[Intraoperative circulatory collapse due to a coronary spasm following successful coronary revascularization]. / Colapso circulatorio intraoperatorio debido a espasmo coronario después de revascularización coronaria exitosa.

Coronary artery spasm is recognized cause of angina and circulatory collapse during the operative and early postoperative period following cardiopulmonary bypass for coronary artery surgery. We present our experience with hemodynamical collapse during cardiopulmonary bypass weaning, which were refractory to treatment with inotropics such as noradrenaline and adrenalin and vasodilators such as nitroglycerin. The electrocardiographic changes, poor answer to medical treatment following successful cardiopulmonary bypass for coronary artery surgery, good myocardial protection and complete revascularization suggested severe coronary artery spasm. We used sublingual nifedipine, achieving hemodynamical stability and stopping inotropic support and cardiopulmonary bypass. We review the literature about pathophysiologic mechanism and treatment of coronary artery spasm.

[Pericardiectomy: a challenge, a reality. The surgical experience of the Instituto Nacional de Cardiología "Ignacio Chávez"]. / Pericardiectomía "un reto, una realidad". Experiencia quirúrgica del Instituto Nacional de Cardiología "Ignacio Chávez".

The surgical aspect of the pericardial disease has grown in the last years due to new diagnostic, surgical and anesthetic procedures. We reviewed 20 patients, who underwent pericardiectomy in the National Institute of Cardiology "Ignacio Chávez" between august 1987 and september 1992. Nine males and eleven females whose age ranged from 18 years to 57 years with a mean of 35.8 years. We found as causes of pericardial disease: 5 patients with recurrent pericardial effusion, 4 constrictive pericarditis, 2 cases with uremic pericarditis, 2 cases of "postpericardiotomy syndrome" 2 cases of infectious origin, idiopathic causes in two, others less frequent causes were neoplastic pericarditis in one, post-traumatic in one and secondary to radiotherapy in another one. The diagnosis was made by clinical findings, chest X rays, echocardiography and cardiac catheterization. A medial sternotomy was made in all patients, and the pericardium resection was made toward the anterior aspect of the phrenic nerve. In all the patients operative monitoring included central venous catheter and radial indwelling catheter, Swan Ganz catheter in 12 cases (60%) and cardiopulmonary bypass available. One death was reported in an uremic patient, secondary to low cardiac output and multiple organic failure. One year mortality increased to 10% with the inclusion of a rhabdomyosarcoma. Surgical complications included two cases (10%) with supraventricular arrhythmias, one case (5%) incomplete right bundle branch block, postoperative bleeding one (5%) and other one (5%) postoperative mediastinitis.(ABSTRACT TRUNCATED AT 250 WORDS)

[The transatrial-transpulmonary correction of tetralogy of Fallot]. / Corrección transatrial-transpulmonar de la tetralogía de Fallot.

The technical problems and morbi-mortality related with operations in two stages repair of tetralogy of Fallot (T.F) had lead several groups to correct it in early stages. We present 19 infants with T.F operated between July of 1988 and August 1992, 11 males and 8 females whose ages ranged from eleven months to eleven years. Without previous surgery, the preoperative catheterization show 71.4 mm Hg of trans-infundibular gradient. The obstruction was relieved through right atriotomy in combination with one pulmonary arteriotomy from above. The ventricular septal defect was closed. One patient with severe pulmonary hypertension died. The rest show gradient less than 21 mm Hg, and NYHA I-II without medicine (23.1 months of follow up). The echocardiography shows that pulmonary regurgitation was present in 54.9% but only 3 cases was it graded as moderated and none was it severe. Transatrial transpulmonary repairs avoids the depression of ventricular performance caused by transannular corrections with ventriculotomy. Preserves muscular contractions and thus reduces the propensity to right ventricular failure. It can be performed to many patients included anomalous origin of the left anterior descending coronary artery.