Cardiac surgery-associated acute kidney injury.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a well-recognized complication resulting with the higher morbid-mortality after cardiac surgery. In its most severe form, it increases the odds ratio of operative mortality 3-8-fold, length of stay in the Intensive Care Unit and hospital, and costs of care. Early diagnosis is critical for an optimal treatment of this complication. Just as the identification and correction of preoperative risk factors, the use of prophylactic measures during and after surgery to optimize renal function is essential to improve postoperative morbidity and mortality of these patients. Cardiopulmonary bypass produces an increased in tubular damage markers. Their measurement may be the most sensitive means of early detection of AKI because serum creatinine changes occur 48 h to 7 days after the original insult. Tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 are most promising as an early diagnostic tool. However, the ideal noninvasive, specific, sensitive, reproducible biomarker for the detection of AKI within 24 h is still not found. This article provides a review of the different perspectives of the CSA-AKI, including pathogenesis, risk factors, diagnosis, biomarkers, classification, postoperative management, and treatment. We searched the electronic databases, MEDLINE, PubMed, EMBASE using search terms relevant including pathogenesis, risk factors, diagnosis, biomarkers, classification, postoperative management, and treatment, in order to provide an exhaustive review of the different perspectives of the CSA-AKI.

Cirugía cardíaca en el anciano: prevalencia y consecuencias de la anemia preoperatoria. Respuesta de los autores / No disponible

No disponible

[Subaortic stenosis more than twenty years after surgical repair of a partial atrial septal defect in an adult]. / Estenosis subaórtica veinte años después de la reparación quirúrgica de un defecto septal auricular parcial en el adulto.

Subaortic stenosis after surgical correction of a partial atrioventricular septal defect is uncommon. When it occurs, it is usually diagnosed 6-8 years after early surgical repair in childhood. We present a female patient who underwent mitral valve cleft repair and closure of a partial atrial septal defect with a Teflon patch at the age of 48 years. Twenty-two years later, she presented with severe subaortic stenosis that required surgical repair. We analyze the intracardiac morphological factors associated with the development of late subaortic stenosis. We recommend long-term follow-up, even after surgical repair in adults.

Estenosis subaórtica veinte años después de la reparación quirúrgica de un defecto septal auricular parcial en el adulto / Subaortic stenosis more than twenty years after surgical repair of a partial atrial septal defect in an adult

La estenosis subaórtica tras la corrección quirúrgica de una comunicación interauricular tipo ostium primum es muy infrecuente. Generalmente, se diagnostica 6-8 años tras la cirugía efectuada en una etapa temprana de la vida. Presentamos el caso de una paciente intervenida a los 48 años en la que se realizó un cierre con parche de la comunicación y la reparación de la hendidura mitral. Veintidós años después fue intervenida por estenosis subaórtica severa. Analizamos los factores morfológicos intracardíacos que predisponen a esta enfermedad y obligan a un seguimiento prolongado para su diagnóstico, incluso en correcciones en adultos

Subaortic stenosis after surgical correction of a partial atrioventricular septal defect is uncommon. When it occurs, it is usually diagnosed 6-8 years after early surgical repair in childhood. We present a female patient who underwent mitral valve cleft repair and closure of a partial atrial septal defect with a Teflon patch at the age of 48 years. Twenty-two years later, she presented with severe subaortic stenosis that required surgical repair. We analyze the intracardiac morphological factors associated with the development of late subaortic stenosis. We recommend long-term follow-up, even after surgical repair in adults

[Myocardial infarction and severe mitral insufficiency. Presentation of an aortic fibroelastoma]. / Infarto miocardico ed insufficienza mitralica severa. Modalità di presentazione di un fibroelastoma aortico.

We report the case of a 75-year-old female with atypical chest pain followed by non-Q wave myocardial infarction. At coronary angiography and ventriculography severe left main stenosis and severe mitral regurgitation were evidenced. Transesophageal echocardiography, performed in order to evaluate a possible mitral repair, showed an aortic tumor (11 x 14 mm in diameter) attached to the commissure between the left and non-coronary cusp, without mitral regurgitation. Cardiac magnetic resonance showed a relationship between the tumor and the left coronary ostium which explained a paroxysmal mitral regurgitation. The tumor was surgically removed and the resulting defect in the aortic leaflet was reconstructed with an autologous pericardial patch. The tumor resulted to be a papillary fibroelastoma. The clinical course was uneventful.

Insuficiencia cardíaca secundaria a rotura traumática de la válvula aórtica / Cardiac Failure due to Traumatic Aortic Valve Rupture

La insuficiencia cardíaca aguda secundaria a disfunción valvular es frecuente como complicación del infarto agudo de miocardio, la endocarditis o los traumatismos torácicos penetrantes que afectan al corazón y a los grandes vasos. Menos frecuente es la asociación a traumatismos torácicos cerrados. Presentamos el caso de un varón de 69 años de edad con insuficiencia cardíaca aguda tras un traumatismo torácico importante con fractura esternal. El ecocardiograma transesofágico demostró una insuficiencia aórtica grave. El paciente fue intervenido quirúrgicamente. Se encontró una rotura de bordes libres del velo no coronariano y coronariano derecho. Se efectuó cirugía de reemplazo valvular aórtico por bioprótesis, con evolución posterior favorable (AU)