Objetivos. Desarrollar curvas percentilares por edad para la presión arterial media (PAM), diastólica (PAD) y sistólica (PAS) en adultos peruanos de 20-59 años, estratificadas por altitud de residencia. Materiales y métodos. Se realizó un estudio transversal analítico con la Encuesta Demográfica y de Salud Familiar (ENDES) 2014-2024. Se incluyeron adultos de 20-59 años con dos mediciones válidas de presión arterial y sin diagnóstico previo de hipertensión. La altitud de residencia se clasificó en <2500, 2500-3499 y ≥3500 metros sobre el nivel del mar (m s.n.m.). Los percentiles (P5-P95) de la PAM, PAD y PAS se estimaron empleando modelos aditivos generalizados para localización, escala y forma (GAMLSS) con distribución Box–Cox Cole and Green (BCCG). Resultados. Se analizaron 227 093 adultos (edad media: 35,7 años; 56,2% mujeres). En todos los estratos de altitud, la PAM, PAD y PAS mostraron incrementos graduales entre los 20 y 50 años, aunque la magnitud del incremento se atenuó a mayor altitud. La PAD y la PAM mostraron relativa estabilidad después de los 50 años, mientras que la PAS continuó aumentando de forma más progresiva. A los 50 y 59 años, los valores de PAS fueron sistemáticamente más bajos en altitudes ≥3500 que en <2500 m s.n.m. Conclusiones. La distribución de la presión arterial varía según la altitud de residencia, con incrementos por edad menos marcados en zonas de mayor altitud. Las curvas de referencia percentilares generadas pueden aportar a la interpretación contextualizada de la presión arterial en poblaciones de alta altitud y fortalecer la vigilancia epidemiológica.

Exposure to high altitude constitutes a complex physiological challenge, driven primarily by hypobaric hypoxia and, in some settings, by extreme environmental conditions such as severe cold and increased ultraviolet radiation. At the cardiovascular level, this exposure elicits a range of acute and chronic adaptations, including activation of the sympathetic nervous system, pulmonary vasoconstriction, and vascular and ventricular remodelling. In the Andean region, millions of people live at elevations above 2,500 metres above sea level, rendering them particularly susceptible to these physiological adaptations and the associated cardiovascular alterations. This manuscript represents the first part of a narrative review and aims to synthesise the available scientific evidence on mechanisms of adaptation to high altitude, as well as the characteristics of pulmonary hypertension, heart failure, and congenital heart disease observed in both native high-altitude populations and individuals originating from low-altitude areas. In addition, it seeks to identify existing gaps in current knowledge of these conditions in order to promote the development of specific diagnostic, preventive, and therapeutic strategies aimed at improving cardiovascular health among populations residing at or temporarily exposed to high altitude.

ABSTRACTObjectives. To analyse factors associated with the rejection of heart donor offers referred to Clínica Guayaquil and to compare these findings with national data from the Instituto Nacional de Donación y Trasplante de Órganos, Tejidos y Células, in order to identify trends influencing organ acceptance.Materials and Methods. We conducted an observational, retrospective study of heart donor offers received between September 2021 and July 2025. Demographic, clinical, anthropometric, and logistical variables were extracted from the institutional database and the National Information System for Donation and Transplantation (SINIDOT). Reasons for organ rejection were classified into eight predefined categories. Univariate and multivariate analyses were performed to identify factors associated with donor acceptance or rejection.Results. A total of 196 heart donor offers were received, of which 75% were rejected. Accepted donor organs were from younger donors, were more frequently male, and had higher predicted heart mass (PHM). Traumatic brain injury was the leading cause of death (49.5%). The most common reasons for rejection were classification as a non-standard risk donor (39.5%), logistical constraints (30.6%), and blood group incompatibility (15.6%). In multivariate analyses, older donor age and origin outside Guayaquil were associated with higher rejection rates, whereas male sex and higher PHM were associated with increased acceptance. Logistical problems rose from 0% in 2021 to more than 40% in 2024-2025, largely driven by limited availability of air transport.Conclusions. The high rate of donor heart rejection reflects substantial underutilisation of potentially viable organs. Strengthening transport logistics and broadening donor acceptance criteria could increase graft utilisation, reduce waiting-list mortality, and improve the overall efficiency of national heart transplantation programmes.

ABSTRACTAnomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect, with an estimated incidence of 1 in 300,000 live births and a mortality rate approaching 90% within the first year of life if left untreated. We present the case of a three-year-old boy with progressive dyspnea, paroxysmal tachycardia, and poor weight gain, initially diagnosed with severe left ventricular dilatation and severe mitral regurgitation. Transthoracic echocardiography and cardiac computed tomography angiography confirmed the diagnosis of ALCAPA. Surgical correction included left coronary artery reimplantation and mitral valve repair. The patient was discharged without complications. At a two-year follow-up, he remained asymptomatic, with preserved left ventricular function and mild mitral regurgitation. This case highlights the importance of advanced imaging in the diagnosis and the role of surgical intervention in improving outcomes in this potentially fatal condition.

RESUMENObjetivo. El tratamiento endovascular de los aneurismas aórticos toracoabdominales y paraviscerales complejos, con el desarrollo de nuevos dispositivos, representa uno de los aspectos más desafiantes de la cirugía endovascular. El objetivo de este estudio fue describir la mortalidad perioperatoria a 30 días, las complicaciones mayores posoperatorias y las reintervenciones de los pacientes tratados por aneurismas aórticos complejos mediante dispositivos de endoprótesis ramificadas off-the-shelf (t-BRANCH) y Physician Modified Endografts (PMEGs).Materiales y métodos. El presente trabajo es un estudio observacional, retrospectivo y unicéntrico sobre una base de datos prospectivamente recolectada de cada paciente tratado por aneurisma aórtico complejo registrado en la historia clínica de nuestro centro aórtico de referencia, entre enero de 2020 y diciembre de 2024.Resultados. Se analizaron 51 pacientes con una media de edad de 69,6 ± 10,3 años, siendo varones el 90,2%. El diámetro medio del aneurisma fue de 66,1 ± 15,2 mm. La mortalidad global fue del 9,8%, siendo la mortalidad intrahospitalria temprana en t-BRANCH del 23,1% en comparación con PMEGs del 5,3% (p=0,0977). Dentro de los predictores de mortalidad intrahospitalaria se encontraron el estado físico según la clasificación del estado físico de la Sociedad Americana de Anestesiólogos (ASA) IV (OR = 11.98; IC95%: 1.46-98.7; p = 0.022) y el antecedente de accidente cerebrovascular (ACV) (OR = 13.07; IC95%: 1.06-161.5; p = 0.043).Conclusiones. La reparación endovascular de aneurismas complejos de aorta mediante endoprótesis con PMEGs y dispositivos t-BRANCH muestra resultados favorables con respecto a la mortalidad y las complicaciones mayores posoperatorias, asociadas a una baja tasa de reintervenciones.

ABSTRACTCongenitally corrected transposition of the great arteries (ccTGA) is a rare and complex cardiac malformation often associated with additional anomalies. We present a 23-year-old patient with ccTGA, a supravalvular stenosing ring, and an Ebsteinoid tricuspid valve who developed severe systemic atrioventricular valve (SAVV) stenosis and regurgitation. Preoperative evaluation revealed tricuspid valve abnormalities, a dilated systemic right ventricle (sRV) with a reduced sRV ejection fraction (42%). The patient underwent bioprosthetic SAVV replacement and excision of the supravalvular membrane. Postoperatively, valve function was preserved, and recovery was favorable despite transient complications. This case emphasizes the surgical challenges and individualized decision-making required in ccTGA with rare anatomical variants, highlighting the value of timely intervention, multidisciplinary care, and long-term follow-up to optimize outcomes.

ABSTRACTObjective. Evaluate the impact and clinical applicability of artificial intelligence (AI) models in cardiovascular diagnosis, assessing their potential to improve diagnostic accuracy, operational efficiency, and reliability compared with conventional methods. Materials andMethods. A critical review of the recent literature was conducted, encompassing retrospective studies, multicenter trials, and external validations that employed machine learning and deep learning algorithms applied to imaging modalities, electrocardiographic and phonocardiographic signals, as well as clinical and proteomic biomarkers.Results. Evidence indicates that in cardiac imaging, automated segmentation and ventricular dysfunction detection achieved accuracy metrics exceeding 90%, suggesting readiness for clinical integration. In cardiac signals, deep learning models demonstrated area under the ROC curve values of approximately 0.99 for predicting atrial fibrillation and ischemic heart disease, further supported by explainability techniques. Regarding biomarkers, ensemble models achieved diagnostic accuracies above 95%, and the integration of proteomic and clinical data substantially enhanced predictive performance. Nonetheless, decreased performance in external validations, limited generalizability to heterogeneous populations, and clinicians’ reluctance due to insufficient explainability remain major barriers.Conclusion. Artificial intelligence in cardiovascular diagnostics holds transformative potential by improving accuracy, reducing interobserver variability, and expanding access in resource-limited settings. However, its consolidation into routine practice requires robust multicenter validations, seamless interoperability with clinical workflows, and strengthened explainability, prerequisites for incorporation into clinical guidelines and precision medicine strategies.

ABSTRACTA double aortic arch is a rare congenital vascular anomaly with clinical significance in the pediatric population due to its potential to cause extrinsic compression of the trachea and esophagus. It should be suspected in infants with persistent respiratory and gastrointestinal symptoms refractory to conventional treatment. We report the case of a 2-year-7-month-old boy presenting with recurrent stridor, repeated respiratory infections, and progressive dysphagia. Cardiac CT angiography revealed a complete vascular ring causing tracheoesophageal compression. Dominance of the left aortic arch was identified, and surgical section and distal ligation of the non-dominant right arch were performed, without direct intervention on the tracheoesophageal structures. At the 12-month follow-up, there was complete resolution of symptoms and nutritional recovery. This case highlights the importance of maintaining high clinical suspicion and ensuring timely referral. Even when surgical correction is delayed, appropriate intervention can reverse symptoms and improve quality of life