ABSTRACT
La angiogénesis terapéutica con factores de crecimiento (factor de crecimiento del endotelio vascular (VEGF) y factor de crecimiento de fibroblastos (FGF) es un nuevo tratamiento encaminado a incrementar la perfusión del miocardio isquémico no revascularizable con métodos tradicionales. Desde el campo experimental se han obtenido muy buenos resultados en cuanto al aumento de neovasos, pasando recientemente al uso clínico en pequeños ensayos. No obstante persisten numerosas dudas respecto a qué utilizar, el FGF, el VEGF o ambos, cómo utilizarlo, directamente la proteína o por medio de plásmidos y/o adenovirus como terapia génica y como administrarlo mediante cirugía o de forma percutánea. Pese a esto, las perspectivas son esperanzadoras, y en breve conoceremos los resultados de varios estudios multicéntricos y randomizados (AU)
Subject(s)
Animals , Humans , Myocardial Ischemia/drug therapy , Genetic Therapy , Endothelial Growth Factors/administration & dosage , Neovascularization, Physiologic , Fibroblast Growth Factors/administration & dosage , Myocardial ReperfusionABSTRACT
Los trabajos experimentales en el campo de la resvascularización trasnmiocárdica con láser (RTML) están encaminados en su mayoría a intentar explicar el mecanismo de acción de esta técnica. En un principio se estudió la evolución de los canales (centrándose en su permeabilidad). Con esta teoría, casi desechada, en la actualidad se intentan buscar explicaciones a la espectacular mejoría clínica. La denervación miocárdica y sobre todo la aparición de nuevos vasos son los temas más estudiados en el momento actual. Respecto a esto último, son muy interesantes los buenos resultados a nivel experimental obtenidos con otros métodos encaminados a realizar canales en el miocardio (simples agujas, taladros eléctricos o radiofrecuencia). En este trabajo se revisa parte del trabajo experimental realizado con RTML con el fin de intentar entender el motivo por el que nuestros pacientes con angina refractaria mejoran con esta técnica (AU)
Subject(s)
Animals , Laser Therapy , Myocardial Revascularization/methods , Myocardial Ischemia/surgery , Disease Models, Animal , Ventricular Function, Left , Endothelial Growth Factors , Angina Pectoris/surgeryABSTRACT
We report a patient with a mitral insufficiency due to myxomatous valve change, with a regurgitation murmur heard principally at aortic area and radiating to the neck base. Even though the topography of the murmur seemed to suggest aortic stenosis, the other auscultation findings and the initial clinical tests clearly supported its source in a mitral insufficiency. The echocardiography allowed us not only to confirm our suspicion, but also to explain this auscultation finding mechanism, to show a severe mitral insufficiency with a anterior and medial jet, which struck the aorta and atrial septum. The surgery found a clear aortic vibration, which disappeared after implanting the mitral protheses. Our case illustrates the value of new diagnostic image techniques to complement the semiologic findings.
Subject(s)
Aortic Valve Stenosis/diagnosis , Mitral Valve Insufficiency/diagnosis , Diagnosis, Differential , Echocardiography, Doppler, Color , Echocardiography, Transesophageal , Heart Auscultation , Heart Valve Prosthesis , Humans , Male , Middle Aged , Mitral Valve , Mitral Valve Insufficiency/surgeryABSTRACT
Aortic dissection usually presents with chest pain, abnormal pulses and a widened mediastinum on chest radiograph. It is rarely associated with the superior vena cava syndrome as the first manifestation. This paper presents a patient who had a superior vena cava syndrome as a result of a painless aortic dissection and compared with other previously reported cases.
Subject(s)
Aortic Aneurysm/diagnosis , Aortic Dissection/diagnosis , Superior Vena Cava Syndrome/etiology , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Aorta , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/surgery , Echocardiography, Transesophageal , Humans , Male , Middle Aged , Phlebography , Radiography, Thoracic , Superior Vena Cava Syndrome/diagnostic imagingABSTRACT
INTRODUCTION AND OBJECTIVES: The superiority of surgical treatment over other procedures in the left main coronary artery stenosis is well known, being today the therapy of choice. The purpose of this work is to analyze the clinical characteristics and the immediate results of surgery in our patients. PATIENTS AND METHODS: In this paper we under-took a retrospective study of 147 consecutive patients, 129 men and 18 women with a 50% or more left main coronary artery stenosis without associated valvular disease, operated on at our institution during a period of 3.5 years, between January 1992 and May 1995. Thirty-one variables were analyzed under Chi-square, comparison of proportions and Student's t-tests. Then, it has been developed into a multivariant logistic regression of significant variables (p less than 0.05) of factors influencing mortality and rhythm disturbances which have been the most frequent postoperative complication. RESULTS: The mean age was 65 years. Sixty-two per cent had unstable angina and 51.7% had previous myocardial infarction. An average of 3.1 grafts were performed. Total mortality was 6.8%. The complications were 17% arrhythmias, 8% low cardiac output and 6% perioperative myocardial infarction. In the multivariate analysis, mortality has been strongly related to the presence of perioperative myocardial infarction and also with moderate to severe cardiomegaly and a high left ventricular end-diastolic pressure. Arrhythmias were related to an advanced age. CONCLUSIONS: 1) In hospital mortality remains within acceptable limits and is influenced by the presence of perioperative myocardial infarction, cardiomegaly and a high left ventricular end-diastolic pressure, and 2) elderly patients have more damaged vessels, more diseased coronary segments, and more complications, especially rhythm disturbances.
