A comparative study of patients perfused with membrane oxygenators and those perfused with d-700e bubble oxygenators
José Ramón Llanes Echevarria, BS in Biological Sciences,
Assistant Investigator, Perfusionist; Omar Gonzalez, MD.,
Specialist in Internal Medicine, Perfusionist; Fausto
Rodriguez, MD., Specialist in Anesthesiology; Fidel
Manuel Caceres Loriga, MD., Specialist in Cardiology;
et al.
Source: Revista Cubana de Cardiología y Cirugía Cardiovascular 1999; 13(1):26-33.
ABSTRACT: Different models of membrane oxygenators (MO group) and of D-700E bubble
oxygenators (BO group) were comparatively studied in 24 patients with extracorporeal circulation valve surgery on the basis of several evolving variables such as: length of ishcemic heart arrest, consciousness recovery time,
intubation time, length of stay in surgical ICU, diuresis, postoperative bleeding, arrhythmias and postoperative complications, and surgery cost for each group. The
study revealed a significant increase (p>0.05) of length of hospital stay in the BO group (14 7 days) whereas this parameter was lower in the MO group (8 3 days).
Arrhythmias were observed in 69% of perfused patients with BO at the beginning of perfusion, but this figure dropped to 38% in patients treated with MO. Unit cost per BO patient was $1,124.48 and bed/day cost was
$1,145.24, whereas unit cost per MO patient was $642.56 and bed/day cost, $97.28. These results confirm economic and recovery advantages reported for the use of membrane oxygenators. 
Atrial flutter with 1: 1 atrioventricular conduction
Francisco D. Rodríguez Martorell, M.D., First Degree Specialist in Cardiology and Comprehensive General Medicine, Calixto García Clinical and Surgical Hospital, Havana.
Source: Rev. Cubana Cardiol Cir Cardiovasc 1997;11(2):74-8. ABSTRACT: Atrial flutter with 1:1 atrioventricular
conduction is a cardiac arrhythmia difficult to diagnose, fatal in many cases, and unmanageable with drug therapy. Seventeen patients presenting this disease were studied. 70.6 % presented palpitations, 64.7 % with
syncope and symptoms such as dizziness, sweating, and angina pectoris. The episode responded to treatment with antiarrhythmic agents intravenously or electrical cardioversion. Ten patients had associated
cardiovascular diseases such as arterial hypertension, ischemic heart disease, and aortic stenosis. During the follow-up, 5 patients were treated with the use of antiarrhythmic drugs. Eleven patients underwent
electrophysiological studies with diagnostic or therapeutic
Dual chamber pacing in obstructive hypertrophic cardiomyopathy. Preliminary report
Jesús Castro Hevia, MD, Second Degree Specialist in Cardiology; Yanela Fayad Ramirez, MD,
Cardiology Fellow; Francisco Dorticós Balea, MD, PhD, Head of the Cardiac Stimulation and Arrythmology Service; Roberto Zayas Molina, MD, Second Degree Specialist in Cardiology; et al. Cuban Institute of Cardiology, Havana.
Source: Revista Cubana de Cardiología y Cirugía Cardiovascular 1999; 13(1):13-18. ABSTRACT
: Dual chamber pacing in patients suffering from obstructive hypertrophic cardiomyopathy reduces subatrial pressure gradient and improves symptoms. We
conducted a two-year clinical trial of 8 patients (4 women and 4 men) aged 15-69 (mean age = 40) who showed subatrial gradients equal to or higher than 54 mmHg, measured by
electrocardiography. In our calculations we added 20 mmHg to the mitral valve failure peak gradient and subtracted the same amount from systolic pressure, measured by
sphygmomanometry. Despite treatment with maximum tolerable dosages of beta-blockers and anticalcic drugs, all patients showed III-IV grade functional capacity, as per the NYHA
classification. They were implanted with dual chamber pacers, with 100 mseg AV delay programming, modified depending on their echocardiographic and clinical evolution. The
average subatrial pressure gradient was 78 mmHg prior to implantation, and 31 mmHg 1.5 to 21 months later. Pressure gradients were reduced by 60% in these patients, who reached
I-II grade functional capacity. This method is an alternative treatment for patients who do not improve with drug therapy, before deciding to revert to surgical options. Nevertheless,
obstruction is just one part of the complex pathology
Endomyocardial biopsies in patients with dilated cardiomyopathy
and myocarditis
Rosa María Coro, MD. Doctor of Biological Sciences. Full professor. Assistant Investigator. Cuban Institute of Cardiology and Cardiovascular Surgery, Havana.
Source: Revista Cubana de Cardiol Cir Cardiovasc 1998;24(2):50-6. Cuban Insitute of Cardioloy and Cardiovascular Surgery. ABSTRACT
: The aim of this study was to determine the correlation between clinical signs and histological findings in patients with a presumed diagnosis of dilated cardiomyopathy or
suspected myocarditis, based on the correlation between the morphology and the contractile function of the myocardium. A scale of point values was used to evaluate qualitative
parameters and quantitative variables for clinical signs and histological findings. Clinical manifestations and evolution as well as electrocardiogram, telecardiogram and
echocardiogram findings were used to evaluate the patients' clinical status. In the evaluation of histological findings, morphometric techniques were used to classify degree of interstitial
fibrosis, hypertrophy of cardiomyocytes and cell damage. Spearman's rank correlation coefficient between clinical signs and histological findings was 0.97 (1%). This significant
strong correlation between morphology and function reveals the high prognostic value of endomyocardial biopsy in these patients.
Hypertension in cuba: evidence of a narrow black-white difference
PO Ordúñez-García, MD, Cienfuegos Medical School and Gustavo Aldereguía Hospital, Cienfuegos, Cuba; AD Espinosa-Brito, MD, Cienfuegos Medical School and Gustavo Aldereguía Hospital,
Cienfuegos, Cuba; RS Cooper, MD, Department of Preventive Medicine and Epidemiology, Loyola University Stritch School of Medicine, Maywood, IL, USA; JS Kaufman, MD, Department of Research
and Planning and Evaluation, Carolinas Medical Center, Charlote, NC, USA; and F Javier Nieto, MD, Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD, USA.
Source: Journal of Human Hypertension (1998) 12, 111-116, Stockton Press. ABSTRACT:
The Caribbean nation of Cuba is comprised of over 10 million persons who trace their ancestry primarily to Africa and Spain. To date, little data on blood pressure (BP)
or hypertension prevalence from Cuba have appeared in English language journals. Because the current government has pursued an active policy of reducing social differentiation on the
basis of ethnic origins, Cuba provides an important population laboratory from which to advance the understanding of black-white differences in BP and hypertension. The authors
conducted a population-based random sample among adults (aged >15 years) in the city of Cienfuegos. Overall response rate was 95%, yielding 1633 participants who provided BP
readings, self-reported racial group, demographic information and treatment status. Overall prevalence of hypertension (SBP 140 mm Hg or DBP 90 mm Hg or currently treated) was
44% (46% among blacks and 43% among whites; P = 0.19). Excess BP among black subjects was reduced slightly by excluding those under treatment, but attained statistical
significance after adjustment for sex and age (P = 0.01). The black-white difference was small, however, relative to that observed in the United States. Racial differences in treatment
status and control were also observed. Although there remains a difference in socioeconomic profile between those of African and of European origin in Cuba, this has decreased over
recent decades. In the United States, the greater magnitude of social differentiation parallels a greater relative risk of BP elevation among blacks, suggesting that social, economic and
psychological factors may play an important role in the observed racial gap in cardiovascular risk.
Is the much-maligned reserpine worth reconsideration?
David García Barreto, M.D., Second Degree Specialist in Cardiology, Principal Investigator, Assistant
Professor; Alberto Toruncha Chukram, M.D., Consultant Professor, Principal Investigator.
Source: Revista Cubana de Cardiología y Cirugía Cardiovascular
1998; 24(2):66-72. ABSTRACT: A review of recent clinical assays in which reserpine at doses of 0.25 mg/day
or lower were used was carried out to determine whether these doses may be efficient and well tolerated by patients. Causes for a decrease in prescription of this medication, despite
having been considerably effective in the reduction of complications resulting from arterial hypertension, were also analyzed. A cost analysis showed that reserpine is more economical
than other antihypertensive drugs. It is concluded that the efficiency, good tolerance, duration, and low cost of reserpine at doses under 0.25 mg may lead to reconsidering
reserpine as a first-choice drug in the treatment of primary arterial hypertension. This drug may be administered alone or in combination with low doses of thiazide diuretics.
Myocardial revascularization in acute myocardial infarction
Karel Morlans Hernández, M.D., First Degree Specialist in General Comprehensive Medicine.
Source:
Rev. Cubana Cardiol Cir Cardiovas 1997; 11(1): 5-11) ABSTRACT:
A total of 212 cases of myocardial revascularization were retrospectively studied from January 1, 1990 through December 31, 1994. The prevalence of myocardial
infarction in the perioperative period was 16.9 %, and 5.9 % in the transoperative period. Chi-square Test was performed to determine relative risk factors and complications
associated with perioperative myocardial infarction. Risk factors assessed were those commonly described in the reviewed medical literature. Transoperative myocardial infarction
was related to recent myocardial infarction and extracorporeal circulation time > 105 min. Risk factors and complications associated with perioperative infarction were: diastolic
diameter of the left ventricle > 55 mm; stenosis of circumflex artery; 3-vessel disease; aortic clamping time > 60 min; duration of extracorporeal circulation > 105 min; implantation of
three or more coronary grafts; myocardial ischemia; intake of positive inotropic drugs in the transoperative period; and obstruction of the coronary bypasses.
Myoglobin/ck mb: a rapid diagnostic method for acute myocardial infarction
José Ramón Llanes Echevarria, BS in Biological Sciences. Assistant Investigator, Perfusionist; Omar Gonzalez, MD., Specialist in Internal Medicine, Perfusionist; Fausto Rodríguez, MD, Specialist in
Anesthesiology; Fidel Manuel Cáceres Loriga, MD., Specialist in Cardiology; et al.
Source: Revista Cubana de Cardiología y Cirugía Cardiovascular
1999; 13(1):26-33. ABSTRACT: 57 patients with suspected acute myocardial infarction and non-conclusive EKG findings, who went to the Emergency Service of the Cuban Institute of Cardiology and
Cardiovascular Surgery, were studied. Qualitative determination of Myoglobin and CK MB and quantitative determination of creatine phosphokinase were carried out. ST segment
elevation under 2 mm in precordial lead and under 1 mm in limb lead, as well as a total left bundle branch block were the most frequent disorders that hindered the electrical diagnosis.
The evolving infarction diagnosis was confirmed in 30 patients. Sensitivities of myoglobin and CK MB were 60% and 70% respectively, specificity 59 and 57% respectively, positive
prognostic value 70 and 78% respectively. The results of qualitative and quantitative enzymes were obtained in 47 minutes and 115 minutes respectively. Time interval from the
onset of symptoms to the obtention of results using the qualitative enzyme kit was 240 minutes and that of the total creatine phosphokinase was 378 minutes.
Orthodromic and intra-nodal tachycardia. Diagnostic failures and ablation
Margarita Dorantes Sánchez, MD., Second Degree Specialist in Cardiology, Principal Investigator;
Jesús Castro Hevia, MD., Second Degree Specialist in Cardiology; Francisco Dorticós Balea, MD., Doctor of Sciences, Principal Investigator, Head of the Cardiac Electrical Stimulation; et al.
Source: Revista Cubana de Cardiología y Cirugía Cardiovascular 1999; 13(1):46-53. ABSTRACT
: Due to their frequency, orientation of electro-physiological studies and anti-arrhythmia or ablation therapies to be used, a differential diagnosis between orthodromic
and intra-nodal tachycardias should be made. Electrophysiological signs revealed through EKG offer some guiding criteria, but some cases do not follow the norm. The objective of
this study was to find out the frequency and variations of each one of these two forms of tachycardia. Forty patients aged 14-78 were followed for 14 months. These patients were
initially diagnosed with tachycardia, as the presumed diagnosis, which was later corroborated by electrical stimulation. Different forms of ablation were also found: intra-nodal tachycardia
(29); orthodromic tachycardia (10) and both (1). There was clinical and electrophysiological coincidence in 30 cases (75 %); there was a diagnostic error or doubt in 10 patients in whom
orthodromic tachycardia was diagnosed in 3 of them and intra-nodal in 6. One (1) patient was diagnosed with both types of tachycardia. Intra-nodal tachycardia variations are: P
overlapped QRS as terminal force; RP under 60 ms, RP higher than or equal to 60 ms; RP longer than PR before QRS. Orthodromic tachycardia had: RP higher than or equal to 60
ms, RP under 60 ms and RP longer than PR. It is concluded that electrocardiogram may be useful for making a diagnosis but there are variations that may lead to mistaken diagnosis,
which can be corrected by an electrophysiological study.
Pre-hospitalization treatment of acute myocardial infarction
Raúl M. Valdesuso Agular, MD, Second Degree Specialist in Cardiology, Cuban Institute of
Cardiology and Cardiovascular Surgery; Caridad Hidalgo Barrios, MD, First Degree Specialist in Comprehensive General Medicine, Manuel Ascunce Domenech Teaching Hospital, Camagüey; Rafael
León Díaz, MD, First Degree Specialist in Cardiology, . Manuel Ascunce Domenech Teaching Hospital, Camagüey; Alejandro Pérez, MD, First Degree Specialist in Cardiology, Manuel Ascunce Domenech
Teaching Hospital, Camagüey.
Source: Rev Cubana Cardiol Cir Cardiovas
1997;11(1):20-28. ABSTRACT: A group of undemanding actions can be implemented to reduce mortality from acute myocardial infarction. The purpose of this article is to provide health
professionals with data from our review of the literature to increase their awareness of the existence of such actions. We also offer suggestions for their implementation.
Use of aspirin in prophylaxis of type III hypertension
Maricela Rodríguez Santana, MD. First Degree Specialist in Obstetrics and Gynecology; Lázaro García León, Second Degree Specialist in Obstetrics and Gynecology. Assistant professor. Head of
OB-GYN Service. Maternity Teaching Hospital of Matanzas, Cuba.
Source: Rev Cubana Obstet Ginecol 1997;(2-3):115-119
ABSTRACT: A study was conducted between January 1994 and January 1995 of 104 pregnant women diagnosed with chronic hypertension at the out-patient service of the
Maternity Teaching Hospital of Matanzas. 54 of them were treated with low doses of aspirin. This study showed that the group thus treated did not develop Type III hypertension
and no complications arose in them or in their newborns.
Weight loss, fever and heart murmur in a 58-year-old woman. Presentation of a case.
Saúl Armenteros Terán, MD. First Degree Specialist in Internal Medicine. Assistant Professor.
Joaquín Albarrán Clinical and Surgical Hospital, Havana.
Source: Rev Cub Cardiol Cir Cardiovasc 1997;11(2):101-105 ABSTRACT:
The diagnosis of cardiac tumors becomes particularly difficult when patients present noncardiac manifestations. Our work reports on the case of a 58-year-old woman
who was admitted to our hospital with progressive weight loss, fever and a very low intensity (II/IV) heart murmur. She was given a bi-dimensional transthoracic echocardiography,
which showed a tumoral mass adhering to the wall of the left auricle (auricular mixoma) and a diastolic prolapse of the left ventricle. The clinical, immunological and imaging features of cardiac tumors are reviewed.
