[Valve repair for chronic mitral regurgitation]. / Reparación valvular en la insuficiencia mitral crónica.

Valve repair is the best surgical treatment for mitral regurgitation. In the present article we describe the results of mitral valve repair in patients with chronic mitral regurgitation treated at our center during the last eight years. The degree of correction of valve insufficiency, functional benefit, in-hospital morbidity and mortality, postoperative outcome of ventricular function, and middle-term overall and reoperation-free survival are analyzed.

Reparación valvular en la insuficiencia mitral crónica / Valve repair for chronic mitral regurgitation

La reparación valvular es el tratamiento quirúrgico ideal de la insuficiencia mitral. En este trabajo presentamos los resultados de la reparación valvular en pacientes con insuficiencia mitral crónica operados en nuestro centro durante los últimos 8 años. Analizamos el grado de corrección de la insuficiencia, el beneficio funcional, la morbimortalidad hospitalaria, la evolución posquirúrgica de la función ventricular y la supervivencia global y libre de reoperación a medio plazo

Valve repair is the best surgical treatment for mitral regurgitation. In the present article we describe the results of mitral valve repair in patients with chronic mitral regurgitation treated at our center during the last eight years. The degree of correction of valve insufficiency, functional benefit, in-hospital morbidity and mortality, postoperative outcome of ventricular function, and middle-term overall and reoperation-free survival are analyzed

Aneurisma coronario gigante y enfermedad de dos vasos en un adulto joven / Giant coronary aneurysm and two-vessel disease in a young adult

Los aneurismas coronarios de gran tamaño, no ateroscleróticos y localizados en el tronco común de la arteria coronaria izquierda son excepcionales. Presentamos el caso de un paciente de 25 años, que a raíz de un evento coronario agudo fue diagnosticado de un aneurisma gigante en el tronco común izquierdo y enfermedad de 2 vasos. Discutimos el diagnóstico diferencial y postulamos como etiología más probable las secuelas de una enfermedad de Kawasaki atípica. El paciente fue sometido con éxito a una revascularización arterial completa del ventrículo izquierdo asociada a ligadura de la circunfleja proximal

Giant, non atherosclerotic aneurysms of the left main coronary artery are exceptional. We report the case of a 25-year-old patient who was diagnosed of a giant aneurysm of the left main coronary artery associated with two-vessel disease after the onset of an acute coronary event. Differential diagnosis is discussed and delayed sequelae of an atypical Kawasaki disease is presented as the most likely etiology. The patient underwent successful complete arterial revascularization of the left ventricle, associated with proximal circumflex coronary artery occlusion

[Surgical treatment for hypertrophic obstructive cardiomyopathy]. / Tratamiento quirúrgico de la miocardiopatía hipertrófica obstructiva.

INTRODUCTION AND OBJECTIVES: Five percent of the patients with hypertrophic obstructive cardiomyopathy (HOCM) have symptoms unresponsive to medical treatment and are candidates for invasive therapy. The objective of this study was to analyze our results with surgical treatment of HOCM during the last 10 years. PATIENTS AND METHOD: Between July 1993 and January 2004 26 patients with HOCM refractory to drug therapy were operated on. An extended septal myectomy was performed, in combination with anterior mitral leaflet plication in 19 cases (73%) and with mitral valve replacement in 5 (19%). Evolution of the grade of dyspnea, left ventricle outflow tract gradient (LVOTG), mitral regurgitation, and systolic anterior motion after surgery was analyzed. RESULTS: Mean follow-up was 63 (37) months. After surgery, a significant reduction in LVOTG (from 96.5 to 19.5 mmHg; P<.001), grade of mitral regurgitation (from 2.54 to 0.69; P<.001) and systolic anterior motion (from 2.92 to 0.23; P<.001) was achieved, which led to improvement in functional class. Hospital mortality and need for pacemaker implantation due to complete heart block after surgery was 3.8% (n=1). There were no cases of iatrogenic ventricular septal defect or mitro-aortic valve injury. Actuarial survival at 5 years was 96% (4%). CONCLUSIONS: Surgery in patients with HOCM yields great clinical improvements with low morbidity and mortality. Simultaneous intervention for both myocardial and valvular components of the disease allows not only reduction in the LVOTG but also correction of mitral regurgitation and abolition of systolic anterior motion.

[Right atrial pheochromocytoma]. / Feocromocitoma de aurícula derecha.

Pheochromocytoma is a catecholamine-producing tumor and a rare cause of hypertension. Most cases are intra-adrenal and intrapericardial pheochromocytomas are extremely uncommon. We report the case of a 46-year-old woman with a 1-year history of hypertension, in which a right atrial pheochromocytoma was detected after a hypertensive crisis. 131I-metaiodobenzylguanidine scintigraphy and magnetic resonance imaging established the diagnosis. The tumor was successfully resected using cardiopulmonary bypass and the right atrium was reconstructed using bovine pericardium.

Feocromocitoma de aurícula derecha / Right Atrial Pheochromocytoma

El feocromocitoma es un tumor productor de catecolaminas y una causa infrecuente de hipertensión arterial. La mayoría están localizados en la glándula suprarrenal, siendo la localización intrapericárdica una rareza. Describimos el caso de una paciente de 46 años, hipertensa de un año de evolución, a la que tras una crisis hipertensiva se le diagnosticó un feocromocitoma de aurícula derecha mediante gammagrafía con 131 I-metaiodobencilguanidina y resonancia magnética. El tumor fue resecado con éxito mediante circulación extracorpórea y la pared auricular, reconstruida con un parche de pericardio bovino (AU)

Edge-to-Edge tricuspid repair for redeveloped valve incompetence after DeVega's annuloplasty.

"Edge-to-edge" technique is a well-accepted procedure with excellent results for correction of mitral insufficiency. We describe a simple edge-to-edge combined with bicuspidalization repair method that was successfully applied in 2 patients for the treatment of redeveloped functional tricuspid regurgitation after previous annuloplasty. Significant improvement in symptoms and echocardiographic results were achieved.