[Surgical treatment of angina pectoris]. / Tratamiento quirúrgico de la angina de pecho.

Coronary artery bypass grafting is a very effective therapy for the relief of angina pectoris. It has been demonstrated that, in certain subsets of patients, it prolongs life when compared to other treatment options. However, the introduction and development of less invasive percutaneous procedures has changed the profile of patients subject to coronary surgery. They are older, with more extensive coronary disease and comorbid conditions. The challenge of coronary artery bypass grafting is to maintain the excellent results obtained tha far and to compete with percutaneous revascularization procedures regarding morbidity and cost-effectiveness. We review the most important randomized trials of coronary surgery, especially those which consider its role in multivessel disease versus angioplasty and the new trends that try to make it cheaper and less invasive.

[Aortico-left ventricular tunnel. Clinical and surgical considerations]. / Túnel aortoventricular izquierdo. Consideraciones clínicas y quirúrgicas.

We report the case of an infant operated on at 11 months, having been clinically, echocardiographically and hemodynamically diagnosed when 2 days at the age. In the Echo-Doppler study the visualisation of the tunnel and the presence of aortic regurgitation within it and in the left ventricular outflow tract confirmed the diagnosis. Surgical access to both orifices, aortic and left ventricular, through the tunnel (after incision in the same) allowed it to be closed with two Goretex patches from its external face. This technique has a double advantage: a) it avoids annular distortions or aortic valvular lesions, b) excluding the tunnel (partial resection of edges and subsequent continuous suture) any possibility of subpulmonary stenosis through compression is eradicated.