[Outcome of pericardiectomy for chronic constrictive pericarditis]. / Resultados de la pericardiectomía por pericarditis constrictiva crónica.

The aim of this study was to assess early and late outcomes following treatment of chronic constrictive pericarditis by pericardiectomy. A retrospective analysis was carried out in 31 consecutive patients who underwent surgery between 1982 and 2005. The mean follow-up period was 6.7 years. In-hospital mortality was 16% (5/31 patients). The cause of death was low cardiac output syndrome in three patients, septic shock in one, and hemorrhage in the remaining patient. In six of the 26 surviving patients, functional class did not substantially improve and, in one patient, it worsened. The cumulative actuarial survival probability was 82% at 6 months, 82% at 1-9 years, and 64% at 10 years. In conclusion, pericardiectomy improved symptomatology in the majority of patients during late follow-up. A subgroup of patients did not experience an amelioration in clinical symptoms, probably because myocardial function did not completely recover.

Resultados de la pericardiectomía por pericarditis constrictiva crónica / Outcome of pericardiectomy for chronic constrictive pericarditis

El objetivo del presente estudio fue analizar los resultados de la pericardiectomía para el tratamiento de la pericarditis constrictiva crónica. Se analizó retrospectivamente a 31 pacientes consecutivos intervenidos entre 1982 y 2005. El seguimiento medio fue de 6,7 años. La mortalidad hospitalaria fue del 16% (5/31 pacientes). La causa de la muerte fue bajo gasto en 3 pacientes, shock séptico en 1 y sangrado en otro. La clase funcional no mejoró de forma sustancial en 6 de 26 pacientes que sobrevivieron y empeoró en 1 paciente. La probabilidad acumulada de supervivencia actuarial fue del 82% a los 6 meses, el 82% a los 1-9 años y el 64% a los 10 años. En conclusión, la pericardiectomía mejoró de los síntomas a la mayoría de los pacientes en el seguimiento tardío. Un subgrupo de pacientes no experimentó alivio de los síntomas clínicos probablemente porque la función cardiaca no se restableció completamente (AU)

The aim of this study was to assess early and late outcomes following treatment of chronic constrictive pericarditis by pericardiectomy. A retrospective analysis was carried out in 31 consecutive patients who underwent surgery between 1982 and 2005. The mean follow-up period was 6.7 years. In-hospital mortality was 16% (5/31 patients). The cause of death was low cardiac output syndrome in three patients, septic shock in one, and hemorrhage in the remaining patient. In six of the 26 surviving patients, functional class did not substantially improve and, in one patient, it worsened. The cumulative actuarial survival probability was 82% at 6 months, 82% at 1­9 years, and 64% at 10 years. In conclusion, pericardiectomy improved symptomatology in the majority of patients during late follow-up. A subgroup of patients did not experience an amelioration in clinical symptoms, probably because myocardial function did not completely recover (AU)

Stent implantation in variant angina refractory to medical treatment.

BACKGROUND: Vasospastic angina usually responds well to medical treatment. HYPOTHESIS: The present study describes our experience in patients who received a coronary stent because of recurrent variant angina refractory to medical treatment and evaluates stent implantation as an alternative treatment. MATERIALS AND METHODS: Between March 1998 and February 2005, recurrent variant angina was diagnosed in 22 patients admitted to our coronary care unit. Of these, five patients (22.7%), were refractory to pharmacologic treatment. Coronary angiography and coronary stents were indicated. Clinical follow-up was 29 +/- 6 months. RESULTS: Stenting was performed during diagnostic coronary angiography in two patients. In the other three patients, the stent was implanted 24-48 h later. We observed coronary spasm recurrences proximal or distal to the stent in four patients-two during the stent implantation procedure and the other two in the coronary care unit within 48 h post angioplasty. Three patients where treated with additional stenting and the fourth patient improved with pharmacologic treatment. During follow-up three patients remained asymptomatic. The fourth patient had diffuse in-stent restenosis in the third month, and the fifth patient showed a de novo lesion in the treated segment 2 years later. CONCLUSIONS: Stent implantation in patients with recurrent variant angina refractory to medical treatment may be an alternative treatment in carefully selected, clinically unstable patients. Spasm recurrences may occur in other segments of the treated artery, probably due to the diffuse nature of the disease. Immediate and continued surveillance is recommended because of the risk of adverse clinical events.

Angina de pecho secundaria al tratamiento tocolítico con ritodrina / Agina pectoris secondary to tocolytic therapy with ritodrine

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[Prognosis of patients admitted in a coronary care unit after resucitating from out-of-hospital sudden cardiac death]. / Pronóstico de los pacientes ingresados en una unidad coronaria después de la recuperación de una muerte súbita de causa cardíaca fuera del hospital.

BACKGROUND AND OBJECTIVE: The aims of the present study were to analyze the prognosis after resuscitation from out-of-hospital sudden cardiac death in patients admitted to the coronary care unit, and to identify the predictor variables of morbi-mortality. PATIENTS AND METHOD: From November 1999 to January 2004 we analyzed 63 patients (47 males) aged 61 +/- 12 years who were admitted to the coronary care unit following successful resuscitation from sudden cardiac death. The clinical and electrocardiographic characteristics were correlated with the mortality and neurological impairment. RESULTS: Thirty-five patients (55.5%) were discharged, while twenty-eight patients (45.5%) died 28 +/- 4 days after admission, most of them during hospitalization. The main underlying disorder was coronary artery disease (80.9%). When survivors and non-survivors were compared, the variables associated with a worse prognosis were diabetes mellitus (68.4% vs 17.1%, P < .02), the presence of valvular heart disease (28.6% vs 0%, p < 0.003), chronic atrial fibrillation (42.9% vs 14.3%, P < .02) and asystole as the initial rhythm observed (42.9% vs 11.4%, P < .01). Multivariate analysis identified asystole as an independent factor of poor prognosis (P < .02). Death was due to severe postanoxic neurological damage in 23 of 28 deaths (82.1%). The remaining 5 patients died due to their underlying cardiac disease (P < .01). The variables associated with neurological damage were out-of hospital resuscitation, delay in beginning resuscitation maneuvers, arrival time > 5 minutes and unconsciousness on admission. CONCLUSIONS: Although many patients survive following resuscitation from out-of-hospital sudden cardiac death, mortality remains high. Neurological impairment is the main cause of mortality. Prognosis is determined by the variables related to the underlying disease, the delay in onset of resuscitation maneuvers and postanoxia cerebral damage.

Pronóstico de los pacientes ingresados en una unidad coronaria después de la recuperación de una muerte súbita de causa cardíaca fuera del hospital / Prognosis of patients admitted in a coronary care unit after resucitating from out-of-hospital sudden cardiac death

Fundamento y objetivo: Los objetivos del presente estudio han sido analizar el pronóstico en pacientes recuperados de una muerte súbita cardíaca extrahospitalaria que ingresaron en la unidad de cuidados intensivos coronarios, así como identificar los factores asociados a la morbimortalidad. Pacientes y método: Analizamos a 63 pacientes consecutivos (47 varones), con una edad media (desviación estándar) de 61 (12) años, que ingresaron entre noviembre de 1999 y enero de 2004 recuperados de una muerte súbita cardíaca y permanecieron en la unidad de cuidados intensivos coronarios. Se examinó la relación de las características clínicas y electrocardiográficas con la mortalidad y las secuelas neurólogicas. Resultados: Sobrevivieron 35 pacientes (55,5%), mientras que 28 (44,5%) fallecieron transcurridos una media de 28 (4) días desde el ingreso, la mayoría en el hospital. El sustrato anatómico principal fue la cardiopatía isquémica (80,9%). En los pacientes que fallecieron, comparados con los que sobrevivieron, las variables que se asociaron a un peor pronóstico fueron la diabetes mellitus (un 68,4 frente al 17,1%; p < 0,02), la presencia de cardiopatía valvular (el 28,6 frente al 0%; p < 0,003), la fibrilación auricular crónica (un 42,9 frente al 14,3%; p < 0,02) y la asistolia como primer ritmo observado (el 42,9 frente al 11,4%; p < 0,01). El análisis multivariable identificó la asistolia como factor independiente de mal pronóstico (p < 0,02). En 23 de los 28 pacientes que fallecieron la muerte fue secundaria a secuelas cerebrales postanóxicas graves (82,1%), mientras que los 5 pacientes restantes fallecieron a consecuencia de su cardiopatía subyacente (p < 0,01). Las variables que se asociaron a daño neurológico fueron la reanimación realizada extrahospitalariamente, el hecho de que el paciente ingresara inconsciente, el tiempo de llegada superior a 5 min y el tiempo de retraso en el inicio de la resucitación cardiopulmonar. Conclusiones: La supervivencia en pacientes recuperados de una muerte súbita cardíaca extrahospitalaria es alta, aunque la mortalidad todavía sigue siendo elevada. Las complicaciones neurológicas son la principal causa de mortalidad. El pronóstico viene determinado por la presencia de factores relacionados con la enfermedad subyacente, el tiempo en iniciar las maniobras de recuperación y la lesión cerebral postanóxica

Background and objective: The aims of the present study were to analyze the prognosis after resuscitation from out-of-hospital sudden cardiac death in patients admitted to the coronary care unit, and to identify the predictor variables of morbi-mortality. Patients and method: From November 1999 to January 2004 we analyzed 63 patients (47 males) aged 61±12 years who were admitted to the coronary care unit following successful resuscitation from sudden cardiac death. The clinical and electrocardiographic characteristics were correlated with the mortality and neurological impairment. Results: Thirty-five patients (55.5%) were discharged, while twenty-eight patients (45.5%) died 28±4 days after admission, most of them during hospitalization. The main underlying disorder was coronary artery disease (80.9%). When survivors and non-survivors were compared, the variables associated with a worse prognosis were diabetes mellitus (68.4% vs 17.1%, P5 minutes and unconsciousness on admission. Conclusions: Although many patients survive following resuscitation from out-of-hospital sudden cardiac death, mortality remains high. Neurological impairment is the main cause of mortality. Prognosis is determined by the variables related to the underlying disease, the delay in onset of resuscitation maneuvers and postanoxia cerebral damage

Angina variante asociada con latanoprost / Variant angina associated with latanoprost

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[Cardiac perforation complicated by cardiac tamponade and sealed with metallic coils]. / Perforación coronaria complicada con taponamiento cardíaco sellada mediante coils metálicos.

Distal coronary artery perforation with an angioplasty guidewire is a rare complication that may cause cardiac tamponade, myocardial infarction, arrhythmia, and even death. The use of platelet IIb/IIIa glycoprotein receptor inhibitors increases the risk of potentially fatal complications that are difficult to manage. We report a patient on treatment with abciximab who presented coronary perforation in a distal branch of the right coronary artery caused by the coronary guidewire tip, and complicated by acute cardiac tamponade. Blood extravasation to the pericardium was stopped by releasing two metallic coils into the distal vessel, thereby avoiding the need for emergent cardiac surgery.

[Irreversible acute heart failure caused by cardiac hemochromatosis secondary to multiple transfusions]. / Insuficiencia cardíaca aguda irreversible debido a hemocromatosis cardíaca secundaria a transfusiones múltiples.

We report a 64 years old male, admitted for dyspnea and edema of two weeks duration. A sideroblastic anemia, requiring multiple transfusions, was diagnosed four years earlier. The chest X-ray showed an enlarged heart and right pleural effusion. A low left ejection fraction was evidenced by echocardiogram. Doppler analysis of the mitral flow revealed a restrictive hemodynamic pattern. A diagnosis of secondary cardiac hemochromatosis deposit was made. Nine days after admission the patient died due to heart failure. The clinical presentation of cardiac hemochromatosis as a sudden and irreversible heart failure, as well as the importance of early diagnosis and surveillance of high-risk patients is emphasized.

Insuficiencia cardíaca aguda irreversible debido a hemocromatosis cardíaca secundaria a transfusiones múltiples / Irreversible acute heart failure caused by cardiac hemochromatosis secondary to multiple transfusions

We report a 64 years old male, admitted for dyspnea and edema of two weeks duration. A sideroblastic anemia, requiring multiple transfusions, was diagnosed four years earlier. The chest X-ray showed an enlarged heart and right pleural effusion. A low left ejection fraction was evidenced by echocardiogram. Doppler analysis of the mitral flow revealed a restrictive hemodynamic pattern. A diagnosis of secondary cardiac hemochromatosis deposit was made. Nine days after admission the patient died due to heart failure. The clinical presentation of cardiac hemochromatosis as a sudden and irreversible heart failure, as well as the importance of early diagnosis and surveillance of high-risk patients is emphasized