[Occlusion of interventricular septal rupture in 2 patients with an infarction]. / Oclusión de ruptura septal interventricular en dos pacientes con infarto.

We describe two women with interventricular septal rupture secondary to a myocardial infarction due to a total obstruction of the anterior descendent coronary artery. With the aim to stabilize the hemodynamic state of the patients before the surgical closure of the defect, we inserted a balloon-catheter introducing it to the left ventricle from the aorta and inflating it in the right ventricle after passing it through the septal orifice. After occlusion, we observed decreases in the pulmonary to systemic blood flow ratio (6% in one patient and 26% in the other) and in the arteriovenous blood flow shunt (8 and 31%); a 10% systemic blood flow increase was observed in one patient. Since the pulmonary arterial pressure did not change and the pulmonary blood flow increased, an increase of the pulmonary arterial resistance was observed but no modification of the pulmonary and systemic arterial pressure occurred. In the following days, the oxymetric differences between the pulmonary artery and the right atrium showed a tendency to remain below the figures before occlusion and the pulmonary blood flow and pressure showed a tendency to decrease. One patient died 14 days after the surgical closure of the rupture, and the other, seven days after the balloon occlusion of the rupture before any surgery. We present the physiological evolution of the patients.

Pulmonary valvular stenosis associated with Takayasu's Disease. Favorable response to corticosteroids. A case report.

The authors describe the first reported case of type IV Takayasu's arteritis with pulmonary valve stenosis. After thirty months under corticosteroid therapy the disappearance of the pulmonary valve stenosis signs was observed in the patient. In the same patient coarctation of the aorta, aortic insufficiency, stenosis of both pulmonary arteries, and left coronary artery stenosis were observed. This case illustrates the extensive cardiovascular involvement that can occur in Takayasu's arteritis and suggests that pulmonary valvular stenosis could be secondary to the same inflammatory process.

Coronary fistula associated with double mitral valve disease. A case report.

The authors report a case of a 54-year-old white male with a coronary fistula associated with double mitral valve disease. The patient was studied by invasive and non-invasive cardiac methods including coronary angiogram in order to reach the correct diagnosis and to define the successful surgical treatment that included the closure of the fistula, partial resection of the left atrium and insertion of a mechanical mitral valve prosthesis. It is concluded that this case represents a very rare association between coronary fistula and double mitral valve disease.

Right ventricular bypass for palliation of cardiac sarcoma.

A 33-year-old woman with a nonresectable right ventricular sarcoma and pulmonary outflow tract obstruction underwent a right ventricular bypass operation for symptomatic relief. The patient had an uneventful recovery and was asymptomatic on discharge, without jugular plethora or hepatomegaly. We consider this procedure to be an excellent palliative treatment of malignant right ventricular obstructive symptoms for improving the patient's quality of life.

Soporte hepático extracorpóreo / Extracorporeal hepatic support

La sobrevida por insuficiencia hepática fulminante, es menor al 50/100, siendo el edema cerebral la principal causa de muerte. El transplante de hígado ortotópico es el único método de tratamiento con que se dispone actualmente de manera rutinaria con una sobrevida de hasta 70/100, sin embargo, muchos pacientes mueren antes de poder ser transplantados y otros mueren después del transplante tardío, debido a daño cerebral irreversible, por lo tanto, entendemos que existe la necesidad de utilizar algún método de soporte hepático en el período de espera del transplante. Existen para resolver este problema: la siembra de hepatocitos en reservorios hemáticos, la utilización de hígados cadavéricos a los que se les recircula la sangre del paciente, puentes circulatorios, hemadsorción, hemodiálidis, intercambio plasmático, lavado total orgánico, enzimas microsomales unidas a transportadores artificiales, así como otras técnicas actualmente en desarrollo. El presente artículo tiene la finalidad de exponer la perfusión hepática extracorpórea, como una alternativa más, ya que en los últimos años ha adquirido dimensiones clínicas importante; la técnica permite la recirculación a través de un hígado de donación cadavérica, logrando transitoriamente ladestoxificación del paciente. Mencionamos el uso creciente de hígados de otras especies, por la gran disponibilidad de órganos que esto implica. El soporte hepático bio-artificial, utiliza la separación plasmática y perfusión, a través de un filtro de carbón y un módulo de fibra hueco, con una matriz de hepatocitos porcinos. Los últimos informes indican que el mejor método de soporte hepático, es la combinación de varias técnicas como en el SISTEMA DE SOPORTE HEPATICO ARTIFICIAL EXTRACORPOREO HIBRIDO, en el cual se utiliza la separación plasmática y la perfusión secuencial de alto rendimiento, a través de una columna con cubierta de celulosa activada, así como partículas de carbón a través de un módulo de fibra hueca que tiene una matriz con hepatocitos xenogénicos

Case report of association of congenital coronary fistulae with coronary atherosclerosis.

The authors report the clinical case of a 70 year old male with a congenital plexiform fistula between a branch of the left coronary artery and the pulmonary artery, associated with the atherosclerotic lesions of the coronary arteries, both surgically treated by ligature of the fistula and aorto-coronary grafts. The patient remained asymptomatic up to the age of 65 when both cardiac ischemia and infarction ocurred, probably coincidental with the development of the coronary arterial obstruction. From data gathered from medical literature, the authors discuss the association between coronary congenital anomalies (fistulae and ectopies) with atherosclerotic obstruction of the coronary arteries. Coronary arterial atherosclerosis affects patients with congenital fistulae of the coronary arteries in the same way as in normal humans.

Low flow veno-venous ECMO: an experimental study.

Clinical use of extracorporeal membrane oxygenation (ECMO) and carbon dioxide removal (ECCO 2R) have become well established techniques for the treatment of severe respiratory failure; however they require full cardiopulmonary bypass, representing major procedures with high morbidity. We theorized the possibility of an efficient low flow veno-venous extracorporeal membrane gas exchange method. Four mongrel 12 kg dogs were submitted to veno-venous extracorporeal membrane gas exchange via a jugular dialysis catheter using a low flow (10 ml/min) roller pump and a membrane oxygenator for a period of four hours. Respiratory rate was set at 4 breaths/min with a FiO 2 of 21% and ventilatory dead space was increased. Adequate gas exchange was obtained (pO 2139, pCO 224, Sat 99.4%), without major hemodynamic changes or hematuria. Our results demonstrate the feasibility of a low flow, less aggressive system. Further research should be considered.

[Cardiac myxoma. A report of 23 cases]. / Mixoma cardiaco. Presentación de 23 caso.

Twenty-three cases of cardiac myxoma are reviewed during a period of 11 years. Seventeen patients were females and 6 males with an average age of 36 years. All patients were symptomatic for an average period of time of 4 months. Dyspnea was the main symptom (91%), congestive heart failure (52%), murmurs (74%), atypical chest pain (65%), palpitations (52%), constitutional manifestation (48%), congestive heart failure (36%), embolic events (23%) and ventricular tachycardia as a first manifestation of a right ventricular myxoma in one case (4.5). In all patients the diagnosis of cardiac tumor was made during life. Among they, in 83%, by echocardiogram, 14%, by cardiac catheterization, and in one case (4.5%) with both methods. Seventy percent were located in the left atrium, 18% in the right atrium, 9% in the right ventricule and 4.5% to both right cavities. Two patients died while waiting surgery, one due to pulmonary emboli and another due to refractory congestive heart failure. In all 21 patients who were sent to surgery a direct correlation was seen with the echocardiographic findings. All 23 patients had a confirmatory histopathological diagnosis. There were no surgical deaths. Excision of the tumor resulted in marked symptomatic improvement. The follow up by echocardiography showed that surgery has been curative with no recurrence up till now. We consider that this entity, that is capable to simulate multiple cardiovascular diseases must be removed surgically once it has been diagnosed in order to avoid fatal complications.

False aneurysm of the left ventricle due to a penetrating chest wound.

A 24-year-old white man had a knife chest wound, and four months after this event, manifested progressive dyspnea. A false aneurysm of the left ventricle was diagnosed by 2D echocardiogram. Surgical resection of the aneurysmal sac with closure of the orifice of the lateral wall of the left ventricle was performed successfully.

[Spontaneous aneurysm of the patent ductus arteriosus with endarteritis. A case report]. / Aneurisma espontáneo del conducto arterioso permeable, con endarteritis. Presentación de un caso.

The spontaneous aneurysm of the ductus arteriosus is an extremely rare disease. From a total of 24 adult cases reported in the literature up to 1987, only in one case the ductus was open and other, was recanalized after being closed. We described the second case in the literature in a patient with totally permeable ductus arteriosus who developed a spontaneous aneurysm and endarteritis, showing the great importance of the diagnostic procedures such as echocardiogram, tomography and angiogram, as well as the surgical treatment which was successful in our patient. The probable etiology of this disease is discussed.