Heart transplantation in chile: preliminary report from the Gustavo Fricke hospital in Vina del Mar.

OBJECTIVE: The aim of this study was to analyze our results as the national reference center of the public health network in Chile. PATIENTS AND METHODS: Retrospective analysis of all transplantations performed between 1998 and 2005 was done and actuarial survival estimates were calculated according to Kaplan-Meier. RESULTS: Heart transplantations were performed in 25 patients of mean age 43 +/- 11.2 years. Eight patients (32%) were transplanted from a national priority list; all patients were under intensive care support with inotropic therapy, 4 were mechanically ventilated, and 1 required an intra-aortic counter pulsation balloon. The average time on the waiting list was 145 days in nonurgent cases and 9.4 days in urgent ones. Perioperative mortality occurred in 1 patient (4%) due to primary graft failure; 2 patients died due to infectious complications during the first year of follow-up; and 1 died due to a non-cytomegalovirus (CMV) infection at 51 months after transplantation. Two patients developed acute rejection with full recovery. The most common morbidities in the current series were hypertension (71%); hyperlipidemia (71%); renal dysfunction (24%); diabetes (10%); and vasculopathy (10%). Actuarial survival rates were 87.2% and 74.7% at 12 and 86 months, respectively. At 7 years follow-up, 20 patients were in New York Heart Association (NYHA) Class I and one Class II. CONCLUSION: Our heart transplantation program showed comparable results in the short and midterm follow-up when compared with other international reports, confirming that heart transplantation is an excellent therapeutic option for patients with end-stage heart failure.

[Partial left ventriculectomy for end stage dilated cardiomyopathy. Is it an alternative for heart transplantation?]. / Ventriculectomía parcial izquierda en un paciente con miocardiopatía dilatada terminal. Una alternativa para el transplante cardíaco?

We present a case of a 60 year old male with end stage dilated cardiomyopathy in NYHA functional class IV in whom a partial left ventriculectomy was performed, a new surgical procedure developed in Brazil and done for the first time in Chile. Left ventricular size reduction produced an objective improvement on echocardiographic parameters of left ventricular function as well as in patient's NYHA functional class in the early post operative period.

[Cardiac transplantation: economizing cyclosporin A by including ketoconazole in the immunosuppressive schedule]. / Trasplante cardíaco: ahorro de ciclosporina "A" mediante la asociación de ketoconazol al esquema inmunosupresor.

Use of cyclosporin A has improved survival in patients submitted to cardiac transplantation. However, high cost of cyclosporin poses a problem for many patients in Chile. Ketoconazole is able to reduce hepatic metabolism of cyclosporin and thus prolong therapeutic levels. A 74 to 82% reduction in cyclosporin requirements was obtained in a cardiac transplant patient by adding ketoconazole. No renal damage was detected. Therefore, this drug association may help extend cardiac transplantation programs in Chile.

Evaluación ecocardiográfica de la valvuloplastia mitral con anillo de Carpenter / Echocardiographic evaluation of Carpenter ring mitral valvuloplasty

Se compararon los Ecocardiogramas pre y postoperatorios, de 13 pacientes sometidos a valvuloplastía con anillo de Carpentier, con insuficiencia mitral pura, su mayoría de origen reumático. Las variaciones obtenidas entre el pre y postoperatorio mediante Eco M de los diámetros de las distintas cavidades de VM fueron los siguientes: aurícula izquierda 70/52, diámetro diastólico de ventrículo izquierdo 66/53, diámetro sistólico de ventrículo izquierdo 48/38, excursión mitral 26/29, pendiente EF 95/45, (p<0.005). 9 pacientes fueron estudiados con ecocardiograma bidimensional en el pre y postoperatorio obteniendo los siguientes resultados: área de aurícula izqda. 39/30, área válvula mitral 5.18/2.91 (p<0.005). 6 pacientes se revaluaron con estudio hemodinámico y angiográfico, por presencia de soplo de regurgitación mitral encontrándose en todos ellos reducciomnes significativas de las variables estudiadas

Dissecting aneurysm of the ascending aorta with aorto-caval fistula. Fiberoptic oximetric findings and surgical management.

A patient presented the rare complication of a dissecting aneurysm of the ascending aorta ruptured into the superior vena cava producing a left-right fistula. Continuous oximetric measurements by a fiberoptic pulmonary artery floated catheter was used to localize the site of the shunt. Emergency surgical repair was successfully performed.

Amrinone in the management of low cardiac output after open heart surgery.

Hemodynamic effects of amrinone were studied in 2 groups of patients after open heart surgery. Group I consisted of 10 patients with moderate heart failure. In the absence of inotropic agents, their mean cardiac index (CI) was 2.02 +/- 0.41 liters/min/m2 and mean pulmonary capillary wedge pressure (PCWP) 19 +/- 3 mm Hg. Amrinone was administered 24 hours postoperatively by bolus injection (2 mg/kg) and by 12-hour infusions (20 micrograms/kg/min). Hemodynamic data and plasma concentrations were obtained 10 and 20 minutes after the bolus injection and at 1, 4, 8 and 12 hours during infusion. Significant beneficial changes were noted in CI, PCWP, right atrial pressure, systemic vascular resistance and pulmonary vascular resistance. Group II consisted of 5 patients in severe cardiogenic shock (mean CI 1.97 +/- 0.3 liters/min/m2, mean PCWP 28 +/- 8 mm Hg) despite adrenergic agonists in all patients and intraaortic counterpulsation in 2. After these measures, amrinone was given intravenously for 36 to 72 hours as additional inotropic support. Significant improvement was observed in CI, PCWP, right atrial pressure, systemic vascular resistance and pulmonary vascular resistance. Four patients in this group were discharged; 1 patient died after 5 days in acute renal failure and coma grade IV. No serious adverse effects of amrinone were observed in any group II patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical use and bacteriological studies of catheter contamination sleeves.

A system combining a valved introducer sheath and a plastic protective sleeve enabling repositioning of pulmonary artery catheters was tested in 73 cardiac surgical patients. It was used for a mean time of 70.3 h and allowed for improved hemodynamic monitoring. A 12 percent incidence of valve contamination was found and makes the safety of the device questionable.