[Clinical characteristics and outcome of infective endocarditis in individuals of the general population managed at a teaching hospital without cardiac surgery facilities. Study of 120 cases]. / Características clínicas y evolución de la endocarditis infecciosa en una población general no seleccionada, atendida en un hospital docente que no dispone de cirugía cardiaca. Estudio de 120 casos.

INTRODUCTION AND OBJECTIVES: To assess the clinical characteristics and management of infective endocarditis at a teaching hospital without cardiac surgery facilities. METHODS: Descriptive case-control study looking at trends. Risk factors, the occurrence of complications, the rate of referral for cardiac surgery, and the mortality rate were assessed. RESULTS: The study included 120 patients referred between 1990 and 2004, with a mean age of 50.8 (17.8) years (67.6% men). Disease incidence did not change throughout the study. Some 55% of infective endocarditis cases were from the ordinary general population, 25% were intravenous drug users, and 20% were of nosocomial origin. The number in the last category had increased over time. The most commonly isolated microorganism was Staphylococcus aureus. Around 83% of patients presented with a severe complication, with cardiac failure and septic metastasis being the most common. The in-hospital mortality rate was 19.2%. Acute renal failure (odds ratio 6.7, 95% confidence interval, 1.9-24) and perivalvular abscess (odds ratio 9.2, 95% confidence interval, 1.6-54) were independent predictors of death. The introduction in 2002 of a multidisciplinary infective endocarditis team, which included a consultant cardiac surgeon, was associated with a significant increase in referrals for surgery, from 14.5% to 34.5% (P=.03), though in-hospital mortality was not significantly altered, decreasing from 20.9% to 13.8% (P=.4). CONCLUSIONS: The occurrence of acute renal failure and perivalvular abscess worsen the prognosis of infective endocarditis. The introduction of a multidisciplinary infective endocarditis team altered management of the disease and increased referrals for cardiac surgery.

Relationships among haemoglobin level, packed red cell transfusion and clinical outcomes in patients after cardiac surgery.

OBJECTIVE: To identify associations among haemoglobin (Hb) concentrations, blood transfusions, and clinical outcomes in patients after cardiac surgery, especially in those who undergo valve replacement or bypass surgery. DESIGN: Prospective observational trial. SETTING: Surgical intensive care unit in a tertiary-level university hospital. PATIENTS: 1216 Consecutive patients. MEASUREMENTS: Haemoglobin at admission and 6, 12, 24, and 48 h later, and then, every 24 h while patients remained in the intensive care unit (ICU); number of transfusions and clinical events. RESULTS: Patients were divided into quartiles according to minimal haemoglobin, the first and second of which (Hb <8.10 and <8.91 g/dL, respectively) differed significantly (P < 0.001) from the other two quartiles in terms of more organ failure, longer ICU stay, and higher mortality. We found associations between being transfused >or=4 packed red cells (PRCs) and a worse clinical outcome and higher mortality. The associated mortality rate was higher for patients who underwent bypass surgery when they had Hb 8.9 g/dL and were transfused >or=4 PRCs. CONCLUSIONS: Low haemoglobin concentrations and transfusions in patients undergoing cardiac surgery are associated with increased morbidity and mortality. Also, anemia and transfusions are associated with poor outcome. Therefore, intra- and postoperative bleeding seem to be a risk factor in patients undergoing cardiac surgery.

Troponin repercussion of defibrillation at the end of cardiopulmonary bypass.

BACKGROUND AND AIM OF THE STUDY: Cardiopulmonary bypass (CPB) is a relatively common procedure in cardiac surgery. At the end, the heart is electrically defibrillated if not already beating. External and internal cardioversion by specific catheters do not raise plasma troponin concentration, but the possible repercussion on troponin of the direct cardioversion of the heart has not been documented. METHODS: Prospective comparative trial in a surgical intensive care unit in a university hospital was conducted. The study sample comprised 364 consecutive patients undergoing cardiac surgery with CPB and without perioperative myocardial infarction. RESULTS: The number of cardioversions applied was recorded and three groups were obtained: A/no cardioversion; B/one or two cardioversions; and C/more than two cardioversions. Serum troponin I and CK-MB were determined at admission and after 6, 12, 24, and 48 hours. Significant differences were found between group C and groups A and B for troponin I and creatine kinase (CK-MB) curves, being higher for both variables in group C. CONCLUSIONS: With more than two cardioversions post-CPB, both troponin I and CK-MB may present an additional increase.

Características clínicas y evolución de la endocarditis infecciosa en una población general no seleccionada, atendida en un hospital docente que no dispone de cirugía cardiaca. Estudio de 120 casos / Clinical characteristics and outcome of infective endocarditis in individuals of the general population managed at a teaching hospital without cardiac surgery facilities. Study of 120 cases

Introducción y objetivos. Analizar las características clínicas y el tratamiento de la endocarditis infecciosa (EI) en un hospital docente que no dispone de cirugía cardiaca. Métodos. Estudio descriptivo, de tendencias, y de casos y controles. Se analizaron los factores de riesgo, las complicaciones, la indicación de cirugía cardiaca y la mortalidad. Resultados. Se recogieron 120 casos entre 1990 y 2004 con una edad de 50,8 ± 17,8 años (67,6%, varones). La incidencia se mantuvo estable a lo largo del estudio. La distribución por categorías de EI fue: población general no seleccionada, 55%; asociada a drogadicción parenteral, 25%, y nosocomial, 20%, y se observó un incremento de esta última en el tiempo. Staphylococcus aureus fue el aislamiento más frecuente. Un 83% de pacientes presentó alguna complicación grave, y las más frecuentes fueron la insuficiencia cardiaca y las metástasis sépticas. La mortalidad intrahospitalaria fue del 19,2%. La insuficiencia renal aguda (odds ratio [OR] = 6,7; intervalo de confianza [IC] del 95%, 1,9-24) y el absceso perivalvular (OR = 9,2; IC del 95%, 1,6-54) fueron predictores independientes de muerte. La disponibilidad desde 2002 de un grupo de trabajo multidisciplinario sobre EI y de una consultoría de cirugía cardiaca se asoció con un aumento significativo de la indicación de tratamiento quirúrgico (el 14,5 frente al 34,5%; p = 0,03) y no se observaron cambios en la mortalidad intrahospitalaria (el 20,9 frente al 13,8%; p = 0,4). Conclusiones. La insuficiencia renal aguda y el absceso perivalvular en el curso de una EI son factores de mal pronóstico. Un enfoque multidisciplinario de la EI ha comportado cambios en su tratamiento y ha incrementado la indicación de cirugía cardiaca

Introduction and objectives. To assess the clinical characteristics and management of infective endocarditis at a teaching hospital without cardiac surgery facilities. Methods. Descriptive case-control study looking at trends. Risk factors, the occurrence of complications, the rate of referral for cardiac surgery, and the mortality rate were assessed. Results. The study included 120 patients referred between 1990 and 2004, with a mean age of 50.8 (17.8) years (67.6% men). Disease incidence did not change throughout the study. Some 55% of infective endocarditis cases were from the ordinary general population, 25% were intravenous drug users, and 20% were of nosocomial origin. The number in the last category had increased over time. The most commonly isolated microorganism was Staphylococcus aureus. Around 83% of patients presented with a severe complication, with cardiac failure and septic metastasis being the most common. The in-hospital mortality rate was 19.2%. Acute renal failure (odds ratio 6.7, 95% confidence interval, 1.9-24) and perivalvular abscess (odds ratio 9.2, 95% confidence interval, 1.6-54) were independent predictors of death. The introduction in 2002 of a multidisciplinary infective endocarditis team, which included a consultant cardiac surgeon, was associated with a significant increase in referrals for surgery, from 14.5% to 34.5% (P=.03), though in-hospital mortality was not significantly altered, decreasing from 20.9% to 13.8% (P=.4). Conclusions. The occurrence of acute renal failure and perivalvular abscess worsen the prognosis of infective endocarditis. The introduction of a multidisciplinary infective endocarditis team altered management of the disease and increased referrals for cardiac surgery

Obstrucción del tracto de salida del ventrículo derecho por un seudoaneurisma gigante de la arteria coronaria descendente anterior en un paciente con enfermedad de behçet / Giant Pseudoaneurysm of the Left Anterior Descending Coronary Artery with Obstruction of Right Ventricular Outflow in a Patient with Behçet's Disease

La presencia de seudoaneurismas gigantes en las arterias coronarias de pacientes afectos de enfermedad de Behçet es un fenómeno inhabitual que ha sido descrito excepcionalmente en la literatura. Presentamos un caso de seudoaneurisma gigante de la arteria coronaria descendente anterior con obstrucción del tracto de salida del ventrículo derecho en un paciente con enfermedad de Behçet. La evolución posterior tras resección quirúrgica y tratamiento esteroide fue satisfactoria (AU)