Mixoma intraventricular izquierdo / Left ventricular myxoma

Los tumores primarios del corazón son entidades poco frecuentes. Se reporta el caso de una mujer joven con un mixoma del ventrículo izquierdo, el cual se manifestó como enfermedad coronaria, y cuyo diagnóstico se hizo mediante ecocardiografía. Se realiza tratamiento quirúrgico por vía transeptal, con resección extensa del tumor, su pedículo, el músculo papilar al cual se encuentra adherido, y la valva anterior de la válvula mitral por encontrarse ésta deformada por la presencia misma de la tumoración. Simultáneamente se realiza cambio valvular mitral. Se hace una revisión acerca de esta patología.

Primary tumors of the heart are rare entities. We report a unique case of a young woman presenting a left ventricular myxoma, which manifested itself as coronary artery disease and was diagnosed by echocardiography. Emergency surgical treatment was indicated, done through a transeptal approach with extensive resection of the tumor, its pedicle and the papilar muscle to which it was attached as well as the anterior mitral leaflet, which was thinned and deformed by the presence of the mass. Mitral valve replacement was mandatory. A complete retrospective review of the literature is presented.

[Evaluation of predisposing factors for mediastinal bleeding in myocardial revascularization surgery. Role of acetylsalicylic acid, other platelet adhesion inhibitors, and anticoagulants]. / Evaluación de factores predisponentes para el sangrado mediastinal en cirugía de revascularización miocárdica. Papel del ácido acetilsalicílico, otros antiagregantes plaquetarios, y anticoagulantes.

OBJECTIVE: To determine the main factors for perioperative mediastinal bleeding during coronary artery by-pass grafting and to establish the role of acetylsalicylic acid, other inhibitors of platelet adhesion, and anticoagulants in its occurrence. METHODS: A multivariate analysis was performed to the data obtained from 251 patients subjected to coronary artery by-pass grafting in the year 2002. RESULTS: There were no significant differences for the occurrence of perioperative bleeding induced by the preoperative administration of acetylsalicylic acid. No significant increment in the need for blood, platelet, or cryoprecipitates transfusion existed. Patients receiving non-fractionated or low molecular weight heparin had a significantly greater (p < 0.001) transoperative bleeding than patients without this drug. Administration of the other studied drugs did not increase either mediastinal bleeding or the need for blood derivatives. CONCLUSIONS: No statistical evidence was found to suspend administration of inhibitors of platelet adhesion in patients with coronary syndromes, subjected to coronary artery by-pass grafting. However, data obtained suggest the convenience of suspending administration of low molecular weight or non-fractionated heparin to patients subjected electively to coronary artery by-pass grafting.

Evaluación de factores predisponentes para el sangrado mediastinal en cirugía de revascularización miocárdica: Papel del ácido acetilsalicílico, otros antiagregantes plaquetarios, y anticoagulantes / Evaluation of Predisposing Factors for Mediastinal Bleeding in Myocardial Revascularization Surgery: Role of Acetylsalicylic Acid, Other Platelet Adhesion Inhibitors, and Anticoagulants

Propósito del trabajo: Determinar los factores predisponentes para sangrados perioperatorios en cirugía de revascularización miocárdica y establecer el papel de ácido acetilsalicílico, otros antiagregantes plaquetarios, y anticoagulantes, en la ocurrencia de estos sangrados. Método: Se realizó un análisis multivariado de 251 pacientes sometidos a cirugía de revascularización miocárdica en el año 2002. Resultados: En la administración prequirúrgica de ácido acetilsalicílico no se encontró diferencia significativa para la ocurrencia de sangrado perioperatorio importante. No existió incremento significativo en la transfusión de unidades de paquetes globulares, plaquetas, crioprecipitados. Los pacientes con administración de heparina no fraccionada y de bajo peso molecular, tuvieron un sangrado transoperatorio significativamente mayor (p < 0.001) que los pacientes sin este fármaco. El empleo del resto de los fármacos estudiados, no incrementó la cantidad de sangrado ni la administración de hemoderivados. Conclusiones: No existe evidencia estadística que justifique suspender la administración de antiagregantes plaquetarios en los pacientes con síndromes coronarios urgentes o electivos, a quienes se les someta a cirugía de revascularización miocárdica. Sin embargo, resultaría conveniente suspender la administración de heparina no fraccionada y de bajo peso molecular, a pacientes sometidos a cirugía de revascularización miocárdica en forma electiva.

Objective: To determine the main factors for perioperative mediastinal bleeding during coronary artery by-pass grafting and to establish the role of acetylsalicylic acid, other inhibitors of platelet adhesion, and anticoagulants in its occurrence. Methods: A multivariate analysis was performed to the data obtained from 251 patients subjected to coronary artery by-pass grafting in the year 2002. Results: There were no significant differences for the occurrence of perioperative bleeding induced by the preoperative administration of acetylsalicylic acid. No significant increment in the need for blood, platelet, or cryoprecipitates transfusion existed. Patients receiving non-fractionated or low molecular weight heparin had a significantly greater (p < 0.001) transoperative bleeding than patients without this drug. Administration of the other studied drugs did not increase either mediastinal bleeding or the need for blood derivatives. Conclusions: No statistical evidence was found to suspend administration of inhibitors of platelet adhesion in patients with coronary syndromes, subjected to coronary artery by-pass grafting. However, data obtained suggest the convenience of suspending administration of low molecular weight or non-fractionated heparin to patients subjected electively to coronary artery by-pass grafting.