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This article summarizes the life of Ignacio Chavez Rivera, one of the six most valuable directors that the National Institute of Cardiology has had “Ignacio Chavez Sanchez,” founder of the same and father of the aforementioned. His time in life left a clear example to emulate both in the scientific, academic and teaching as well as in the human, family, social and friendly, which make him in the most outstanding student of Master Chavez. His time in life at the National Academy of Medicine, the National Autonomous University of Mexico, the Interamerican Society of Cardiology, the Mexican Society of Cardiology and the Institute itself, has left an indelible mark on these Institutions. The National Institute of Cardiology bows reverently to the figure of Ignacio Chavez Rivera.

La sociedad contemporánea vive en un cambio permanente y un avance vertiginoso en la generación del conocimiento. Los avances en la informática, en computación y en las tecnológicas de la información y comunicación (TIC) han potenciado su desarrollo.

Coumarins are widely prescribed worldwide, and in Mexico acenocumarol is the preferred form. It is well known that despite its efficacy, coumarins show a high variability for dose requirements. We investigated the pharmacogenetic variation of 110 genes in patients receiving acenocumarol using a targeted NGS approach. We report relevant population differentiation for variants on CYP2C8, CYP2C19, CYP4F11, CYP4F2, PROS, and GGCX, VKORC1, CYP2C18, NQO1. A higher proportion of novel-to-known variants for 10 genes was identified on 41 core pharmacogenomics genes related to the PK (29), PD (3), of coumarins, and coagulation proteins (9) including, CYP1A1, CYP3A4, CYP3A5, and F8, and a low proportion of novel-to-known variants on CYP2E1, VKORC1, and SULT1A1/2. Using a Bayesian approach, we identified variants influencing acenocumarol dosing on, VKORC1 (2), SULT1A1 (1), and CYP2D8P (1) explaining 40–55% of dose variability. A collection of pharmacogenetic variation on 110 genes related to the PK/PD of coumarins is also presented. Our results offer an initial insight into the use of a targeted NGS approach in the pharmacogenomics of coumarins in Mexican Mestizos.

Solamente habiendo vivido como actor y como espectador loocurrido en la ultima mitad del siglo anterior y los comienzosdel actual, se puede tener una idea, apenas aproximada,de los profundos cambios que ha sufrido la cardiologia, lamedicina en su totalidad y, de hecho, la ciencia en general.La ciencia permanecio estatica no lustros, sino milenios yhace apenas unos 100 a˜nos que su devenir se trasforma demanera inusitada.El atraso del conocimiento tiene mucho que ver con lasantiguas actitudes del pasado que por largo tiempo asolarony mantuvieron a los hombres del pensar y del saber, sobretodo a los del querer saber, limitados, apartados, investi-gando en la oscuridad, cuando no castigados. Los ejemplosson innumerables y solo por se˜nalar algunos, vienen a nues-tra mente los de Erasmo de Rotterdam, Leonardo, Vesalio,Colon, Servet, Darwin y hasta en epocas recientes el mismoFreud. Lo que resulta muy evidente para todo el mundo esque los avances en las ultimas 3 decadas abarcan mucho,pero mucho mas de lo que la humanidad habia logrado entoda su existencia hasta hace apenas una centuria.No es el objeto de esta revision se˜nalar los nombresde los personajes que contribuyeron de manera notable aldesenvolvimientodelacardiologiaennuestropais,nimucho

Background: Valvular Aortic Sclerosis (AVS) and Calcified Degenerative Valvular Aortic Stenosis (AS) are important risk factors for cardiovascular events. Matrix Metalloproteinases (MMPs) and other inflammatory markers might play an important role in the mechanisms underlying endothelial dysfunction described in AS. The participation of MMPs in AVS is poorly studied as of yet. We evaluated the concentrations of MMPs 1,2 and 9 and tissue-1 inhibitor (TIMP-1) and inflammatory markers in AVS patients. Methods: The research and the ethics committees of our institution approved the study. Samples were obtained from peripheral blood in a cohort of 107 subjects: 30 healthy blood donor controls, 47 with AS and 30 AVS. Serum concentrations of Interleukins (ILs) 1 and 6, Tumor Necrosis Factor (TNF-α) and MMPs 1, 2 and 9 and TIMP-1 were measured by quantitative immunoassay technique with commercial kits, while concentrations of C Reactive Protein (CRP) by nephelometry. In all patients endothelial function and carotid plaque, 256 slice coronary computed tomography and coronary calcium score were evaluated. A one way ANOVA nonparametric test (Kruskall-Wallis), Kaplan Meier and multivariate Cox regression model were performed. Results: Serum concentrations of CRP, ILs 6 and 10, MMPs-1, 2, 9 and TIMP-1 were higher in AVS and AS patients than in healthy controls (p400 (14%) was similar in both patients groups. During follow-up of 19.96±14.51 months, 50.7% of AVS and AS patients developed cardiovascular events. Type 2 diabetes was the stronger predictors for cardiovascular events in ASV (RR= 2.67, IC95% de 1.027 - 6.926). Conclusions: Our findings suggest an important inflammatory role of MMPs, TIMPs and cytokines in AVS disease, which could explain a higher prevalence of coronary artery disease in this patients.

Significant Coronary Artery Disease (CAD50%) it can easily detected with Multislice Computed Tomography (MSCT), nevertheless if MSCT may replace Invasive Coronary Angiography (ICA) in the preoperative assessment of the patient undergoing to non-coronary cardiac surgery is not well defined. The objective of this study was to know if the MSCT can replace ICA in the preoperative valuation of patients who go to cardiac surgery64 consecutive patients in Class I recommendation of American College of Cardiology / American Heart Association (ACC/AHA) guidelines for preoperative ICA were evaluated. Patients with angina, contrast medium allergy, serum creatinine up to 2.0 mg/dL, previous coronary cardiac surgery or coronary angioplasty and supraventricular arrhythmias were excluded. Both, Coronary artery calcium (CAC) and coronary angiography were evaluated.The prevalence of significant (50%) CAD was 12.5%. The Sensitivity of MSCT to detect significant CAD was 87.5%, its Specificity of 92.8%, Predictive Negative Value was 98.1% and Area Under the Curve (ROC analysis) = 0.90. Anyone with Rheumatic Valvular Disease had significant CAD or CAC400 UA (RR = 0.80, IC95% 0.69-0.94). Degenerative Aortic Valve Stenosis had a major probability of significant CAD (RR of 9.0; IC 95% 1.64-49.80). Logistic Regression Analysis showed than CAC400 UA (Coef β 0,351, t = 4.402 p = 0.000) and male gender (Coef β 0,179, t = 2.445, p = 0.017), were the best predicting variables of CAD. This study shows different populations in patients undergoing to non-coronary cardiac surgery.Gender, CAC400 UA and type of cardiac disease previously surgery may be useful for triage to MSCT or ICA in the preoperative assessment. This study shows that ICA may be necessarily indicated in some patients in assessment of non-coronary cardiac surgery but not absolutely indicated in all patients that Guidelines of ACC/AHA have recommended.

In our hospital, the patients that need an elective cardiac surgery are admitted through the admission department on the basis of a waiting list. Since 1999, a fast track to hospitalization program has existed in the National Institute of Cardiology Ignacio Chavez for patients with low surgical risk. Later, in 2004, this program was extended to patients to moderate risk, based on rules accepted worldwide, and our own experience.1) To compare two ways of admission that are used currently: fast track to hospitalization, against admission department waiting list. We compared major events: death or events that increased the hospital stay by more than 14 days (infections, alterations of rhythm and conduction, reoperations and others), 2) To compare the days of hospitalization and money spent by the hospital.We conformed 2 groups of 347 patients. The admission department waiting list group was admitted before doing their preoperative studies, which is the customary form for hospitalization by our admissions department, while the group of fast track to hospitalization was obligated to have their laboratory exams complete and any other diseases resolved or controlled previously. The monetary cost per patient for the hospital was calculated based on the patient's socioeconomic classification.Student t test was conduncted on independent samples and numerical variables, and Chi square for categorical variables. We considered a p0.05 to be statistically significant.In average in both groups, 75% underwent valve operation and 25% underwent congenital heart disease repair, 49% were women, age 47 15 years. The comparison between the groups fast track to hospitalization and admission department waiting list group were: Mortality: 4.3% vs. 5.8% (p=0.38). Major events that needed a hospital stay of more than 14 days: 73 vs. 97 cases respectively (p = 0.032). Infections: 22 vs. 29 (p = 0.14). Mediastinitis: 2 vs. 9 respectively (p = 0.033). In-hospital stay: were 11 days vs. 20 days (p = 0.0001), the biggest difference was found in the pre-surgical time: 2 vs. 9 days respectively (p = 0.0001).The postoperative morbidity in general was lower in fast track to hospitalization group, and the mediastinitis showed a decrease with statistical significance. The time interval between hospital admission an operation in fast track to hospitalization group was significantly shorter. We believe that the decrease in the exposure time to nosocomial pathogens present in the hospital environment was directly related to the low number of mediastinitis. Finally, the decrease in time of hospital stay represented a 32% monetary savings for the hospital.

In 1999 so as to decrease the list of cardiac surgery the "fast track" program was started for patients with very mortality low risk. In 2004, this program was extended to moderate risk patients.A prospective, descriptive study to evaluate the clinical and demographic characteristics of "fast track" program patients for elective cardiac surgery. We also analyzed the hospital stay, mortality, complications and readmissions.From March 2004 to February we included adult patients with indications for cardiac surgery, low to intermediate risk of mortality and complete preoperative requirements.From a total of 598 patients, 533 were analyzed, aged 47±14 years, 62.5% female. They were classified in four groups: valvular (68%), congenital (25%), coronary artery disease (5%), and mixed (2%). The average hospital stay was: preoperative 1.9, intensive care unit three, postoperative in hospitalization 6.9 and total 11.9 days. We found that 17.8% had a hospital stay longer than 14 days due to: reoperations, pulmonary complications, arrhythmias or infections. The mortality was 4.1 and 2.8% had readmissions three months after surgery.This program shows a low rate of mortality, hospital stay and readmissions."

The Barlow's syndrome is a disease characterized by the presence of mitral valve prolapse and a wide range of signs and symptoms. We know that its manifestations has a great variety existing cases with little clinical expression as those seen frequently in daily practice or the other side opposite completely in which, the syndrome is so complex getting to the patient to present many symptoms secondary to hemodynamics alterations that reduce by much its quality of life and even modify its prognosis.The case that we present is a female patient of 25 years old with Barlow's syndrome and functional class II-III of NewYork Heart Association as a result of the alterations in the contractility function of the heart that finally caused her death.

When aneurysm of the root of aorta, bicuspid aorta valve and coarctation coexist, surgical repair involves technical problems. We present the case of a patient in whom initial correction of the coarctation was made by means of interventional treatment, with an impressive and practically immediate resolution of heart failure. In a second intervartional, the aortic root pathology was corrected through the Bentall and de Bono's surgical technique. We present the short- and mid-term results. In addition this case demostrates the little well-know fact, that the patients with bicuspid aorta also have cystic media degeneration of the wall of the aorta.

Traditional risk factors for atherosclerosis are well known and their control decreases importantly the appearance of the disease. These factors are the genetic charge, dyslipidemia, smoking, systemic arterial hypertension, diabetes, obesity, gender, age, stress, estrogen levels in women, and life style. However, in the last decade, new risk factors have been identified especially for coronary and cerebrovascular atherosclerosis. Among these factors, the inflammatory process has been pointed out in which acute stage reactants participate, such as C-reactive protein, leukocyte count, globular sedimentation, multiple cytokines, alpha tumor necrosis factor, vascular and cellular adhesion molecules, some metalloproteinases, pregnancy-associated plasma protein A, lipoprotein-associated phospholipase A2, angiotensin II, and very probably infection. This article discusses the mechanism by which these markers participate in the atherosclerotic process and their value as predictors of future coronary events, as well as to what extent current therapeutics can contribute to decrease these events and to improve patient care.

Studies performed in the last five years have led to the knowledge of new mechanisms by which the hypertensive process produces hypertrophy and cardiac fibrosis, at the same time, favoring development of the atheroesclerotic plaque. The Renin-Angiotensin-Aldosterone axis is relevant by involved in the physiopathology of these alterations, not only by producing hyperplasia and hypertrophy of vascular smooth muscle cells or by increasing protein and DNA syntheses, mediated by Angiotensin II (by itself a potent Growth factor) but also through inflammatory processes exerted upon the vascular smooth muscle cells. These alterations (hypertrophy, fibrosis, inflammation, and destabilization of the atherosclerotic plaque) can now be counteracted by blocking the Angiotensin-Converting enzyme or its AT1 receptors with the consequent improvement in ventricular diastolic functions.