Cirugía de revascularización miocárdica de la arteria descendente anterior con arteria mamaria interna izquierda sin circulación extracorpórea: Experiencia en el largo plazo / Beating heart anterior descending coronary artery grafting with left internal mammary artery: A long term follow up experience

Background: In recent years the use of left internal mammary artery (LIMA) as a gran to anterior descending artery (DA) with the offpump technique has been associated with similar good long term results as with the on pump technique. Aún: To repon the results of LIMA to DA bypass grafting without extracorporeal circulation (EC) for isolated DA lesions. Patients and methods: Descriptive study of 80 patients subjected to coronary surgery between 1999 and 2007. Results: Mean age ofpatients was 63 + 10 years and 60 were male. There was no operative mortality or stroke. One patient with a myocardial infarction required a reoperation. Actuarial survival was 98% at 97 months. Conclusions: In this group ofpatients the use ofLIMA as a coronary bypass gran to DA with the off pump technique is a safe surgical procedure, providing a prolonged cardiac event free survival (mortality, angina, myocardial infarction, and need for a new coronary procedure).

Fibroelastoma valvular aórtico como causa de accidente cerebrovascular embólico: reporte de un caso / Aortic valve fibroelastoma as a cause of an embolic cerebrovascular accident: a case report

Los tumores cardíacos son una causa rara de accidente cerebrovascular embólico. Comunicamos el caso de una paciente de 65 años quien debuta su historia con un accidente cerebrovascular. El estudio de fuente embólica con ecocardiografía transesofágica demostró un fibroelastoma de la válvula aórtica en el borde libre del velo no coronariano. El tumor fue extraído mediante circulación extracorpórea. El estudio anatomopatológico confirmó el diagnóstico y la paciente se encuentra en capacidad funcional I y sin síntomas neurológicos a 19 meses de seguimiento.

Background: Cardiac tumors are an infrequent cause of an embolic source and aortic fibroelastoma is even more rare as causative of a stroke. We report a 65 year old female with no particular clinical history admitted to the hospital with an embolic cerebrovascular accident whose embolic source study with a transesophageal echocardiogram revealed a fibroelastoma in the free edge of the non coronarian leaflet of the aortic valve. The patient was subjected to surgery by means of extracorporeal circulation and the tumor was excised. The pathological study confirmed the diagnosis. Post operative recovery was uneventful with no neurological damage and after 19 months of follow up she is in functional class I.

Miniesternotomía para cirugía valvular aórtica: experiencia inicial en un centro cardiovascular en Chile / Ministernotomy for aortic valve surgery: report of 20 patients

Background: Aortic valve surgery can be performed through a reduced mid sternotomy with excellent long term results. Aim: To report the initial results obtained with this technique. Patients and methods: Descriptive study of 20 patients aged 48±11 years, subjected to valve replacement surgery for aortic valve disease between 2004 and 2007. Arterial and venous cannulation were performed with the usual method and extracorporeal circulation was performed with a mean perfusion of 4.5 L/min. Hypothermia and cardioplegia were performed infusing the hematic cardioplegic solution at 4°C in the aortic root or coronary ostia. Results: Sixteen patients were in functional class (FC) III. Fourteen patients had aortic insufficieney and six had predominant stenosis. There was no operative mortality One patient had a left hemothorax and was reoperated. All patients were discharged between 4 and 6 days after surgery. Mean follow up was 21 ± 4 months. AU patients are in FC I and free from cardiac events. Echocardiographic assessment was done in 16 patients, showing a good motility of valve disks. Actuarial survival probability was 100 percent and probability of freedom from cardiac events was 100 percent at 42 months of follow up. Conclusions: Ministernotomy is an excellent approach for aortic valve surgery providing good visualization ofthe ascending aorta, simplifying the surgical technique.

Cirugía de la endocarditis infecciosa en un centro regional en Chile: Análisis de casos y resultados en el largo plazo / Surgery for bacterial endocarditis: Retrospective study of 32 patients

Background: Surgery for active endocarditis is indicated in cases of congestive heart failure (CHF), persistent sepsis, systemic embolization and paravalvular involvement. Aim: To assess and report the long term results of surgery in adult patients. Patients and methods: Retrospective review of clinical records and operative procedures of 32 patients aged 43± 13 years (28 women) subjected to reparative surgery for complications of endocarditis between 1993 to 2005. Results: In 25 percent of cases, endocarditis presented as a prolonged sepsis syndrome and in 31 percent as a CHF or both. The causative bacteria was Gram (+) in 53 percent and blood cultures were negative in 47 percent. Preoperative echocardiography showed vegetations in 56 percent of cases. An annular abscess, aortic valve rupture and bicuspid valve, was observed in 13 percent of patients. Post operative mortality was due to persistent sepsis and multiorganic dysfunction in 16 percent. Mean long term follow up was 43.8±47.2 months. Actuarial survival was 78 percent at 146 months. Conclusion: Surgical management of active endocarditis provides a good symptomatic recovery, with an excellent long term actuarial survival.

Revascularización miocárdica de la arteria descendente anterior con arteria mamaria interna izquierda con circulación extracorpórea: seguimiento a 10 años / Myocardial revascularization of the anterior descending coronary artery with left internal mammary artery by means of extracorporeal circulation: 10 years follow-up

Background: The use of left internal mammary artery (LIMA) as a graft to anterior descending artery (LAD) has been associated with better long term results in coronary surgery. Aim: To assess and report the long-term results of LIMA to LAD bypass grafting for isolated LDA lesions. Patients and methods: Retrospective analysis of the medical records and surgical protocols of 40 patients (aged 60±10 years, 28 male) subjected to coronary surgery between 1992 and 2002. Results: Thirty-four patients presented with unstable angina. On angiography, the LAD had a proximal obstruction in 35 patients. Sixteen presented with a myocardial infarction of the LAD territory. Six were managed previously with angioplasty; four had a new critical obstruction, 1 was catalogued as a procedure failure, and one was totally occluded. There was no operative mortality, myocardial infarction, stroke or need for re operation. There were two late deaths, caused by an advanced cardiac failure at 120 months in one patient, and chronic renal failure at 61 months of follow-up in another. Actuarial survival probability was 100%, 93% and 75% at 1, 5 and 10 years. Probability of freedom from angina was 98%, and freedom of suffering a new myocardial infarction was 100% at more than 10 years. The probability of no need for a new coronary procedure (angioplasty or surgery) also was 100% at more than 10 years. Conclusions: The use of LIMA as a coronary bypass graft to LAD is a safe surgical technique, with an excellent duration and permeability and also provides a prolonged time free from cardiac events as mortality, angina, myocardial infarction, and the need of a new coronary procedure.