Disección aórtica Stanford tipo B no complicada tratada con reparación aórtica endovascular / Stanford Type B Uncomplicated Aortic Dissection Treated with Endovascular Aortic Repair

Resumen La disección aórtica aguda es una urgencia médica asociada a una alta mortalidad, por lo que es fundamental el diagnóstico precoz a partir de una historia clínica detallada, hallazgos a la exploración física y estudios de imagenología, pilares fundamentales para su diagnóstico. El tratamiento depende de su localización, con recomendación de abordaje quirúrgico urgente para las disecciones agudas de tipo A y principalmente el tratamiento farmacológico en la disección aórtica tipo B no complicada. Presentamos el caso de un paciente del sexo masculino, de origen mexicano, que desarrolló disección aórtica tipo B no complicada, a quien se decidió abordar con tratamiento farmacológico y reparación aórtica endovascular, y presentó una adecuada evolución del cuadro clínico, sin complicaciones al egreso ni durante su seguimiento.

Abstract Acute aortic dissection is a medical emergency associated with high mortality, so an early diagnosis based on a detailed clinical history, physical examination findings, and imaging studies is essential for its diagnosis. The treatment depends on its location, with the recommendation of an urgent surgical approach for acute type A dissections and mainly pharmacological treatment in uncomplicated type B aortic dissection. We present the case of a Mexican male patient who developed uncomplicated type B aortic dissection, that was treated with pharmacological treatment and endovascular aortic repair, and presented an adequate clinical evolution without complications at discharge or during follow-up.

Acute coronary syndrome associated with anomalous origin of circumflex artery. Case report and literature review / Síndrome coronario agudo asociado al origen anómalo de la arteria circunfleja. Reporte de caso y revisión de literatura

Abstract: We present a case of an acute coronary ischemic syndrome associated with anomalous origin of the circumflex artery, with a right coronary sinus origin independent of the right coronary artery, which has a prevalence of 0.1 to 8.4%. This type of anomaly is classified according to the international guidelines as low-risk, however, at high risk of presenting atheroma, coronary complications,(1) and acute coronary ischemic syndrome due to its occasionally intraarterial pathway. The treatment depends on the complexity of the coronary anatomy. In this case with the presence of total obstruction the correct therapy was to perform a percutaneous coronary angioplasty with drug-eluting stent (DES) placement, which improves the survival and is therapeutic at the acute phase, as in the case of this patient.

Resumen: Presentamos un caso de síndrome isquémico coronario agudo asociado al origen anómalo de la arteria circunfleja, a partir del seno coronario derecho independiente de la arteria coronaria derecha, que tiene una prevalencia de 0.1 a 8.4%. Este tipo de anomalía se clasifica según las guías internacionales como de bajo riesgo; sin embargo, con alto riesgo de presentar desarrollo de ateroma y complicaciones coronarias, síndrome isquémico coronario agudo debido a su trayecto en ocasiones intraarterial. El tratamiento depende de la complejidad de la anatomía coronaria. En este caso de obstrucción total, la terapéutica correcta fue realizar angioplastia coronaria percutánea con la colocación de stent fármaco activo, lo que mejora la sobrevida y es terapéutico en el momento agudo, como en el caso de este paciente.

Tratamiento endovascular del aneurisma de aorta abdominal / Endovascular treatment of the abdominal aorta aneurysm

Objetivo: Reportar nuestra experiencia en el tratamiento endovascular en la resolución de la patología aórtica y evaluar la morbi-mortalidad. Sede: Centro Médico del Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM). Diseño: Estudio descriptivo, observacional, transversal, retrospectivo. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Métodos: Se revisaron los expedientes clínicos de los pacientes con aneurisma de aorta abdominal (AAA) a los cuales se les realizó procedimiento endovascular entre junio de 2005 a junio de 2009. Analizando las siguientes variables: género y edad, diámetro del aneurisma aórtico, endoprótesis utilizada, patología concomitante, complicaciones, uso de hemoderivados, días de estancia intra-hospitalaria y morbi-mortalidad. Resultados: 12 pacientes, 10 del género masculino, edad promedio de 57.8 años, diámetro del aneurisma de 66.8 mm, procedimiento anestésico general en todos los pacientes, promedio de unidades de hemoderivados utilizados fue de 0.5, se presentaron tres complicaciones, dos inherentes al procedimiento endovascular. Conclusión: El tratamiento endovascular de la enfermedad aórtica se ha convertido en una opción terapéutica, que ofrece una baja morbi-mortalidad y excelentes resultados a corto plazo, siendo realizado por un grupo multidisciplinario en el área cardiovascular.

Objective: To report our experience in the endovascular treatment to resolve aortic pathology and assess the associated morbidity and mortality. Setting: Medical Center of the Instituto de Seguridad Social del Estado de México y Municipios (ISSEMyM), Mexico. Design: Descriptive, observational retrospective, transversal study. Statistical analysis: Percentages as summary measure for qualitative variables. Method: We reviewed the clinical records of patients with abdominal aorta aneurysm (AAA) that were subjected to an endovascular procedure between June 2005 and June 2009. We analyzed the following variables: gender and age, diameter of the aortic aneurysm, used endoprosthesis, concomitant pathology, complications, use of hemoderivates, length of in-hospital stay, morbidity, and mortality. Results: We found 12 patients, 10 were men, average age of 57.8 years, aneurysm diameter of 66.8 mm, general anesthesia was used in all patients, the average of hemoderivate units was of 0.5, three complications occurred, two of them were inherent to the endovascular procedure. Conclusion: Endovascular treatment of aortic disease has become a therapeutic alternative that offers a low morbidity and mortality and excellent results in the short term when it is performed by a multidisciplinary team in the cardiovascular area.

Ten-year clinical and echocardiographic follow-up of patients undergoing percutaneous mitral commissurotomy with Inoue balloon / Comisurotomía mitral percutánea con balón de Inoue: seguimiento clínico y ecocardiográfi co a 10 años

Percutaneous mitral commissurotomy (PMC) has emerged as an effective nonsurgical technique for the treatment of patients with symptomatic mitral stenosis. This report highlights the immediate and long-term follow-up results of this procedure in an unselected cohort of patients with rheumatic mitral stenosis from a single center. PMC with Inoue balloon was performed in 70 patients in a 2-year period (1993-1994). Age of patients ranged from 18 to 67 years (mean 38 +/- 11). Atrial fibrillation was present in 18 (30%) patients. A detailed clinical and echocardiographic (two-dimensional, continuous-wave Doppler and color-flow imaging) assessment was done at follow-up. The procedure was technically successful in 61 (85%) patients with an increase in mitral valve area (MVA) from 0.96 +/- 0.2 to 1.7 +/- 0.28 cm2 (P < .001) and a reduction in mean trans-mitral gradient from 14.3 +/- 4.8 to 6.0 +/- 2.8 mmHg (P < .01). Mitral regurgitation appeared or worsened in 25 (30%) patients, of which 3 (4%) developed severe mitral regurgitation. Urgent mitral valve replacement was performed in these 3 patients. Data of 52 patients followed over a period of 105 +/- 10 months revealed MVA of 1.4 +/- 0.4 cm. Elective mitral valve replacement was done in 14 (23%) patients. Mitral restenosis diagnosed with echocardiography was seen in 24 (50%) patients, of which 14 were having recurrence of class III or more symptoms and were treated with surgery. Thus, percutaneous mitral commissurotomy is an effective and safe procedure and over 2/3 of the patients were event-free at the end of follow-up. The benefits are sustained in most of these patients on long-term follow-up.