Abstract Self-efficacy is the confidence in one’s own abilities to avoid smoking in situations that can trigger desire. It is considered an important predictor of relapses. In Argentina there is no valid instrument to evaluate it. The objective of this article was to adapt and validate a Spanish version (in local Argentinean language) of the Self-Efficacy/Temptation Scale. The transcultural adaptation of the scale was carried out: translation, review by a committee of experts, reverse translation, new review and test of the questionnaire. Reliability (reproduc ibility, stability and internal consistency) and validity were then evaluated. We performed a factor analysis of main components with Varimax rotation with data from a sample of 200 smokers. A culturally and linguistically adapted version of the instrument was obtained, with inter-observer reliability of Intraclass Correlation Coefficient (ICC) = 0.90 and stability of ICC = 0.77. The internal consistency analysis yielded a global Crombach α = 0.93 and 0.85 for versions of 20 and 9 items, respectively. In the domain of Positive Affections α = 0.82 and α = 0.89; Negative Affections α = 0.89 and α = 0.90 and for Craving α = 0.84 and α = 0.75, also respectively for the two versions. In the exploratory factor analysis, three factors were identified that explained 95% of the variance of the questionnaire in its extensive version and 69% in its short version. A reliable and valid Argentinean version of the Self-Efficacy/Temptation Scale was obtained, to be applied to smokers.

Resumen La autoeficacia es la confianza en las propias habilidades para evitar fumar en situaciones que puedan desencadenar el deseo. Se la considera un importante predictor de recaídas. En Argentina no existe un instrumento válido que permita evaluarla. El objetivo del presente trabajo fue adaptar y validar una versión en español (Argentina) de la Escala de Autoeficacia/Tentaciones. Se llevó a cabo la adaptación transcul tural de la escala: traducción, revisión por un comité de expertos, traducción inversa, nueva revisión y prueba del cuestionario. Luego se evaluaron la confiabilidad (reproducibilidad, estabilidad y consistencia interna) y la validez. Se realizó un análisis factorial de componentes principales con rotación Varimax con datos de una muestra de 200 pacientes fumadores. Se obtuvo una versión cultural y lingüísticamente adaptada del instrumento, con una confiabilidad interobservador evaluada con el Coeficiente de Correlación Intraclase (ICC) = 0.90 y estabilidad de ICC = 0.77. En el análisis de la consistencia interna se obtuvo un α de Crombach global de 0.93 y de 0.85 para las versiones de 20 y 9 ítems, respectivamente. En el dominio de afectos positivos α = 0.82 y α = 0.89; afectos negativos α = 0.89 y α = 0.90 y para deseo intenso de fumar (craving) α = 0.84 y α = 0.75, también respectivamente para las dos versiones. En el análisis factorial exploratorio se identificaron tres factores que explicaron el 95% de la varianza del cuestionario en su versión extensa y 69% en su versión corta. Se obtuvo una versión argentina de la Escala de Autoeficacia/Tentaciones confiable y válida para ser aplicada a fumadores.

ABSTRACT INTRODUCTION The use of tobacco, alcohol and other drugs usually starts during the adolescence. In Argentina, it happens at an increasingly younger age. The purpose of the study was to explore social and personal factors that can predict the start of consumption among adolescents in this country. METHODS In 2014, an anonymous self-administered survey was conducted among first-year secondary school students in 33 public and private schools in Buenos Aires, Córdoba and Tucumán, that was repeated in the same students the following year. The survey included sociodemographic and personal aspects and also inquired about smoking among friends and family, as well as personal use of tobacco, alcohol, marijuana, cocaine or paco. Multilevel logistic regression with random intercept for schools was applied to determine the association between the independent variables and the start of consumption of each substance at follow-up. RESULTS In 2014,3172 students completed the baseline survey and 2018 of them (64%) also completed the follow-up. In 2015, 16.4% of the students were current smokers, 49.8% were current drinkers and 10.8% were using illicit drugs. Being a woman and having a high sensation seeking index predicted both tobacco and alcohol use. Being a smoker, a drinker, having friends who use illicit drugs and older age predicted consumption of illicit drugs. CONCLUSIONS It is important to identify students with a high sensation seeking index, as it is the common risk factor for the use of all these substances.

RESUMEN INTRODUCCIÓN El consumo de tabaco, alcohol y otras drogas comienza generalmente en la adolescencia. En Argentina, sucede a edades cada vez más tempranas. El objetivo de este estudio fue explorar factores sociales y personales predictores del inicio del consumo en adolescentes del país. MÉTODOS En 2014 se realizó una encuesta anónima autoadministrada en estudiantes de primer año del secundario en 33 escuelas públicas y privadas de Buenos Aires, Córdoba y Tucumán, que se repitió en los mismos alumnos en 2015. Incluyó aspectos sociodemográficos, personales, consumo de tabaco en familiares y amigos, y consumo personal de tabaco, alcohol, marihuana y paco o cocaína. Mediante regresión logística multinivel con intercepto aleatorio según escuela, se determinó la asociación entre las variables independientes y el inicio del consumo de cada sustancia durante el seguimiento. RESULTADOS En 2014 respondieron 3172 alumnos, de los cuales 2018 (64%) completaron la segunda encuesta. En 2015 hubo 16,4% de incidencia de consumo de tabaco, 49,8% de consumo de alcohol y 10,8% de drogas ilícitas. Ser mujer y tener un índice de búsqueda de sensaciones alto fueron predictores del consumo de tabaco y alcohol, y haber fumado, bebido, tener amigos que consumen y mayor edad fueron predictores del consumo de drogas ilícitas. CONCLUSIONES Es importante identificar a los alumnos con un índice de búsqueda de sensaciones alto, que es el factor de riesgo común al inicio del consumo de todas las sustancias.

Abstract Objective To assess the validity of a standard measure of smoking susceptibility for predicting cigarette and e-cigarette use in a sample of early adolescents in Argentina and Mexico. Materials and methods A school-based longitudinal survey was conducted in 2014-16 among secondary students. We analyzed students who were never smokers of regular cigarettes or e-cigarettes at baseline and who completed both surveys. The main independent variable was smoking susceptibility. Multilevel logistic regression models were used, adjusting for sociodemographic and personal variables, social network use of cigarettes and exposure to advertising. Results In the adjusted analysis, smoking susceptibility independently predicted cigarette initiation (Argentina: AOR 2.28; 95%CI 1.66-3.14; Mexico: AOR 2.07; 95%CI 1.74-2.45) and current smoking (Argentina: AOR 3.61; 95%CI 2.48-5.24; Mexico: AOR 1.69; 95%CI 1.29-2.22); however, it only predicted e-cigarette initiation in Mexico (Mexico: AOR 1.29; 95%CI 1.02-1.63). Conclusion Smoking susceptibility was a valid measure to predict future cigarette smoking in this sample.

Resumen Objetivo Evaluar la validez de una medida estándar de susceptibilidad para predecir el consumo de cigarros convencionales y electrónicos en una muestra de adolescentes de Argentina y México. Material y métodos Entre 2014 y 2016 se realizó una encuesta longitudinal en alumnos de secundarias. Se analizaron los alumnos no fumadores y que no habían probado cigarrillos electrónicos en la encuesta basal y que completaron ambas encuestas. La variable independiente principal era la susceptibilidad al consumo de cigarros. Se efectuó una regresión logística multinivel, ajustando por variables sociodemográficas y personales, consumo en el círculo social íntimo y exposición a la publicidad. Resultados En el análisis ajustado, la susceptibilidad al consumo predijo de manera independiente el inicio del consumo de cigarros convencionales (Argentina: RMA2.28; IC95%1.66-3.14; México: RMA2.07; IC95%1.74-2.45) y su consumo actual (Argentina: RMA3.61; IC95%2.48-5.24; México: RMA1.69; IC95%1.29-2.22). Sin embargo, sólo predijo el inicio del consumo de cigarros electrónicos en México (México: ORA 1.29; IC95%1.02-1.63). Conclusión Esta medida es válida para predecir el futuro consumo de cigarros en esta muestra.

Abstract Objective To assess the validity of a standard measure of smoking susceptibility for predicting cigarette and e-cigarette use in a sample of early adolescents in Argentina and Mexico. Materials and methods A school-based longitudinal survey was conducted in 2014-16 among secondary students. We analyzed students who were never smokers of regular cigarettes or e-cigarettes at baseline and who completed both surveys. The main independent variable was smoking susceptibility. Multilevel logistic regression models were used, adjusting for sociodemographic and personal variables, social network use of cigarettes and exposure to advertising. Results In the adjusted analysis, smoking susceptibility independently predicted cigarette initiation (Argentina: AOR 2.28; 95%CI 1.66-3.14; Mexico: AOR 2.07; 95%CI 1.74-2.45) and current smoking (Argentina: AOR 3.61; 95%CI 2.48-5.24; Mexico: AOR 1.69; 95%CI 1.29-2.22); however, it only predicted e-cigarette initiation in Mexico (Mexico: AOR 1.29; 95%CI 1.02-1.63). Conclusion Smoking susceptibility was a valid measure to predict future cigarette smoking in this sample.

Resumen Objetivo Evaluar la validez de una medida estándar de susceptibilidad para predecir el consumo de cigarros convencionales y electrónicos en una muestra de adolescentes de Argentina y México. Material y métodos Entre 2014 y 2016 se realizó una encuesta longitudinal en alumnos de secundarias. Se analizaron los alumnos no fumadores y que no habían probado cigarrillos electrónicos en la encuesta basal y que completaron ambas encuestas. La variable independiente principal era la susceptibilidad al consumo de cigarros. Se efectuó una regresión logística multinivel, ajustando por variables sociodemográficas y personales, consumo en el círculo social íntimo y exposición a la publicidad. Resultados En el análisis ajustado, la susceptibilidad al consumo predijo de manera independiente el inicio del consumo de cigarros convencionales (Argentina: RMA2.28; IC95%1.66-3.14; México: RMA2.07; IC95%1.74-2.45) y su consumo actual (Argentina: RMA3.61; IC95%2.48-5.24; México: RMA1.69; IC95%1.29-2.22). Sin embargo, sólo predijo el inicio del consumo de cigarros electrónicos en México (México: ORA 1.29; IC95%1.02-1.63). Conclusión Esta medida es válida para predecir el futuro consumo de cigarros en esta muestra.

El consumo de tabaco, alcohol y otras drogas comienza a temprana edad. Es importante identificar los factores de riesgo asociados al inicio. En 2014, se encuestaron estudiantes de primer año del secundario en Buenos Aires, Córdoba y Tucumán. Respondieron 3172 alumnos (42% de mujeres); edad media de 12,8 años. El 10% había fumado; el 32% había consumido alcohol; el 17% había tenido consumo excesivo durante el último mes, y 8% había consumido, al menos, una droga ilícita en su vida. El índice de búsqueda de emociones alto se asoció al consumo de tabaco (OR 4,25; IC 95%: 2,2-8,1), alcohol (OR 5,56; IC 95%: 3,73-8,31) y marihuana / paco / cocaína (OR 11,73; IC 95%: 5,81-23,69). Tener amigos que consumían tabaco / alcohol se asoció al consumo de tabaco (OR 12,6; IC 95%: 7,8-20,5) y alcohol (OR 5,17; IC 95%: 4,15-6,40). Tener padres que imponían pocas restricciones en el uso de medios se asoció al consumo de tabaco (OR 3,7; IC 95%: 2,1-6,5) y percibir un bajo control y soporte parental (OR 3,02; IC 95%: 1,40-6,52) se asoció al consumo de marihuana/paco/cocaína.

Abstract: Objective: To examine and compare overall prevalence and time trends in tobacco and alcohol portrayals and brand appearances in youth-rated US and nationally-produced films that were the most successful in Argentina and Mexico from 2004-2012. Materials and methods: Top-grossing nationally produced films from Argentina (n=73), Mexico (n=85) and the US (n=643) were content analyzed. Logistic regression was used to determine differences between Mexican, Argentine and US produced films. Linear regression models assessed significant cross-country differences in the mean number of tobacco and alcohol seconds. Results: Films from Mexico and Argentina were more likely than US films to contain tobacco, (OR=4.2; p<0.001) and (OR=7.2; p<0.001). Alcohol was present in 93% of Argentine, 83% in Mexican and 83% US films. Conclusions: Smoking and alcohol were highly prevalent in nationally produced films. They may have a significant impact and should be targeted by policies to reduce youth exposure to portrayals of risk behaviors.

Resumen: Objetivo: Este estudio evalúa la representación en el tiempo de contenidos de tabaco y alcohol en las películas para adolescentes más populares en Argentina y México de 2004 a 2012. Material y métodos: Se analizaron las películas localmente más taquilleras producidas en Argentina (n=73), México (n=85) y EE.UU. (n=643). Se realizaron modelos de regresión logística para determinar diferencias entre películas mexicanas, argentinas y norteamericanas en variables dicotómicas, y de regresión lineal para evaluar las diferencias significativas entre países para variables continuas. Resultados: Las películas mexicanas y argentinas muestran mayor contenido de tabaco en comparación con las norteamericanas (OR=4.2; p<0.000) y (OR=7.2; p<0.000, respectivamente). El alcohol estuvo presente en 93% de películas argentinas, y en 83% tanto de las mexicanas como de las norteamericanas. Conclusión: Los resultados observados muestran tendencias que pueden tener un impacto significativo en la exposición de conductas de riesgo en jóvenes, y por ello son relevantes en la política pública.

Abstract: Objective: To examine and compare overall prevalence and time trends in tobacco and alcohol portrayals and brand appearances in youth-rated US and nationally-produced films that were the most successful in Argentina and Mexico from 2004-2012. Materials and methods: Top-grossing nationally produced films from Argentina (n=73), Mexico (n=85) and the US (n=643) were content analyzed. Logistic regression was used to determine differences between Mexican, Argentine and US produced films. Linear regression models assessed significant cross-country differences in the mean number of tobacco and alcohol seconds. Results: Films from Mexico and Argentina were more likely than US films to contain tobacco, (OR=4.2; p<0.001) and (OR=7.2; p<0.001). Alcohol was present in 93% of Argentine, 83% in Mexican and 83% US films. Conclusions: Smoking and alcohol were highly prevalent in nationally produced films. They may have a significant impact and should be targeted by policies to reduce youth exposure to portrayals of risk behaviors.

Resumen: Objetivo: Este estudio evalúa la representación en el tiempo de contenidos de tabaco y alcohol en las películas para adolescentes más populares en Argentina y México de 2004 a 2012. Material y métodos: Se analizaron las películas localmente más taquilleras producidas en Argentina (n=73), México (n=85) y EE.UU. (n=643). Se realizaron modelos de regresión logística para determinar diferencias entre películas mexicanas, argentinas y norteamericanas en variables dicotómicas, y de regresión lineal para evaluar las diferencias significativas entre países para variables continuas. Resultados: Las películas mexicanas y argentinas muestran mayor contenido de tabaco en comparación con las norteamericanas (OR=4.2; p<0.000) y (OR=7.2; p<0.000, respectivamente). El alcohol estuvo presente en 93% de películas argentinas, y en 83% tanto de las mexicanas como de las norteamericanas. Conclusión: Los resultados observados muestran tendencias que pueden tener un impacto significativo en la exposición de conductas de riesgo en jóvenes, y por ello son relevantes en la política pública.

Background: Mitral balloon valvuloplasty (MBV) is the therapy of choice for the treatment of symptomatic mitral stenosis with suitable anatomy. Although its short and mid-term results are favorable, there is a paucity of information about long-term follow-up. Aim: To assess the late results of MBV. Material and Methods: A cohort of 225 patients aged 8 to 20 years who were subjected to a MBV from 1989 to 2001, was studied. All variables at the time of the procedure, short and long-term results and major events during follow-up (new mitral intervention and mortality) were recorded. Uni and multivariate analysis were used to assess prognosis. Results: The mean follow-up lapse was 13.5 years (range 8 to 20 years). During this period, 88 patients (39.1%) remained event-free and in acceptable functional capacity. Eight percent died, 8% required a second MBV and 43.5% required a surgical mitral valve replacement. A post-procedural area equal or greater to 1.9 cm² was associated with a greater likelihood of free-event survival (log rank test: p = 0.02/Cox proportional regression model: coefficient 0.54, p = 0.04). Conclusions: MBV is effective, although there is a high chance of new interventions in the long-term follow-up. A larger post-procedure mitral area is associated with a better prognosis.

O objetivo deste estudo foi verificar se existem diferenças nos índices das dimensões de SB, Perfil 1 e 2 entre professores de ensino especial e regular. A amostra constituiu-se de 160 professores, 80 de ensino especial e 80 de ensino regular. Os instrumentos utilizados foram um questionário elaborado para levantamento de dados demográficos e laborais e o Cuestionario para la Evaluacióndel Síndrome de Quemarse por elTrabajo - CESQT. Os resultados encontrados, por meio do teste t de student, evidenciaram que professores de ensino especial possuem média mais elevada na dimensão de Ilusão pelo Trabalho e professores de ensino regular, maiores índices médios de Perfil 1 e Perfil 2 de Burnout. Resultados apontam a necessidade de intervenções diferenciadas que considerem as peculiaridades funcionais dos grupos investigados.

In this study we propose to determine whether there is a difference in the rates of the dimensions of BS and Profile 1 and Profile 2 among special education and regular teachers. The sample consisted of 160 teachers, 80 in special education and 80 in regular education. We used a questionnaire to survey demographic and professional data and the Cuestionariopara La Evaluación del Síndrome de Quemarsepor el Trabajo - CESQT to evaluate Burnout Syndrome, as instruments. The results obtained by means of the Student's t test show that special education teachers have higher averages in the dimension of Enthusiasm toward the job, and regular education teachers have higher average rates of Profile 1 and Profile 2 of Burnout Syndrome. Results point to the need for different interventions that consider the peculiarities of the investigated groups.

El objetivo de este estudio fue verificar si existen diferencias en índices de dimensiones de SB, Perfil 1 e 2 entre profesores de educación especial y regular. La muestra fue compuesta por 160 profesores, 80 de educación especial y 80 de educación regular. Los instrumentos utilizados fueron un cuestionario elaborado para levantar datos demográficos y laborales y el Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo - CESQT. Los resultados encontrados por medio del test t de student mostraron que profesores de educación especial tienen promedio más elevado en la dimensión de Ilusión por el Trabajo, en cuanto que los profesores de educación regular, mayores índices promedio de Perfil 1 y Perfil 2 de Burnout. Los resultados señalan para la necesidad de intervenciones diferenciadas que considere las peculiaridades funcionales de los grupos investigados.

Background: Rates ofmorbidity and mortality in Infective Endocarditis (IE) remain high and prognosis in this disease is still difficult and uncertain. Aim: To study IE in Chile in its active phase during inpatient hospital stay and long term survival rates. Material and Methods: Observational prospective national cohort study of 506 consecutive patients included between June 1,1998 and July 31, 2008, from 37 Chilean hospitals (secondary and tertiary centers) nationwide. Results: The main findings were the presence of Rheumatic valve disease in 22.1 % of patients, a history of intravenous drug abuse (IVDA) only in 0.7%, the presence of Staphylo-coccus aureus in 29.2% of blood cultures, negative blood cultures in 33.2%, heart failure in 51.7% and native valve involvement in 86% ofpatients. Echocardiographic diagnosis was achieved in 94% of patients. Hospital mortality was 26.1% and its prognostics factors were persisting infection (Odds ratio (OR) 6.43, Confidence Interval (CI) 1.45-28.33%), failure of medical treatment and no surgical intervention (OR 48.8; CI 6.67-349.9). Five and 10 years survival rates were 75.6 and 48.6%, respectively. The significant prognostic factors for long term mortality, determined by multivariate analysis were the presence of diabetes, Staphylococcus aureus infection, sepsis, heart failure, renal failure and lack of surgical treatment during the IE episode. Conclusions: The microbiologic diagnosis of IE must be urgently improved in Chile. Mortality rates are still high (26.1%) partly because of a high incidence of negative blood cultures and the need for more surgical valve interventions during in-hospital period. Long term prognostic factors for mortality should be identified early to improve outcome.

Background: Cerebrovascular accident (CVA) is the second most frequent cause of death in Chilean adults, accounting for 20^10% of cases. In patients with no clinical or trans thoracic echocardiographic (TTE) evidence of heart disease, transesophageal echo (TEE) may reveal the presence of complicated aortic plaques (CAP) as an etiologic factor for CVA. Aim: to evaluate clinical predictors of CAP that may help select patients for TEE in search for a cause of CVA. Method: 398 patients with ischemic CVA admitted to a general hospital from Jan 2008 through Dec 2010 were screened. 112 were excluded due to the presence of arrhythmia or an abnormal TTE. The remaining 286 patients underwent TEE in search of CAP. Clinical and echocardiographic findings were compared between patients with or without CAP Chi square, Fisher's exact test, Mann Whitney U test and binary logistic regression were used for analysis. Results: Aortic plaques were detected in 57% of patients, CAP being present in 11.2%. Multivariate analysis identified age above 60 years old (OR 6.23, p<0.001) and smoking habit (OR 4.89, p<0.001) as independent predictors of CAP. Conclusion: These findings suggest that TEE should be more strongly considered in the study of patients with CVA who are above 60 years old or smoke.

Introducción: El ACV es la segunda causa específica de muerte en nuestro país, siendo el origen cardioembólico responsable del 20% al 40% de los casos. En pacientes sin patología cardiovascular evidente, clínica o por ecocardiografía transtorácica (ETT), la identificación de la fuente embólica requiere la realización de ecocardiografía transesofágica (ETE), que puede confirmar la presencia de una placa aórtica complicada (PAC) como agente causal de este fenómeno. Objetivo: Evaluar cuales son los predictores clínicos para la presencia de PAC que permitan definir y estratificar aquellos pacientes que más se beneficien de la búsqueda cardioembólica mediante el ETE. Métodos: Se analizaron todos los pacientes con diagnóstico de ACV isquémico ingresados a nuestro hospital entre enero del 2008 a diciembre del 2010, co-!respondientes a 398 pacientes. Se excluyeron 112 por presentar historia de arritmias o tener ETT anormal. A los 286 pacientes restantes se les realizó un ETE, para analizar la presencia o no de PAC. Se compararon características clínicas y ecográficas entre aquellos con y sin PAC. Se utilizó chi-cuadrado, test exacto de Fisher, test U Mann Whitney y regresión logística binaria. Resultados: En los 286 pacientes el ETE detectó placas aórticas en 163 (57%) pacientes; de éstos, 32 (11.19 %) presentaban PAC. Por análisis multivariado se identificaron como predictores independientes de la presencia de PAC a la edad > 60 años (OR 6.232, p 0.001) y al tabaquismo (OR 4.893, p <0.001). Conclusiones: A la luz de estos resultados, se podría sugerir que en casos de AVE/TIA de pacientes en ritmo sinusal y sin cardiopatía evidente por ETT, se debería realizar ETE al menos en fumadores y en pacientes > de 60 años.

Background: Dissections that involve the ascending aorta are classified as type A, regardless of the site of the primary intimal tear, and all other dissections as type B. Type B dissections can have fatal ischemic and hemorrhagic complications. In the chronic state, dilatation and rupture can be mortal. Endovascular surgery is a therapeutic alternative, considering the high rate of complications of conventional surgery Aim: To report the results of endovascular treatment of type B aortic dissection. Material and methods: Report of 36 treated patients (30 males) aged 43 to 87 years, with a type B aortic dissection. Seventy eight percent were hypertensive and 39% smoked. The diagnosis was conñrmed by CAT sean. Acute patients were treated for complications and chronic patients, for dilatation. In the operating room, an endoprothesis was placed through the femoral artery, to cover the tear. The tear was located and the lumens were differentiated using angiography and transesophageal echocardiography. Results: All procedures were successful. In 16 acute dissections the indications were malperfusion syndrome or unmanageable hypertension in seven patients and imminent rupture or persistent pain in nine. Twenty chronic patients were operated due to dilatation (mean 6 cm). One patient died due to cardiac failure. One patient had a transient paraparesia and two had pulmonary embolism. No patient died in a follow up períod ranging from 2.5 to 74 months. Four patients required a new aortic endovascular procedure due to progressive dilatation or endoleak. Conclusión: Endovascular treatment of type B aortic dissection has good immediate andlong term results.

Background: Surgery of the aortic arch is a very complex procedure since it requires protective strategies for the brain, heart and rest of the body. Aim: To communicate our experience in the first 23 total or partial replacements of aortic arch. Material and methods: Retrospective search in the database of the Cardiovascular Surgery Unit for patients subjected to partial or total replacement of the aortic arch since 1998. Results: Between 1988 and 2002, 23 patients were operated. Seventeen had aortic dissection (10 acute and 7 chronic), five had an atherosclerotic aneurysm and one had a traumatic lesion. Thirteen patients were subjected to a replacement of the arch plus ascending aorta, six to a replacement of the arch plus descending aorta and four to a replacement of the arch, ascending and descending aorta. Seven patients had previous operation of the thoracic aorta. Arterial perfusion was done via the femoral artery, axillary artery or a combination of both. A hypothermic circulatory arrest was induced in 22; it was associated with cerebral retro perfusion alone in 8 patients, antegrade cerebral perfusion in 5; isolated or associated axillary perfusion was used in five patients. In seven, procedures on the aortic or mitral valve, or coronary artery operations were added. Operative mortality was 26%, 3 of the 8 patients operated as an emergency and 3 of 15 elective operations. There was no mortality among those without dissection and of 7 chronic dissections, one died. All patients were followed for an average of 45 months. Two patients required reinterventions on the aorta and one for colon cancer. There was one late death of unknown cause. Postoperative complications were agitation, bleeding and temporary vocal cord dysfunction. Conclusions: There is a learning curve, where more extensive operations, particularly those done as emergency or for dissections, had an increased operative risk

Background: Primary pulmonary hipertension (PPH) is a progressive disease leading to right heart failure and death. Right heart catherization and maximal or submaximal tests are employed to assess the course of the disease. A neurohormonal parameter such as pro-brain natriuretic peptide (BNP) would be helpful in the assessment of these patients. Aim: To study the correlation of BNP with functional status and non-invasive hemodynamic determinations in patients with PPH. Material and methods: Twelve patients (mean age: 48 years; 58% female) were evaluated with 6 minutes walk distance test (6-min WT), plasma BNP, systolic pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR) and cardiac output (CO) determined by echocardiogram. Plasma BNP levels were compared with normal subjects. Results: BNP levels were increased in PPH patients (1270±547 vs 48±8 pg/ml, p-value <0.01). Mean PAPs was 82±27 mmHg and the mean distance walked in 6 minutes was 407±113 meters. BNP levels were positively correlated with PVR (r=0.58, p-value=0.006) and negatively correlated with 6-min WT (r=-0.83, p-value <0.001). No correlation was found between BNP levels, PAPs and CO. Conclusions: In PPH patients, BNP levels are increased and correlate with functional class and PVR. Follow-up studies are needed to evaluate the role of BNP as a marker of progression and therapeutic response in PPH patients

Mitral valve repair is considered better than mitral valve replacement for degenerative mitral regurgitation. Aim: To evaluate late clinical results of mitral valve repair as compared to mitral valve replacement in patients with degenerative mitral regurgitation. Patients and methods: All patients subjected to open heart surgery for degenerative mitral regurgitation between 1990 and 2002 were assessed for surgical mortality, late cardiac and overall mortality, reoperation, readmission to hospital, functional capacity and anticoagulant therapy. Eighty eight patients (48 males) had mitral valve repair and 28 (19 males) had mitral valve replacement (23 with a mechanical prosthesis). Mean age was 59.9 ± 14.8 (SD) and 61.3 ± 14.6 years, respectively. Sixty three percent of patients with repair and 50% of those with valve replacement were in functional class III or IV before surgery. Results: Operative mortality was 2.3% for mitral valve repair and 3.6% for mitral valve replacement (NS). Also, there was no statistical difference in the need of reoperation during the follow-up period between both procedures (2.3% and 0%, respectively). Ninety four percent of the replacement patients but only 26% of the repair patients were in anticoagulant therapy at the end of the follow-up period (p <0.001). Ten years survival rates were 82 ± 6% for mitral valve repair and 54 ± 11% for replacement. The corresponding cardiac related survival rates were 89 ± 6% and 79 ± 10%. At the end of follow-up, all surviving patients were in functional class I or II. Ten years freedom from cardiac event rates (death, cardiac related rehospitalization and reoperation) were 90 ± 3% for mitral valve repair and 84 ± 6% for replacement. Conclusion: Repair of the mitral valve offers a better overall survival and a better chance of freedom from cardiac events as well as need for anticoagulation 10 years after surgery (Rev Méd Chile 2005; 133: 1139-46)