[Treatment of pulmonary vein stenosis secondary to radiofrequency ablation]. / Tratamiento de estenosis de venas pulmonares secundaria a ablación por radiofrecuencia.

Isolation of the pulmonary veins by applying radiofrequency is an effective treatment for atrial fibrillation. One of the potential complications with higher clinical compromise utilizing this invasive technique is the occurrence of stenosis of one or more pulmonary veins. This complication can be treated by angioplasty with or without stent implantation, with an adequate clinical improvement, but with a high rate of restenosis.

[Perioperative control of vitamin K antagonists in elective surgery]. / Control perioperatorio de la anticoagulacion con antagonistas de la vitamina K en cirugía electiva.

Anti-coagulated patients who undergo elective surgery require temporary interruption of vitamin K antagonists. The aim of this study was to evaluate the incidence of thromboembolic events and bleeding complications in anti-coagulated patients undergoing elective invasive procedures by using an institutional management protocol. This was a descriptive study with prospective follow-up that included patients over 18 year old anti-coagulated with vitamin K antagonists, undergoing elective surgery. Those with atrial fibrillation (AF) at moderate and high risk of thromboembolic events, with mechanical heart valve (MCV) at moderate and high risk of thromboembolic events, and patients' venous thromboembolism (VTE) at high risk of thromboembolic events received bridging therapy with enoxaparin. Embolic and bleeding events in the pre-operative period were recorded. Seventy-eight received bridging, mean age 69.4 ± 11.9 years. Twenty-eight had AF (36.4 %), 12 had VTE (15.6 %) and 37 had MCV (48.1 %). Postoperatively, 1 embolic event (1.6 %) and 12 bleeding events (15.4 %) were documented, of which 10 were minor (12.8 %) and 2 major (2.6 %). The safety of bridging therapy is still under debate, and we should await the result of randomized studies comparing different strategies of bridging vs. interruption of anticoagulant therapy in the pre-operative period prior to reaching a definitive conclusion.

Sufficient versus deficient rims during percutaneous closure of ostium secundum type atrial septal defect: A systematic review and meta-analysis.

BACKGROUND: The aim of this meta-analysis was to compare the efficacy and adverse events of percutaneous occlusion among patients with sufficient and deficient rims. METHODS: A systematic review of all articles published in the Pubmed, MEDLINE and Google Scholar databases was performed. Odds ratio (OR) and 95% CI were used as a measure of effect of the combination of studies. I2 with 95% CI was estimated to assess study heterogeneity. For the meta-analysis, a random effects model was used. RESULTS: The systematic search identified ten studies which included 4355 patients; 2661 of those had sufficient rim and the remaining 1694 patients showed some rim deficiency. Implant failure rate was 4.13% CI 95% 3.53-4.72%. Compared to frequency of failures in the group with a deficient rim (5.43% CI 95% 4.35-6.50%), implant failure in patients with a sufficient rim was significantly lower (3.30% CI 95% 2.62-3.97%), OR 2.27 CI 1.34-3.83 (p 0.002). The combined adverse events were 5.19% CI 95% 4.22-6.35% vs 2.7% CI 95% 2.08-3.31% in the deficient vs sufficient rim groups respectively (OR 2.21 CI 0.93-5.29; p 0.07). Implant failures and adverse events were more frequent in patients with posterior inferior rim deficiency. CONCLUSION: Patients presenting a posteroinferior rim deficiency are associated to both, an increased incidence of closure failure and a combined adverse events occurrence. More studies on posterior rim deficiency are necessary to ensure the feasibility and safety of the percutaneous approach.

[Temporary occlusion of atrial septal defect in the Lutembacher syndrome]. / Oclusión transitoria de comunicación interauricular en el síndrome de Lutembacher.

We report the case of an 82 year-old woman with symptoms of advanced heart failure and pulmonary arterial hypertension. An echocardiogram showed an ostium secundum type atrial septal defect and concomitant mitral valve stenosis (Lutembacher syndrome). Echocardiographic assessment of mitral pathology was hampered by the interatrial septal defect. Transient percutaneous occlusion test of the atrial septal defect was performed and severe mitral valve stenosis was detected. Atrial septal defect size modified the clinical manifestations and the transient occlusion test helped to decide the therapeutic strategy.

[Risk of hemorrhage in patients older than 85 years, anticoagulated due to atrial fibrillation]. / Riesgo de hemorragía en pacientes mayores de 85 años anticuagulados por fibrilación auricular.

BACKGROUND: Atrial fibrillation is the most common cardiac tachyarrhythmia and is an important independent risk factor for ischemic stroke. Its prevalence begins to increase in both sexes after 40 years of age as well as the risk of hemorrhage. The aim of this study was to compare the annual rate of hemorrhagic events between patients older and younger than 85 years, with diagnosis of nonvalvular atrial fibrillation and anticoagulated with warfarin. MATERIAL AND METHODS: A retrospective study was performed. We included 118 patients with diagnosis of nonvalvular atrial fibrillation monitorized by an informatized follow up system. RESULTS: The study follow-up was 28,2 ± 17,5 months and 24 patients (20,3%) were older than 85 years of age. The rate of major bleedings was 4,62%/year (older than 85 years) vs 0,95%/year (younger than 85 years) , p= 0,05, OR 6,57 (IC 95% 1,04-41,8) and minor bleeding was 4,62%/year (older than 85 years) vs 5,2%/year (younger than 85 years), p=0,99, OR 1,08 (IC 95% 0,28-4,21). There was no difference in the Time in Therapeutic Range between both groups (56.4 ± 16.3 % vs 60.5 ± 17.7 %, p 0,30). CONCLUSION: The age should not be considered a contraindication to anticoagulant therapy, however, special care and careful monitoring of patients older than 85 years should be considered due to they had high risk of bleeding.

[Atrial fibrillation in postoperative cardiac surgery. Prevalence and hospitalized period]. / Fibrilación auricular en el postoperatorio de cirugía cardíaca. Prevalencia y tiempo de internación.

Atrial fibrillation is the most common heart rhythm disorder after cardiac surgery. In previous studies it has been associated with prolonged hospitalization, increased costs and mortality. This study aimed to determine the prevalence of postoperative atrial fibrillation in cardiac surgery and its impact on the hospitalization period. Medical records of consecutive patients undergoing cardiac surgery (coronary artery bypass graft, valvular, or both) between January 2006 and November 2008 were included and retrospectively analyzed. Primary outcome was the presence of postoperative atrial fibrillation. The sample was divided into two groups, with and without atrial fibrillation in the postoperative. The clinical variables and length of hospital stay were compared between both groups. A total of 172 patients underwent surgery in this period. Seven patients were excluded from analysis due to lack of data. The mean age was 64.2 +/- 9.5 years, and they were predominantly male. Atrial fibrillation was the most common complication (23.6%). The average length hospital stay was 6.7 +/- 4.6 days. There were no significant differences between both groups, with atrial fibrillation (7.5 +/- 4.1 days), and without (6.5 +/- 4.7 days), p = 0.21. The presence of atrial fibrillation did not prolong hospitalization. Probably, such strategy of prevention would not be cost-effective.

[Euroscore system validation for cardiac surgery in Cordoba city]. / Validacion del sistema euroscore para cirugía cardiaca en la ciudad de Córdoba.

BACKGROUND: We recommend the use of models to estimate mortality hospital risk in cardiac surgery (CC). The aim of this study was to validate a risk stratification system, widely used as the EuroSCORE (ES), in our institution. MATERIAL AND METHODS: We retrospectively analyzed the records of patients undergoing CC consecutively between January 2006 and November 2008. The ES was calculated retrospectively based on data from medical records. Mortality was considered until the time of discharge. In all patients, the ES was calculated by logistic and additive. To study the validity of the model, we analyzed their ability to calibration and discrimination through the goodness of fit test of Hosmer and Lemeshow and area under the ROC curve, respectively. RESULTS: 153 patients were included, mean age 64.1 ± 9.5 years, 77.8% men. The CRM was 60.8%, 24.8% and 14.4% valvular surgery combined (bypass + valve). Overall mortality was 3.9%. The area under the curve of the logistic model was 0.87 and the Hosmer Lemeshow test was 0.84. The area under the curve of the additive model was 0.86 and the Hosmer Lemeshow test was p = 0.89. A score greater than 7 points is additive had a sensitivity of 66% and 91,5% specificity for predicting hospital mortality. CONCLUSION: The ES is a useful model and can be used to estimate the risk of hospital mortality in CC in the city of Cordoba.

[TIMI risk score validation for patients with acute coronary syndrome without ST elevation]. / Validación del score de riesgo TIMI para pacientes con síndrome coronario agudo sin elevación del ST.

Non-ST elevation acute coronary syndromes (NSTE-ACS) are frequent cause of hospitalization, being responsible for 10-15% of infarcts or deaths per year. The study was designed to analyze 6 months follow-up of cardiovascular events as well as to validate the Thrombolysis in Myocardial Infarction (TIMI) risk score for patients hospitalized for NSTE-ACS. We retrospectively analyzed patients admitted with NSTE-ACS. Telephone follow-up were performed at 6 month. Combination of death, re-admission for acute coronary syndrome and revascularization were considered as end point. Two hundred and four patients were included for the analysis. There were 70.2% males, with a mean age of 64.5 +/- 11.8 years. After the initial evaluation, we diagnosed unstable angina in 34.6% of cases, MI in 38.9% of cases, and 26.4% of patients were categorized as "non coronary chest pain". Applying the TIMI risk score, 52 (25.5%) patients had low risk, 106 (52%) intermediated risk, and 46 (22.5%) high risk. The global mortality was 12.3%. We found a progressively and significant increase in the rate of combined events as the TIMI score increase (p < 0.001). We conclude that in our population, the intermediated and high TIMI risk score was well related to newer cardiovascular events at 6 month follow-up.

[Clinical characteristics and tilt test of patients with vasovagal syncope suspicion]. / Características clínicas y Tilt test de pacientes con sospecha de síncope vasovagal.

BACKGROUND: Vasovagal syncope is the most common cause of syncope and is an amount medical, social and economic problem. MATERIAL AND METHODS: We study a population of patients with history of syncope of presumed vasovagal origin submitted to head-up tilt test (TT) with intention to describe and to compare symptoms, signs and trigger situations between positive and negative TT. Twenty four variables were investigated (chosen according to the clinical experience). RESULTS: One hundred thirteen patients were included. The age mean was 33,3 ± 19,4 years and 67.3% corresponded to women. 81 patients (71,7%) experienced syncope during test. The more frequent response was mixed subtype (58 %), followed by vasodepressor response (30,9%) and cardioinhibitory response (11,1%). There were not significant differences between both groups in symptoms, signs and trigger situations. In patients with negative TT was more frequent syncopes triggered by extreme exercise (p = 0,012). CONCLUSION: In patients with vasovagal syncope suspicion, a clinic history does not predict TT results.

[Endocarditis of pacemaker or implantable cardioverter-defibrillator leads]. / Endocarditis relacionada a cables de marcapasos o cardiodesfibriladores implantables.

BACKGROUND: Infective endocarditis includes the endovascular devices infection. The main objective was to evaluate the clinical characteristics and evolution of the endocarditis related to electronics devices. CASE REPORTS: Between 2002 - 2007 periods were identified 7 patients, age average of 56.5 years. The clinical presentation was fever of unknown origin in 85.7%, with a mean of 28 days of evolution. The microbiology isolated was coagulase-negative staphylococci in 6 patients and staphylococcus aureus in 1 patient. The treatment was complete system extraction and antibiotic therapy, except in 1 case that only received antibiotics. There were 2 deaths (28,5%) during in hospital follow-up. CONCLUSION: The endocarditis related to devices is a disease with high mortality. Early diagnosis and system extraction are very important for the treatment and prognosis.