Fístula arteriovenosa radial oscilante / An oscillating radial arteriovenous fistula

Introducción. Las fístulas arteriovenosas de aparición espontánea constituyen una patología vascular poco frecuente. Caso clínico. Varón de 44 años, trabajador de la construcción sin antecedentes traumáticos, que presentó una tumoración pulsátil en la muñeca izquierda. Un estudio con eco-Doppler evidencia la existencia de una fístula arteriovenosa en la arteria radial. Posteriormente se realiza una arteriografía que fue normal, y tras ella desaparece la clínica del paciente. Al cabo de tres semanas reaparece y un nuevo eco-Doppler informa de la existencia de una fístula arteriovenosa. Se realiza otra arteriografía y también una flebografia; ambas son normales, y también desaparece la clínica tras los procedimientos. Se realiza un eco-Doppler, y es normal. Al cabo de tres semanas reaparece nuevamente la tumoración y un eco-Doppler confirma los diagnósticos anteriores. También se realiza una angiotomografía computarizada que sugiere la existencia de una fístula arteriovenosa. El paciente fue intervenido quirúrgicamente, y se pudo ver un plexo venoso alrededor de la arteria radial muy dilatado y con paredes arterializadas, que se le extirpó. El estudio anatomopatológico informó de la existencia de estructuras vasculares de pequeño y mediano calibre con morfología de arteria (AU)

[Diaphragmatic paralysis in the postoperative period after heart surgery in children]. / Parálisis diafragmática en el postoperatorio de cirugía cardíaca en la infancia.

OBJECTIVE: The purpose of our study was to determine the incidence, pathological features, clinical relevance and treatment of diaphragmatic paralysis (DP) after pediatric cardiac surgery. PATIENTS AND METHODS: Five hundred fifty-six children who had undergone cardiac surgery between 1990 and 1994 were retrospectively analyzed. Persistent raising of one or both hemidiaphragms on chest x-ray films lead to the diagnosis in all cases. RESULTS: Diaphragmatic paralysis was diagnosed in 13 patients (2.3%) ranging from 3 days to 13 years of age. Atrial septal defect closure (3 cases) and systemic-pulmonary shunt derivations (3 cases) were the type of operations most frequently involved. The other cases included, 2 arterial switch in transposition of the great vessels, 1 repair of total anomalous pulmonary venous drainage, 1 tetralogy of Fallot repair, 1 coarctation and aortic stenosis repair, 1 resection of subpulmonary stenosis of transposition of the great vessels and 1 pacemaker implantation. There was no significant association with the use of extracorporeal circulation. There were seven cases of right hemidiaphragmatic paralysis, but no bilateral paralysis was found. Ipsilateral thoracotomy section concordance was found in all patients and no relation with central venous line placement was found. Diagnosis was made by chest x-ray in all cases, and further confirmation was done using fluoroscopy in 6 patients and ultrasound studies in 2. Prolonged mechanical ventilation was needed in 3 patients, and one patient required diaphragmatic plication. No long term complications were found. CONCLUSIONS: Diaphragmatic paralysis is a rare complication of pediatric cardiac surgery which must be suspected when failed attempts of respiratory weaning, not attributable to cardiac or pulmonary problems, are present.

[The surgical treatment of sustained ventricular tachycardias. The short- and midterm results in the era of the implantable defibrillator and the heart transplant]. / Tratamiento quirúrgico de las taquicardias ventriculares sostenidas. Resultados a corto y medio plazo en la "era" del desfibrilador implantable y del transplante cardíaco.

BACKGROUND: The surgical treatment of refractory ventricular tachycardia has been shown to be effective. Its use has been limited by a high perioperative mortality. OBJECTIVE: To study the extent to which the introduction of new therapeutic options, i.e. the implantable defibrillator and cardiac transplantation, improves patient selection and results of direct antiarrhythmic surgery. PATIENTS AND METHODS: We analyzed 24 consecutive patients operated upon for ventricular tachycardia (study population). At the same time, 42 patients were treated with implantable defibrillator and 11 patients, with symptomatic ventricular arrhythmias, underwent cardiac transplantation (reference population). RESULTS: The clinical characteristics of the study population (age, functional class, ejection fraction) were significantly different from those of both reference groups. Nine patients (38%) were operated upon because of electrical instability and/or contraindication for other therapeutic options despite of having criteria of high surgical risk. There was one perioperative death (4.2%) and no other early arrhythmic recurrences. Persistence of inducibility occurred in 5 cases (22%). During follow up (35 +/- 22 months) there was a single arrhythmic recurrence. Three patients died of nonarrhythmic causes. Presently, 16 patients are in I or II NYHA functional class. CONCLUSIONS: 1) Direct surgery remains as a useful tool in the treatment of ventricular tachycardia; 2) clinical differences among groups caused by the individual selection of the three therapeutic options preclude comparison of their results, and 3) the introduction of other therapeutic approaches, although resulting in only partial improvement of patient selection, leads to acceptable short and mid-term results of direct antiarrhythmic surgery.

[The myxoma syndrome: "cardiac myxoma, cutaneous pigmented lesions and peripheral and endocrine neoplasms". Apropos 2 cases]. / Síndrome mixoma: "Mixoma cardíaco, lesiones pigmentadas cutáneas y tumores periféricos y endocrinos". A propósito de dos casos.

We present two cases, mother and son, with "syndrome myxoma". Both had cardiac myxoma and cutaneous pigmented lesions. The son had a cutaneous myxoma and the mother had been diagnosed as having Cushing's syndrome caused by adrenal adenoma. The "syndrome myxoma" is a systemic disease which causes cardiac, cutaneous, and breast myxomas, adrenal disease, testicle and pituitary tumours. Whenever it is diagnosed all first relatives should be tested for the syndrome. The patient should be re-examined every six-twelve months, due to frequent recurrence of cardiac myxoma.

[Chyluria of non-parasitic origin. Presentation of a case and review of the literature]. / Quiluria de origen no parasitario. Presentación de un caso y revisión de la literatura.

Chyluria is defined as the lymph reflux to the urinary collecting system through fistulous communications secondary to lymphatic stasis caused by obstruction of the lymphatic flow. Filariasis is the most frequent cause of chyluria, which is endemic in some areas, mainly in the Asian continent. In our environment chyluria is extremely rare, most cases being due to non-parasitical causes: tumours, abscesses, trauma, tuberculosis, congenital, etc. A patient case of chyluria in a 39 year-old male with background of chest trauma in which the source of chyluria was discovered to be an obstruction of the chest duct due to post-traumatic aneurysm of the aortic notch. The picture of chyluria ceased immediately after surgery, an aneurysmal resection with replacement with an aortic prosthesis. Considering the infrequency of chyluria in our environment, a literature review is made, explaining the most frequent etiological data, as well as accompanying clinical signs, diagnostic means and conservative and surgical procedures in the treatment of this process.

[A double-blind study comparing the clinical efficacy of the preparation F-117 (hidrosmin) versus diosmin in the treatment of patients with peripheral venous disorders]. / Estudio doble ciego comparando la eficacia clínica del preparado F-117 (hidrosmina) versus diosmina en el tratamiento de pacientes con trastornos venosos periféricos.

A controlled double-blind clinical trial was performed comparing therapeutic efficacy of hidrosmin versus diosmin in patients suffering from chronic venous insufficiency with varicose symptomatology in the inferior limbs. Ten patients were treated with hidrosmin and other 10 with diosmin randomly. The controls carried out during the trial were as follows; basal control before the beginning of the trial and therapeutic controls on days 15, 30, 60 and 90 of the study. With that aim clinical examinations and different explorations were performed: physical exam, phlebography, electrocardiogram, ophthalmological examination and biochemical analyses (hemogram, globular sedimentation rate, platelet counts, etc.). The clinical therapeutic efficacy of hidrosmin in the treatment of chronic venous insufficiency of inferior limbs was superior to the diosmin in most of the studied parameters even though a lower posology was employed. From a clinical point of view the clinical improvement in the subjective symptomatology (heaviness, local tenderness, cramps, paresthesias, etc.) was very superior to the one obtained with the objective signs (phlebography, skin trophism, evolution of the edema, etc.). No significative adverse reactions appeared.

Cor triatriatum with mitral valve disease in adults.

One 16-year-old boy with cor triatriatum and congenital mitral regurgitation and two women, 35- and 54-years-old, with cor triatriatum and rheumatic mitral stenosis are reported. The regurgitant mitral valve in the boy had three papillary muscles and short chordae tendineae. One of the patients with rheumatic mitral stenosis had a subtotal cor triatriatum with enlargement of the left atrial appendage and without asymmetry in the signs of pulmonary congestion. The mitral regurgitation facilitated the angiographic diagnosis of cor triatriatum. However, neither of the two patients associated with rheumatic mitral stenosis were correctly diagnosed preoperatively. All three patients were operated on with satisfactory results.

[Role of the ballon of intraaortic contrapulsation in a patient with stenosis of the main left branch and renovascular hypertension]. / Papel del balón de contrapulsación intraaórtico en un paciente con estenosis del tronco principal izquierdo e hipertensión renovascular.

A 34 year old patient with prolonged unstable angina pectoris who did not respond to medical treatment is presented. In the course of three days he developed acute subendocardial infarction complicated by severe ventricular arrhythmias and cardiac arrest. Previously renovascular arterial hypertension due to important stenosis of the right renal artery had been diagnosed by renal arteriography. The precordial pain did not disappear with acute myocardial infarction. He presented acute postinfarction angina which required the use of vasodilator and beta-adrenergic blocking agents which did not alleviate his symptoms completely. Coronary arteriography performed a month after acute myocardial infarction demonstrated 99% stenosis of the left main coronary artery and 70% stenosis of the left anterior descending artery. During three days before surgery intraaortic ballon pumping was employed and the patient did not present precordial pain. The patient became asymptomatic after placing two aortocoronary vein grafts to the left anterior descending and circumflex arteries, and three months later blood pressure fell to normal after placing a right aorto renal graft. The poor prognosis of critical stenosis of the main left branch, its medical treatment and better evolution after surgery is discussed. The indications for intra-aortic ballon pumping in this type of patients and its use before surgery so as to be able to suspend beta-adrenergic blocking agents without risks are specified. Finally the surgical indications for renovascular hypertension are discussed.

[Carpentier's ring in mitral surgery. Surgical technic]. / Anuloplastia mitral con anillo de Carpentier Técnica quirúrgica

The technic used to insert Carpentier's ring in the mitral position, in 128 patients, is described.