[Congenital aortic supravalvular stenosis. Frequency and results of surgical treatment in a third level hospital]. / Estenosis supravalvular aórtica congénita. Frecuencia y resultados del tratamiento quirúrgico en un hospital de tercer nivel.

In a prospective study made between 1 September 1996 and 31 December 2001, pediatric patients with a diagnosis of supravalvular aortic stenosis confirmed by a reduction in the aortic inner diameter and a gradient > or = 50 mmHg were detected. Of 83 patients with aortic stenosis, only 7 (8.4%) had supravalvular aortic stenosis. All 7 patients underwent surgical treatment consisting of resection of fibrous tissue and reconstruction of the ascending aorta with a preclotted Dacron patch. One patient with severe, diffuse stenosis died and the another had perioperative heart failure, cardiac arrest and reversible neurological sequelae. A significant decrease in the postoperative gradient was obtained (p < 0.05). At present all surviving patients are free of symptoms. It was concluded that supravalvular aortic stenosis is infrequent in Mexico. In our experience, surgical treatment produced good results and success depended on the magnitude and type of stenosis.

[Coronary endarterectomy and bypass grafting without cardiopulmonary bypass]. / Endarterectomía coronaria y revascularización miocárdiaca sin derivación cardiopulmonar.

We prospectively analyzed patients who underwent simultaneous off-pump coronary artery bypass grafting and endarterectomy between March 1, 1997 and February 28, 2002. The incidence of perioperative myocardial infarction, need for inotropic support, morbidity, long-time functional class, and mortality were evaluated. Nine endarterectomies were performed in eight patients, more frequently in the right coronary artery. Dopamine was used in four patients. One perioperative myocardial infarction (12.5%) occurred. No deaths occurred and all patients are now functional class I. Tests for ischemia have been negative in all patients.Coronary endarterectomy is an alternative procedure that has little morbidity and enables complete myocardial revascularization without cardiopulmonary bypass.

[Myocardial revascularization versus percutaneous transluminal coronary angioplasty in the treatment of ischemic cardiopathy]. / Revascularización miocárdica versus angioplastía coronaria transluminal percutánea para el tratamiento de la cardiopatía isquémica.

BACKGROUND AND OBJECTIVE: Ischemic heart disease affects a high number of patients, and may be treated by surgery or coronary angioplasty. The objective of this study is to compare the middle term results of both procedures. MATERIAL AND METHODS: Between January and March of 1999, 59 patients with a mean age of 65 years old ranging 46 to 79, were treated with myocardial revascularization (group I) and 57 patients with a mean age of 59 years old ranging 33 to 88 were submitted to coronary angioplasty (group II). It was evaluated and compared risk factors, morbidity, mortality, evolution in two years after the procedures, presence of symptoms, freedom of events. RESULTS: In group I a higher number of diabetic patients was found. The 89.8% of patients was asymptomatic two years after the procedure in group I against 52.6% in group II (p = 0.03). One patient in group I presented angina six months after the procedure and 27 patients in group II (47.3%), presented angina between the first seven months after the procedure (p = 0.034). Morbidity affects in special to diabetic patients and was higher in group I. Mortality was similar in both groups: 6.7% for group I and 6% in group II. The length of stay in hospital was lower in group II (p = 0.03). CONCLUSION: In a middle time, coronary artery bypass grafting offers better results related to freedom of angina and better quality of life.

[Myocardial revascularization in patients with ischemic heart disease and left ventricular dysfunction]. / Revascularización miocárdica en pacientes con alteración ventricular izquierda crónica.

BACKGROUND: Operative morbidity and mortality in coronary artery bypass surgery has decreased over the last decades and coronary artery bypass surgery offers an increase in long-term survival in selected patients with lower ejection fraction. We do not know exactly the results of the surgery and evolution of our patients with chronic lower ejection fraction. OBJECTIVE: To evaluate clinical results of myocardial revascularization in patients with ischemic heart disease and chronic lower ejection fraction. MATERIAL AND METHODS: We analyzed the experience between January 2000 and December 2001 of patients with ejection fraction = 30% treated with surgical myocardial revascularization. The procedure was carried out with cardiopulmonary bypass and moderate hypothermia (30 degrees C), and myocardial protection with intermittent cold crystalloid cardioplegia. We evaluated demographic characteristics, surgical procedure carried out, length-of-stay in intensive postoperative care unit, and morbidity and mortality in perioperative period and in middle term follow-up. RESULTS: During this period, 738 patients were treated with aorto-coronary bypass surgery Thirty eight patients were patients with chronic lower ejection fraction (5.14%) and were included in this evaluation. Six patients were female (15.78%), and 32 males (84.21%). Range of duration of cardiopulmonary bypass was 65-245 min (mean, 123 min), range of aortic cross-clamping time was 30-120 min (mean, 59 min). Twelve month follow-up showed improvement in two functional classes in 15 patients (39.4%), and improvement in one functional class in 10 patients (26.3%); two patients remained in the same functional class (5.2%), and one patient decreased his/her functional class (2.6%). Mean of length-of-stay in intensive care unit was 6.5 days and in hospital, 12.5 days. Perioperative morbility was 34.2% and same-period mortality was 26%; 12 month survival was 74%. It was concluded that even with high mortality as in other series, survival and quality of life of these patients is better with than medical therapy.

Revascularización miocárdica versus angioplastía coronaria transluminal percutánea para el tratamiento de la cardiopatía isquímica / Myocardial revascularization versus percutaneous transluminal coronary angioplasty in the treatment of ischemic cardiopathy

BACKGROUND AND OBJECTIVE: Ischemic heart disease affects a high number of patients, and may be treated by surgery or coronary angioplasty. The objective of this study is to compare the middle term results of both procedures. MATERIAL AND METHODS: Between January and March of 1999, 59 patients with a mean age of 65 years old ranging 46 to 79, were treated with myocardial revascularization (group I) and 57 patients with a mean age of 59 years old ranging 33 to 88 were submitted to coronary angioplasty (group II). It was evaluated and compared risk factors, morbidity, mortality, evolution in two years after the procedures, presence of symptoms, freedom of events. RESULTS: In group I a higher number of diabetic patients was found. The 89.8 of patients was asymptomatic two years after the procedure in group I against 52.6 in group II (p = 0.03). One patient in group I presented angina six months after the procedure and 27 patients in group II (47.3), presented angina between the first seven months after the procedure (p = 0.034). Morbidity affects in special to diabetic patients and was higher in group I. Mortality was similar in both groups: 6.7 for group I and 6 in group II. The length of stay in hospital was lower in group II (p = 0.03). CONCLUSION: In a middle time, coronary artery bypass grafting offers better results related to freedom of angina and better quality of life.

Estenosis supravalvular aórtica congénita. Frecuencia y resultados del tratamiento quirúrgico en un hospital de tercer nivel / Congenital aortic supravalvular stenosis. Frequency and results of surgical treatment in a third level hospital

En un estudio prospectivo realizado entre el 1 de septiembre de 1996 y el 31 de diciembre de 2001, se identificó a los pacientes pediátricos con diagnóstico confirmado de estenosis supravalvular aórtica. Se consideró estenosis supravalvular cuando se detectó la disminución del calibre aórtico y un gradiente 50 mmHg. De 83 pacientes con estenosis aórtica, sólo en 7 (8,4 por ciento) fue de tipo supravalvular y fue tratada con resección del tejido fibroso y ampliación de la luz aórtica con injerto de dacrón precoagulado, sin accidentes ni complicaciones. Hubo disminución significativa del gradiente preoperatorio (p < 0,05). Un paciente falleció y otro presentó choque cardiogénico y paro cardiorrespiratorio reversible con secuelas neurológicas en remisión, y en la actualidad los pacientes se encuentran asintomáticos. Concluimos que la estenosis supravalvular aórtica es poco frecuente en México y los resultados del tratamiento quirúrgico son satisfactorios en función del tipo de lesión y de acuerdo con ello (AU)

Endarterectomía coronaria y revascularización miocárdica sin derivación cardiopulmonar / Coronary endarterectomy and bypass grafting without cardiopulmonary bypass

Presentamos en forma prospectiva la experiencia con la endarterectomía coronaria combinada con la revascularización miocárdica sin derivación cardiopulmonar entre el 1 de marzo de 1997 y el 28 de febrero de 2002. Se evaluaron la necesidad de administrar fármacos inotrópicos, la presencia de infarto perioperatorio, la morbilidad, la clase funcional a largo plazo y la mortalidad. En 8 pacientes se efectuaron 9 endarterectomías. Predominó el procedimiento en la arteria coronaria derecha. Un total de 4 pacientes requirió dopamina a dosis bajas. Hubo un infarto perioperatorio (12,5 por ciento). No hubo mortalidad y en el momento actual todos los pacientes se encuentran en clase funcional I, con pruebas de esfuerzo negativas. Concluimos que la endarterectomía coronaria es una opción complementaria que permite una revascularización miocárdica más completa, aun sin utilizar la derivación cardiopulmonar (AU)

Derivación extracorpórea izquierda transoperatoria para la corrección de un aneurisma de aorta torácica / Intraoperative left heart bypass for correction of a thoracic aorta aneurysm

Se presenta el caso de un paciente masculino de 26 años de edad en quien se utilizó una derivación izquierda con canulación en la aurícula izquierda y la aorta descendente para perfusión distal con bomba centrífuga, durante el tratamiento quirúrgico de un aneurisma de la aorta torácica, el cual se efectuó sin complicaciones mediante plastia con parche de dacrón. La evolución postoperatoria fue satisfactoria, sin complicaciones ni daño a órganos y estructuras distales.Se puede concluir que la derivación izquierda es una alternativa de protección intraoperatoria durante la cirugía de la aorta torácica.