Shock anafiláctico versus síndrome de Kounis durante el intraoperatorio de cirugía cardiaca: diagnóstico diferencial / Anaphylactic shock versus Kounis syndrome in cardiac surgery: Differential diagnosis

Pese a que fue descrito hace casi 3 décadas, ha sido en los últimos años cuando se ha producido un incremento notable en la comunicación de casos de síndromes coronarios agudos desarrollados en el contexto de reacciones alérgicas, entidad que es conocida como síndrome de Kounis. En este artículo nos planteamos esta posibilidad diagnóstica ante un fracaso biventricular agudo en el transcurso de una reacción anafiláctica durante el intraoperatorio de una cirugía valvular cardiaca

Although Kounis syndrome was described almost 3 decades ago, there has been a notable increase in the reports of cases of acute coronary syndromes developed in the context of allergic reactions, also known as Kounis syndrome. This article discusses the diagnostic possibility in the face of an acute biventricular failure in the course of an anaphylactic reaction during the intra-operative period of a cardiac valve surgery

Anaphylactic shock versus Kounis syndrome in cardiac surgery: Differential diagnosis. / Shock anafiláctico versus síndrome de Kounis durante el intraoperatorio de cirugía cardiaca: diagnóstico diferencial.

Although Kounis syndrome was described almost 3 decades ago, there has been a notable increase in the reports of cases of acute coronary syndromes developed in the context of allergic reactions, also known as Kounis syndrome. This article discusses the diagnostic possibility in the face of an acute biventricular failure in the course of an anaphylactic reaction during the intra-operative period of a cardiac valve surgery.

[Complex implantation of an automatic defibrillator-cardioverter through a left superior vena cava]. / Implantación compleja de desfibrilador-cardioversor automático a través de una vena cava superior izquierda.

We describe the case of a 19-year-old girl with a left superior vena cava and a surgically corrected complete atrioventricular canal defect. After an inhospital sudden death an automatic defibrillator-cardioverter was implanted through her left superior vena cava. During the postoperative course, multiple inappropriate discharges caused by myopotential oversensing indicated the relocation of the electrode and, finally, insertion of two epicardial leads by a left submammarian thoracotomy approach, produced an optimal result.

[Severe chronic ischemic ventricular dysfunction. Determinants of surgical risk and long-term clinical outcome]. / Disfunción ventricular isquémica crónica severa. Determinantes del riesgo quirúrgico y del resultado clínico a largo plazo.

INTRODUCTION: In patients with chronic ischemic heart disease, a severe ventricular dysfunction is associated with a higher operative risk and to a worse late clinical outcome. However, when there is sufficient viable myocardium, surgical revascularization can improve ventricular performance and above all the functional capacity and survival of these patients. OBJECTIVES: To analyze long-term results of a large series of patients with an ejection fraction < or = 0.30 that underwent isolated coronary artery bypass surgery and to investigate factors, mainly clinical, that determined favorable clinical results: being that the patient was alive and free of incapacitating symptoms. PATIENTS AND METHODS: This series included 100 patients, 93 males and 7 females, with a mean age of 62 +/- 8 years. The predominant clinical manifestation was angina in 37, congestive heart failure in 22 and both in 41. Seventy-nine patients were in functional class III or IV, and 19 had emergency surgery. RESULTS: There were 10 in-hospital deaths, 6 of which occurred in patients who had emergency surgery. Mortality in the elective cases was 4.9%. Only age (p < 0.05), functional class (p < 0.05) and emergency surgery (p < 0.0001) were identified as independent predictors of early mortality. Actuarial survival rates after 5 and 8 years were 65 and 52% respectively. Long-term clinical outcome was considered favorable in 66 patients. We did not find any preoperative clinical variables that were predictors of the clinical outcome. Only preoperative mitral insufficiency correlated with a poor long-term clinical result. CONCLUSIONS: Patients with chronic and severe ventricular dysfunction secondary to coronary artery disease have an acceptable surgical risk when they are operated on electively, before their clinical condition deteriorates. Long-term results are satisfactory in the majority of the patients. In these types of patients clinical manifestations are of limited value in the selection process for surgical revascularization.