Successful surgery of neuroendocrine carcinoma infiltrating right ventricle and pulmonary artery.

We present the clinical case of a 60-year-old woman complained of dyspnea on exertion. Echocardiogram showed a giant mass in the right ventricle (RV) with obstruction to the outflow tract. Thorax computed tomography confirmed a mass of greater than 60 mm infiltrating RV and causing severe stenosis in the pulmonary artery, with severe pericardial effusion. Cardiac surgery was performed for tumor resection and pulmonary root replacement with a biological valved conduit. Histological analysis diagnosed a poorly differentiated large-cell neuroendocrine carcinoma. The patient had no immediate postoperative complications and has completed radiotherapy at a 9-month follow-up.

[Long-term clinical and angiographic follow-up of drug-eluting stents in patients with ST-elevation acute myocardial infarction]. / Resultados clínicos y angiográficos tardíos de stents liberadores de fármacos en pacientes con infarto agudo de miocardio con elevación del ST.

INTRODUCTION AND OBJECTIVES: Drug-eluting stents (DES) have proven to be effective in reducing the rate of restenosis and have, therefore, been incorporated into the treatment of patients with ST-elevation acute myocardial infarction (STEMI). The aim of this study was to investigate long-term clinical and angiographic outcomes following the use of DESs in patients with STEMI. METHODS: A prospective study involving clinical and angiographic follow-up was performed in 81 patients with STEMI who underwent percutaneous coronary intervention including DES implantation. This group was compared with 82 patients with similar characteristics who were treated with bare-metal stents (BMS) in an earlier period. RESULTS: At one year, there was no significant difference between the groups in the mortality (2.5% in the DES group vs 7.3% in the BMS group; P=.15) or reinfarction rate (4.8% in the DES group vs. 4.8% in the BMS group; P=.98). The target lesion revascularization rate was significantly lower in the DES group (8.6% vs 23.2% in the BMS group; P=.001), as was the restenosis rate (13.8% vs. 30.9% in the BMS group; P=.02). Acute or subacute stent thrombosis was diagnosed in five patients (3 with a DES and 2 with a BMS; P=.64), and one late stent thrombosis was detected after a year, in a sirolimus-eluting stent. CONCLUSIONS: Implantation of a DES in patients with STEMI did not result in a reduction in either the mortality or reinfarction rate at 1 year compared with BMS implantation. However, there were reductions in the rates of restenosis and target lesion revascularization. The incidence of thrombosis was similar with the two types of stent.

[Prognostic value of discharge hemoglobin level in patients hospitalized for acute heart failure]. / Valor pronóstico de las cifras de hemoglobina en el momento del alta en pacientes hospitalizados por insuficiencia cardiaca.

INTRODUCTION AND OBJECTIVES: Recent studies show that the prevalence of anemia in patients with heart failure is high and indicate that its presence leads to increased mortality and morbidity. Our aims were to determine the prevalence of anemia in patients hospitalized for heart failure and to study the long-term prognostic significance of anemia by evaluating its relationship with mortality (total and due to heart failure) and readmission for heart failure. METHODS: The study included 242 consecutive patients admitted to our cardiology department and discharged with a diagnosis of congestive heart failure. The Kaplan-Meier technique and Cox regression modeling were used to determine whether anemia is an independent predictor of death or readmission for heart failure. Anemia was defined as a hemoglobin level <12 g/dL. The mean follow-up period was 23.5 (10.9) months. RESULTS: Overall, 79 patients (32.6%) were anemic. During follow-up, 77 died (53 due to heart disease) and 117 were readmitted for heart failure. Multivariate analysis showed that anemia was an independent predictor of death (hazard ratio [HR]=1.85, 95% confidence interval [CI], 1.12-3.06), death due to heart disease (HR=1.88, 95% CI, 1.03-3.45), and readmission for heart failure (HR=1.87, 95% CI, 1.28-2.74). CONCLUSIONS: The prevalence of anemia was high in patients hospitalized for heart failure. Moreover, a discharge hemoglobin level less than 12 g/dL was a predictor of all-cause death, cardiac death, and readmission for heart failure.