Fiebre, astenia, mialgia y soplo por mixoma cardíaco / Fever, asthenia, myalgia and murmur due to cardiac myxoma

Los tumores cardíacos son infrecuentes, sobre todo en la edad pediátrica, y en su mayoría son benignos. Los mixomas son excepcionales en pediatría, aunque son los más frecuentes en el adulto. La mayoría se encuentra en la aurícula izquierda, presentándose en un 25% en la derecha. Su cuadro clínico depende principalmente de la ubicación del tumor. Una característica de estos tumores es que se pueden acompañar de clínica sistémica y de alteraciones analíticas. La ecocardiografía es el estudio de elección y debe realizarse su resección temprana para evitar complicaciones graves. Se presenta el caso de una niña de 10 años diagnosticada de un mixoma auricular derecho a partir de una clínica de fiebre, mialgias, astenia y alteraciones analíticas. Se llega al diagnóstico mediante ecocardiografía; se realiza la exéresis de la tumoración sin incidencias y presenta buena evolución posquirúrgica (AU)

Cardiac tumours are rare, especially in children, and most of them are benign. Myxomas are unusual in children, being more common among adults. They are usually located in the left atrium, with 25% appearing in the right. The clinical signs and symptoms depend mainly on where the tumour is located. A feature of these tumours is that they can be accompanied by constitutional symptoms and laboratory abnormalities. Echocardiography is the study of choice, and a prompt resection is required to prevent serious complications. We present a case of a 10 year-old girl diagnosed with right atrial myxoma who presented with a fever, myalgia, asthenia and laboratory abnormalities. Diagnosis was made by echocardiography, and the early surgical resection of the tumour ran smoothly and showed a good postoperative recovery (AU)

[Fever, asthenia, myalgia and murmur due to cardiac myxoma]. / Fiebre, astenia, mialgia y soplo por mixoma cardíaco.

Cardiac tumours are rare, especially in children, and most of them are benign. Myxomas are unusual in children, being more common among adults. They are usually located in the left atrium, with 25% appearing in the right. The clinical signs and symptoms depend mainly on where the tumour is located. A feature of these tumours is that they can be accompanied by constitutional symptoms and laboratory abnormalities. Echocardiography is the study of choice, and a prompt resection is required to prevent serious complications. We present a case of a 10 year-old girl diagnosed with right atrial myxoma who presented with a fever, myalgia, asthenia and laboratory abnormalities. Diagnosis was made by echocardiography, and the early surgical resection of the tumour ran smoothly and showed a good postoperative recovery.

[Palliative arterial switch]. / Switch arterial paliativo.

We report the first case published in Spain of a palliative anatomic correction associated with aortic arch repair in a neonate with (S,D,L)-transposition of the great arteries, multiple ventricular septal defects, and severe hypoplasia of the right ventricle with subaortic obstruction and hypoplasic aortic arch with coarctation. A one stage palliative surgery on cardiopulmonary bypass was performed with reconstruction of the aortic arch and an arterial switch procedure which obtained a satisfactory result. The principle of this operation is to switch the subaortic obstruction into a subpulmonary obstruction and reconstruct a large natural aortic root from the principal ventricle. The right ventricle-pulmonary artery continuity may promote growth of the right ventricle with the possibility of a future biventricular repair. We conclude that this operation, when used by surgical teams experienced with arterial switch surgery, is the best treatment for the complex newborn group with single ventricles or severe ventricular disbalance, ventriculoarterial discordance and stablished subaortic stenosis.

[The anatomical correction of transposition of the great arteries in the neonatal period]. / Corrección anatómica de la transposición de grandes arterias en período neonatal.

INTRODUCTION AND OBJECTIVES: Anatomic correction of transposition of the great arteries in simple and complex form is theoretically the only procedure which offers the possibility of real cure to the problem. We report there our operative results and mid-term follow-up with this approach. METHODS: From June 1989 to February 1994, anatomical surgical correction was performed in 41 patients in the neonatal period, 31 with simple TGA and 9 patients with transposition associated with ventricular septal defect. We report our preoperative management, anatomic findings and surgical technique. RESULTS: Our initial experience with the arterial repair was associated with a high operative mortality. The actuarial survival rate was 74% at 56 months. Hospital mortality of the last 31 patients was 12.9%. Intermediate-term follow-up was 18 months. No late deaths. One patient underwent reoperation for supravalvular pulmonary stenosis. All survivors are in functional class I. The only significant risk factor of in-hospital mortality was the time of surgery (learning curve). CONCLUSION: The initial experience with arterial repair is associated with a difficult learning curve. Primary repair must be performed during the newborn period in simple and complex transpositions. Mid-term results are very encouraging. Longer follow-up is necessary to secure this technique and to render obsolete all other types of repair.

[Myocardial protection: antegrade cardioplegia versus mixed cardioplegia (with right atrial perfusion) in high risk elective coronary surgery. A prospective trial]. / Protección miocárdica: cardioplejía anterógrada frente a cardioplejía mixta (con infusión en aurícula derecha) en cirugía coronaria electiva de alto riesgo. Estudio prospectivo aleatorio.

INTRODUCTION: It is unclear after review the literature, whether the techniques of retrograde cardioplegia provides more optimal myocardial protection in the setting of coronary surgery that is possible with conventional antegrade cardioplegia, due to inhomogeneous patient subset that appears in clinical trials. PATIENTS AND METHODS: The present clinical study, prospective and randomized was undertaken in 40 patients undergoing high risk myocardial revascularization to compare the efficacy of both techniques. Inclusion criterias were: age > 65 years, unstable angor, multivessel disease and impaired ventricular function. One control group received cardioplegia through the aortic root, and the study group received combined antegrade-retrograde cardioplegia with perfusion into the right atrium. In both groups the vehicle of cardioplegia was oxygenated blood. RESULTS: There were 3 deaths, two in the control group and another one in the study group. Overall operative mortality was 7.3%. Left main coronary stenosis was present in the 2 patients dying in the control group. There were no significant differences between the two groups with regard to the operative and postoperative parameters analyzed; trials to wean off cardiopulmonary bypass, inotropic support, intra-aortic balloon counterpulsation, perioperative myocardial infarction, and levels of myocardial enzymes. There were higher incidence of temporal heart block in patients in study group. CONCLUSIONS: It was difficult to identify any appreciable difference in the clinical efficacy of these two methods of myocardial protection. We review the literature, trying to identify the "better" alternative in the setting of coronary revascularization and different patient subset.

[Anomalous origin of the right pulmonary artery from the ascending aorta. Its surgical correction in early infancy]. / Origen anómalo de la arteria pulmonar derecha de la aorta ascendente. Corrección quirúrgica en la primera infancia.

Anomalous origin of the right pulmonary artery from the ascending aorta is a rare congenital malformation associated with a high mortality during the first year of life. Up to 1990, 75 cases have been reported in the literature. We are reporting 2 cases diagnosed and operated before 3 months of age. Repair was facilitated by the use of deep hypothermic circulatory arrest. The duration of follow up is 5 and 6 years, respectively. Pre and postoperative cardiac catheterization pressure data and angiograms are shown. We review the literature, presenting the physiopathological, embryological and surgical features of this rare congenital anomaly.

[The surgical treatment of aneurysms of the ascending aorta with associated aortic insufficiency. Total replacement with reimplantation of the coronary arteries]. / Tratamiento quirúrgico de los aneurismas de aorta ascendente con insuficiencia aórtica asociada. Reemplazo completo con reimplantación de coronarias.

We reviewed our experience with replacement of the ascending aorta and aortic valve with a composite graft and reimplantation of coronary arteries to the tube graft during 8 years interval from April, 1982, to April 1990. 24 patients underwent repair, the mean age was 49.83 years. Annuloaortic ectasia was the most common indication (58.33%), followed by aortic dissection (acute or chronic). Emergency operation was carried out in nine patients with aortic dissection (37.5%) and elective in 15. The mean duration of cardiopulmonary bypass was 118 +/- 4 minutes and of aortic clamping 83.85 +/- 2 minutes. Hospital mortality was 4.17%, reoperation for hemorrhage was 12.5% and perioperative morbidity for other causes was 34.7%. There were one late death. 20 patients were follow-up with a total of 638 patients-months (two patients excluded with insufficient follow-up and one late death). At last follow-up 14 patients were in functional class I. Eight year actuarial survival for the 24 patients was 91%. We believe that replacement of the ascending aorta and aortic valve with a composite graft and coronary arteries reimplantation to the tube graft is more than one satisfactory alternative to supracoronary graft replacement and aortic valve replacement. It offers the advantage of excluding all abnormal aortic tissue, eliminating the risk for later development of complications in the non excluded disease aorta. It supposes the method of choice for patients with anuloaortic-ectasia, aneurysms of the sinuses of Valsalva with aortic insufficiency, and aortic dissection with proximal affectation of coronary arteries and aortic valve.

[Primary tumors of the small intestine]. / Tumores primarios del intestino delgado.

We made a retrospective analysis of 43 cases of primary tumor of the small intestine, 28 benign and 15 malignant, diagnosed and treated in our hospital over a period of 18 years. A preoperative diagnosis was reached in 13 cases (30%), while in 37.2% the tumor was a casual finding during operation by other methods. The remaining 32.5% debuted as acute abdomen and were an emergency surgical indication. Simple tumoral resection was practiced in 19 cases (44.1%) of benign tumor, intestinal resection with end-to-end anastomosis in 22 cases (51%) and only biopsy in two cases (4.6%). Coadjuvant chemotherapy was given to five patients (11.5%) and radiotherapy to one (2.3%). The one-year survival for malignant tumors was 73%, and only 18% (2 cases) survived more than 5 years after the operation).