Risk scores' performance and their impact on operative decision-making in left-sided endocarditis: a cohort study.

The accuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A single-center retrospective review of adult patients diagnosed with acute left-sided IE undergoing surgery from May 2014 to August 2019 (n = 142) was done. Individualized risk calculation was obtained according to the available mortality risk scores: EuroScore I and II, PALSUSE, Risk-E, Costa, De Feo-Cotrufo, AEPEI, STS-risk, STS-IE, APORTEI, and ICE-PCS scores. A cross-validation analysis was performed on the score with the best area under the curve (AUC). The 30-day survival was 96.5% (95%CI 91-98%). The score with worse area under the curve (AUC = 0.6) was the STS-IE score, while the higher was for the RISK-E score (AUC = 0.89). The AUC of the majority of risk scores suggested acceptable performance; however, statistically significant differences in expected versus observed mortalities were common. The cross-validation analysis showed that a large number of survivors (> 75%) would not have been operated if arbitrary high-risk threshold estimates had been used to deny surgery. The observed mortality in our cohort is significantly lower than is predicted by contemporary risk scores. Despite the reasonable numeric performance of the analyzed scores, their utility in judging the operability of a given patient remains questionable, as demonstrated in the cross-validation analysis. Future guidelines may advise that denial of surgery should only follow a highly experienced Endocarditis Team evaluation.

Delayed sternal closure for life-threatening complications in cardiac operations: an update.

Over a 7-year-period, 25 patients had delayed sternal closure after open heart operations out of 34 patients whose sternum was not closed. The indications were extreme cardiac dilatation and uncontrollable mediastinal hemorrhage. This represented a 1.79% incidence in the overall open heart surgical experience at our unit. Sternal closure was performed at a mean of 2.64 days after the initial operation. Eighteen patients (52.9%) left the hospital alive and well, representing a 72% survival rate among patients undergoing delayed sternal closure. No mediastinal or fatal infection developed and only 1 patient had late superficial wound infection after delayed sternal closure. We conclude that delayed sternal closure is an effective method to treat severe complications after cardiac operations.

Cardiac hemangioma with papillary endothelial hyperplasia: report of a resected case and review of the literature.

A case of left atrial hemangioma with papillary endothelial hyperplasia in a 42-year-old man is reported. With the aid of cardiopulmonary bypass, the tumor was resected, and the patient is well 22 months after operation. The clinical symptoms at initial examination, operative procedure, and pathological findings are reported, and the diagnostic and therapeutic approaches to cardiac tumors are described briefly. A review of surgically treated hemangiomas is also given.

Traumatic tricuspid regurgitation.

Tricuspid valvular insufficiency caused by blunt thoracic trauma may be clinically silent and imprecise. Diagnosis is often done by cardiac catheterization and two-dimensional echocardiography (2-DE); the latter may show abnormalities of the tricuspid leaflet motion. The surgical technique for its correction is still controversial. We report here the case of an eighteen year old man who was involved in a high-speed motorcycle accident. Seven months later, due to dyspnoea and fatigue, 2D-E examination revealed cardiac enlargement and severe tricuspid regurgitation. Surgery was indicated in order to repair valve incompetence. Reinsertion of the chordae tendineae at the anterolateral papillary muscle and annuloplasty was performed and ten months postoperatively, he is in good clinical condition and 2D-E control shows a trivial residual tricuspid insufficiency.

Dysfunction of a Duromedics valve in the tricuspid position. Case report.

Tricuspid dysfunction appeared in a 47 year-old woman fifteen months after multiple valvular surgery, including aortic and tricuspid valvular replacement with Duromedics valves. At reoperation one of the leaflets of the tricuspid prosthesis was blocked with overgrown tissue from the native tricuspid annulus. The prosthesis was replaced with another Duromedics valve and the patient is doing well nineteen months later. This case, is the first report of dysfunction of a Duromedics mechanical cardiac valve inserted in the tricuspid position.

Early results with intraoperative transluminal coronary artery balloon dilatation.

We used intraoperative transluminal coronary balloon dilatation, together with coronary artery bypass grafting, to obtain complete myocardial revascularization in extensively diseased coronary arteries. Our patient population consisted of ten males and two females, with a mean age of 58 years. The left anterior descending artery was dilated in five patients, the posterior descending artery was dilated in three, the obtuse marginal artery in two, the left circumflex artery in one, and the right coronary artery in one. Additionally, a mean of 2.81 grafts per patient were placed. Hospital mortality was one patient (8.33%). There was also one case of perioperative myocardial infarction. Postoperative angiography was done in seven patients: five were shown to be improved, one had a vessel that appeared unchanged, and one had an occluded vessel. We found intraoperative transluminal coronary balloon dilatation to be a simple and efficient technique that offers potential improvement in myocardial revascularization.

Aortico-left ventricular tunnel: a case report and review of the literature.

A 5-year-old child was operated on for aortico-left ventricular tunnel (ALVT). Postoperative cardiac catheterization revealed obliteration of the aortic end of the tunnel, normalization of systemic pressure and mild residual aortic valvular insufficiency. A review of the literature carefully considers the anatomical and clinical findings from previous reports involving 27 other patients, along with suggestions for appropriate surgical management of ALVT.

[Postinfarction ventricular septal defect. Surgical approach by right ventriculotomy in 4 patients]. / Comunicación interventricular postinfarto agudo de miocardio. Abordaje quirúrgico por ventriculotomía derecha con éxito en 4 pacientes.

Ventricular septal defect secondary to myocardial infarction still have high mortality. Early and swift surgical repair is needed to obtain adequate results. Surgical exposure of defect through the infarcted left ventricle wall is the usual technique. Nevertheless right ventricular access to the interventricular septum has given excellent results on 4 of our patients. Our results are analyzed.

[Transposition of the great arteries. Its anatomical correction. Our initial experience]. / Transposición de las grandes arterias. Corrección anatómica. Experiencia inicial.

Arterial switch correction of transposition of the great arteries has been performed without mortality on 8 children, 7 neonates and one 6 years old child, at our institution. One infant and the 6 year old child has previous pulmonary artery banding and modified Blalock-Taussig shunts. The coronary cuffs were anastomosed to the neo-aorta using the "trap-door" technique described by Mee and in seven the Lecompte manoeuvre was used. Postoperative management included treatment for persistent pulmonary hypertension and left ventricular dysfunction. All patients were discharged in satisfactory condition, and continue to do so at a maximum follow-up of ten months. These results encourage us to elect the arterial switch procedure as the primary treatment of transposition of the great arteries.

[Traumatic rupture of the tricuspid valve. Its conservative surgical treatment]. / Rotura traumática de la válvula tricúspide. Tratamiento quirúrgico conservador.

Tricuspid insufficiency caused by blunt chest trauma is rare and usually unsuspected clinically, early after trauma. Cross-sectional Echocardiography and Cardiac Catheterization are essential to establish the diagnosis. Therapy applied varies from repair to valvular replacement. We describe an 18-year-old boy with traumatic tricuspid regurgitation treated by reconstruction of the attachments of the anterosuperior leaflet and annuloplasty with a Puig-Massana ring. Six month after surgery he is fully recovered, although persist a moderate degree of tricuspid insufficiency.

[Coarctation of the abdominal aorta. Surgical treatment]. / Coartación de aorta abdominal. Tratamiento quirúrgico.

Five cases of aortic abdominal coarctation are presented, 4 of them surgically treated (by-pass). A revision of the theme, specially its etiology and surgical options, is carried out.

Acute thrombotic occlusion of the suprarenal aorta: importance of early diagnosis and treatment.

Five patients with suprarenal aortic thrombosis were diagnosed and treated over the past 6 years. Attempts were made to establish aggressive medical and surgical treatment promptly. Three patients died in spite of immediate therapeutic measures. Two patients survived operation but one died 9 months later from myocardial infarction. The syndrome of high acute aortic occlusion is considered; attention is focused towards immediate diagnosis and treatment.