[Postoperative course of prosthetic valve replacement]. / Evolución postoperatoria en el recambio valvular protésico.

In order to know the post-operative outcome of patients with valvular replacement due to prosthetic dysfunction, we reviewed the clinical charts of 94 patients operated at the Instituto Nacional de Cardiología "Ignacio Chávez" between January 1986 and December 1988. Eighty four cases were replaced by the first time the remaining 10 by a second time. Diagnosis of prosthetic dysfunction was made by clinical, radiological, echocardiographic and haemodynamic parameters. The most frequent causes of dysfunction were the rupture of prosthetic leaflets, stenosis with calcific deposition and paravalvular leaks. The global mortality rate was 19.15%, higher than the native valve replacement group. The most important predictors of surgical mortality were: 1) poor ventricular function (functional classes III and IV), 2) aortic clamping period, 3) the need of a second prosthetic replacement and 4) the time of prosthetic dysfunction. Thus, we conclude that it is of great importance the early recognition of prosthetic valve dysfunction. The need of special surgical procedures in these cases should be evaluated in order to reduce morbidity and mortality.

[Bacteremic brucellosis in heart patients]. / Brucelosis bacterémica en cardiópatas.

Human brucellosis is an endemic illness in certain areas of Mexico, it is a bacteremic disease, and therefore a potential cause of infective endocarditis. At the Instituto Nacional de Cardiología "Ignacio Chávez" we saw 7 cases of brucellosis in the last 10 years. Bacteriological and serological diagnosis were established, all patients had structural heart abnormalities or carried valvular prosthesis. Only one developed infectious endocarditis with echocardiographic evidence and kidney disease due to immune complex deposition. Six patients including those with valvular prosthesis were cured. However, treatment required two drugs during long periods and frequently, addition of imidazoleinmunodulating agent to avoid relapses.