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Morales-Quispe, América Rebollar-Domínguez, Rocío Caballero-Caballero, Israel Gutiérrez-Gutiérrez, Pedro Jara-Alvis, Guadalupe Brunner-Cruz, Fausto Pinal-González" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Jorge A." "apellidos" => "Morales-Quispe" ] 1 => array:2 [ "nombre" => "América" "apellidos" => "Rebollar-Domínguez" ] 2 => array:2 [ "nombre" => "Rocío" "apellidos" => "Caballero-Caballero" ] 3 => array:2 [ "nombre" => "Israel" "apellidos" => "Gutiérrez-Gutiérrez" ] 4 => array:2 [ "nombre" => "Pedro" "apellidos" => "Jara-Alvis" ] 5 => array:2 [ "nombre" => "Guadalupe" "apellidos" => "Brunner-Cruz" ] 6 => array:2 [ "nombre" => "Fausto" "apellidos" => "Pinal-González" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X1405994011023758?idApp=UINPBA00004N" "url" => "/14059940/0000008100000001/v0_201307091102/X1405994011023758/v0_201307091103/es/main.assets" ] "itemAnterior" => array:16 [ "pii" => "X1405994011023731" "issn" => "14059940" "estado" => "S300" "fechaPublicacion" => "2011-01-01" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Arch Cardiol Mex. 2011;81:13-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5555 "formatos" => array:3 [ "EPUB" => 39 "HTML" => 4723 "PDF" => 793 ] ] "es" => array:11 [ "idiomaDefecto" => true "titulo" => "Diseño de un registro multicéntrico para evaluar control de ritmo contra control de la frecuencia en fibrilación auricular: Registro Mexicano de Fibrilación Auricular (ReMeFA)" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "13" "paginaFinal" => "17" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Design of a multicenter registry to evaluate rhythm versus rate control in atrial fibrillation: Atrial Fibrillation Mexican Registry (ReMeFA)" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro Iturralde-Torres, Susano Lara-Vaca, Alejandro Cordero-Cabra, Santiago Nava-Townsend, Celso Mendoza, Manlio F. Márquez, Néstor Saucedo-Sánchez, Enrique Martínez-Flores" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Pedro" "apellidos" => "Iturralde-Torres" ] 1 => array:2 [ "nombre" => "Susano" "apellidos" => "Lara-Vaca" ] 2 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Cordero-Cabra" ] 3 => array:2 [ "nombre" => "Santiago" "apellidos" => "Nava-Townsend" ] 4 => array:2 [ "nombre" => "Celso" "apellidos" => "Mendoza" ] 5 => array:2 [ "nombre" => "Manlio F." "apellidos" => "Márquez" ] 6 => array:2 [ "nombre" => "Néstor" "apellidos" => "Saucedo-Sánchez" ] 7 => array:2 [ "nombre" => "Enrique" "apellidos" => "Martínez-Flores" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X1405994011023731?idApp=UINPBA00004N" "url" => "/14059940/0000008100000001/v0_201307091102/X1405994011023731/v0_201307091102/es/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Spontaneous rupture of an aneurysm of the sinus of Valsalva into the right atrium, associated with an atrial septal aneurysm" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "18" "paginaFinal" => "21" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Pedro López-Velarde B, Nydia Avila-Vanzzini, Tatiana López-Velarde Peña, Alejandro Dabaghi-Richerand, Fernando López-Soriano, Nilda Espinola-Zavaleta" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Pedro" "apellidos" => "López-Velarde B" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Nydia" "apellidos" => "Avila-Vanzzini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "nombre" => "Tatiana" "apellidos" => "López-Velarde Peña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 3 => array:3 [ "nombre" => "Alejandro" "apellidos" => "Dabaghi-Richerand" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 4 => array:3 [ "nombre" => "Fernando" "apellidos" => "López-Soriano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] 5 => array:3 [ "nombre" => "Nilda" "apellidos" => "Espinola-Zavaleta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Cardiovascular Hemodynamic Department, American British Cowdray Medical Center, Mexico City." "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Cardiovascular Echocardiography Department, Instituto Nacional de Cardiología Ignacio Chávez and The American British Cowdray Medical Center, Mexico City." "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Medicine School, Universidad La Salle, Mexico City. " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] 3 => array:3 [ "entidad" => "Cardiothoracic Surgery Department, Instituto Nacional de Cardiología Ignacio Chávez and The American British Cowdray Medical Center, Mexico City." "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ruptura espontánea de un aneurisma del seno de Valsalva a la aurícula derecha en una paciente con aneurisma del septum interatrial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "293v81n01-90002374fig1.jpg" "Alto" => 1025 "Ancho" => 1829 "Tamanyo" => 165235 ] ] "descripcion" => array:1 [ "en" => "A. Two-dimensional short axis view at the level of the great arteries, showing the site of the rupture (arrow) of the right coronary sinus aneurysm into the right atrium. B. With color Doppler flow, the turbulent flow through the site of the rupture is evidenced. Abbreviations: RA=Right atrium, RV= Right ventricle, LA=Left atrium, RVOT=Right ventricular outflow tract, Ao=Aortic valve" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Case report</span></p><p class="elsevierStylePara">A 28-year-old woman was referred to our department, she had a history of 10- day progressive dyspnea, five hours previous to her admission at the hospital, and she presented suddenly oppressive anterior chest pain without irradiations, accompanied by palpitations at rest and orthopnea. Physical examination showed heart rate (HR) of 110 beats/min, blood pressure (BP) of 120/40 mmHg and the jugulars veins were distended. There was a grade 4/6 continuous murmur along the left parasternal line without thrill. There was also hepatomegaly 2-2-1. The electrocardiogram showed tachycardia and incomplete right bundle branch block. An increase of pulmonary vascularity and normal cardiac silhouette was seen in the chest x-ray. </p><p class="elsevierStylePara">The two-dimensional Doppler echocardiogram documented a short aneurysmal dilatation of the right sinus of Valsalva, protruding into the right atrium. The place of rupture was shown with color flow imaging, revealing a unidirectional continuous mosaic jet from the aorta to the right heart chamber, (<span class="elsevierStyleBold">Figure</span><span class="elsevierStyleBold">1A, 1B</span>). In a four chamber view with posterior angulation, an interatrial septal aneurysm (<span class="elsevierStyleBold">Figure 2</span>) with a 19 mm base and an 11 mm right excursion beyond the plane of the atrial septum was found. No association with patent foramen ovale was observed with agitated saline solution (baseline and Valsalva maneuver). This defect had all the features to be deemed an aneurysm, the cutoff criteria reported in an autopsy study by Silver and Dorsey<span class="elsevierStyleSup">1 </span>was used. Cardiac catheterization with contrast medium injected into the ascending aorta showed shunting from the right sinus of Valsalva to the right atrium (<span class="elsevierStyleBold">Figure 3</span>). Oximetries and pressure in this cavity were increased. Surgical closure of the communication was performed under extracorporeal circulation. The aortotomy showed the sinus of Valsalva aneurysm's origin in the right coronary sinus. The right atrium was open and the aneurysm´s coat was seen, including the basal and medium portion of the interventricular septum. Resection of the aneurysm´s coat was made and replaced with a 1.5 cm diameter woven Dacron patch. Aortic valve replacement was not considered necessary. Laboratory tests searching for connective tissue disease were negative. In the early postoperative period, the patient developed variable degrees of atrioventricular block, and a definite VVI pacemaker was implanted. The patient was discharged on the 10<span class="elsevierStyleSup">th</span> postoperative day being in a NYHA functional class I. </p><p class="elsevierStylePara"><img src="293v81n01-90002374fig1.jpg" alt="Figure 1. A. Two-dimensional short axis view at the level of the great arteries, showing the site of the rupture (arrow) of the right coronary sinus aneurysm into the right atrium. B. With color Doppler flow, the turbulent flow through the site of the rupture is evidenced. Abbreviations: RA=Right atrium, RV= Right ventricle, LA=Left atrium, RVOT=Right ventricular outflow tract, Ao=Aortic valve"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 1. A.</span> Two-dimensional short axis view at the level of the great arteries, showing the site of the rupture (arrow) of the right coronary sinus aneurysm into the right atrium. <span class="elsevierStyleBold">B.</span> With color Doppler flow, the turbulent flow through the site of the rupture is evidenced. <span class="elsevierStyleBold">Abbreviations:</span> RA=Right atrium, RV= Right ventricle, LA=Left atrium, RVOT=Right ventricular outflow tract, Ao=Aortic valve</p><p class="elsevierStylePara"><img src="293v81n01-90002374fig2.jpg" alt="Figure 2. Four chambers apical view with posterior angulation, showing the atrial septal aneurysm (arrow). Abbreviations: LA=Left atrium, LV= Left ventricle, RA= Right atrium, RV= Right ventricle. "></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 2.</span> Four chambers apical view with posterior angulation, showing the atrial septal aneurysm (arrow). <span class="elsevierStyleBold">Abbreviations: </span>LA=Left atrium, LV= Left ventricle, RA= Right atrium, RV= Right ventricle. </p><p class="elsevierStylePara"><img src="293v81n01-90002374fig3.jpg" alt="Figure 3. Aortography at the root of the aorta, in left anterior oblique projection with abnormal flow in the ruptured aneurysm of the right sinus of Valsalva (arrow). "></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 3. </span>Aortography at the root of the aorta, in left anterior oblique projection with abnormal flow in the ruptured aneurysm of the right sinus of Valsalva (arrow). </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion</span></p><p class="elsevierStylePara">Aneurysm of the sinus of Valsalva (ASV) is a rare cardiac abnormality, occurring in 0.15% to 1.5% of patients who undergo cardiopulmonary bypass. They may be congenital or acquired. A congenital aneurysm is caused by separation or failed fusion of the aortic media layer with the fibrous annulus of the aortic valve. Acquired aneurysm of sinus of Valsalva can develop as the result of traumatic injury,<span class="elsevierStyleSup">2</span> endocarditis,<span class="elsevierStyleSup">3</span> syphilis,<span class="elsevierStyleSup">4</span> Behcet´s disease<span class="elsevierStyleSup">5</span> or Marfan´s syndrome. The first reports of ASV appeared in the 19<span class="elsevierStyleSup">th</span> century and Lillehei et al.6 reported the first successful surgical repair in 1957. </p><p class="elsevierStylePara">Aneurysms are generally silent for prolonged periods of time. Regarding complications, the most frequent occurrence is rupture. It occurs in most cases between the third and fourth decades of life.<span class="elsevierStyleSup">7</span> The clinical presentation of this entity varies considerably due to the fact that it can be asymptomatic. It can be found in a postmortem or angiographic study, or they present with cardiogenic shock and death. This wide variety in initial clinical presentations can be due to the size of the shunt; little shunts are asymptomatic, and big aortocardiac fistulas cause a clinical presentation similar to an acute aortic regurgitation.<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">There are numerous complications that can originate from a Valsalva aneurysm, including obstruction of the right ventricular outflow tract, infectious endocarditis, and thrombus formation, with systemic or local embolic events.<span class="elsevierStyleSup">7</span> The compression of the origin of the coronaries or the obstruction of their ostia can cause ischemia or necrosis. Ischemia has been reported as a conditioning factor for ventricular fibrillation in some patients.<span class="elsevierStyleSup">9</span> Whereas, in others, ventricular fibrillation is secondary to the dissection of the interventricular septum due to a ruptured aneurysm at this site. In this case, complete atrioventricular block usually accompanies the clinical presentation.<span class="elsevierStyleSup">10</span></p><p class="elsevierStylePara">Aneurysms are most frequently localized at the right sinus of Valsalva (76.8%) and at the non-coronary sinus (20.2%). Left sinus of Valsalva localization is not very frequent (3%).<span class="elsevierStyleSup">11</span> The least frequent sites are the pericardium, pleural space, interventricular septum,<span class="elsevierStyleSup">9</span> or the left ventricle chambers. </p><p class="elsevierStylePara">Eventhough the first report of a Valsalva aneurysm diagnosed by echocardiography was in 1974,<span class="elsevierStyleSup">12</span> currently the gold standard for the diagnosis of these lesions continues to be cardiac catheterization with aortography. Development of new generation ultrasonography machines has made transthoracic and, especially, the transesophageal echocardiography a useful tool in the confirmation of the diagnosis.<span class="elsevierStyleSup">8,13</span> Additionally, it may help in the differential diagnosis of other abnormalities causing continuous murmurs like patent ductus arteriosus, aorto-pulmonary window, or coronary fistulas. Nuclear magnetic resonance imaging is equally useful,<span class="elsevierStyleSup">14</span> but more expensive and less available than echocardiography. The latter is a better and faster diagnostic tool, especially when dealing with critically ill patients. </p><p class="elsevierStylePara">Congenital sinus of Valsalva aneurysms can coexist with other malformations; the most common of which is the association with subaortic ventricular septal defect (25-55%) and aortic regurgitation. Other associated abnormalities less frequently found are pulmonary stenosis, patent <span class="elsevierStyleItalic">ductus arteriosus</span>, atrial septal defect, subaortic stenosis, and Fallot's Tetralogy.<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">Regarding the atrial septal aneurysm,<span class="elsevierStyleSup">1,15</span> this is an infrequent finding in adult patients. Its formation may be secondary to raised interatrial pressure gradients, producing a bulging septal shift toward the low-pressure side. </p><p class="elsevierStylePara">However, it has been found also in patients with normal atrial pressure,<span class="elsevierStyleSup">15</span> suggesting a primary malformation.16 </p><p class="elsevierStylePara">The coexistence of sinus of Valsalva aneurysms and atrial septal aneurysms is very rare. Atrial septal aneurysm is believed to be a disorder of connective tissue,<span class="elsevierStyleSup">17</span> which is manifested along time in adults. In fact, connective tissue abnormalities must be suspected when both defects coexist together. Replacement of the valve was not considered necessary in the absence of aortic valve dysfunction. Regarding the atrioventricular block, this was temporal, because in a follow-up revision of the patient, she had sinus rhythm, alternanting with pacemaker rhythm (data not shown). We consider that the presence of this block was secondary to the inflammatory process of the surgery. </p><p class="elsevierStylePara"> The present case illustrates the rare coexistence of two congenital malformations, as are sinus of Valsalva aneurysm and aneurysm of the interatrial septum. </p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleItalic">Corresponding author:</span> Nilda Espinola Zavaleta. <br></br> Instituto Nacional de Cardiología Ignacio Chávez. Echocardiography in Out-patient's Clinic. <br></br> Telephone: 5573-2911 ext. 1196. <span class="elsevierStyleItalic"><br></br> E-mail:</span><a href="mailto:niesza2001@hotmail.com" class="elsevierStyleCrossRefs">niesza2001@hotmail.com</a></p><p class="elsevierStylePara"> Received on November 26, 2008; <br></br> accepted on March 29, 2010.</p>" "pdfFichero" => "293v81n01a90002374pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec192424" "palabras" => array:1 [ 0 => "Seno de Valsava; Aneurisma del septum interatrial; Ruptura espontánea; Asociación de dos malformaciones aisladas; Ecocardiografía; Aortografía; México" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec192423" "palabras" => array:1 [ 0 => "Sinus of Valsalva; Atrial septal aneurysm; Spontaneous rupture; Association of two isolated malformations; Echocardiography; Aortography; Mexico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "Aneurysms of the sinus of Valsalva (SV) and the atrial septum are a rare association. We report the case of a 28-year-old woman, who was admitted to our department complaining of progressive dyspnea of 10 days of evolution, five hours previous to her admission to the hospital; she presented sudden oppressive anterior chest pain, accompanied by palpitations. The presence of rupture of the right SV to the right atrium was clinically confirmed, by echocardiography and hemodynamic studies. In addition, an associated atrial septal aneurysm was found. She underwent surgical correction through sinusplasty without requiring aortic valve replacement. The patient presented persistent postoperative atrioventricular block, which required a permanent pacemaker. Clinical evolution was satisfactory. To our knowledge, this case is a rare combination of two isolated malformations, without previous events that could explain the rupture of the right SV." ] "es" => array:1 [ "resumen" => "Los aneurismas del seno de Valsalva y del septum interauricular son una asociación rara. Informamos el caso de una mujer de 28 años de edad con un cuadro de disnea progresiva en los últimos 10 días, al cual se agregó dolor precordial opresivo, cinco horas previas a su ingreso. Se comprobó clínicamente, por ecocardiografía y hemodinamia la presencia de ruptura del seno de Valsalva derecho hacia el atrio derecho. Un hallazgo interesante fue la presencia de un aneurisma del septum interauricular asociado. La paciente fue sometida a corrección quirúrgica con plastía del seno de Valsalva, sin requerir reemplazo valvular aórtico. En el postoperatorio presentó bloqueo aurículo-ventricular persistente, requiriendo implante de marcapaso definitivo. Su evolución fue satisfactoria. Este es un caso de una rara asociación de dos malformaciones aisladas." ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "293v81n01-90002374fig1.jpg" "Alto" => 1025 "Ancho" => 1829 "Tamanyo" => 165235 ] ] "descripcion" => array:1 [ "en" => "A. Two-dimensional short axis view at the level of the great arteries, showing the site of the rupture (arrow) of the right coronary sinus aneurysm into the right atrium. B. With color Doppler flow, the turbulent flow through the site of the rupture is evidenced. Abbreviations: RA=Right atrium, RV= Right ventricle, LA=Left atrium, RVOT=Right ventricular outflow tract, Ao=Aortic valve" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "293v81n01-90002374fig2.jpg" "Alto" => 1279 "Ancho" => 912 "Tamanyo" => 103466 ] ] "descripcion" => array:1 [ "en" => "Four chambers apical view with posterior angulation, showing the atrial septal aneurysm (arrow). Abbreviations: LA=Left atrium, LV= Left ventricle, RA= Right atrium, RV= Right ventricle." ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "293v81n01-90002374fig3.jpg" "Alto" => 1166 "Ancho" => 987 "Tamanyo" => 82984 ] ] "descripcion" => array:1 [ "en" => "Aortography at the root of the aorta, in left anterior oblique projection with abnormal flow in the ruptured aneurysm of the right sinus of Valsalva (arrow)." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Aneurysm of the septum primum in adults." 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Idioma original: Inglés
año/Mes | Html | Total | |
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2024 Octubre | 21 | 2 | 23 |
2024 Septiembre | 41 | 7 | 48 |
2024 Agosto | 33 | 18 | 51 |
2024 Julio | 24 | 9 | 33 |
2024 Junio | 36 | 1 | 37 |
2024 Mayo | 25 | 2 | 27 |
2024 Abril | 26 | 5 | 31 |
2024 Marzo | 40 | 3 | 43 |
2024 Febrero | 55 | 3 | 58 |
2024 Enero | 73 | 9 | 82 |
2023 Diciembre | 74 | 16 | 90 |
2023 Noviembre | 62 | 12 | 74 |
2023 Octubre | 60 | 7 | 67 |
2023 Septiembre | 34 | 5 | 39 |
2023 Agosto | 26 | 5 | 31 |
2023 Julio | 58 | 3 | 61 |
2023 Junio | 63 | 0 | 63 |
2023 Mayo | 71 | 9 | 80 |
2023 Abril | 53 | 0 | 53 |
2023 Marzo | 56 | 8 | 64 |
2023 Febrero | 37 | 12 | 49 |
2023 Enero | 38 | 8 | 46 |
2022 Diciembre | 28 | 3 | 31 |
2022 Noviembre | 44 | 8 | 52 |
2022 Octubre | 41 | 9 | 50 |
2022 Septiembre | 51 | 9 | 60 |
2022 Agosto | 50 | 4 | 54 |
2022 Julio | 19 | 7 | 26 |
2022 Junio | 34 | 11 | 45 |
2022 Mayo | 32 | 5 | 37 |
2022 Abril | 30 | 9 | 39 |
2022 Marzo | 33 | 9 | 42 |
2022 Febrero | 23 | 8 | 31 |
2022 Enero | 26 | 9 | 35 |
2021 Diciembre | 27 | 10 | 37 |
2021 Noviembre | 40 | 10 | 50 |
2021 Octubre | 56 | 10 | 66 |
2021 Septiembre | 24 | 13 | 37 |
2021 Agosto | 44 | 7 | 51 |
2021 Julio | 21 | 10 | 31 |
2021 Junio | 13 | 8 | 21 |
2021 Mayo | 23 | 4 | 27 |
2021 Abril | 46 | 8 | 54 |
2021 Marzo | 34 | 8 | 42 |
2021 Febrero | 31 | 3 | 34 |
2021 Enero | 26 | 7 | 33 |
2020 Diciembre | 23 | 10 | 33 |
2020 Noviembre | 34 | 6 | 40 |
2020 Octubre | 31 | 7 | 38 |
2020 Septiembre | 21 | 10 | 31 |
2020 Agosto | 46 | 7 | 53 |
2020 Julio | 24 | 1 | 25 |
2020 Junio | 18 | 1 | 19 |
2020 Mayo | 22 | 7 | 29 |
2020 Abril | 16 | 5 | 21 |
2020 Marzo | 30 | 2 | 32 |
2020 Febrero | 17 | 2 | 19 |
2020 Enero | 14 | 6 | 20 |
2019 Diciembre | 44 | 7 | 51 |
2019 Noviembre | 15 | 3 | 18 |
2019 Octubre | 17 | 5 | 22 |
2019 Septiembre | 19 | 3 | 22 |
2019 Agosto | 22 | 1 | 23 |
2019 Julio | 43 | 15 | 58 |
2019 Junio | 63 | 33 | 96 |
2019 Mayo | 189 | 82 | 271 |
2019 Abril | 36 | 46 | 82 |
2019 Marzo | 13 | 4 | 17 |
2019 Febrero | 16 | 6 | 22 |
2019 Enero | 10 | 2 | 12 |
2018 Diciembre | 5 | 5 | 10 |
2018 Noviembre | 17 | 10 | 27 |
2018 Octubre | 15 | 15 | 30 |
2018 Septiembre | 30 | 4 | 34 |
2018 Agosto | 9 | 2 | 11 |
2018 Julio | 13 | 1 | 14 |
2018 Junio | 9 | 2 | 11 |
2018 Mayo | 10 | 2 | 12 |
2018 Abril | 5 | 2 | 7 |
2018 Marzo | 3 | 2 | 5 |
2018 Febrero | 5 | 3 | 8 |
2018 Enero | 4 | 0 | 4 |
2017 Diciembre | 10 | 1 | 11 |
2017 Noviembre | 1 | 0 | 1 |
2017 Octubre | 13 | 2 | 15 |
2017 Septiembre | 3 | 1 | 4 |
2017 Agosto | 13 | 1 | 14 |
2017 Julio | 6 | 0 | 6 |
2017 Junio | 18 | 1 | 19 |
2017 Mayo | 21 | 3 | 24 |
2017 Abril | 14 | 1 | 15 |
2017 Marzo | 16 | 24 | 40 |
2017 Febrero | 10 | 4 | 14 |
2017 Enero | 9 | 0 | 9 |
2016 Diciembre | 17 | 2 | 19 |
2016 Noviembre | 15 | 3 | 18 |
2016 Octubre | 22 | 2 | 24 |
2016 Septiembre | 12 | 1 | 13 |
2016 Agosto | 15 | 2 | 17 |
2016 Julio | 12 | 1 | 13 |
2016 Junio | 41 | 16 | 57 |
2016 Mayo | 22 | 11 | 33 |
2016 Abril | 20 | 9 | 29 |
2016 Marzo | 27 | 14 | 41 |
2016 Febrero | 47 | 14 | 61 |
2016 Enero | 39 | 24 | 63 |
2015 Diciembre | 25 | 10 | 35 |
2015 Noviembre | 22 | 4 | 26 |
2015 Octubre | 29 | 10 | 39 |
2015 Septiembre | 37 | 7 | 44 |
2015 Agosto | 52 | 6 | 58 |
2015 Julio | 42 | 12 | 54 |
2015 Junio | 30 | 7 | 37 |
2015 Mayo | 54 | 8 | 62 |
2015 Abril | 51 | 6 | 57 |
2015 Marzo | 36 | 16 | 52 |
2015 Febrero | 33 | 6 | 39 |
2015 Enero | 27 | 4 | 31 |
2014 Diciembre | 65 | 13 | 78 |
2014 Noviembre | 47 | 5 | 52 |
2014 Octubre | 56 | 5 | 61 |
2014 Septiembre | 51 | 6 | 57 |
2014 Agosto | 50 | 6 | 56 |
2014 Julio | 49 | 4 | 53 |
2014 Junio | 53 | 5 | 58 |
2014 Mayo | 43 | 1 | 44 |
2014 Abril | 48 | 4 | 52 |
2014 Marzo | 86 | 11 | 97 |
2014 Febrero | 94 | 12 | 106 |
2014 Enero | 77 | 4 | 81 |
2013 Diciembre | 95 | 10 | 105 |
2013 Noviembre | 89 | 8 | 97 |
2013 Octubre | 80 | 7 | 87 |
2013 Septiembre | 79 | 7 | 86 |
2013 Agosto | 86 | 9 | 95 |
2013 Julio | 99 | 14 | 113 |
2013 Junio | 50 | 3 | 53 |
2013 Mayo | 49 | 4 | 53 |
2013 Abril | 41 | 14 | 55 |
2013 Marzo | 37 | 10 | 47 |
2013 Febrero | 12 | 7 | 19 |
2013 Enero | 11 | 4 | 15 |
2012 Diciembre | 7 | 3 | 10 |
2012 Noviembre | 1 | 2 | 3 |
2012 Octubre | 2 | 3 | 5 |
2012 Septiembre | 2 | 1 | 3 |
2011 Enero | 807 | 0 | 807 |