Revascularización transmiocárdica con láser de holmio / Transmyocardial revascularization with holmium laser

Cuarenta y dos pacientes con angina refractaria a terapia médica en los cuales no existía indicación de revascularización convencional, se sometieron a revascularización transmiocárdica con láser de holmio.La edad media de los pacientes era de 63,2 años (ñ 10,5 años). Todos ellos tenían angina clase 3 ó 4, y 56 por ciento de ellos se habían sometido previamente a cirugía de revascularización clásica. Cuatro pacientes murieron durante los 6 meses posteriores a la cirugía. Entre los supervivientes, la angina decreció a clase 2 ó 1 en 6 meses (p=0,002). La fracción de eyección no cambió. La carga isquémica por Holter disminuyó de 85,3 ñ 6,5 a 65,5 ñ 9,7 min (p=0,046). Se observó una mejoría significativa en las imágenes en reposo y tras dipiridamol de la perfusión miocárdica con 201Tl tomografía por emisión de fotones entre los segmentos isquémicos y los tratados (p=0,015). La fracción de eyección fue de algún modo más baja en pacientes que no respondían que en los que respondían 33 ñ 13 frente a 49 ñ 10 (p= 0,052).Concluimos que la revascularización transmiocárdica con láser de holmio es efectiva en el tratamiento de pacientes con isquemia no tratables con cirugía o procedimientos percutáneos, como en anteriores informes con láser de CO2. Se necesitan nuevas investigaciones para determinar cuáles son los perfiles clínicos de los pacientes susceptibles de esta terapia. (AU)

[Aortic coarctation: different anatomo-clinical forms depending on the age of presentation]. / Coartación de aorta: diferentes formas anatomoclínicas según la edad de presentación.

OBJECTIVE: To analyse the anatomo-clinical characteristics of the coarctation of the aorta at different ages of presentation as well as the findings and results of its surgical correction at different periods. PATIENTS AND METHODS: We retrospectively studied the clinical and angiographic data, as well as the intraoperative findings and surgical outcomes of 82 consecutive patients (54 M and 28 F) with coarctation of the aorta. Mean age was 16.2 +/- 13.7 years (1 month to 63 years). The patients were divided into three groups according to age: Group A (n = 10) under 1 year; Group B (n = 30) from 1 to 12 years and Group C (n = 42) over 12 years. RESULTS: A preductal form was found in 20.7% cases (50.0%, 30.0% and 7.1% of groups A, B, and C respectively; p = 0.003). An associated left-to-right shunt was present in 19.5% (40.0%, 16.7% and 16.7% of groups A, B and C respectively; p = NS). The first manifestation of the disease was different in groups A, B and C. Among group A patients, congestive heart failure was the most frequent presentation (70.0%). In group B, the most frequent presentation (30%) was as an incidental finding in an asymptomatic patient. Finally, systemic hypertension or its complications predominated among group C patients (38.0%). Left ventricular hypertrophy on ECG was present in 0.0%, 30.0% and 54.7% of patients in groups A, B and C (p = 0.003) respectively. Postoperative complications including death, hypertensive crisis and re-coarctation were observed in 90.0%, 33.3% and 21.4% in groups A, B and C (p = 0.01) respectively. CONCLUSIONS: Among patients with coarctation of the aorta, the age of clinical presentation allows us to define groups of patients with different anatomical characteristics, clinical course and postoperative outcome.

Twenty-year comparison of the human allograft and porcine xenograft.

This study compares a retrospective consecutive series of human allografts and concurrent porcine xenografts implanted over a 10-year interval. There were 571 allograft valves and 1,351 xenograft valves implanted in the aortic and mitral position with mean follow-up of 12.8 years for the allografts and 6.2 years for the xenografts. This study compares the incidence of structural deterioration over long-term follow-up. We found that there was no significant difference between four manufacturers of porcine xenografts, in spite of substantial differences in processing techniques. We found that there was a significant difference in allografts that were premounted on stents as compared with allografts that were not premounted on stents for aortic valve replacement. We found that there was no significant difference between allografts for aortic valve replacement that were not premounted on stents and porcine xenografts implanted in the aortic position. These findings are in marked contrast to those of other reported series with the use of allograft valves.