Coronary sinus aneurysm and left ventricular-coronary sinus fistula. Implantation of CRT device.

We describe a 72-year-old man referred for implantation of a cardiac resynchronization therapy device who had previously undergone repeated operations to replace the mitral valve. Retrograde venography of the coronary sinus (CS) to implant the left ventricular (LV) pacing lead revealed aneurysmal dilatation of the CS with LV-CS fistula that hindered-but did not prevent-complete implantation of the system.

Management of aortic valve dysfunction after transapical approach using the technique "valve after valve".

We report a case of a 77-year-old patient with severe aortic stenosis who underwent transapical aortic valve implantation with a 23-mm Edwards Sapien valve (Edwards Lifesciences Inc, Irvine CA). This procedure was complicated with the occurrence of an acute regurgitation due to entrapment of one of the leaflets that was successfully managed by valve after valve technique.

Dolor torácico atípico y hemoptisis 27 años después de cirugía de coartación aórtica: fístula aortobronquial, manejo y tratamiento endovascular / Atypical chest pain and hemoptysis 27 years after aortic coarctation surgery: aortobronchial fistula, management and endovascular treatment

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Functional anatomy of aortic regurgitation. Role of transesophageal echocardiography in aortic valve-sparing surgery.

INTRODUCTION AND OBJECTIVES: The aim was to evaluate the usefulness of transesophageal echocardiography (TEE) for the preoperative functional anatomical assessment of patients with aortic regurgitation (AR) to identify those eligible for valve-sparing surgery (VSS). METHODS: We determined the accuracy and diagnostic value of TEE for identifying underlying lesions and mechanisms in 66 patients who underwent surgery for severe AR by comparing TEE findings with those obtained on surgical inspection. The usefulness of TEE for predicting the feasibility of VSS was determined. RESULTS: The overall diagnostic accuracy of TEE was excellent (87%, kappa=0.82), with valve prolapse being the principle cause of discrepancy between the methods (in 23/27 cases; 85%). Three anatomical forms of dilatation of the ascending aorta (AA) were correctly classified (accuracy >88%; kappa 0.83): supratubal aneurysm (19 patients), aortic root aneurysm (4), and annuloaortic ectasia (24). The mechanism underlying AR was identified with an accuracy of 85% (kappa 0.8) and there was a significant association between the type of mechanism identified by TEE and the success of VSS (P< .001): VSS was successful in 73% of patients with dilatation of a functional annulus (i.e. with tethering), but aortic valve replacement was required in 78% with prolapses, 90% with thickened leaflets with restricted movement, and 100% with perforation. There was also a relationship between the type of aneurysm and the technique required for AA replacement (P=.004). CONCLUSIONS: Use of TEE enabled the mechanism underlying AR to be accurately identified. There was a high level of agreement with surgical inspection and the technique was useful for predicting the feasibility of VSS and the surgical procedure for AA replacement.

Anatomía funcional de la insuficiencia aórtica. Papel de la ecocardiografía transesofágica en la cirugía conservadora de válvula aórtica / Functional anatomy of aortic regurgitation. Role of transesophageal echocardiography in aortic valve-sparing surgery

Introducción y objetivos. Intentamos determinar el papel de la ecocardiografía transesofágica (ETE) en la descripción preoperatoria de la anatomía funcional de la insuficiencia aórtica (IAo) para identificar candidatos a cirugía conservadora (CCVAo). Métodos. En 66 pacientes intervenidos de IAo severa se determinan precisión y valores diagnósticos de la ETE en la descripción de lesiones y mecanismos, empleando la observación quirúrgica como referencia. Se valora la utilidad de la ETE para predecir aplicabilidad de técnicas de CCVAo. Resultados. La exactitud diagnóstica general de la ETE es excelente (87%, índice kappa = 0,82); el prolapso presenta la principal discrepancia (23/27 casos; 85%) entre los métodos. Tres formas anatómicas de dilatación de aorta ascendente (AA) fueron correctamente clasificadas (precisión, > 88%; kappa = 0,83): aneurisma de AA supratubular (19), aneurisma de raíz (4) o anuloectasia aórtica (24). La precisión en el diagnóstico del mecanismo fue del 85% (kappa = 0,8) y éste presentó una asociación significativa con el éxito de la CCVAo (p < 0,001) en el 73% de los casos de dilatación de los anillos funcionales (tethering). El 78% de prolapsos, el 90% de movimiento restrictivo de velos engrosados y el 100% de perforaciones requirieron sustitución valvular aórtica. Las formas de aneurisma también se relacionaron con el procedimiento de sustitución de AA (p = 0,004). Conclusiones. La ETE permite una descripción precisa de los mecanismos de la IAo, tiene una elevada tasa de acuerdo con las observaciones quirúrgicas y predice adecuadamente la aplicabilidad de la CCVAo y el procedimiento de sustitución de AA (AU)

Introduction and objectives. The aim was to evaluate the usefulness of transesophageal echocardiography (TEE) for the preoperative functional anatomical assessment of patients with aortic regurgitation (AR) to identify those eligible for valve-sparing surgery (VSS). Methods. We determined the accuracy and diagnostic value of TEE for identifying underlying lesions and mechanisms in 66 patients who underwent surgery for severe AR by comparing TEE findings with those obtained on surgical inspection. The usefulness of TEE for predicting the feasibility of VSS was determined. Results. The overall diagnostic accuracy of TEE was excellent (87%, kappa=0.82), with valve prolapse being the principle cause of discrepancy between the methods (in 23/27 cases; 85%). Three anatomical forms of dilatation of the ascending aorta (AA) were correctly classified (accuracy >88%; kappa 0.83): supratubal aneurysm (19 patients), aortic root aneurysm (4), and annuloaortic ectasia (24). The mechanism underlying AR was identified with an accuracy of 85% (kappa 0.8) and there was a significant association between the type of mechanism identified by TEE and the success of VSS (P < .001): VSS was successful in 73% of patients with dilatation of a functional annulus (i.e. with tethering), but aortic valve replacement was required in 78% with prolapses, 90% with thickened leaflets with restricted movement, and 100% with perforation. There was also a relationship between the type of aneurysm and the technique required for AA replacement (P=.004). Conclusions. Use of TEE enabled the mechanism underlying AR to be accurately identified. There was a high level of agreement with surgical inspection and the technique was useful for predicting the feasibility of VSS and the surgical procedure for AA replacement (AU)

Masson tumor as humeral artery aneurysm.

Intravascular papillary endothelial hyperplasia (Masson's vegetant hemangioendothelioma) is a rare condition affecting the arteries. In the literature, we did not find any reference to this lesion involving the humeral artery. We present a case of asymptomatic humeral artery vascular tumor due to this abnormality. A 58-year-old woman was admitted to our hospital with an asymptomatic pulsatile humeral artery mass. Echography revealed an increase in size in the last year. The tumor was removed, and the vascular segment was replaced by a segment of inverted cephalic vein. The findings of the pathological examination were compatible with intravascular papillary endothelial hyperplasia. At follow-up examination 5 months after the operation, the patient had no tumor, remained asymptomatic, and had preserved upper limb artery patency. This rare vascular lesion may be clinically and histopathologically mistaken for a malignant tumor. As the Masson tumor can be cured by complete surgical resection, it is important to get a correct diagnosis.

Ventricular tachycardia in a man with spontaneous coronary artery dissection.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute ischemic coronary events. It is more prevalent in young women, particularly in the peripartum period. In men it is an extremely rare cause. We described the clinical course of a patient, man, presenting pain chest and ventricular malignant arrhythmias. Four days after admission the patient underwent coronary angiography, showing a large SCAD. After this, he had undergone coronary artery bypass surgery. He presented an angiography and clinical resolution and he was still asymptomatic at a 6-month clinical follow up. Pathophysiologic aspects and treatment options of spontaneous coronary artery dissection are discussed.

Las facetas del cambio no están lejos del entorno cotidiano / Facets of the change are not far from the daily environment

Este artículo centra su interés en las distintas facetas del cambio en las que están inmersas las organizaciones modernas. De manera gradual se han ido sintiendo las influencias y repercusiones del cambio, por lo que es del interés de muchos profesionales el conocer y reflexionar sobre las nuevas orientaciones en ese campo. Con la globalización, los mercados se tornaron más abiertos y agresivos, por lo que es imperativo crear conciencia en las instituciones de servicio de la relevancia y del rumbo seguido, en particular en la cultura de atención al cliente, como sinónimo de apertura y aprendizaje. Las transnacionales destinan significativas sumas en sus presupuestos para el estudio del comportamiento de los mercados, pero en particular en las nuevas orientaciones del servicio al cliente, ¿por qué ese proceder?, ¿hacia dónde quieren ir? ¿Qué podemos aprender de ello e incorporarlo en nuestro desarrollo profesional?. De ahí el interés, de muchas empresas, por la motivación y la capacitación de su personal, conel claro convencimiento de redoblar esfuerzos para ofrecer excelencia a sus clientes. No cabe duda, necesitamos mirar con nuevos ojos el entorno para desmenuzar la realidad en la que estamos inmersos. La actual orientación se centra en la continua capacitación, estamos obligados en saber en qué dirección se perfilan los recursos humanos; qué rumbo sigue la economía mundial y sus posibles repercusiones. Las fronteras perdieron sus limites. debemos estar abiertos al cambio, con una enorme capacidad de innovar para ofrecer nuevos servicios en un mercado cada día más voraz. ¿Qué hacer?, es la impostergable pregunta que debemos formularnos, si estamos interesados en el cambio: que no está lejos de nuestro entorno.