Mixoma cardiaco: Caracterización clínica, métodos diagnósticos y resultados alejados del tratamiento quirúrgico durante tres décadas de experiencia / Cardiac myxoma: Clinical characterization, diagnostic methods and late surgical results

Background: Cardiac myxoma is the most common primary cardiac tumor. Aim: To evaluate clinical aspects, diagnostic methods and surgical outcomes in patients with cardiac myxoma. Patients and Methods: AH patients who underwent surgical resection of a cardiac myxoma between January 1973 and December 2004 at our institution, were identified and their medical records and diagnostic data reviewed. Results: Thirty seven patients identified (24 women), with a median age of 54 years (range 2-74). The most common symptom was dyspnea (51 percent), followed by embolism (24 percent) and cardiac murmurs (16 percent). The diagnosis was made by echocardiogram in 84 percent of patients. The mean tumor size was 4.9 ± 1.3 cm. The tumor was located in the ¡eft atrium in 83 percent of the patients, right atrium in 8 percent and ¡eft ventricle in 3 percent. Two patients had multiple tumors. Surgical approach was transeptal in 51 percent, left atriotomy in 22 percent, combined transeptal and roof of the left atrium in 19 percent and right atriotomy in 8 percent. The tumor and its attachment base were excised in one piece. There were two operative deaths and five late deaths. The mean follow-up was 11.5 years. The 5, 10, 15 and 20 years survival was 89 percent, 83 percent, 75 percent and 64 percent, respectively. Two patients had recurrence (5.4 percent), at 2 and 25years after surgery, respectively, and the recurrence free survival at 10 and 25years was 97 percent and 73 percent, respectively. Conclusions: Dyspnea was the most common symptom and echocardiogram the main diagnostic method. Surgical treatment was highly effective, with low mortality and recurrence rate, with good long term survival.

Factores determinantes en la aparición de fibrilación auricular post-cirugía de revascularización miocárdica: un estudio prospectivo / Risk factors for postoperative atrial fibrillation after coronary artery bypass grafting: a prospective analysis

Background: Atrial fibrillation (AF) is a relevant complication after coronary artery bypass grafting (CABG). However there is controversy regarding possible contributing factors. Aim: To study the incidence of AF, its risk factors and its repercussion on hospital stay and charges, in patients undergoing CABG. Material and methods: We prospectively collected information from all patients undergoing CABG in our institution, including demographic, surgical and laboratory variables. Exclusion criteria were chronic AF, recent onset AF and patients who needed additional surgical procedures. The primary endpoint was the incidence of AF during the hospital stay. Secondary endpoints were hospital length of stay and hospital charges. Results: We included 250 patients aged 62±9 years (199 males) in the analysis. Incidence of AF was 22 percent (54 patients). Multivariable analysis showed that age (Odds Ratio (OR) =1.10), previous CABG (OR =9.39), previous use of ACE inhibitors (OR =3.28) and aortic clamp >57 minutes (OR =3.97) were significantly associated with an increased risk of postoperative AF. Previous use of beta-blockers was associated with risk reduction (OR =0.43). Patients who developed AF had a longer hospital stay (p <0.001) and higher hospital charges (p =0.003). Conclusion: AF is a frequent complication in patients undergoing CABG. Risk factors are age, time of aortic clamp, previous CABG and ACE inhibitors. Beta-blockers may prevent its occurrence. Furthermore, AF has a negative impact on both hospital stay and hospital charges.

Criocoagulación de venas pulmonares como tratamiento complementario de la fibrilación auricular en cirugía valvular / Cryoablation of pulmonary veins as complementary treatment of atria I fibrillation in valvular surgery

Background: The Cox MAZE III operation for the treatment of atrial fibrillation (AF) is complex and consumes significant operative time. Cryoablation of the pulmonary veins (CPV) is a simpler alternative for patients that require concomitant valvular surgery. Aim: To evaluate CPV in patients with AF submitted to valvular surgery. Patients and Methods: Twenty one patients had simultaneous valvular surgery and CPV, 81 percent of them had permanent AFfor an average of 5 years. Twenty patients had mitral valve disease. The etiology was rheumatic in 14. Average left atrial diameter was 60 mm. In 7patients the mitral valve was replaced, in 5 it was repaired, in 7 both mitral and aortic valve were replaced, in 1 the mitral valve was repaired and the aortic valve was replaced and in 1 only the aortic valve was replaced. A combined transeptal and superior approach was used for all patients. The CPV was performed after the valvular procedure with cryothermy at -60°C for 2 minutes with two 15 mm cryoprobes applied simultaneously. Results: CPV increased surgical time by 10 to 20 minutes. Operative mortality was 4.8 percent (1 patient). One patient developed a pericardial effusion and another a complete heart block that required a permanent pacemaker. All patients improved their functional class. At the end of an average 10.5 months of follow-up, 50 percent of patients were in normal sinus rhythm and 25 percent persisted in AF. The remaining patients were in some type of regular rhythm. Conclusions: CPV as a complementary procedure in patients with AF undergoing valvular surgery had good results to abate AF. It restored normal sinus rhythm in 50 percent of the cases, with low morbidity and mortality and little increment in surgical time.

Reemplazo parcial o total del arco aórtico: Experiencia en 23 pacientes / Partial or total replacement of the aortic arch: Experience in 23 patients

Background: Surgery of the aortic arch is a very complex procedure since it requires protective strategies for the brain, heart and rest of the body. Aim: To communicate our experience in the first 23 total or partial replacements of aortic arch. Material and methods: Retrospective search in the database of the Cardiovascular Surgery Unit for patients subjected to partial or total replacement of the aortic arch since 1998. Results: Between 1988 and 2002, 23 patients were operated. Seventeen had aortic dissection (10 acute and 7 chronic), five had an atherosclerotic aneurysm and one had a traumatic lesion. Thirteen patients were subjected to a replacement of the arch plus ascending aorta, six to a replacement of the arch plus descending aorta and four to a replacement of the arch, ascending and descending aorta. Seven patients had previous operation of the thoracic aorta. Arterial perfusion was done via the femoral artery, axillary artery or a combination of both. A hypothermic circulatory arrest was induced in 22; it was associated with cerebral retro perfusion alone in 8 patients, antegrade cerebral perfusion in 5; isolated or associated axillary perfusion was used in five patients. In seven, procedures on the aortic or mitral valve, or coronary artery operations were added. Operative mortality was 26%, 3 of the 8 patients operated as an emergency and 3 of 15 elective operations. There was no mortality among those without dissection and of 7 chronic dissections, one died. All patients were followed for an average of 45 months. Two patients required reinterventions on the aorta and one for colon cancer. There was one late death of unknown cause. Postoperative complications were agitation, bleeding and temporary vocal cord dysfunction. Conclusions: There is a learning curve, where more extensive operations, particularly those done as emergency or for dissections, had an increased operative risk.

Reemplazo valvular mitral y aórtico en niños: resultados durante la última década con prótesis de última generación / Mitral and aortic valve replacement in children: last decade results with latest generation prothesis

Antecedentes: El reemplazo valvular mitral (RVM) y aórtico (RVA) es poco frecuente en pacientes pediátricos y las series publicadas reportan elevada morbi-mortalidad. Objetivo: Evaluar los resultados a mediano plazo en niños sometidos a RVM y RVA durante los últimos diez años, con el fin de determinar morbimortalidad y calidad de vida. Método: Análisis retrospectivo de 26 niños consecutivos (mediana de edad 5,6 años) sometidos a RVM y RVA, entre marzo 1992 y junio 2003. Diecisiete presentaban patología mitral y once aórtica. Resultados: Se realizaron 26 operaciones implantando 28 prótesis (26 mecánicas y 2 biológicas). Tres pacientes (12 por ciento) fallecieron durante el primer mes. La mediana de seguimiento fue de 6,2 años. Tres pacientes con RVM fallecieron alejadamente por causa no atribuible al reemplazo valvular con una sobrevida actuarial de 87 por ciento. Tres pacientes requirieron reoperación. Todos realizan actividades adecuadas a su edad, restringiéndose los deportes de contacto. Conclusión: Los resultados a mediano plazo del reemplazo valvular en niños con valvulopatía grave son satisfactorios.

Tratamiento endovascular del trauma de aorta descendente / Endovascular treatment of descending aorta trauma

Background: Mortality of traumatic aortic lesions is over 80 percent. A group of those who survive, develop a chronic pseudo aneurism, usually asymptomatic, that is detected during imaging studies. Since conventional surgical treatment of traumatic aortic lesions has a great mortality, endovascular treatment has been used as an alternative treatment in the last decade. Aim: To report our experience with endovascular treatment of traumatic aortic lesions. Patients and methods: Report of seven patients aged 22 to 65 years, with traumatic aortic lesions. Under general anesthesia an endovascular prosthesis was inserted through the femoral artery. Results: No complications were observed in the postoperative period, and after a follow up ranging from 4 to 40 months, no endoleaks or other complications have been detected. Conclusions: Endovascular treatment of traumatic aortic lesions has good immediate and midterm results.

Cirugía paliativa mediante operación de Norwood en distintas formas de corazón univentricular: resultados quirúrgicos inmediatos / Immediate results of palliative surgery for different forms of univentricular heart using the Norwood procedure

Background: Norwood procedure is used as the first stage in the palliative treatment of the hypoplastic heart syndrome and can be used, with some technical modifications, in other forms of univentricular heart with aortic stenosis or hypoplasia. These patients have a high mortality (50 percent), derived from the procedure itself and from their abnormal physiological status. Aim: To report our experience with the Norwood procedure. Patients and methods: Retrospective analysis of all patients subjected to the Norwood procedure between February 2000 and June 2003. Results: Thirteen patients (9 females, age range 5-60 days and median weight of 3.3 kg) were operated. Eight had hypoplastic heart syndrome and five had a single ventricle with aortic arch hypoplasia. The diagnosis was done in utero in eight patients. All technical variations, according to the disposition and anatomy of the great vessels, are described. Cardiac arrest with profound hypothermia was used in all and regional cerebral perfusion was used in nine. Three patients died in the perioperative period and three died in the follow up (two, four and 10 months after the procedure). Gleen and Fontan procedures were completed in five and one patients, respectively. Conclusions: Our results with the Norwood procedure are similar to other series. There is an important mortality in the immediate operative period and prior to the Glenn procedure (Rev MÚd Chile 2004; 132: 556-63).