Mitral plasticity results in less moderate and severe IMR. Longer time-duration of diabetes mellitus and higher haemoglobin level are independently associated with mitral plasticity, while smoking independently associates with no plasticity. Increased anterior papillary muscle-to-annulus length in CII patients with plasticity suggests complex LV remodelling mechanisms are involved in plasticity.

Portopulmonary hypertension (PPH) is a rare condition worldwide, although epidemiological data are unknown in Mexico. However, chronic liver diseases are very prevalent in Mexico. PPH is the 4th subtype in frequency in the group of pulmonary arterial hypertension. Its diagnosis is made within 2 scenarios: patients with suspected pulmonary hypertension and candidates for orthotopic liver transplantation (OLT). Both echocardiogram and a right cardiac catheterisation are crucial for diagnosis in both cases. PPH is a challenge for OLT, since it can significantly increase perioperative mortality. The use of specific therapy is the cornerstone of this disease, as a measure to improve the outcome of those who become candidates for OLT with moderate to severe PPH. It is important to recognise that PPH can be a contraindication to OLT. The role of lung-liver transplantation or heart-lung-liver transplantation as a measure to heal pulmonary vascular disease in patients with PPH is still uncertain.

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Background: Ventricular septal defects (VSDs) are one of the most common congenital heart defects, although many close spontaneously by adulthood. The main aim of this investigation was a) to investigate by echo the best cutoff value of pulmonary artery systolic pressure (PASP) in relation to VSD size, for defining the surgical or interventional treatment (SIT), b) to compare medical versus SIT results and c) to analyze morbidity and mortality of adults with VSDs. Material: 193 patients aged ≥16 years with VSDs were studied. All had a complete clinical examination, electrocardiogram, chest x-ray and transthoracic echocardiography. Fifty three (27.5%) patients underwent cardiac catheterization. Results: Seventy (36.3%) were asymptomatic, 119 (61.7%) had cardiomegaly, and 124 (64.2%) pulmonary artery hypertension (PAH). The PASP in small defined VSDs was 38 ± 19, and in large it was 69 ± 34 mmHg. Twenty one (11%) developed Eisenmenger syndrome (ES). The best cutoff point for PASP was 65 mmHg. The coefficient of correlation between VSD size and degree of PASP was 0.64 (p ≤0.000). Forty-five patients had surgical and 10 interventional VSD closure. The patients who underwent SIT had better survival than those who received medical treatment (P <0.000). There were 32 (16.6%) cardiac deaths. Conclusions: VSD in adulthood is symptomatic in the majority of cases. The best cutoff point for PASP was 65 mmHg for defining SIT. There were 32 (16.6%) deaths during the follow-up period. Patients with ES had a poor prognosis. Patients who underwent SIT had better survival than those who received medical treatment.

Background: Left ventricular hypertrophy is associated with poor prognosis and adverse events. Left ventricular and left atrial global strain and left atrial reservoir strain (LV-GS; LAGS ; LA-RS) could be used as markers for myocardial function in different forms of ventricular remodeling. The aim of this study was to evaluate LV-GS and LAGS scores in different ventricular remodeling variants and identify risk factors for myo-cardial dysfunction. Methods and Results: This cross-sectional study was divided into four groups of ventricular remodeling: normal geometry, eccentric hypertrophy (EH), concentric hypertrophy (CH) and concentric remodeling (CR). Strain analysis was obtained using standardized protocols. We included 121 subjects, 33 with previous myocardial infarction (MI). We found that EH had the lowest LV-GS and CH the lowest LAGS and LA-RS. Atrial and ventricular dysfunction was present in 40 (33%) and 14 (11.5%) subjects, respectively. Smoking, male sex and previous MI were associated with LV dysfunction and smoking and dyslipidemia with LA dysfunction. EH was closely associated with LV dysfunction and CH with LA dysfunction. Conclusions: We conclude that different types of ventricular geometry had echocardiographic profiles associated with different risk factors for dysfunction assessed by strain. The assessment of ventricular remodeling by global strain could be used as a complementary tool in the echocardiographic evaluation of ventricular and atrial function.