Experience acquired after 34 years of the first heart transplantation in Mexico.

On July 21, 1988, a successful heart transplant was carried out for the first time in Mexico; 34 years later, several hospitals in the country have performed this procedure. We present information and comments on the results obtained within this period at Mexican Social Security Institute La Raza National Medical Center "Dr. Gaudencio González Garza" General Hospital, where 234 transplants have been performed (one out of every three carried out throughout the country), with a short- and mid-term survival comparable to that reported in the rest of the world. This hospital is the only center that performs simultaneous heart-kidney transplantation and elective heart re-transplantation, with favorable results.

El 21 de julio de 1988, en México se realizó con éxito el primer trasplante de corazón; 34 años después, diversos centros hospitalarios del país efectúan este procedimiento. Aquí se presenta información y comentarios de los resultados obtenidos en este periodo en el Hospital General "Dr. Gaudencio González Garza", Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, donde se han llevado a cabo 234 trasplantes (uno de cada tres efectuados en el país), con una supervivencia a corto y mediano plazo equiparable a la reportada en el resto del mundo. Ese hospital es el único centro que realiza trasplante simultá de corazón-riñón y retrasplante cardiaco electivo, con resultados favorables.

La experiencia adquirida a 34 años del primer trasplante de corazón en México / Experience acquired after 34 years of the first heart transplantation in Mexico

Resumen El 21 de julio de 1988, en México se realizó con éxito el primer trasplante de corazón; 34 años después, diversos centros hospitalarios del país efectúan este procedimiento. Aquí se presenta información y comentarios de los resultados obtenidos en este periodo en el Hospital General "Dr. Gaudencio González Garza", Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, donde se han llevado a cabo 234 trasplantes (uno de cada tres efectuados en el país), con una supervivencia a corto y mediano plazo equiparable a la reportada en el resto del mundo. Ese hospital es el único centro que realiza trasplante simultáneo de corazón-riñón y retrasplante cardiaco electivo, con resultados favorables.

Abstract On July 21, 1988, a successful heart transplant was carried out for the first time in Mexico; 34 years later, several hospitals in the country have performed this procedure. We present information and comments on the results obtained within this period at Mexican Social Security Institute La Raza National Medical Center "Dr. Gaudencio González Garza" General Hospital, where 234 transplants have been performed (one out of every three carried out throughout the country), with a short- and mid-term survival comparable to that reported in the rest of the world. This hospital is the only center that performs simultaneous heart-kidney transplantation and elective heart re-transplantation, with favorable results.

Dispositivos de asistencia ventricular como tratamiento de destino. A propósito de un caso.

The treatment of refractory terminal heart failure has been heart transplantation. However, there are limitations with regard to clinical conditions of the recipient and availability of donors, and ventricular support has therefore been alternatively used as destination therapy. We describe the case is of a female patient with ischemic cardiomyopathy-associated heart failure who had a left ventricular assist device successfully implanted and at eight months of the procedure was at functional class I, with no complications.

El tratamiento de la falla cardiaca terminal avanzada ha sido el trasplante de corazón, sin embargo, hay limitantes en cuanto a las características del receptor y disponibilidad de donadores, por lo que se ha utilizado alternativamente el soporte ventricular como tratamiento de destino. Se describe a una paciente con falla cardiaca terminal por cardiomiopatía isquémica en quien se implantó exitosamente un sistema de soporte ventricular izquierdo y a ocho meses del procedimiento se encontraba en clase funcional I, sin complicaciones.

Dispositivos de asistencia ventricular como tratamiento de destino. A propósito de un caso / Ventricular assist devices as destination treatment. About a case

Resumen El tratamiento de la falla cardiaca terminal avanzada ha sido el trasplante de corazón, sin embargo, hay limitantes en cuanto a las características del receptor y disponibilidad de donadores, por lo que se ha utilizado alternativamente el soporte ventricular como tratamiento de destino. Se describe a una paciente con falla cardiaca terminal por cardiomiopatía isquémica en quien se implantó exitosamente un sistema de soporte ventricular izquierdo y a ocho meses del procedimiento se encontraba en clase funcional I, sin complicaciones.

Abstract The treatment of refractory terminal heart failure has been heart transplantation. However, there are limitations with regard to clinical conditions of the recipient and availability of donors, and ventricular support has therefore been alternatively used as destination therapy. We describe the case is of a female patient with ischemic cardiomyopathy-associated heart failure who had a left ventricular assist device successfully implanted and at eight months of the procedure was at functional class I, with no complications.

[Retrasplante cardiaco electivo. Primer caso en México].

Orthotopic cardiac retransplantation is used to treat transplanted cardiac graft end-stage failure. We present the first case of successful elective cardiac retransplantation in Mexico. It was a 25-year old male with heart transplantation who developed graft-resistant chronic vasculopathy. He underwent elective retransplantation in September 2017; complications during postoperative evolution were treated with favorable response. He was discharged owing to improvement at four weeks postoperatively. It is concluded that in adequately selected cases and comprehensively assessed, cardiac retransplantation is an appropriate option to treat cardiac graft failure.

El retrasplante cardiaco ortotópico se utiliza para tratar la falla cardiaca terminal del injerto cardiaco trasplantado. Presentamos el primer caso exitoso de retrasplante cardiaco electivo en México. Se trató de un varón de 25 años con trasplante de corazón, quien presentó vasculopatía crónica resistente del injerto. Fue retrasplantado electivamente en septiembre de 2017; las complicaciones durante la evolución posoperatoria fueron tratadas con respuesta favorable. Egresó por mejoría a las cuatro semanas del posoperatorio. Se concluye que en los casos apropiadamente seleccionados y valorados integralmente, el retrasplante cardiaco es una opción adecuada para el manejo de la falla cardiaca del injerto.

STEMI and NSTEMI: Real-world Study in Mexico (RENASCA).

INTRODUCTION: Mexico is the country with the highest mortality due to acute myocardial infarction in adults older than 45 years old according to the OECD (28 vs. 7.5% of the average). The first real-world study, RENASCA IMSS, showed a high-risk population at 65%, but 50% without reperfusion strategies. The aim was to describe the clinical presentation, treatment, and outcomes of acute coronary syndromes at the IMSS. METHODS: RENASCA IMSS is a nation-wide, prospective, longitudinal-cohort study. We include consecutive patients with an Acute Coronary Syndrome diagnosis (ACC/AHA/ESC) admitted in 177 representative hospitals of the IMSS (166 of second level and 11 of third level of attention). In an electronic database clinical, paraclinical, times, reperfusion treatment, complications, and other variables were assessed. Confidentiality was maintained in data and informed consent was obtained. Registrer calibration was performed with more than 80% of the variables and 80% of the cases. RESULTS: From March 1, 2014 to December 25, 2017; 21,827 patients were enrolled presenting an average age 63.2 ± 11.7, 75% men (16,259) and 25% women (5,568). The most frequent risk factors were: hypertension (60.5%), smoking (46.8%), diabetes (45.5%), dyslipidemia (35.3%) and metabolic syndrome (39.1%). STEMI diagnosis was established in 73.2% of the patients and NSTEMI in 26.8%. The STEMI group within the Code Infarction showed an improvement in the reperfusion therapy (34.9% before vs. 71.4% after, p ≤0.0001) and reduction of mortality (21.1 vs. 9.4%, p ≤0.0001); while the NSTEMI group showed high risk set by a GRACE score of 131.5 ± 43.7 vs. 135.9 + 41.7, p ≤0.0001. Mortality was more frequent within the STEMI group (14.9 vs. 7.6%, p ≤0.0001). CONCLUSIONS: RENASCA IMSS study represents the largest Acute Coronary Syndromes real-world study in Mexico, demonstrating that the Mexican population has a high risk. Patients with a STEMI diagnosis were more frequently enrolled and were associated with higher mortality and complications; however, there is improvement in the reperfusion therapy and in mortality with the Code Infarction strategy.

[Transcatheter aortic valve implantation for aortic stenosis. Initial experience]. / Tratamiento de la estenosis valvular aórtica con implante de prótesis valvular transcatéter. Experiencia inicial.

BACKGROUND: Aortic stenosis is a frequent disease in the elderly, and is associated with other systemic pathologies that may contraindicate the surgical procedure. Another option for these patients is percutaneous aortic valve implantation, which is less invasive. We present our initial experience with this procedure. MATERIAL AND METHODS: Patients with aortic stenosis were included once selection criteria were accomplished. Under general anaesthesia and echocardiographic and fluosocopic control, a transcatheter aortic valve was implanted following s valvuloplasty. Once concluded the procedure, angiographic and pressure control was realized in order to confirm the valve function. RESULTS: Between November 2014 and May 2015, 6 patients were treated (4 males and 2 females), with a mean age of 78.83±5.66 years-old. The preoperative transvalvular gradient was 90.16±28.53mmHg and posterior to valve implant was 3.33±2.92mmHg (P<.05). Two patients had concomitant coronary artery disease which had been treated previously. One patient presented with acute right coronary artery occlusion which was immediately treated. However due to previous renal failure, postoperative sepsis and respiratory failure, the patient died one month later. CONCLUSION: It was concluded that our preliminary results showed that in selected patients percutaneous aortic valve implantation is a safe procedure with clinical improvement for treated patients.

[Heart transplantation for the treatment of isolated left ventricular myocardial noncompaction. First case in Mexico]. / Trasplante cardiaco: una opción para tratamiento del miocardio no compactado aislado de ventrículo izquierdo. Primer caso en México.

BACKGROUND: Myocardial noncompaction of the left ventricle is a congenital cardiomyopathy characterised by left ventricular hypertrabeculation and prominent intertrabecular recesses. The incidence ranges from 0.15% to 2.2%. Clinical manifestations include heart failure, arrhythmias, and stroke. Prognosis is fatal in most cases. Heart transplantation is a therapeutic option for this cardiomyopathy, and few had been made worldwide. CLINICAL CASE: The case is presented of a 20 year-old male with noncompacted myocardium of the left ventricle, who had clinical signs of heart failure. His functional class was IV on the New York Heart Association scale. He was successfully transplanted. Its survival to 15 months is optimal in class I New York Heart Association, and endomyocardial biopsies have been reported without evidence of acute rejection. CONCLUSION: It is concluded that heart transplantation modified the natural history and improved survival in patients with this congenital heart disease.

[Combined heart-kidney transplantation in Mexic]. / Trasplante combinado de corazón-riñón en México.

BACKGROUND: In our country, heart and kidney transplantation is a novel option for treatment of combined terminal heart and kidney failure. This program began in 2012 for selected patients with documented terminal heart failure and structural kidney damage with renal failure. Description of cases: Between January 1, 2012 and April 30, 2016, we made 92 orthotopic heart transplantations. In five of these cases the heart transplantation was combined with kidney transplantation. RESULTS: There were three male and two female patients with a mean age 25.6 ± 5.2 years (range, 17-29). The patients improved their renal function and the heart transplantation was successful with an improved quality of life. One patient died from abdominal sepsis. The other patients are doing well. CONCLUSION: The combined heart-kidney transplantation is a safe and efficient procedure for patients with structural kidney and heart damage as a cause of terminal failure.

[Primary cardiac hemangioendothelioma: early diagnosis and surgical resection]. / Hemangioendotelioma cardiaco primario: diagnóstico y resección quirúrgica temprana.

BACKGROUND: The term hemangioendothelioma encompasses all tumors that derive from the endothelium of blood vessels. It has an uncertain prognosis, and it is always considered as a low-grade malignancy. CLINICAL CASE: Male, 23, who was admitted to the emergency room with chest pain, intermittent paroxysmal nocturnal dyspnea and malaise. He denied having a history of degenerative diseases, and had a weight loss of 6 kg in two months. Chest X-rays suggested pericardial effusion. Patient presented a tendency to hypotension tamponade, which was solved with subxiphoid puncture, and drain 800 mL of liquid from ancient hematological parameters. He presented a tumor in the right atrium of 8x4 cm, attached to the anterior wall of the atrium without involucre of interatrial septum. When patient underwent surgery, it was identified a tumor lesion in the anterior wall of right appendage. It was done the resection of the tumor and of 70% of the right atrial appendage. The latter was replaced with bovine pericardium. Patient showed good outcome; it was discharged after 10 days of follow-up surgery for six months in the outpatient clinic. CONCLUSION: The hemangioendothelioma is a vascular tumor of unpredictable behavior, and whose origin rarely comes from the heart. A timely detection, and a radical surgical resection is, so far, the more acceptable management, given the worldwide little experience for handling this type of tumor. Our experience suggests an aggressive clinical approach and surgical removal within the first hours of the suspected diagnosis for the greatest chance of complete resection and reducing the risk of recurrence.

Introducción: el hemangioendotelioma engloba todos los tumores que derivan del endotelio de los vasos sanguíneos. Es de pronóstico incierto y siempre se considera como una lesión maligna de bajo grado. Caso clínico: paciente masculino de 23 años que ingresó a urgencias con dolor retroesternal intermitente, disnea paroxística nocturna y ataque al estado general. Negó antecedentes crónico-degenerativos y tuvo pérdida ponderal de 6 kg en dos meses. Las pruebas sugirieron derrame pericárdico. Presentó tendencia a la hipotensión por tamponade, resuelta con punción subxifoidea, y drenaje de 800 mL de líquido de características hemáticas antiguas. El paciente presentó un tumor de la aurícula derecha de 8 x 4 cm, dependiente de la pared anterior de la aurícula, sin involucro de septum interatrial. Al someter al paciente a cirugía, se identificó lesión tumoral en la pared anterior de orejuela derecha. Se hizo resección del tumor y del 70 % de la orejuela derecha, sustituida con parche de pericardio bovino. El paciente presentó buena evolución; egresó a los 10 días de la cirugía con seguimiento por seis meses en la consulta externa. Conclusión: estamos ante un tumor vascular oncológicamente impredecible y que rara vez se origina en el corazón. Una detección oportuna y la resección quirúrgica radical es el manejo más aceptado ante la poca experiencia que hay a nivel mundial para lidiar con esta entidad. Sugerimos un abordaje clínico agresivo y la extirpación quirúrgica dentro de las primeras horas de la sospecha diagnóstica para obtener la mayor posibilidad de resección total y la reducción del riesgo de recidiva.

[Routine hormonal therapy in the heart transplant donor]. / Terapia hormonal de rutina en el donador para trasplante cardiaco.

BACKGROUND: Successful heart transplantation depends largely on donor heart function. During brain death many hormonal changes occur. These events lead to the deterioration of the donor hearts. The 2002 Crystal Consensus advises the use of a triple hormonal scheme to rescue marginal cardiac organs. MATERIAL AND METHODS: A prospective, longitudinal study was conducted on potential donor hearts during the period 1 July 2011 to 31 May 2013. All donor hearts received a dual hormonal rescue scheme, with methylprednisolone 15mg/kg IV and 200mcg levothyroxine by the enteral route. There was at least a 4 hour wait prior to the harvesting. The preload and afterload was optimised. The variables measured were: left ventricular ejection fraction cardiac graft recipient; immediate and delayed mortality. RESULTS: A total of 30 orthotopic heart transplants were performed, 11 female and 19 male patients, with age range between 19 and 63 years-old (Mean: 44.3, SD 12.92 years). The donor hearts were 7 female and 23 male, with age range between 15 and 45 years-old (mean 22.5, SD 7.3 years). Immediate mortality was 3.3%, 3.3% intermediate, and delayed 3.3%, with total 30 day-mortality of 10%. Month survival was 90%. The immediate graft left ventricular ejection fraction was 45%, 60% intermediate, and 68% delayed. The causes of death were: 1 primary graft dysfunction, one massive pulmonary embolism, and one due to nosocomial pneumonia. CONCLUSION: It was concluded that the use of double rescue scheme hormonal therapy is useful for the recovery and preservation of the donor hearts. This scheme improves survival within the first 30 days after transplantation.

[Mucha-Habermann disease and orthotopic heart transplant. Case report]. / Enfermedad de Mucha-Habermann y trasplante ortotópico de corazón. Informe de un caso clínico.

BACKGROUND: Mucha-Habermann disease is a cutaneous clinical manifestation of unknown etiology that frequently appears in young patients. The aim was to present Mucha-Habermann disease that occurred in an old man who had a heart transplant. CLINICAL CASE: a 62 year-old male, heart transplant recipient, who four years after that transplantation procedure presented with papular lesions in neck, thoracic members of which extended to all body surfaces and that evolved vesicles and pustular lesions. A skin biopsy was performed and Mucha-Habermann disease was diagnosed. The patient was treated with steroids and antimicrobial therapy with favorable response. After two years there are no skin lesions. CONCLUSIONS: Mucha-Habermann disease is a low frequency disease and it requires skin biopsy to confirm diagnose. This is an uncommon case due to the age and kind of patient.

Introducción: la enfermedad de Mucha-Habermann es la afección cutánea de etiología desconocida más frecuente en los pacientes jóvenes. Se caracteriza por la erupción aguda de lesiones papulares que evolucionan a vesículas, pústulas y cicatrices deprimidas hiperpigmentadas de aspecto varioliforme. Su curso habitual es subagudo o crónico. El objetivo es describir la enfermedad de Mucha-Habermann en un hombre con trasplante ortotópico de corazón. Caso clínico: hombre de 62 años de edad que cuatro años después de recibir trasplante de corazón presentó lesiones papulares diseminadas en cuello y miembros torácicos, las cuales se extendieron al resto del cuerpo y evolucionaron a vesículas y pústulas. Se obtuvo biopsia de piel y se conformó el diagnóstico de enfermedad de Mucha-Habermann. El paciente recibió tratamiento con esteroide y antimicrobiano, al que respondió favorablemente. Al momento de este informe, las lesiones habían desaparecido. Conclusiones: la enfermedad de Mucha-Habermann es poco frecuente y requiere confirmación mediante biopsia de piel para tratarla adecuadamente. El caso que se describe es poco común por el tipo de paciente y la edad en que se manifestó la enfermedad.

Retiro de "Stents" intracoronarios y cirugía de revascularización miocárdica / Retirada de "Stents" intracoronários e irurgia de revascularização miocárdica / Intracoronay “stents” removal and coronary artery Bypass grafting surgery

Introducción: es cada vez más frecuente la necesidad de retirar “stents” en la cirugía de revascularización. Material y métodos: serie de casos en los que se realiza endarterectomía y retiro de “stents” de vasos coronarios entre el 1 de enero y el 30 de abril del 2011. Se analizó morbilidad, antecedentes y evolución. Resultados: tres pacientes requirieron remoción de “stents”, dos de la descendente anterior y uno de la coronaria derecha, un paciente con infarto del miocardio falleció por choque cardiogénico. Conclusión: La remoción de “stents” en cirugía de revascularización debe considerar se como opción terapéutica en casos bien determinados.

Introdução: Cada vez é mais frequente a necessidade de retirar “stents” na cirurgia de revascularização. Material e métodos: série de casos onde são realizadas endarterectomia e retirada de“stents” de artérias coronárias entre 1 de janeiro e 30 de abril de 2011. Analisou-se morbilidade, antecedentes e evolução. Resultados: três pacientes tiveram remoção de “stents”, dois da artéria descendente anterior e um da coronária direita, um paciente com infarto do miocárdio faleceu por choquecardiogênico. Conclusão: A remoção de “stents” em cirurgia de revascularização deve considerar-se como opção terapêutica em casos bem determinantes.

Introduction: Stent removal is associated to coronary artery by-pass surgery is a more fre-quent procedure. Material and Methods: We present the cases that required endarterectomy, stent removal and coronary artery by-pass surgery between January 1, 2011, and April 30, 2011. We analyzedmedical history, morbidity, and evolution.Results: Three patients required stents removal, two in coronary anterior descending artery and one on right coronary artery. One patient with acute myocardial infarction died, due tocardiogenic shock. Conclusion: It was concluded that stent removal in coronary artery by-pass surgery shouldbe considered as a surgical option in selected cases.

Complicaciones de safenectomía en pacientes sometidos a cirugía de revascularización miocárdica / Complications of saphenectomy in patients subjected to myocardial revascularization surgery

Objetivo: Conocer la prevalencia y factores de riesgo de complicaciones en safenectomía de pacientes postoperados de revascularización miocárdica, en el Departamento de Cirugía Cardiotorácica. Diseño: Estudio prospectivo, transversal, descriptivo y comparativo. Análisis estadístico: Medidas de tendencia central y t de Student. Pacientes y métodos: Se estudiaron pacientes sometidos a revascularización miocárdica entre el 1 de enero y el 31 de octubre del 2011, en los que se utilizó vena safena como injerto libre, con o sin uso adicional de arteria mamaria interna izquierda. La obtención del injerto fue a través de múltiples incisiones. Fueron consideradas como complicaciones: hematoma, infección, edema, rechazo de material de sutura, dehiscencia, necrosis, celulitis, dermatitis, trombosis, seroma, síndrome compartimental. Se comparó número de incisiones, longitud de incisiones, obtención de vena safena inversa, tiempo quirúrgico y pinzamiento de aorta, entre los pacientes complicados y los no complicados. Resultados: En el periodo de estudio, en 150 pacientes (129 hombres y 21 mujeres), se realizó safenectomía para utilizar la vena safena como injerto libre. La edad promedio fue 61 ± 9.48 años. La prevalencia de complicaciones fue de 29%. Correspondiendo a hematoma 19% (n = 29), infección del sitio quirúrgico 4.6% (n = 7), edema 2% (n = 3), reacción al material de sutura 1.3% (n = 2) y dehiscencia 2% (n = 3). No existió diferencia estadística entre las variables evaluadas entre pacientes complicados y no complicados. Conclusiones: La prevalencia de complicaciones en la safenectomía para revascularización miocárdica es baja y se encuentra en los rangos aceptados en la literatura médica. No identificamos factores de riesgo.

Objective: To know the prevalence and risk factors for complications of saphenous vein harvesting for myocardial revascularization in patients operated at the Department of Cardiothoracic Surgery. Design: Prospective, cross-sectional, descriptive, and comparative study. Statistical analysis: Central tendency measures and Student's t test. Patients and methods: We studied patients subjected to myocardial revascularization between January 1st and October 31st 2011, in whom the saphenous vein was harvested to be used as free graft, with or without using additionally the left internal mamary artery. The graft was obtained through multiple incisions. Hematoma, infection, edema, suture material rejection, dehiscence, necrosis, cellulitis, dermatitis, thrombosis, seroma, compartmental syndrome were considered complications. We compared the number of incisions, length of incisions, inverse saphenous vein obtainment, surgical time and aorta clamping between complicated and non-complicated patients. Results: In the studied period, 150 patients (129 men and 21 women) were subjected to saphenous vein harvesting to be used as a free graft. Average age was of 61 ± 9.48 years. Prevalence of complications was of 29%, corresponding 19% (n = 29) to hematoma, 4.6% (n = 7) to infection of the surgical site, 2% (n = 3) to edema, 1.3% (n = 2) to reaction of the suture material, and 2% (n = 3) to dehiscence. No statistical difference was found in the variables between complicated and non-complicated patients. Conclusions: Prevalence of complications in saphenous vein harvesting for myocardial revascularization was low, and was within the ranges accepted in the medical literature. We did not identify risk factors.

Intracardiac malignant fibrous histiocytoma. A case report.

BACKGROUND: Primary cardiac tumors are rare forms of cardiac disease. The reported incidence varies between 0.002 and 0.3%; 25% of these tumors are malignant, usually a variant of sarcoma. Malignant fibrous histiocytoma constitutes <3% of primary cardiac tumors. CLINICAL CASE: We review the case of a 53-year-old female who presented with congestive heart failure and pleural effusion. Transthoracic echocardiography and chest computed tomography revealed cardiac tumor involving the left atrium. Tumor was excised surgically and histologically proven to be a malignant fibrous histiocytoma, primarily confined to the heart. During the immediate postoperative evolution, the patient presented left pleural effusion for 2 weeks. The patient was referred to Oncology Service for complementary treatment. CONCLUSION: Malignant fibrous histiocytoma is a rare tumor and, in this case, prognosis is reserved.

[Gated single photon emission computed tomography (SPECT) and radionuclide ventriculography for evaluate the left ventricle ejection fraction in heart transplant recipients. Comparative study]. / Comparación de la ventriculografía isotópica de equilibrio y la tomografía computarizada con emisión de fotones individuales (SPECT) sincronizado para evaluar la fracción de expulsión del ventrículo izquierdo en pacientes trasplantados de corazón.

OBJECTIVE: To evaluate which is the best method to determine the left ventricular ejection fraction in heart transplant recipients: radionuclide ventriculography or gated SPECT, compared with echocardiography as the gold standard method. MATERIAL AND METHODS: A prospective, transversal, observational, and open study including all orthotopic heart transplant recipients between January 1, 1993 and December 31, 2010 was realized after signed Informed Consent, and we performed echocardiography, radionuclide ventriculography and gated SPECT in 14 patients. Normal value for left ventricle ejection fraction was considered 50% in all the methods. RESULTS: Fourteen heart transplant recipients were considered for the study. Two patients were excluded because of arrhythmic heartbeat at the time of gated SPECT acquisition and two by being newly transplanted. The mean left ventricle ejection fraction was: echocardiography: 69.9%;gated SPECT: 60%; radionuclide ventriculography: 61.1%. The sensitivity of gated SPECT was 75% and 100% for radionuclide ventriculography. Specificity could not be obtained because our population was very small and there were no false negatives. (All the echocardiography results were over 50%). CONCLUSION: It was concluded that despite our small population, the gated SPECT was a useful tool in the evaluation of heart transplant patients due to its functional and prognostic information, besides offering myocardial perfusion imaging.

[Combined coronary artery bypass-graft surgery and valve surgery. Cardiothoracic surgery department of a high specialty medical unit experience]. / Revascularización miocárdica combinada con cirugía valvular. Experiencia en el Departamento de Cirugía Cardiotorácica de una Unidad Médica de Alta Especialidad.

BACKGROUND: the combined heart valve surgery and coronary artery bypass graft surgery has increased in frequency. The combined procedures have an increased risk of perioperative complications and mortality and usually is realized in older patients. We present our experience with this combined procedure. METHODS: we analyzed the files of patients treated with combined valve surgery and coronary artery bypass graft surgery, between June 1, 2008 and June 30, 2011. We evaluated risk factors, surgical time, morbidity and mortality. RESULTS: in the analyzed period, we included 74 patients. There were 51 male patients (69%) and 23 female patients (31%). The mean age was 63 ± 7.3 years. The most frequent procedure was aortic valve replacement with one or two coronary artery bypass grafts. The main complications were postoperative bleeding (18.9%), mediastinitis (8.1%) and cardiac rhythm disturbances (2.7%). The mortality was 2.7%. CONCLUSION: it was concluded that combined valve surgery with myocardial revascularization has similar results to that reported by other authors and on this basis this procedure is safe and useful.

[Brain death, physiopathology, optimal care and hormonal therapy for cardiac donation]. / Muerte encefálica, fisiopatología, cuidado óptimo y terapia hormonal para donación cardíaca.

Heart transplantation goes on leading the standard therapy for the terminal heart failure. The success of this procedure and the post-transplantation survival, meaning during the perioperative time, is variable because of the good performance of the donor graft, due to this situation, the pre-harvesting evaluation is very important. The brain death brought many changes: 1) first of all the "adrenergic storm" with its hemodynamic and cardiac dangerous events; 2) Thyroidal hormones, cortisol, vasopressin, and seric insulin depletion with its metabolic consequences respectively. Since 2002 during the Crystal Consensus started the using of the hormonal therapeutic with triyodothironine, vasopressin and metilprednisolone for improving, meaning those limitrophes ones, the performance donor hearts with brain death, and the goal has been to harvest more donated organs en quality and numbers. This hormonal therapeutic has had great acceptation and is successful; having more harvesting of solids organs: hearts, lungs and kidneys; with more performance and surviving at 1 year post-transplantation and less mortality. Our Hospital began the hormonal therapeutic since January 2011with excellent results. On this basis we can concluded that, hormonal rescue therapy, improves the availability and performance of organs for transplantation.