[Surgical complications and mortality in octogenarian patients undergoing revascularization surgery]. / Complicaciones operatorias y mortalidad en pacientes octogenarios sometidos a cirugía de revascularización.

UNLABELLED: Our objective was to identify preoperative, operative and postoperative factors associated with complications and mortality in patients equal to or greater than 70 years of age with coronary artery disease treated with coronary bypass surgery. From january 1990 to june 1994 of those that underwent 37 coronary artery bypass surgery. 32 were men (86.5%) and five women (13.5%). History of cardiovascular disease, diabetes mellitus, systemic arterial hypertension, pulmonary disease, hypercholesterolemia, renal function, and severity of coronary artery disease were considered. Also analysed were aortic clamp and cardiopulmonary bypass time, number and type of grafts. Use of intraaortic balloon counterpulsation, inotropic drugs, ventilatory support, hemorrhage, infection, renal and liver failure, neurological, rhythm and conduction abnormalities and myocardial ischemia were also considered. Identified risk factors: diabetes mellitus, (p = 0.028), ejection fraction < 30% (p = 0.023), ventricular wall motion abnormalities (p < 0.05), aortic clamp > 60 minutes (p = 0.026), cardiopulmonary bypass < 120 minutes (p = 0.022), reverse saphenous vein grafts (p = 0.014), prolonged ventilatory support, inotropic drugs and intraaortic balloon counterpulsation. CONCLUSIONS: Surgery should be reserved for patients with at least three vessel or left main coronary artery disease or proximal lesion of the left anterior descending artery with severe ischemia, deteriorated myocardial function and angina with no response to medical treatment; age of the patient is not a contraindication.

[Electrocardiographic data suggesting anteroseptal myocardial infarction, in presence of infarction of the left ventricle]. / Datos electrocardiográficos sugestivos de infarto del miocardio anteroseptal, en presencia de infarto del ventrículo derecho.

We present a case of right ventricular myocardial infarction, secondary to postangioplasty occlusion of ventricular ramus of the right coronary artery, that developed electrocardiographic changes suggestive of septal myocardial infarction, this diagnosis was eliminated through angiographic study. We conclude that the carefully analysis of the electrocardiographic changes in ST segment in V1 to V4 can guide to the diagnosis of right ventricular myocardial infarction. For that reason we recommend the routinary register of the right electrocardiographic derivations as V3R and V4R, and left derivations V7 and V8, that is, the thoracic circle, in all patients with acute myocardial infarction regardless its location.

[Myocardial ischemia secondary to coronary fistula of the anterior descending artery with drainage into the pulmonary artery]. / Isquemia miocárdica secundaria a fístula coronaria de la arteria descendente anterior con drenaje al tronco de la arteria pulmonar.

This article reports the clinical and angiographic aspects of three patients with congenital coronary arteriovenous fistula to the main pulmonary artery, which manifested as dyspnea crisis and angina. This three cases were found in the course of 4,400 consecutive cardiac catheterization procedures to study coronary artery disease. The interest of the cases reported is based on the peculiar anatomy of the fistula. Prompt diagnosis is relevant for better prognosis and treatment.

[Is the use of prophylactic antibiotics of benefit in patients undergoing heart catheterization?]. / Es útil el uso de antibióticos profílacticos, en pacientes sometidos a cateterismo cardíaco?

The use of antibiotics in patients who undergo cardiac catheterization, by percutaneous approach, using re-sterilized catheters, is controversial, and there is not clear information in this regard. We investigated the frequency of bacteremia during cardiac catheterization and the evidence of later infection, using re-sterilized material. We studied 227 consecutive patients over one year, and we obtained 200 blood cultures of the beginning and the end of the procedure. All the cultures were negative and there was not evidence of clinical infection in the year following the study. These results indicated that bacteremia is rare during cardiac catheterization, if aseptic technics are followed. Based on these result we do not recommend the use of antibiotics in patients undergoing cardiac catheterization. The sex, age, type of heart disease and re-sterilized material do not alter this recommendation.

[A double myocardial rupture (septal and the free wall) due to an infarct. A case report and review of the literature]. / Doble ruptura miocárdica (septal y pared libre) por infarto. Reporte de un caso y revisión de la literatura.

Rupture of the myocardium is often a catastrophic complication of myocardial infarction with a poor prognosis in the short term. The occurrence of more than one myocardial rupture is a rare condition, and has been published in most cases as a necropsy finding. The purpose of this communication is to report one case of double rupture of the myocardium, diagnosed in life; and the clinical and surgical implication of such cases.

[Acute myocardial infarction and pyocholecystitis. Report of a case]. / Infarto agudo del miocardio y piocolecisto. Informe de un caso.

The clinical data of a 43 year old male with acute myocardial infarction and acute abdominal syndrome on the 4th day after the onset of infarction is reported. During abdominal surgery, a gall bladder abscess was found and a cholecystectomy was performed, without abdominal or cardiac complications. This report emphasizes the rare association of these entities and that even in evolving myocardial infarction surgery can be performed with reasonable risk. The collaboration of cardiologist, surgeon and anesthesiologist is suggested.