Venovenous extracorporeal membrane oxygenation as a bridge to traumatic bronchial fistula closure. / Membrana de oxigenación extracorpórea venovenosa como puente a la reparación de una fístula bronquial traumática.

Traumatic tracheobronchial injuries occur in 1% of patients with thoracic trauma, most of them dying at the site of the trauma. In this case report, we present a 26-year-old female patient admitted to the ICU due to a blunt chest trauma causing life threatening hypoxaemia and acidosis; deciding to implant percutaneous venovenous extracorporeal membrane oxygenation. The use of percutaneous venovenous extracorporeal membrane oxygenation, implemented with a lower anticoagulation target, allowed the diagnosis and treatment of a bronchopleural fistula under conditions of respiratory and hemodynamic stability without haemorrhagic complications, obtaining a fast and adequate assistance achieving the survival of the patient.

[Post-infarction left ventricular free wall rupture]. / Rotura post-infarto de la pared libre del ventrículo izquierdo.

We report four cases of subacute left ventricular free wall rupture after myocardial infarction successfully treated with emergency surgery. Some aspects dealing with clinical presentation, diagnosis and treatment are discussed.

[Prolonged bradyarrhythmias after coronary revascularization surgery]. / Bradiarritmias prolongadas después de cirugía de revascularización coronaria.

The authors report four cases of prolonged bradyarrhythmias after isolated coronary artery bypass graft surgery. All the four patients required permanent pacemaker implantation. Etiologic factors of conduction disturbances after coronary artery bypass and long term follow-up are discussed.

Aortobronchial fistula secondary to chronic post-traumatic thoracic aneurysm.

A few patients with traumatic aortic laceration remain undiagnosed and survive long enough to develop a chronic aneurysm. Such aneurysms are frequently asymptomatic; alternatively, they may manifest themselves in the form of chest pain, dysphonia, dysphagia, bronchial irritation, or sudden death. A case of aortobronchial fistula secondary to a chronic post-traumatic aneurysm of the aortic isthmus is presented. Hemoptysis was the main sign. The affected segment of the thoracic aorta was replaced with a Dacron graft and a left superior lobectomy was performed. Nevertheless, the patient died during the postoperative period due to adult respiratory distress syndrome. Pathogenesis, diagnosis, and management of aortobronchial fistulae are discussed.

Eosinophilic myocarditis in patients waiting for heart transplantation.

We report three patients waiting for heart transplantation who suddenly worsened clinically. All three explanted hearts showed a myocarditis with a dense eosinophilic infiltrate. Follow-up biopsies and necropsies showed no further evidence of cardiac eosinophilic infiltrates. The possible relationship between drugs administered before transplantation and clinico-pathological findings is discussed.

Blunt traumatic rupture of the right hemidiaphragm and Budd-Chiari syndrome.

We present 2 cases of delayed diagnosis of rupture of the right hemidiaphragm caused by blunt thoracic trauma, in which herniation of the liver toward the thoracic cavity had occurred. Both patients showed signs of noncardiogenic hepatic venous outflow obstruction. Venous outflow returned to normal on reintroduction of the liver into the abdominal cavity and closure of the defect in the diaphragm. The pathogenesis, diagnosis, and treatment of this problem are discussed.

[The expression of atrial natriuretic peptide in the cardiomyocytes of left ventricular aneurysms]. / Expresión del péptido natriurético auricular en los cardiomiocitos de aneurismas de ventrículo izquierdo.

We report three patients with left ventricular aneurysm who underwent coronary artery bypass grafting and resection of the ventricular aneurysm. The walls of the aneurysms were immunohistochemically investigated to study whether atrial natriuretic peptide was present or not. Immunoreactivity for atrial natriuretic peptide was observed in some of the viable cardiomyocytes within the scar tissue. Mechanisms of regulation of the expression of atrial natriuretic peptide are discussed.

[Clonidine in the treatment of tobacco withdrawal. A comparison with nicotine chewing gum]. / Clonidina en el tratamiento de la deshabituación tabáquica. Comparación con chicles de nicotina.

The objective of our work was to carry out a prospective study on the effectiveness of clonidine and nicotine gum in the treatment of tobacco withdrawal. Sixty smokers were randomly distributed in two groups and were included in a tobacco withdrawal program. One group received oral clonidine treatment while the other group was given nicotine gum. Adjuvant therapy such as group therapy or psychotherapy was not performed. At the end of one year there were no significant differences between the two groups with regards to the number of subjects who have continued to stop smoking. There were also no significant differences between the two groups with regards to the symptoms of tobacco abstinence. When we studied the relation between treatment fulfillment and tobacco withdrawal we observed that the clonidine treated group had a significantly greater number of success compared to the nicotine group (p < 0.01).

Intracardiac thrombi after orthotopic heart transplantation: clinical significance and etiologic factors.

The frequency and clinical significance of intracardiac thrombi after orthotopic heart transplantation are still not fully understood. The aim of this article is to present five patients with heart transplants with intracardiac thrombi and to subject the possible cause, methods of diagnosis, and treatment of this phenomenon to scrutiny. The frequency of intracardiac thrombi may well be higher than anticipated, with emboli occurring only in a small proportion of cases. Hematologic, anatomic, and hemodynamic factors seem to have a bearing on thrombogenesis. Further multicenter studies are required to gain a better understanding of this disorder.

[Dynamic cardiomyoplasty. Preliminary experience]. / Cardiomioplastia dinámica. Experiencia preliminar.

INTRODUCTION AND OBJECTIVES: The purpose of this study is to show our experience in clinical dynamic cardiomyoplasty. PATIENTS, MATERIALS AND METHODS: Six patients with end-stage heart failure and 2 patients with left ventricular aneurysm underwent dynamic cardiomyoplasty using the latissimus dorsi muscle. The latissimus dorsi was electrically conditioned before the procedure through a lead placed under local anesthesia and connected to an external cardiac pace-maker. Surgical technique--including dissection of the latissimus dorsi and encircling of the ventricles with the muscle flap--was performed in general terms as described at the Broussais Hospital. In the first 3 patients a bipolar lead connected to a single impulse generator was used. In the other 5 patients a train of impulses cardiomyostimulator was used. Changes in systolic function were studied through Doppler-echocardiography and radionuclide studies. Changes in diastolic function were evaluated through E wave velocity and deceleration time. RESULTS: Mean follow up was 9 +/- 5.7 months. No early deaths were recorded. One patient underwent emergency surgery, one week after the procedure, because of a tear of the patch used to close the wall defect after left ventricular aneurysm resection. In 2 patients a subcutaneous serous collection secondary to muscle dissection was evacuated. One patient died due to a stroke 4 months after the procedure. Another patient died after an unsuccessful coronary transluminal percutaneous angioplasty 11 months after the procedure. An improved functional class was observed in all patients. No changes in systolic function were observed after surgery when the cardiomyoestimulator was turned-off either with echocardiography (26.7 +/- 8.6 vs 24.8 +/- 5.8% [NS]) or radionuclides (24.5 +/- 9.5 vs 20.2 +/- 8.3% [NS]). When the cardiomyostimulator was turned-on a statistically significant increase of the left ventricular ejection fraction was observed either with echocardiography (24.8 +/- 5.8 vs 37 +/- 10.3%; p < 0.05) or radionuclides (20.2 +/- 8.3 vs 33.3 +/- 12.2%; p < 0.05). This significant increase of the ejection fraction has been observed in subsequent studies. Nevertheless the differences when the cardiomyostimulator is turned-on and turned-off have decreased several months after the procedure. A significant increase of the left ventricular outflow velocity (cm/seg) was observed when the generator was turned-on (57.7 +/- 20.4 vs 75.1 +/- 17.8%; p < 0.01). A significant increase of the dP/dt (mmHg/seg) was observed when the generator was turned-on (706.3 +/- 291.5 vs 592.6 +/- 181.6%; [NS]). No significant changes were observed on E wave velocity. A significant decrease of the deceleration time was observed several months after the procedure (p < 0.05). CONCLUSIONS: We believe that dynamic cardiomyoplasty is a safe and valid surgical procedure for some patients with end stage cardiomyopathies as well as in association with Jatene's technique for the management of left ventricular aneurysms. An improvement in functional class is present and a significant increase of the left ventricular systolic function. Nevertheless it is necessary to find new systolic parameters, independent of volumetric calculations, to evaluate the mechanical support of the muscle as well as to determine the long-term pattern of electrical stimulation.

[Aerobic capacity. Differences between smokers and non-smokers. Effects of withdrawal]. / Capacidad aeróbica. Diferencias entre fumadores y no fumadores. Efectos de la deshabituación.

The purpose of this study is to determine the aerobic capacity in a group of smokers and to carry out a prospective study of the changes in cardiorespiratory and metabolic response to exercise after smoking withdrawal. An aerobic capacity test was performed in 90 smokers and 30 non-smokers. Afterwards, the smokers were included in a smoking withdrawal program. One year later, the aerobic capacity test was repeated in those individuals who were able to stop smoking. The initial study of the aerobic capacity during exercise showed that smokers had significantly lower values of maximal oxygen uptake per kg body weight (VO2 max./kg) (28.7 +/- 8 vs. 35.1 +/- 7 ml/kg/min) (p < 0.001), work time (5.8 +/- 2.6 vs. 7.5 +/- 3.1 min) (p < 0.01) and work load (1.1 +/- 0.3 vs. 1.4 +/- 0.3 W/kg) (p < 0.001) under aerobic conditions. Aerobic capacity test performed one year after smoking withdrawal in those who were able to stop smoking showed a significant increase in VO2 max./kg (35.5 +/- 6.1 vs. 31.1 +/- 5.5) (p < 0.05), work time (8.1 +/- 3.2 vs. 5.8 +/- 3.2 min) (p < 0.05) and work load (1.5 +/- 0.4 vs. 1.1 +/- 0.4 W/kg) (p < 0.01) under aerobic conditions. No differences were observed in the aerobic capacity test performed on the ten subjects who did not stop smoking. From these data we suggest that tobacco consumption produces impairment of the aerobic capacity that can be reverted, at least in part, after smoking withdrawal.