Cardiogenic shock in acute coronary syndrome.

This is a review of current knowledge on cardiogenic shock (CS), with particular attention to recommended management. The bibliography for the study was compiled through a search of different databases between 1966-2008. The references cited in the selected articles were also reviewed. The selection criteria included all reports published on CS, from case reports and case series to controlled studies. Languages used were Spanish, French, Italian, Portuguese, German, and English. Cardiogenic shock is the most frequent cause of in-hospital death as a complication of acute coronary syndrome. The incidence is about 7% and, despite therapeutic advances, it continues to have an ominous prognosis, with mortality rates of over 50%. Coronary reperfusion is fundamental in the management of cardiogenic shock, particularly with the use of percutaneous coronary intervention. However, if this is not available, systemic thrombolysis may be performed together with balloon counterpulsation or the use of pressor drugs. Despite the historical importance of the Swan-Ganz catheter, this would appear to have limited use, with echocardiography nonetheless having a fundamental role in the management of CS. Although patients with cardiogenic shock often present a left ventricular ejection fraction of around 30%, survivors often have a good functional classification one year after the event. Neurohormonal and inflammatory mechanisms play a fundamental role in the pathophysiology of CS. These mechanisms are currently the target of studies looking into developing new therapeutic strategies.

[Mitral valve repair for mitral regurgitation]. / Cirugía de reparación valvular en la regurgitación mitral.

We analyzed the results of mitral valve repair in 81 consecutive patients with severe mitral regurgitation. Of these patients, 66.6% had myxomatous degeneration, 11% ischemic disease, 8% chordal rupture, 5% congenital disease, and 3.7% endocarditis. Repair could not be achieved in five patients, and valve replacement was necessary. Six died during surgery (mortality 7%). During follow-up (mean 30 [8] months), there was one death due to refractory ischemic heart failure and mitral regurgitation (>or= 2/4) was observed in 11 patients. A good result (i.e., survival without a prosthesis, major complications, or mitral regurgitation >1/4) was obtained in 78% of patients with myxomatous degeneration versus 48% of those with other etiologies (P=.023). A good result was obtained more frequently in cases of isolated posterior cusp degeneration than in those involving degeneration of both cusps (85% vs 70%; P=.03).

Cirugía de reparación valvular en la regurgitación mitral / Mitral valve repair for mitral regurgitation

Analizamos los resultados de la reparación valvular mitral en 81 pacientes consecutivos con insuficiencia severa de la válvula. El 66,6% de los pacientes tenía degeneración mixoide; el 11%, etiología isquémica; el 8%, rotura de cuerdas; el 5%, congénita y el 3,7%, endocarditis. En 5 casos fue preciso sustituir la válvula al no conseguirse una reparación adecuada. La mortalidad operatoria fue de 6 pacientes (7%). En el seguimiento (media, 30 +/- 8 meses) hubo un fallecimiento por insuficiencia cardiaca isquémica refractaria y 11 pacientes quedaron con insuficiencia mitral >= 2/4. Se obtuvo buen resultado (supervivencia sin prótesis, regurgitación mitral > 1/4 o complicación mayor) en el 78% de los pacientes con afección mixoide frente al 48% de aquellos cuya enfermedad no era mixoide (p = 0,023). La tasa de buen resultado fue superior en la degeneración aislada del velo posterior que en la afección de ambos velos (85% frente a 70%; p = 0,003)

We analyzed the results of mitral valve repair in 81 consecutive patients with severe mitral regurgitation. Of these patients, 66.6% had myxomatous degeneration, 11% ischemic disease, 8% chordal rupture, 5% congenital disease, and 3.7% endocarditis. Repair could not be achieved in five patients, and valve replacement was necessary. Six died during surgery (mortality 7%). During follow-up (mean 30 [8] months), there was one death due to refractory ischemic heart failure and mitral regurgitation (>= 2/4) was observed in 11 patients. A good result (i.e., survival without a prosthesis, major complications, or mitral regurgitation >1/4) was obtained in 78% of patients with myxomatous degeneration versus 48% of those with other etiologies (P=.023). A good result was obtained more frequently in cases of isolated posterior cusp degeneration than in those involving degeneration of both cusps (85% vs 70%; P=.03)