Extracapsular dissection and minimally invasive procedures of primary benign parotid tumours: Case series

Extracapsular dissection is an old technique use for the removal of benign parotid tumours, which is not generally chosen as the first treatment option due to the association of recurrences in the past but is currently considered again accord to the aesthetic requirements of the patients. The general trend in the last decade is to return to minimally invasive procedures for this type of lesions, which are mainly conditioned by the pleomorphic adenoma and its positive margins in its capsule. By this, the purpose of this case series study is to analyze those patients diagnosed with benign parotid tumors and treated by extracapsular dissection in a tertiary hospital in Chile between 2018-2020.

Prescripción de antibióticos en las infecciones respiratorias agudas no neumonías en atención ambulatoria en la práctica privada / Prescription of antibiotics in acute respiratory infections non-pneumonia in a private outpatient practice

BACKGROUND: The over prescription of antibiotics for acute respiratory infections is a major public health problem worldwide. Aim: To evaluate the frequency of prescription of antibiotics for non-pneumonia acute respiratory infections in private outpatient clinics in individuals without chronic diseases or immunosuppression. MATERIAL AND METHODS: All medical records of adult consultants in a national network of private ambulatory medical centers during May 2018 whose primary diagnosis corresponded to acute respiratory infections not pneumonia (ICD10) were identified and retrospectively analyzed, excluding those with chronic respiratory conditions or states of immunosuppression. RESULTS: Of the 38,072 consultants (aged 36 years, 63% women) who met this criterion, 54% (n = 20,499) received a prescription for at least one antibiotic. The diagnoses that most frequently received this prescription were acute bronchitis (28.7%), acute sinusitis (16.5%) and acute tonsillitis (16.2%). The most frequently prescribed antibiotic globally was azithromycin (37.4%), followed by amoxicillin (20.1%) and amoxicillin plus clavulanic acid (17.7%). Levofloxacin prescription reached 12.5% of total prescriptions. CONCLUSIONS: An antibiotic was prescribed in more than half of the non-pneumonia outpatient acute respiratory infections. Azithromycin was the most prescribed antibiotic, while levofloxacin exceeded 10% of prescriptions. These results reinforce the need to implement an antibiotic prescription surveillance system at the outpatient level.

Acute pulmonary thromboembolism: risk stratification, treatment modalities, mortality and adherence to clinical guidelines / Tromboembolismo pulmonar agudo: estratificación del riesgo, modalidades de tratamiento, mortalidad y apego a guías clínicas

Abstract: Introduction: Pulmonary thromboembolism (PTE) is a cardiovascular emergency threatening life. It is classified at low, intermediate and high risk of mortality. By the above, it allows to establishing conservative treatment for low-intermediate risk PTE and more intense treatment for high risk PTE. Objective: To report the number of cases of acute PTE, risk stratification and prognosis in those treated with adherence to clinical guidelines. Material and methods: Review of clinical records with a diagnosis of acute PTE by confirmatory diagnostic test. The type of treatment was determined by: oral anticoagulation (OAC) or parenteral anticoagulation (PAC), percutaneous thrombectomy, supraselective thrombolysis, systemic thrombolysis, surgical thrombectomy or combinations. The type of initial anticoagulation and maintenance therapy. Hard results: TIMI major bleeding, re-thrombosis, death and brain stroke (BS). Normality was verified by Kolmogorov-Smirnov test. Then was compared with Student t or U Mann-Whitney. Results: A sample of 36 patients was obtained, the mean age was 67.24 ± 18.83 years, 62.2% were females. The 29.7% were low-risk PTE, 51.4% were intermediate risk and 18.9% were high risk. The 70.3% received OAC, 8.1% percutaneous trombectomy, 8.1% systemic thrombolysis, 10.8% systemic thrombolysis + percutaneous thrombolysis, 2.7% percutaneous trombectomy + supraselective thrombolysis. There is increased risk of death in this group OR = 2.63 (95% CI 0.45-16.08) but not significant (p = 0.255). Conclusions: Lack of adherence to clinical guidelines confers increased risk of death in patients with acute PTE, this difference is not statistically significant.

Resumen: Introducción: La tromboembolia pulmonar (TEP) es una urgencia cardiovascular que pone en riesgo la vida. Se cataloga en riesgo bajo de mortalidad, intermedio y alto. Lo anterior permite establecer estrategias terapéuticas conservadoras para la TEP de riesgo bajo-intermedio y más intensas para alto riesgo. Objetivo: Reportar el número de casos de TEP aguda, la estratificación de riesgo y el pronóstico en quienes recibieron tratamiento con apego a guías clínicas. Material y métodos: Revisión de expedientes clínicos con diagnóstico de TEP aguda, mediante prueba diagnóstica confirmatoria. Se determinó el tipo de tratamiento: anticoagulación (ACO), oral o parenteral (ACP), trombectomía percutánea(TBTP), trombolisis supraselectiva (TBLSU), trombolisis sistémica (TBLSIS), trombectomía quirúrgica (TBTQ) o sus combinaciones. El tipo de anticoagulación inicial y de mantenimiento. Los resultados duros: sangrado TIMI mayor, retrombosis, muerte y evento vascular cerebral (EVC). Se verificó la normalidad mediante prueba de Kolmogorov-Smirnov. Posteriormente se comparó con t Student o U de Mann-Whitney. Resultados: Se obtuvo una muestra de 36 pacientes, la edad media fue 67.24 ± 18.83 años, el 62.2% fueron del género femenino. El 29.7% correspondía a TEP de riesgo bajo, 51.4% riesgo intermedio y 18.9% a riesgo alto. El 70.3% se dio ACO y ACP, 8.1% TBTP, 8.1% TBLSIS, 10.8% TBLSIS + TBTP y 2.7% TBTP + TBLSU. Existe mayor riesgo de muerte en el grupo de falta de apego a guías OR = 2.63 (IC 95% 0.45-16.08), sin embargo, no es significativo (p= 0.255). Conclusiones: La falta de apego a guías clínicas confiere mayor riesgo de muerte en pacientes con TEP aguda, esta diferencia no es estadísticamente significativa.

Y de cómo el corazón se convirtió en el centro de la vida y de la espiritualidad (y de los otros órganos con los que tuvo que competir a lo largo de la historia por este sitial) / How the heart became the center of life and spirituality of man (and the other organs with which it had to compete along history for this seat)

Si bien pudiera parecer que desde siempre el corazón fue el centro de la vida y de la espiritualidad del hombre, esto no es exactamente así. A lo largo de la historia, debió competir con otros órganos por esta posición. Su primer competidor fue el hígado, especialmente en Babilonia. Para los babilonios, el hígado, una masa grande, inmóvil en la cavidad abdominal, era el órgano ideal para que los dioses hicieran saber el futuro. Sin embargo, los egipcios eligieron al corazón como el órgano central de la vida y asiento del alma y le atribuyeron toda clase de facultades. En Israel, es el pulmón donde radica la vida. La característica de este no son las palpitaciones, sino la respiración. Dios crea a Adán soplándole Su aliento en la nariz. Pero el competidor más serio fue el cerebro. Los filósofos y médicos griegos van a discrepar, dando origen a una larga controversia. La discusión se termina con Aristóteles, quien afirma que, al igual que el mundo tiene un punto central, también el hombre lo tiene, y este es el corazón. Y así es hasta cinco siglos más tarde, en que Galeno vuelve a sostener que la vida mental y espiritual del hombre se asienta en el cerebro. Sin embargo, hasta hoy, hombres y mujeres siguen sintiendo que su espíritu habita en el corazón y que el centro de la vida es el corazón, puesto que el corazón simboliza lo más propio del hombre, el amor.

Though it could seem that the heart has always been the center of life and spirituality of man, this is not exactly so. Along history the heart had to compete with other organs for this position. Its first competitor was the liver, specially in Babylonia. For the Babylonians, the liver, a big, immobile mass in the abdominal cavity, was the ideal organ for the gods to make the future known. On the other hand, the Egyptians chose the heart as the central organ of life and seat of the soul, and attributed to it all kinds of faculties. In Israel the lung was the site where life took root. The distinctive features of life were not the throbs but the breathing. God created Adam blowing His breath into Adam’s nose. But, the most serious competitor was the brain. The Greek philosophers and physicians had different opinions, giving origin to a long controversy. The discussion was settled by Aristotle, who stated that as the world has a central point, man also has one, and this is the heart. This remained so for five centuries until Galen declared that the brain is the seat of mental and spiritual life of man. However men and women up to today continue feeling that their spirit inhabits in the heart and that the center of their life is the heart, since it symbolizes love, an inherent faculty of man.

Cincuenta años de circulación extracorpórea: la historia de la máquina corazón-pulmón / Fifty years of extracorporeal circulation: the history of the heart-lung machine

Si bien 1953 fue el año del descubrimiento del ADN y de la conquista del Monte Everest, también lo fue de un gran invento tecnológico: la máquina corazón-pulmón, la que ofreció un tratamiento, y en muchos casos cura, a la mayoría de las enfermedades cardiovasculares. En efecto, el 6 de mayo de 1953 John Gibbon logró coronar con el éxito el trabajo de toda su vida al cerrar por primera vez una comunicación interauricular en una joven mujer utilizando una máquina corazón-pulmón de su invención. Sin embargo, previamente la cirugía exploró otros caminos para operar el corazón, como la hipotermia, la que consistía en bajar la temperatura del paciente introduciéndolo en una tina de agua fría para luego efectuar la corrección quirúrgica de una malformación del corazón, en el menor tiempo posible. Por otra parte, luego de su primer éxito, los 4 pacientes siguientes de Gibbon fallecieron, por lo que este abandonó todo intento ulterior, lo que fue seguido por un pesimismo generalizado sobre la circulación extracorpórea. Este fue revertido un año más tarde por Walton Lillehei con la introducción de la "circulación cruzada controlada" en la que un paciente, habitualmente un niño, era conectado a un "donante", habitualmente el padre o la madre, cuyo corazón y pulmón servían como un oxigenador para así efectuar la cirugía a corazón abierto del paciente. Finalmente, es el mismo Lillehei, quien un año más tarde introduce el oxigenador de burbujas, simple y de bajo costo, que abrió las puertas de la cirugía a corazón abierto a todos los cirujanos del mundo. Por esto, para muchos, Walton Lillehei es considerado el "Padre de la Cirugía a Corazón Abierto". Lillehei visitó Chile en 1963 y luego de operar en los pabellones del Hospital Clínico de la Universidad Católica fue nombrado Miembro Honorario de la Facultad de Medicina de dicha Universidad. Previamente, en 1957, Helmuth Jaeger había efectuado el primer cierre quirúrgico exitoso de una comunicación interauricular con circul...

Canulación de arteria axilar para circulación extracorpórea / Cannulation of axillary artery for extracorporeal circulation

Background: When the ascending aorta and the femoral artery cannot be used for extracorporeal circulation, an emerging alternative is the use of axillary artery. Aim: To report the experience using the axillary artery for extracorporeal circulation. Patients and methods: Between November 1998 and May 2002, 22 patients (14 male) were operated with extracorporeal circulation, cannulating the axillary artery. Briefly, an incision is made below the middle third of the clavicle and a cut is made on major pectoris muscle. Minor pectoris muscle is retracted and axillary artery is exposed. It is cannulated directly or with the aid of a prosthesis. Results: Right axillary artery was used in 21 patients and in 20 it was cannulated with the aid of a prosthesis. Mean flow was 4.5 + 0.6 l/min. The most common indications were aortic dissection or aneurysms. The most common procedures done, were ascending aorta replacement in 8 cases and replacement of ascending aorta and aortic arch in 5. Thirty five percent of operations were emergencies and 32 percent were reoperations. In 15 patients (68 percent), a circulatory arrest was done. Of these, retrograde brain perfusion was used in 9, antegrade brain perfusion through the same axillary artery was used in 2 and mixed perfusion was used in 2. One patient had a complication related to the axillary cannulation. None had cerebrovascular accidents or thromboembolic complications. Two patients died in the postoperative period. Patients were followed up to 42 months after the procedure and no secondary complications of the cannulation were detected. Conclusions: When the ascending aorta and the femoral artery cannot be used, axillary artery is a good alternative for extracorporeal circulation

Transección traumática aguda de la aorta torácica: tratamiento endovascular / Endovascular treatment of acute traumatic rupture of the thoracic aorta: report of 1 case

Traumatic rupture of the aorta has a near 80 percent mortality. Most patients die on the site of the accident. Conventional surgical repair of these lesions has a high morbidity and mortality, generally associated to the severity of associated lesions. Over the last decade, endovascular treatment has become an effective therapeutic alternative. We report a 40 years old male, that suffered a traumatic rupture of the descending thoracic aorta in a car accident. A successful endovascular repair was performed, installing an endoprothesis on the site of the lesion, using a femoral artery approach. The patient had a good postoperative evolution and was discharged from the hospital once complete rehabilitation of his associated lesions was obtained

Operación de Fontan: resultados inmediatos y a mediano plazo con anastomosis cavopulmonar total / Fontan procedure: early and mid-term results wiht total cavopulmonary anastomosis

Background: During the last five years, 65 patients with univentricular heart have been treated surgically in our institution, according to a protocol of staged operations that have been previously reported. Aim: To evaluate the early and mid-term outcome of those patients that have completed their staging protocol by means of a Fontan procedure. Patients and Methods: Between April 1996 and June 2001, 23 patients (age 16 to 223 months) underwent a Fontan procedure, 15 with an intracardiac lateral tunnel technique and 8 with an extracardiac conduit. A retrospective review of their clinical, surgical, echocardiographic, angiographic and hemodynamic data was performed, trying to identify risk factors for both mortality and functional capacity (FC). Follow up was complete in all survivors. Results: Three patients died early after surgery (13.04 percent). Excessive pulmonary blood flow was a risk factor for early death (p= 0.03). One patient died at 14 months. Follow up was 29.9 months (1-63). For those who survived the operation, five years survival was 93.3 percent. The majority of patients are in FC I or II, with no related risk factors. Conclusions: Our current results are comparable with those of larger series. Patients reach good FC and mid-term survival, irrespective of type of single ventricle or the surgical strategy

Tratamiento quirúrgico de la coartación aótica en recién nacidos y lactantes menores de tres meses / Surgical treatment of the aortic coarctaction in newborn and infants under 3 months old

Antecendentes: La cirugía es el tratamiento de elección de la coartación aórtica. Sus resultados deben evaluarse no sólo en base de morbimortalidad operatoria si no también en relación a la incidencia de coartación residual y recoartación, hecho que es más frecuente en recién nacidos. Actualmente, dado el interés progresivo en la angioplastia primaria como tratamiento de esta patología se hace necesario conocer los resultados actuales del tratamiento quirúrgico. Objetivo: Analizar y reportar nuestra experiencia en el subgrupo de pacientes de mayor riesgo. Método: Se analizaron retrospectivamente todos los pacientes de hasta 3 meses de edad (menores de 120 días) sometidos a cirugía de coartación aórtica en nuestra institución, entre enero de 1989 y agosto de 1999. Se efectuó un análisis descriptivo de las características generales y de la técnica quirúrgica, así como de los resultados inmediatos y alejados. Resultados: Cincuenta y nueve pacientes fueron sometidos a reparación quirúrgica de la coartación aótica. La edad fue de 35ñ33 días, correspondiendo un 57 por ciento a recién nacidos. Treinta y seis pacientes (61 por ciento) eran del sexo masculino. El peso fue de 3.650ñ1.057 g. La coartación aótica se presentó en forma aislada en 28 pacientes (47,5 por ciento), asociada a CIV en 7 (11,9 por ciento) y a otra patología intracardíaca en 24 (40,7 por ciento). Treinta y seis pacientes (61 por ciento) presentaron unarco aórtico normal, 17 hipoplasia del istmo (28,8 por ciento) y 6 hipoplasia del arco transverso (10 por ciento). La principal indicación de cirugía fue insuficiencia cardíaca. Al momento de la cirugía 17 pacientes (31,5 por ciento) se encontraban en ventilación mecánica y 20 (37 por ciento) habían recibido de protaglandinas. La técnica quirúrgica fue: anastomosis término-terminal en 31 (52,5 por ciento); anastomosis término-terminal extendida en 24 (40,7 por ciento) y colgajo subclavio en 4 (6,7 por ciento). El tiempo de clampeo aórtico fue de tomosis fue de 18,4ñ6,2 minutos. En siete pacientes (11.9 por ciento) se efectuó cirugía cardíaca adicional. Cuatro pacientes (6,7 por ciento) presentaron coartación aórtica residual la cual motivó cirugía en un caso (1,7 por ciento) y angioplastia en otro. Ningún paciente presentó paraplejia. La mortalidad quirúrgica a 30 días fue de 3,4 por ciento (2 casos). Siete pacientes (11,8 por ciento) fallecieron durante el seguimiento, obteniéndose una sobrevida actuarial a 5 años de 83,9 por ciento

Experiencia de 36 años con marcapasos implantables: un análisis histórico / A 36 year experience with implantable pacemakers

Background: The implantation of pacemakers improves cardiac function and quality of life, in particular with dual chamber DDD and DDDR modes. Aim: To evaluate our clinical experience and results on pacemaker implantation, from 1963 to 1998. Material and methods: Computerized data collected from 2,445 consecutive paced patients was reviewed. A total of 3,554 operative procedures were performed, including 412 procedures for complications and 697 pacemaker replacement. Patient survival was determined from clinical records, inquiry to pacemaker manufacturers and death certificates from Servicio de Registro Civil e Identificaci-n de Chile (Chilean Civil and Identification Registry). Results: Use of dual chamber (DDD and DDDR) pacemakers increased progressively up to 74 percent from 1988 to 1998. Complication rate was 42 percent in the 1963-1976 study period, it decreased to 10.6 percent in the 1977-1987 study period, and to 5.6 percent by 1988-1998. Only two patients died during surgery in the study period (0.08 percent). In the 1977-1987 period, pacemakers lasted 10.6 years. Survival rates were 52 percent at ten years, 33 percent at 15 years, and 21 percent at 20 years, with a median survival of 11.7 years, and 7.24 years in patients over 80 years old. Conclusions: Transvenous permanent pacing can be accomplished today with a low complication rate, mainly due to better technology and surgical procedures

Cirugía de la insuficiencia mitral isquémica / Surgery for ischemic mitral regurgitation

Background. Ischemic mitral regurgitation (IMR) is a severe condition which may be best treated by surgery, nowithstanding a relatively high mortality rate. Objectives. To evaluate the results of mitral valve replacement or repair in patients with IMR. Patients and methods. Retrospective review of the clinical records in 29 patients with IMR who were surgically treated from 1990 to 1999. They represent 8 percent of surgical procedures on the mitral valve. Results. Mean age was 67 ñ 9 years. Surgery was performed urgently in 19 patients (66,5 percent). NYHA functional class was 3.4 ñ 0.8. The mechanism of IMR was annular dilatation and spreading of papillary muscles in 18 patients, papillary muscle rupture in 9 and fibrosis in 2. Mitral valve replacement was performed in 14 patients and mitral valve repair in 15. Twenty four patients (83 percent) had concomitant myocardial revascularization. Overall surgical mortality was 24 percent; 26 percent for mitral replacement and 13 percent for mitral valve repair (p=0.215). On follow up of 26ñ33 months, one year survival was 76ñ0.8 percent and 5 years survival was 59ñ12 percent. Excluding in hospital mortality, survival was 100 percent at one year and 78ñ14 percent at 5 years. Functional class improved in all survivors, to 1.4ñ0.5. Late echocardiographic evaluation of patients with mitral valve repair showed absence of mitral regurgitation in 58 percent, 1+ MR in 17 percent and 2+ MR in 25 percent. Conclusion. In spite of a high perioperative mortality, surgery for IMR is a valuable procedure for patients with an otherwise highly lethal disease

Reoperaciones coronarias: análisis retrospectivo de 16 años de experiencia / Coronary artery bypass grafting reoperation: a 16 years retrospective analysis

Background: Coronary artery bypass grafting (CABG) reoperation is being performed with increasing frequency. Aim: To assess the early and long term results of coronary reoperations in our institution and to identify prognostic factors. Patients and methods: 214 patients subjected to coronary reoperations between 1983 and 1999 were retrospectively studied. Results: Mean age was 64.2 years (range 42-79 years), 202 (94.4 per cent) were male and 12 (5.6 per cent) female. The mean interval between the operations was 125.7 months (range 6-252 months). 10 (4,6 per cent) were emergency surgeries. Overall operative mortality was 5.6 per cent (11 deaths) and in 5 patients (3.4 per cent) a perioperative myocardial infarction was noted. Univariate analysis identified moderate or severe left ventricular failure (p=0.048) as predictor of increased operative mortality, meanwhile age over 75 years (p=0.02) and moderate or severe left ventricular failure (p=0.01) were identified as predictors of increased in hospital mortality in the multivariate analysis. Follow up of in hospital survivors (mean interval 65 months, range 4 to 190 months) documented a 5 years survival rate of 82.9 per cent, a 10 years survival rate of 73.1 per cent and a 15 years survival rate of 53.4 per cent. Moderate or severe left ventricular failure (p <0.0001) and emergency surgeries (p=0.007) were identified as factors influencing the late survival in the stepwise logistical regression analysis. Multivariate analysis identified left ventricular failure (p=0.01) and peripheral vascular disease (p=0.01) as predictors of decreased late survival. Conclusions: Coronary reoperation has a low mortality in patients with a normal ventricular function and also has an excellent overall and disease free survival in the first 10 years of follow up. Left ventricular function is an independent risk factor increasing in hospital and late mortality

Fibroelastoma papilar múltiple de válvula aórtica complicado de accidente vascular encefálico embólico: caso clínico / Aortic valve multiple papillary fibroelastoma complicated with a cerebrovascular accident: report of case

The echocardiographic identification of cardiac tumors as cause of embolic episodes is infrequent, and the finding of multiple papillary fibroelastoma is even less common. We report a 70 years old female with a history of a rheumatic mitral valve lesion, subjected to a commissurotomy in 1970. She was admitted with a cerebrovascular accident and the transesophageal echocardiogram revealed the presence of a multiple papillary fibroelastoma in the aortic valve. The patient was operated and the tumor excised, the pathological analysis confirmed the diagnosis. The patient was discharged in good conditions and after 8 months of follow up, she has no neurological abnormality and is in functional class I

Infección de prótesis de aorta ascendente: tratamiento con aseo quirúrgico, preservación de prótesis y transposición de colgajo muscular en dos casos / Infection of ascending aortic graft: treatment with surgical cleaning, graft preservation and transposition of muscle flaps, report of 2 cases

Mediastinitis with graft infection is a serious complication of ascending aorta replacement. We report two cases of graft infection, treated with surgical cleaning, graft preservation and transposition of muscle flaps. A 62 years old male was admitted 34 days after an ascending aortic grafting due to a sternal dehiscence and mediastinitis. Antimicrobial treatment was started and a surgical cleaning performed, leaving an open sternotomy. Three days later, the thoracic cavity was closed with a rectus abdominis muscle flap. After 23 months of follow up, the patient is well and without evidence of infection. A 74 years old male was subjected to an aortic valve and ascending aorta replacement and a myocardial revascularization. In the postoperative period, the patient developed septic signs, and a purulent drainage. A CAT scan showed a liquid collection surrounding the aortic graft. On tW Sixteenth postoperative day, a surgical cleaning was performed and the thorax was closed with the pectoralis major muscle. After 10 months of follow up, the patient is in Good condition and without evidence of infection

Del camino recorrido por la cirugía para tratar la enfermedad coronaria: trabajo dedicado como homenaje póstumo al Dr. René Favorolo / A short history of coronary surgery: apropos of Dr. Favaloroïs death

The first surgical procedure for the treatment of coronary artery disease, in 1933, was total thyroidectomy. Some years later, procedures to increase heart irrigation such as pectoral or great epiplon grafting and cardiopeumopexy were attempted. In 1940, the ligation of great cardiac vein or coronary sinus were introduced. Five years later, pericoronary neurectomy was used. In 1945, Beck used an arteriovenous fistula between the descending aorta and the coronary sinus and, from 1954, he used the erosion of heart surface with asbestos application, complemented with the occlusion of the coronary sinus and the application of parietal pericardium. In 1958, Glover introduced the bilateral ligation of mammary arteries and Vineberg, developed the internal mammary artery implant, that consisted in the tunneling of the free portion of such artery in the myocardium. En 1956, Lillehei and Bailey introduced coronary endarterectomy and finally in 1967, Favaloro introduced systematically the aortocoronary bypass using safenous vein, that became the definitive surgical treatment for coronary artery disease. In Chile the first coronary surgery was done by Torwall and Uribe in 1950 and modern coronary surgery was initiated by Salvestrini in1970

Tratamiento de la insuficiencia cardíaca avanzada mediante trasplante de corazón / Heart transplantation as a treatment for advanced heart failure

Background: Heart transplantation currently provides the most effective treatment for advanced heart failure. However, medical therapy for this condition has also improved, heart donors are scarce and the cost of the procedure is high. Therefore the indications and management of these patients need reevaluation. Aim: To analyze the results of 24 patients submitted to heart transplantation for end-stage heart failure needing repeated hospitalizations and i.v. inotropes for compensation. Patients and methods: The group was comprised by 21 men and 3 women with a mean age of 36.8 years, mean left ventricular ejection fraction 19ñ4.5 percent, mean systolic pulmonary artery pressure 48ñ13 mmHg (24-70) and mean pulmonary vascular resistance 2.6 Wood Units (1-5). Fourteen patients (58 percent) had a previous median sternotomy. Immunosupression did not include induction therapy and steroids were discontinued early...