Osteogenesis imperfecta and coronary artery surgery. A case report.

A new case of Osteogenesis Imperfecta (OI) suffering ischemic heart disease is reported. The patient was successfully operated on in our Institution and the bibliographic search showed only another case of such an association of diseases successfully treated by surgery. This patient proves that coronary artery surgery procedures are possible when OI complicates the cardiac ischemic syndrome.

[Infectious endocarditis caused by Q fever]. / Endocarditis infecciosa por fiebre Q.

A case of aortic valve endocarditis caused by Coxiella burnetii and operated on with success is reported. The patient is doing well at 18 months follow up. Diagnosis of Q-fever endocarditis was made by high antibodies against phase I Coxiella burnetii antigens titration and by demonstration of aortic valvular vegetations by bidimensional echocardiography. Our patient suffered emergency aortic valve substitution due to acute hemodynamic failure and started a long-term treatment with doxycycline and rifampicin. Some interesting aspects about the diagnosis and treatment of this patient are reviewed because long-term follow-up and serological controls are still rare in the literature.

Submammary median sternotomy.

A vertical skin incision is used as routine approach for sternotomy. The resulting scar is often disappointing and the top is visible and unpleasant, especially for young women. In 35 women ranging from 10 to 48 years (mean 29.2 years), median sternotomy was performed via a submammary skin incision. In all cases an open heart surgical procedure was performed. Adequate exposure of the heart was achieved in every case and there were no technical problems related to this approach, no hospital mortality or major complications. The cosmetic result is excellent and this approach is certainly justified in open heart surgery for young women.

[Use of both internal mammary arteries; not everything is advantageous]. / Utilización de ambas arterias mamarias internas; no todo son ventajas.

The internal mammary artery is considered the elective graft for performing aortocoronary by-pass as its long-term results have proven better than those obtained with the internal saphenous vein. Our results in a series of 21 patients in whom both internal mammary arteries were used are reported. Four patients (19.04%) needed reoperation for sternal dehiscence and two of them had mediastinitis (9.52%). Those patients were successfully treated by continuous povidone-iodine flushing. A clear statistical difference was found between this group of patients, in whom both internal mammary arteries were used, and the rest of the patients (182 patients) in whom just the internal saphenous vein and/or only one internal mammary artery was used. The second group presented 8 cases of sternal dehiscence (4.39%) and 1 mediastinitis (0.55%).

Rate-responsive pacing: clinical experience.

Single chamber, rate-responsive pacing is emerging as a new modality in cardiac pacing and in the near future, dual chamber rate-responsive pacing may be the optimal solution for most pacemaker patients. In this report we describe our short- and long-term clinical experience with two different rate-responsive pacemakers: the RS4, an asynchronous atrial sensing ventricular pacemaker, and the TX-pacemaker, which senses the evoked QT after a ventricular paced beat, as an indicator of metabolic demand. Both systems use a single ventricular lead. Nine patients received RS4 and 10 patients received TX units. All of these patients had AV block and good ventricular function except for three patients with sinus node disease in the TX group. Between 1 and 3 months after implantation, a 24-hour Holter monitoring was performed, during which two maximal symptom-limited treadmill exercise tests (Bruce protocol) were conducted in VVI (70 bpm) and rate-responsive modes, in a random fashion. The mean follow-up was 25 months in RS4 group and 10 months in TX group. Significant improvements in patient exercise tolerance were found in the rate-responsive mode (9.0 vs. 6.6 METs in VVI) with similar results in both groups (RS4 and TX) despite higher ventricular pacing rates in the TX group (121 bpm vs. 102 bpm in RS4). An autolimited rate-responsive pacemaker-mediated tachycardia, induced by retrograde ventriculo-atrial conduction, was observed in a patient with an RS4.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis and treatment of subacute free wall ventricular rupture after infarction.

Ventricular rupture is usually a sudden, lethal complication after acute myocardial infarction (MI). Some patients, however, may survive several hours after ventricular rupture, and there is time for surgical repair if the diagnosis is made quickly. In 1980 and 1981, 7 patients underwent operation for ventricular rupture at our institution. Bedside hemodynamic studies with a Swan-Ganz catheter confirmed the diagnosis of pericardial tamponade. Urgent operation with cardiopulmonary bypass was performed. Control of hemorrhage was obtained by covering the ventricular tear and the surrounding infarcted myocardium with a wide Teflon patch. Four patients are alive and well 2, 3, 4, and 10 months after operation. Clinically, free wall ventricular rupture should be suspected when any patient recovering from an acute MI experiences chest pain and cardiovascular collapse. Bedside hemodynamic monitoring will confirm the diagnosis of cardiac tamponade, and urgent operation will save some of these patients.