Coronary artery abnormalities in Puerto Rico

A retrospective study was done to determine the frequency of coronary artery anomalies in terms of their origin, course, and structure. The clinical history, catheterization data and surgical reports of patients undergoing coronary angiography at the Cardiovascular Center of Puerto Rico and the Caribbean, from 1999 to 2004, were analyzed. Thirty-eight patients were identified with a coronary artery anomaly in this population. These anomalies were classified according to their clinical consequences and the need for surgical intervention.

Heart transplantation in females: the experience in Puerto Rico

BACKGROUND: Heart transplantation is the procedure of choice for a selected group of patients with end stage heart disease. Gender related differences have been observed in the heart transplant field: less women than men are recipients of heart transplants, more risk of rejection in female recipients, and a perception toward reduced survival in women. We report our experience of heart transplantation in females in Puerto Rico. METHODS: We studied the data bank of 69 heart transplant recipients in the Puerto Rico Heart Transplant Program from June 1999 to June 2005. Gender related differences in the number of recipients: males or females, incidence of rejection, survival, and other outcomes were analyzed. RESULTS: 69 patients received an orthotopic heart transplant from June 1999 to June 2005, in a single center in Puerto Rico. The mean age of the patients was 47 (11-62) years. Fifty patients (72%) were men, and 19 patients (28%), were women. Survival in the female group at 3 months, 1, 2, 3, 4, and 5 years was 100%, 100%, 100%, 100%, 90%, and 90% respectively. The survival in the male group at 3 months, 1, 2, 3, 4 and 5 years was 97%, 97%, 97%, 94%, 86 and 79% respectively. There was an early, higher incidence of rejection in women during the first three months post transplant; 1.5 vs. 0.75, (P=0.04) episodes per patient in the female, and male group respectively. After the third month post transplant there was no significant difference in rejection incidence. The incidence of infectious episodes was significantly more frequent in female than in male recipients, 2.8 vs. 1 (P=0.02) per patient respectively. CONCLUSIONS: There were more male than female heart transplant recipients at a ratio of 3:1, without a significant gender difference in survival. The risk of rejection was higher in females in the early period post transplantation, but thereafter this risk showed no signinificant statistical difference. The incidence of infection was more frequent in female...

Extra-adrenal pheochromocytoma

We have presented our experience in the diagnosis and management of three patients with extra-adrenal pheochromocytomas. Only two had hypertension, although all three had increased catecholamine production. The third patient was normotensive preoperatively and remained normotensive after the immediate postoperative period. Two patients are alive and without evidence of disease, the third patient died from what was considered to be a malignant pheochromocytoma. All three patients presented with palpable masses, confirmed by computerized tomography

Some aspects of clinical & anesthetic management of heart transplantation

El transplante de corazón se ha convertido en uma terapia utilizada con relativa frecuencia para el tratamiento de enfermedad cardíaca en etapa final. Sin embargo, no existe acuerdo absoluto con respecto a ciertos aspectos relacionados con el manejo clínico y de anestesia del donante y menos aun del recipiente. Las condiciones que más comunmnete se citan como causa para transplante cardíaco lo son la cardiomiopatia dilatada de origen idiopático y la cardiomiopatía de origen isquémico. Existen múltiples contraindicaciones para transplante cardíaco. Sin embargo, una vez se decide evaluar un paciente como candidato a transplante es esencial, en la etapa inicial de evaluación, descartar la presencia de resistencia pulmonar aumentada, pues se han demostrado pobrísimos resultados en presencia de esta entida. El uso de técnicas estériles de intubación, inducción anestésica rápida y el uso de vasopresores son los aspectos más sobresalientes en el manejo anestésico del recipiente. Entre los problemas más comunes en el período post-operatorio inmediato se cuentan el débito cardíaco disminuido y problemas con la regulación de electrolitos. Algunos de estos aspectos se revisan en el seguiente artículo

Physiology of the denervated heart: a review

Fisiología del corazón denervado. Se discute la fisiología del corazón transplantado. El órgano transplantado puede llevar a cabo todas las funciones del corazón normal, sin embargo éste posee propiedades intrinsecas que modifican su respuesta al ejercicio y a los agentes farmacológicos. Se hace un repaso de la literatura sobre este tema