of LS measurement ranged from 94.2% for left ventricle global LS (LVGLS) to 98.1% for other chamber strain parameters. Strain values were 26.7 ± 2.3% for LVGLS; 30.5 ± 4.4% and 26.9 ± 4% for right ventricle free wall LS (RVFWLS) and four chambers view LS (RV4CLS) respectively; and 57.8 ± 10.5%, 44.9 ± 9.5%, and 12.9 ± 5.5% for left atrium LS reservoir phase (LALSr), conduct phase (LALScd) and contraction phase (LALSct), also respectively. Body surface area (BSA) and age presented a negative correlation with strain values. Higher values were found in females than in males, except for LALScd. Excellent intra- and inter-observer reproducibility were found for right and left ventricular strain measurement, with intraclass correlation coefficients (ICC) ranging from 0.88 to 0.98, respectively. In conclusion, we described strain values in a healthy Spanish paediatric population. LS assessment by this new strain analysis software by semi-automatic manner was highly feasible and reproducible

Executive summary of the Consensus Document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and of the Spanish Association of Surgeons (AEC) in antibiotic prophylaxis in surgery

[ES] La profilaxis antibiótica en cirugía es una de las medidas más eficaces para la prevención de la infección de localización quirúrgica, aunque su uso es con frecuencia inadecuado, pudiendo incrementar el riesgo de infección, toxicidades y resistencias bacterianas. Debido al avance en las técnicas quirúrgicas y la emergencia de microorganismos multirresistentes las actuales pautas de profilaxis precisan ser revisadas. La Sociedad Española de Enfermedades Infecciosas (SEIMC), conjuntamente con la Asociación Española de Cirujanos (AEC) ha revisado y actualizado las recomendaciones de profilaxis antimicrobiana para adaptarlas a cada tipo de intervención quirúrgica y a la epidemiología actual. En este documento se recogen las recomendaciones de los antimicrobianos utilizados en profilaxis en los diferentes procedimientos, las dosis, la duración, la profilaxis en huéspedes especiales, y en situación epidemiológica de multirresistencia, de tal forma que permitan un manejo estandarizado, un uso racional, seguro y efectivo de los mismos en la cirugía electiva.[EN] Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and antimicrobial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. The Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis in surgery to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery

Genotype, environment and their interaction on olive

Resumen del trabajo presentado en la 6th International Conference on the Olive Tree and Olive Products, celebrada en Sevilla (España) del 15 al 19 de octubre de 2018.The wide olive genetic patrimony has revealed high variability for most of the agronomic and oil quality traits of interest in olive growing. Few studies, however, have addressed the interaction of this variability with the environment, a subject of particular interest considering the natural high instability of the Mediterranean climate and the challenge of the predicted climate change. The current work presents results on the interaction between genotype and environment from multi-environment trials of olive cultivars and breeding selections, planted in different edaphoclimatic conditions of Andalusia, Southern Peninsular Spain and Canary Islands. For most of the agronomic and oil quality characters evaluated (flowering phenology, flower quality, pattern of oil accumulation, fatty acid composition and phenol content and composition), significant genotype and environment effects have been observed. For example, olive cultivars grown in Tenerife under much milder winter temperatures than in the Iberian Peninsula showed substantially earlierflowering and oil accumulation. Only in the case of flowering phenology was no significant genotype effect found. Furthermore, a strong genotype x environment effect was highly consistent in all characters considered. Regarding resistance to disease, such as Verticillium wilt, the variability of results from both natural and artificial inoculations also tends to indicate a considerable environmental effect and the need for careful testing of disease evolution. All this information strongly suggests the necessity of comparative trials of olive cultivars for both adequate choice of cultivar and final selection in breeding programs