Environmental scanning of cocaine trafficking in Brazil: Evidence from geospatial intelligence and natural language processing methods.

Cocaine trafficking threatens countries' national security and is a major public health challenge. Cocaine is transported from producer countries to consumer markets using various routes, methods, and transportation means. These routes develop in the geographical environment, are carefully planned and are geo-strategic objects that respond to the opportunities that drug trafficking organisations (DTOs) find to reduce the risks of interdiction. In this sense, individual drug seizure data (IDS) become essential indicators for identifying trends and understanding trafficking flows associated with drug trafficking routes. However, due to the illicit nature of DTOs, the availability of these data is considerably limited, hindering the ability to analyse and identify trends. This study presents a methodology for collecting and processing data from open-source information reported by Brazil's federal government news website. Using geospatial intelligence and natural language processing methods, we created a dataset with 939 records and 44 variables related to cocaine seizures in Brazil in 2022. We applied geospatial analysis techniques from this dataset to identify trends and potential cocaine trafficking flows. The results were broadly consistent with existing literature on drug trafficking. They demonstrated the potential of open-source information for environmental scanning and knowledge generation through geographic information science. The approach proposed in our research provides tools that can be used to complement drug trafficking monitoring and formulate public policies to strengthen prevention and enforcement strategies.

Aortic valve reimplantation in patients with connective tissue syndromes: A 15-year follow-up.

OBJECTIVES: The goal of this study was to analyse early- and long-term outcomes of aortic valve reimplantation (David operation) in patients with heritable thoracic aortic disease. METHODS: This is a retrospective observational analysis using data from a prospectively maintained surgical database from March 2004 to April 2021. Patients with heritable thoracic aortic disease were included in the study. RESULTS: A total of 157 patients with aortic root aneurysm with the diagnosis of heritable thoracic aortic disease received the David procedure. Marfan syndrome was found in 143 (91.1%) patients, Loeys-Dietz in 13 and Ehler-Danlos in 1 patient. The median age was 35.0 (IQR: 17.5) years and the median ascending aorta diameter in the Valsalva sinuses was 48 mm (IQR: 4). A Valsalva graft was used in 8 patients; the David V technique was performed in the rest of the cases. The median follow-up time was 7.3 years [standard deviation: 0.58, 95% confidence interval (CI): 6.12-8.05]. Only 2 patients died during the follow-up period. The overall survival was 99% (95% CI: 95%; 99%); 98% (95% CI: 92%; 99%); and 98% (95% CI: 92%; 99%) at 5, 10 and 15 years. Freedom from significant aortic regurgitation (AR> II), reintervention and postoperative type-B dissection was 90% (95% CI: 77%; 95%), 96% (95% CI: 91%; 99%) and 87% (95% CI: 68%; 95%) at 15 years, respectively. No differences were found in any outcome between Marfan syndrome and Loeys-Dietz syndrome. No statistically significant differences in survival were found when we compared expected gender- and age-specific population survival values. CONCLUSIONS: The David operation is an excellent option for the treatment of patients with heritable thoracic aortic disease and dilatated aortic root. Surgical expertise in referral centres is essential to achieve the best long-term results.

Very low peroneal nerve compound muscle action potential amplitude predicts poor outcome in patients with Guillain-Barré syndrome: a prospective cohort.

INTRODUCTION: Twenty percent of patients with Guillain-Barré syndrome (GBS) have poor outcomes despite proper management. The aim of the study was to characterize electrophysiological factors related to poor outcome in patients with GBS. METHODS: We conducted an observational study from a prospective cohort of 91 patients with GBS in a tertiary healthcare center in Mexico, from 2017 to 2019. Demographics and nerve conduction studies were performed on admission, and a 3-month follow-up for GBS disability score was ensued, allocating patients in good (GBS disability score ≤ 2) and poor outcome (GBS disability score ≥ 3) groups. A logistic regression analysis for independent walk at 3 months was performed. Kaplan-Meier estimator curves for independent walk in very low (< 20% LLN) and low-normal ( ≥20% LLN) peroneal nerve CMAPs are presented. RESULTS: From the 91 GBS patients included, 37 (40.6%) did not regain independent walk at 3 months. Axonal variants were more common in the poor outcome group (31.4% vs 59.4%, p = 0.01) as well as AIDP variants with motor conduction block (6.6% vs 42.4%, p = 0.018). Univariable analysis was statistically significant for very low median, ulnar, tibial, and peroneal CMAP amplitudes in poor outcome patients; however, multivariable analysis was only significant for very low peroneal nerve CMAP amplitude (OR 3.6 [1.1-11.5, p = 0.024]). Conversely, a greater proportion of GBS patients with low-normal CMAPs recovered independent walk at 90 days (75% vs 30%, p < 0.001). CONCLUSION: Severe axonal injury of the peroneal nerve, axonal, and AIDP with motor conduction block variants predicts worse functional outcome regarding independent walk at 3 months.

Reconstrucción compleja de gran defecto de pared torácica derecha tras resección de tumor desmoide. A propósito de un caso / Complex reconstruction of a large right chest wall defect after desmoid tumor resection. Case report

El tumor desmoide es una forma infrecuente de fibromatosis de origen musculoaponeurótico extremadamente raro. En su mayoría, se localiza en abdomen y es muy raro en pared torácica. Dada su incapacidad para metastatizar se ha considerado benigno, sin embargo, su crecimiento local rápido y agresivo hace que el tratamiento quirúrgico sea igualmente agresivo y completo.Presentamos un caso de tumor desmoide de pared torácica intervenido en paciente de 40 años, de 1 año de evolución y crecimiento rápido y agresivo con deformidad de pared torácica.Realizamos exéresis del tumor y de 5 arcos costales parcialmente, más reconstrucción con material protésico y colgajo dermograso.La resolución quirúrgica de este tipo de tumores en etapas avanzadas requiere participación interdisciplinaria. (AU)

Desmoid tumor is an uncommon form of fibromatosis of extremely rare musculoaponeurotic origin. Most are located in the abdomen, and its location in the chest wall is very rare. Due to its inability to produce metastases it has been considered benign, however, its rapid and aggressive local growth makes the surgical treatment equally aggressive and complete.We present a case of a thoracic wall desmoid tumor in a 40-year-old patient, one year evolution, with rapid and aggressive growth which deforms the anatomy of the thoracic wall.Excision of the tumor and 5 partially costal arches were performed, with subsequent thoracic reconstruction with prosthetic material and dermo-fat flap.Desmoid tumors, in advanced stages, requires multidisciplinary participation. (AU)

Electrophysiological subtypes and associated prognosis factors of Mexican adults diagnosed with Guillain-Barré syndrome, a single center experience.

BACKGROUND: The clinical characteristics of electrophysiological subtypes and prognostic factors of Mexican adults diagnosed with Guillain-Barré Syndrome (GBS) have not been described. MATERIALS AND METHODS: A single center, ambispective, cohort study was performed (2015-2019). GBS was defined following the Asbury and Cornblath criteria. Electrodiagnosis was made according to Hadden criteria. Clinical, biochemical and electrodiagnostic parameters were described, compared and analyzed using a multivariate model. Only patients who completed a 3-month follow-up were included. RESULTS: 137 GBS patients (92 males; mean age 46.6 ± 16.6).132 (96.3%) underwent an electrodiagnostic assessment.68 (51.5%) were classified as axonal GBS, with further classified into two groups: acute motor axonal neuropathy (AMAN) 45.4%, and acute motor and sensory axonal neuropathy (AMSAN) 8,6%. The following characteristics were lower in the AMAN group: Medical Research Counsel sumscore (MRC) 30.1 ± 16.3 vs 36.4 ± 14.4, unilateral facial palsy 10% vs 25.9% and albuminocytologic dissociation 41.3% vs. 71.7%.Multivariate analysis found AMAN as an independent predictor of an unfavorable outcome OR: 3.34 (p = 0.03) CONCLUSIONS: AMAN subtype is the most frequent presentation of GBS in Mexican adult patients and an independent predictor of inability to walk independently at 3 months after discharge.

The influence of Marfans and bicuspid valves on outcomes following aortic valve reimplantation.

BACKGROUND: We analyzed our early and midterm results with aortic valve reimplantation surgery to determine the influence of Marfan syndrome and bicuspid valves on outcomes with this technique. METHODS: Between March 2004 and December 2015, 267 patients underwent aortic valve reimplantation operations. The mean diameter of the sinuses of Valsalva was 50 ± 3 mm and moderate/severe aortic regurgitation was present in 34.4% of these patients. A bicuspid aortic valve was present in 21% and 40% had Marfan syndrome. RESULTS: Overall 30-day mortality was 0.37% (1/267). Mean follow-up was 59.7 ± 38.7 months. Overall survival at 1, 3, and 5 years was 98 ± 8%, 98 ± 1%, and 94 ± 2%, respectively. Freedom from reoperation and aortic regurgitation >II was 99 ± 5%, 98 ± 8%, 96.7 ± 8%, and 99 ± 6%, 98 ± 1%, 98 ± 1%, respectively at 1, 3, and 5 years follow-up, with no differences between Marfan and bicuspid aortic valve groups. (p = 0.94 and p = 0.96, respectively). No endocarditis or thromboembolic complications were documented, and 93.6% of the patients did not receive any anticoagulation therapy. CONCLUSIONS: The reimplantation technique for aortic root aneurysms is associated with excellent clinical and functional outcomes at short and mid-term follow-up.

Efficacy of losartan vs. atenolol for the prevention of aortic dilation in Marfan syndrome: a randomized clinical trial.

AIMS: To determine the efficacy of losartan vs. atenolol in aortic dilation progression in Marfan syndrome (MFS) patients. METHODS AND RESULTS: A phase IIIb, randomized, parallel, double-blind study was conducted in 140 MFS patients, age range: 5-60 years, with maximum aortic diameter <45 mm who received losartan (n = 70) or atenolol (n = 70). Doses were raised to a maximum of 1.4 mg/kg/day or 100 mg/day. The primary end-point was the change in aortic root and ascending aorta maximum diameter indexed by body surface area on magnetic resonance imaging after 36 months of treatment. No serious drug-related adverse effects were observed. Five patients presented aortic events during a follow-up (one in the losartan and four in the atenolol groups, P = 0.366). After 3 years of follow-up, aortic root diameter increased significantly in both groups: 1.1 mm (95% CI 0.6-1.6) in the losartan and 1.4 mm (95% CI 0.9-1.9) in the atenolol group, with aortic dilatation progression being similar in both groups: absolute difference between losartan and atenolol -0.3 mm (95% CI -1.1 to 0.4, P = 0.382) and indexed by BSA -0.5 mm/m2 (95% CI -1.2 to 0.1, P = 0.092). Similarly, no significant differences were found in indexed ascending aorta diameter changes between the losartan and atenolol groups: -0.3 mm/m2 (95% CI -0.8 to 0.3, P = 0.326). CONCLUSION: Among patients with MFS, the use of losartan compared with atenolol did not result in significant differences in the progression of aortic root and ascending aorta diameters over 3 years of follow-up.

Outcomes in aortic and mitral valve replacement with intervalvular fibrous body reconstruction.

BACKGROUND: Surgery for intervalvular fibrous body reconstruction in aortic and mitral valve replacement is a complex operation, although mandatory in some circumstances. The long-term result of this operation remains unknown. The objective of this study was to analyze the outcomes of this technique. METHODS: A descriptive and retrospective study was carried out to analyze operative morbidity and mortality in fibrous body reconstruction with the "David technique" and to evaluate the midterm and long-term results regarding durability and survival. RESULTS: A total of 40 consecutive patients underwent the David technique between 1997 and 2014. The mean age was 58 ± 15 years and 62.5% were male. The indications were active endocarditis with paravalvular and fibrous body abscesses in 26 patients (group A) and massive calcification of the intervalvular fibrous body in 14 patients (group B). Mean European system for cardiac operative risk evaluation I predicted risk of mortality was 36 ± 24 and 16 ± 15, respectively. The hospital mortality rate was 15.3% in group A and 7.1% in group B. Survival rate after 1, 5, and 10 years was 65.4%, 57.7%, and 50% for group A and 92.9%, 85.7%, and 78.6% for group B. Freedom from reoperation at 1, 5, and 10 years was 92.3%, 84.6%, and 76.9% for group A and 90.9%, 90.9%, and 90.9% for group B. Mean follow-up was 53 ± 8 months. CONCLUSIONS: Although this complex operation is associated with high perioperative mortality, the long-term results are acceptable in patients where there are not suitable alternative procedures.

Preservación de la válvula aórtica bicúspide asociada a aneurismas de la raíz de aorta y aorta ascendente / Preservation of the bicuspid aortic valve associated with aneurysms of the aortic root and ascending aorta

Introducción y objetivos. Cuando la válvula aórtica bicúspide se asocia a dilatación de la aorta, la reparación quirúrgica precisa actuar sobre todos los componentes de la raíz de aorta. Revisamos nuestra experiencia en esta cirugía. Métodos. Se realizó un estudio observacional descriptivo y retrospectivo con el objetivo de analizar la morbilidad y la mortalidad de estas técnicas y valorar la durabilidad a medio plazo de la válvula aórtica. Se incluyó a todos los pacientes con válvula aórtica bicúspide y dilatación de la aorta intervenidos en nuestro centro entre 1999 y 2011 con alguna técnica de preservación valvular. Resultados. Se intervino a 151 pacientes. En 51 se empleó alguna técnica de preservación valvular. La media de edad era 51 ± 12 años y el 92% eran varones. En el 69% la insuficiencia aórtica era menor de grado II y los velos aórticos presentaban poca degeneración estructural. En 32 pacientes se realizó reimplante valvular. No hubo mortalidad hospitalaria. Con una mediana de seguimiento de 36 [intervalo intercuartílico, 18-45] meses, ningún paciente ha fallecido o ha requerido reintervención y todos los pacientes están libres de insuficiencia aórtica mayor de grado II . Conclusiones. La cirugía de preservación de la válvula aórtica bicúspide asociada a dilatación de la aorta muestra unos resultados a corto y medio plazo excelentes en válvulas seleccionadas. La estabilización de todos los componentes de la raíz de aorta mejora la durabilidad de la válvula, y las técnicas propuestas se muestran reproducibles y estables a medio plazo (AU)

Introduction and objectives: When the bicuspid aortic valve is associated with dilatation of the aorta, surgical repair requires correction of all the components of the aortic root. Here, we review our experience in this type of surgery. Methods: A descriptive and retrospective observational study was carried out to analyze morbidity and mortality in valve-sparing techniques and evaluate the medium-term durability of the aortic valve. We included all patients with a bicuspid aortic valve and dilatation of the aorta who underwent surgery with a valve-sparing technique in our center between 1999 and 2011. Results: A total of 151 patients underwent surgery. A valve-sparing technique was used in 51 patients. The mean (standard deviation) age of the patients was 51 (12) years and 92% were men. In 69% of the patients, aortic insufficiency was less than grade II and the aortic cusps showed little structural degeneration. Valve reimplantation was performed in 32 patients. There was no hospital mortality. With a median follow-up of 36 months (interquartile range, 18-45 months), none of the patients died or required reoperation, and all patients were free of aortic insufficiency greater than grade II. Conclusions: Valve-preserving surgery in bicuspid aortic valves associated with dilatation of the aorta shows excellent short- and medium-term results in selected valves. The stabilization of all of the components of the aortic root improves the durability of the valve, and the techniques proposed are reproducible and stable in the medium-term (AU)

Should aortic valve reimplantation be offered to patients with a large aorto-ventricular junction?

OBJECTIVES: Large aortic root aneurysms might increase leaflet stress and compromise aortic valve durability after the reimplantation technique. We analysed the impact of the preoperative aorto-ventricular junction (AVJ) diameter on the durability of the valve. METHODS: Between March 2004 and January 2012, 150 patients underwent the David operation on the aortic root. We identified 47 patients with a preoperative AVJ >28 mm (Group A) and 103 patients with a diameter ≤ 28 mm (Group B). The mean follow-up was 44 ± 27 months. Both groups were compared regarding mortality, freedom from moderate or severe aortic valve regurgitation and freedom from reoperation. RESULTS: Early mortality was 1.3%. Actuarial survival at 1, 3 and 5 years was 97 ± 2, 94 ± 3 and 94 ± 3% for Group A, and 99 ± 1, 97 ± 1 and 94 ± 3% for Group B, respectively (P = 0.3). Two patients in Group B were reoperated for severe aortic regurgitation (AR). Actuarial freedom from reoperation at 1, 3 and 5 years was 100% for Group A, and 98 ± 1, 98 ± 1 and 96 ± 2% for Group B, respectively (P = 0.3). During the follow-up, 6 patients (3 in each group) developed AR ≥ Grade II. Therefore, actuarial freedom from AR grade II or greater at 1.3 and 5 years was 97 ± 2, 94 ± 4 and 87 ± 7% for Group A, and 99 ± 1, 97 ± 1 and 95 ± 2% for Group B (P = 0.3). CONCLUSIONS: The reimplantation technique shows excellent results. Medium-term stability of the aortic valve repair was not influenced by the preoperative aorto-ventricular junction diameter.

Preservation of the bicuspid aortic valve associated with aneurysms of the aortic root and ascending aorta.

INTRODUCTION AND OBJECTIVES: When the bicuspid aortic valve is associated with dilatation of the aorta, surgical repair requires correction of all the components of the aortic root. Here, we review our experience in this type of surgery. METHODS: A descriptive and retrospective observational study was carried out to analyze morbidity and mortality in valve-sparing techniques and evaluate the medium-term durability of the aortic valve. We included all patients with a bicuspid aortic valve and dilatation of the aorta who underwent surgery with a valve-sparing technique in our center between 1999 and 2011. RESULTS: A total of 151 patients underwent surgery. A valve-sparing technique was used in 51 patients. The mean (standard deviation) age of the patients was 51 (12) years and 92% were men. In 69% of the patients, aortic insufficiency was less than grade II and the aortic cusps showed little structural degeneration. Valve reimplantation was performed in 32 patients. There was no hospital mortality. With a median follow-up of 36 months (interquartile range, 18-45 months), none of the patients died or required reoperation, and all patients were free of aortic insufficiency greater than grade II. CONCLUSIONS: Valve-preserving surgery in bicuspid aortic valves associated with dilatation of the aorta shows excellent short- and medium-term results in selected valves. The stabilization of all of the components of the aortic root improves the durability of the valve, and the techniques proposed are reproducible and stable in the medium-term.

Cirugía de preservación valvular en 120 pacientes con aneurismas de la raíz aórtica / Aortic valve sparing in 120 patients with aortic root aneurysms

Introducción y objetivos. Existen varias técnicas para tratar de preservar la válvula aórtica en los aneurismas de la raíz aórtica. Presentamos nuestra experiencia con la técnica del reimplante valvular aórtico en 120 pacientes. Métodos. Desde marzo de 2004 hasta octubre de 2010, se ha realizado la técnica de David en 120 pacientes con aneurismas de la raíz de aorta; 51 tenían síndrome de Marfan, con una media de edad de 31±12 años. El diámetro aórtico medio a nivel de los senos de Valsalva fue de 51±5mm y el 16% tenía una insuficiencia aórtica moderada/severa. En los 69 pacientes restantes, la media de edad era 56±14 años, el diámetro aórtico medio, 53±7mm y el 66% tenía una insuficiencia aórtica moderada/severa. En 14 pacientes la válvula aórtica era bicúspide. Resultados. La mortalidad hospitalaria fue del 1,7%. Con un seguimiento medio de 37±21 meses, la supervivencia a los 5 años es del 94±3%, y el 96% presenta insuficiencia aórtica de grado ≤ II (el 87% de los pacientes con insuficiencia aórtica ausente o de grado I). Un paciente ha sido reoperado por presentar insuficiencia aórtica severa. No ha habido endocarditis o eventos cerebrovasculares, y el 96% está libre de tratamiento anticoagulante. Conclusiones. La técnica de reimplante de la válvula aórtica ofrece unos resultados excelentes. Elimina las complicaciones asociadas a las prótesis valvulares, por lo que debe considerarse el tratamiento de elección para los aneurismas de la raíz de aorta en pacientes jóvenes (AU)

Introduction and objectives. Several aortic valve sparing techniques have been described for the treatment of aortic root aneurysms. We report our experience using the reimplantation technique in 120 patients. Methods. Between March 2004 and October 2010, 120 patients with aortic root aneurysms underwent David operations. Of these, 51 were diagnosed with Marfan syndrome. Mean patient age was 31±12 years. The mean diameter of the sinuses of Valsalva was 51±5mm and moderate/severe aortic regurgitation was present in 16% of these patients. In the other 69 patients mean age was 56±14 years, the mean diameter of the sinuses of Valsalva was 53±7mm and moderate/severe aortic regurgitation was present in 66%. A bicuspid aortic valve was presented in 14 cases. Results. Hospital mortality was 1.7%. Mean follow-up was 37±21 months; 94% of the patients survived and 96% had an aortic regurgitation below grade II during 5 years of follow-up. One patient required re-operation because of severe aortic regurgitation. No endocarditis or thromboembolic complications have been documented, and 96% of the patients did not receive any anticoagulation therapy. Conclusions. Short- and mid-term results with the reimplantation technique for aortic root aneurysms are excellent. This technique prevents the need for chronic anticoagulation treatment as well as the complications arising from mechanical prostheses, and it should be the treatment of choice for young patients (AU)

Valoración de la eficacia y la seguridad del losartán frente al atenolol en la prevención de la dilatación de la aorta en el síndrome de Marfan / Study of the efficacy and safety of losartan versus atenolol for aortic dilation in patients with marfan syndrome

Introducción y objetivos. El síndrome de Marfan es una enfermedad hereditaria que afecta al tejido conectivo. Estudios experimentales recientes indican que la utilización de losartán en pacientes con síndrome de Marfan podría prevenir la progresión de la enfermedad. En el presente artículo se describen el diseño y los principales objetivos de un ensayo clínico para evaluar la eficacia y la seguridad del losartán frente al atenolol en la prevención de la dilatación de la aorta en pacientes con este síndrome. Métodos. Se trata de un ensayo clínico en fase IIIb y coordinado en dos centros. Se incluirá a 150 pacientes diagnosticados de síndrome de Marfan según los criterios de Gante, con edades comprendidas entre 5 y 60 años. El estudio será aleatorizado y a doble ciego en grupos paralelos en tratamiento con la misma dosis de atenolol o losartán (50 mg al día en pacientes con menos de 50 kg y 100 mg al día en pacientes con más de 50kg). Se valorarán el tamaño y la distensibilidad de la aorta mediante ecocardiografía y resonancia magnética. El seguimiento será de 3 años. Conclusiones. Este ensayo clínico permitirá evaluar la eficacia del losartán frente al atenolol en la prevención de la dilatación de la aorta y en la mejora de su distensibilidad, así como la incidencia de eventos adversos. También aportará información sobre el beneficio terapéutico en relación con la edad y la dilatación basal de la aorta (AU)

Introduction and objectives. Marfan syndrome is an inherited disease of the connective tissue. Aortic rupture and dissection are the main causes of mortality in these patients. Recent trials have indicated the use of losartan (a transforming growth factor beta inhibitor) in these patients prevents aortic root enlargement. The aim of our clinical trial is to assess the efficacy and safety of losartan versus atenolol in the prevention of progressive dilation of the aorta in patients with Marfan syndrome. Methods. This is a phase III clinical trial conducted in two institutions. A total of 150 subjects diagnosed with Marfan syndrome, aged between 5 and 60 years, of both sexes, and who meet the Ghent diagnostic criteria will be included in the study, with 75 patients per treatment group. It will be a randomized, double blind trial with parallel assignment to atenolol versus losartan (50mg per day in patients below 50kg and 100mg per day in patients over 50kg). Both growth and distensibility of the aorta will be assessed with echocardiography and magnetic resonance. Follow-up will be 3 years. Conclusions. Efficacy of losartan versus atenolol in the prevention of progressive dilation of the aorta, improved aortic distensibility, and prevention of adverse events (aortic dissection or rupture, cardiovascular surgery, or death) will be assessed in this study. It will also show the possible treatment benefits at different age ranges and with relation to the initial level of aortic root dilation (AU)

[Study of the efficacy and safety of losartan versus atenolol for aortic dilation in patients with Marfan syndrome]. / Valoración de la eficacia y la seguridad del losartán frente al atenolol en la prevención de la dilatación de la aorta en el síndrome de Marfan.

INTRODUCTION AND OBJECTIVES: Marfan syndrome is an inherited disease of the connective tissue. Recent trials have indicated the use of losartan (a transforming growth factor beta inhibitor) in these patients prevents aortic root enlargement. The aim of our clinical trial is to assess the efficacy and safety of losartan versus atenolol in the prevention of progressive dilation of the aorta in patients with Marfan syndrome. METHODS: This is a phase III clinical trial conducted in two institutions. A total of 150 subjects diagnosed with Marfan syndrome, aged between 5 and 60 years, of both sexes, and who meet the Ghent diagnostic criteria will be included in the study, with 75 patients per treatment group. It will be a randomized, double blind trial with parallel assignment to atenolol versus losartan (50 mg per day in patients below 50 kg and 100 mg per day in patients over 50 kg). Both growth and distensibility of the aorta will be assessed with echocardiography and magnetic resonance. Follow-up will be 3 years. CONCLUSIONS: Efficacy of losartan versus atenolol in the prevention of progressive dilation of the aorta, improved aortic distensibility, and prevention of adverse events (aortic dissection or rupture, cardiovascular surgery, or death) will be assessed in this study. It will also show the possible treatment benefits at different age ranges and with relation to the initial level of aortic root dilation.

[Aortic valve sparing in 120 patients with aortic root aneurysms]. / Cirugía de preservación valvular en 120 pacientes con aneurismas de la raíz aórtica.

INTRODUCTION AND OBJECTIVES: Several aortic valve sparing techniques have been described for the treatment of aortic root aneurysms. We report our experience using the reimplantation technique in 120 patients. METHODS: Between March 2004 and October 2010, 120 patients with aortic root aneurysms underwent David operations. Of these, 51 were diagnosed with Marfan syndrome. Mean patient age was 31 ± 12 years. The mean diameter of the sinuses of Valsalva was 51 ± 5 mm and moderate/severe aortic regurgitation was present in 16% of these patients. In the other 69 patients mean age was 56 ± 14 years, the mean diameter of the sinuses of Valsalva was 53 ± 7 mm and moderate/severe aortic regurgitation was present in 66%. A bicuspid aortic valve was presented in 14 cases. RESULTS: Hospital mortality was 1.7%. Mean follow-up was 37 ± 21 months; 94% of the patients survived and 96% had an aortic regurgitation below grade II during 5 years of follow-up. One patient required re-operation because of severe aortic regurgitation. No endocarditis or thromboembolic complications have been documented, and 96% of the patients did not receive any anticoagulation therapy. CONCLUSIONS: Short- and mid-term results with the reimplantation technique for aortic root aneurysms are excellent. This technique prevents the need for chronic anticoagulation treatment as well as the complications arising from mechanical prostheses, and it should be the treatment of choice for young patients.

A modified David technique in endocarditis with multiple paravalvular abscesses.

A case is reported of infective endocarditis with extension into the annulus, presence of paravalvular abscesses, and fibrous body destruction. Treatment of this high-risk condition and eradication of infection represents a major surgical challenge. This 31-year-old patient was diagnosed with acute native aortic valve endocarditis caused by Staphylococcus aureus. He presented multiple paravalvular abscesses, left ventricular outflow destruction and fibrous body infection. Reconstruction of the intervalvular fibrous body was carried out with a single folded pericardial patch to simplify closure of the left atrium roof. In addition, the aortic root was reconstructed by the insertion of a composite graft attached to a semi-circumferential left ventricular outflow patch. The postoperative course was favorable, and transthoracic echocardiography after six months showed normal prosthesis function. In this type of situation, the extensive debridement of all infected tissues is mandatory, while surgery to eradicate the infection and restore functionality of the structures presents a formidable challenge.

Aortic valve-sparing in 37 patients with Marfan syndrome: midterm results with David operation.

BACKGROUND: We reviewed our experience with aortic valve-sparing operations in Marfan syndrome during last 5 years. METHODS: Between March 2004 and June 2009, 94 patients with aortic root aneurysms underwent valve-sparing operations. Of these, 37 (68% male) were diagnosed with Marfan syndrome, according to the Ghent diagnostic criteria. Mean age was 30 +/- 10 years (range, 11 to 59 years). Moderate/severe aortic regurgitation was present in 13%, and the mean diameter of the Valsalva sinuses was 50 +/- 4 mm (range, 42 to 62 mm). The David V modification was performed in the last 28 patients. Additional procedures were mitral valve repair in 6, tricuspid valve repair in 3, closure of septal atrial defect in 2, and closure of a patent foramen ovale in 13. Mean follow-up was 27 +/- 16 months (range, 1 to 61 months). RESULTS: There were no in-hospital deaths and no major adverse outcomes. One patient required implantation of a mechanical prosthesis during the same procedure because of moderate aortic regurgitation. One late death occurred. No patients required reoperation. In the last follow-up, 23 patients did not have aortic regurgitation, 12 had grade I, and 1 had grade II. No thromboembolic complications have been documented, and 97% of the patients are free from anticoagulation. CONCLUSIONS: Short-term and midterm results with the reimplantation technique for aortic root aneurysms in Marfan patients are excellent. If long-term results are similar, this technique could be the treatment of choice for these patients.

Calcificación caseosa del anillo mitral: papel de la cardiorresonancia / No disponible

No disponible

Acute type A aortic dissection: 18 years of experience in one center (Hospital 12 de Octubre).

Here, we review our experience in acute type A aortic dissection analyzing the role of antegrade brain protection. A total of 105 patients underwent surgery for acute type A aortic dissection between March 1990 and October 2008. An open technique with deep hypothermia was used in 81 patients. Deep hypothermia alone was induced in 32 patients; in combination with retrograde cerebral perfusion in 26 patients and in combination with antegrade cerebral perfusion (ACP) in the final 23 patients. The overall hospital mortality rate was 15%. Hospital mortality risk factors were age >or=70 years and preoperative shock (P<0.05). Hospital mortality was reduced to 9% in the last 23 consecutive patients in whom ACP was accomplished (P=0.05). Survival rate after 1, 5, 10 and 15 years of follow-up was 97.6+/-1.7%, 84.3+/-4.4%, 60.7+/-7.5% and 57.1+/-7.8%, respectively. The only late death risk predictor was the non-use of ACP (P<0.05). Surgery for acute aortic dissection provides excellent results. ACP via the axillary artery improves the prognosis for these patients and should be the brain protection method of choice.