Hidatidosis cardiaca: caso clínico / Cardiac hydatidosis: Report of one case

Background: Hydatidosis is an endemic zoonosis in Chile. We report a 48-year-old former slaughterman, with a previous history of pulmonary hydatidosis, who presented a stroke without associated cardiovascular symptoms. An echocardiogram revealed a tumor mass with cystic features in the left ventricle. The patient was operated and the cyst was successfully excised. During the follow up, the patient remains asymptomatic.

Asistencia circulatoria mecánica / Mechanical circulatory support

La insuficiencia cardiaca constituye una verdadera epidemia a nivel mundial, y Chile no es la excepción. Como respuesta, la medicina ha ido ofreciendo un número cada vez mayor de alternativas para enfrentarla, con mejoras significativas en el tratamiento farmacológico, dispositivos de resincronización cardiaca y diferentes alternativas quirúrgicas, todo lo cual ha mejorado la sintomatología y ha prolongado parcialmente la supervivencia de esta patología en las fases iniciales. Sin embargo en las fases más avanzadas de esta enfermedad, sólo el trasplante cardiaco y actualmente la asistencia circulatoria, han demostrado una mejoría significativa de la supervivencia de este complejo grupo de pacientes. En esta revisión, intentamos revisar en profundidad los aspectos epidemiológicos, clínicos y terapéuticos en el enfrentamiento de esta patología, haciendo hincapié en diferentes aspectos quirúrgicos y en la indicación y manejo de la asistencia circulatoria mecánica, aspectos que son fundamentales a la hora de usar en forma segura esta nueva tecnología.

Heart failure is an epidemic worldwide disease, affecting mainly developed countries. In response, medicine has been offering an increasing number of treatment alternatives with significant improvements in drug therapy, cardiac resynchronization devices and surgical alternatives, all of which have improved symptoms and prolonged survival in the early stages of this pathology. However, in final stages, only heart transplantation has shown significant improvement in survival, and in the last years, Mechanical Circulatory Assistance has shown good results in this complex group of patients. In this article we review epidemiological, clinical and therapeutic aspects of Mechanical Circulatory Support, emphasizing on indications and contraindications, management, quality assurance and education of this therapeutic alternative for heart failure.

Disección aórtica tipo A: Resultados operatorios y seguimiento a mediano plazo / Surgical results among 100 patients with type A aortic dissection: Retrospective review

Background: Tipe A aortic dissection involves the ascending aorta and has high mortality rates without surgical treatment. Aim: To report the results of surgical treatment of type A aortic dissection. Material and Methods: Retrospective review of medical records of 100 patients aged 17 to 78 years (73 percent males) operated between January 2000 and August 2008, for type A aortic dissection. Follow up was performed with telephone interviews and review of national death records. Results: Eighty three percent of patients had an acute dissection. Operative mortality was 27 and 20 percent for patients with acute and chronic dissection, respectively. Mortality was 50 percent among patients aged 70 years or more, compared with 21 percent among their younger counterparts, The most common complication was bleeding that required a new surgical procedure in 18 percent of patients. Actuarial survival was 70 percent at five years. Cardiovascular problems caused the death of two of the nine patients that died during follow up. Conclusions: Surgical mortality among patients with type A aortic dissection was higher among patients with acute episodes and those aged 70 years or more.

Disección aórtica y síndrome de Marfán en el embarazo: A propósito de un caso clínico / Acute type A aortic dissection in pregnant patient with Marfan syndrome: Report of one case

Aortic dissection is a life-threatening disease that requires immediate surgical intervention. Marfan syndrome is a hereditary disease with an autosomaldominant transmission, which affects the connective tissue, with skeletal, cardiovascular and ocular involvement. It is one of the most prevalent connective tissue disorders, presenting a risk of aortic dissection of approximately 1% even without dilatation of the aorta. When dissectionoccurs during pregnancy and requires surgical intervention (type A dissection), maternal mortality is high (20%-30%). We report a 38 year-old woman with Marfan syndrome that hadan acute type A aortic dissection and severe aortic regurgitation at 37 weeks of gestation. The patient underwent a cesarean section and delivered a healthy baby. Afterwards, aortic valverepair and ascending aortic replacement was successfully performed under circulatory arrest with deep hypothermia. Additionally mitral valve repair for degenerative disease with posterior, autologous pericardium mitral valve ring was performed.

Cáncer del tiroides / Thyroid cancer

Se presentan 92 casos de cánceres tiroideos operados entre 1972 y 1992. Se analizan las características clínicas de la serie, los procedimientos quirúrgicos efectuados y los resultados alejados. En el 69,5 por ciento de los casos el bocio fue uninodular. El 55,5 por ciento de los bocios malignos estudiados mediante cintigrafía fueron hipocaptantes. La punción citológica fue de gran rendimiento en 18 casos sometidos a ese estudio diagnóstico. Trece pacientes fallecieron por cáncer del tiroides. Quince se perdieron de control. El resto de la serie se controló entre 3 meses y 26 años después de la operación. Veinticuatro pacientes se controlaron más de cinco años. La mortalidad operatoria fue de 2,17 por ciento. El tratamiento radiante con I 131 o radioterapia externa no tuvo eficacia para modificar el curso de metástasis establecidas