Alberto Domenech

Surgery for papillary fibroelastoma with uncommon location in left ventricle.

Cardiac papillary fibroelastoma is a rare tumor. Its location in the left ventricular wall is uncommon. A 59-year-old woman with 2 previous strokes presented with a tumor in the left ventricular apex. The patient underwent tumor resection through a left ventriculotomy. The histopathologic diagnosis was papillary fibroelastoma.

Determinantes pronósticos en la insuficiencia mitral de origen degenerativo. ¿Podemos adelantar hoy el momento quirúrgico?

En los ultimos anos, dados los excelentes resultados obtenidos fundamentalmente con la reparacion quirurgica de la valvula mitral, en la insuficiencia mitral de origen degenerativo (tipo II de Carpentier), existe una tendencia creciente de indicar la cirugia de forma precoz. Algunos autores proponen incluir aqui a los pacientes todavia asintomaticos, sin ningun deterioro anatomico ni hemodinamico generado por esta enfermedad. Es proposito de esta revision analizar cada uno de los determinantes pronosticos principales ya conocidos, asi como alguno todavia no suficientemente considerado, como el monto de la regurgitacion mitral grave medido ecocardiograficamente y ponderado como volumen regurgitante y/o como area del orificio de regurgitacion efectiva. Tambien se estima el valor de la medicion de los peptidos natriureticos tanto atrial como cerebral, y su correlacion con el incremento observado a medida que aumenta el grado de insuficiencia valvular y su repercusion clinica y hemodinamica. Se hace hincapie en el valor aditivo de mas de una variable en forma combinada con otra para valorar con mayor precision el riesgo y pronostico de la enfermedad.

Aortic Annulus Enlargement vs. Conventional Surgery in Patients with Small Aortic Annulus Undergoing Aortic Valve Replacement

Background: The goal of aortic valve replacement for severe stenosis is to relieve symptoms and prevent the mortality associated with the disease. Appropriate prosthetic valve size must be selected for each patient according to body surface area to avoid patientprosthesis mismatch. Objective: The aim of this study was to evaluate transvalvular gradient reduction at one-year follow-up in patients with small aortic annulus undergoing valve replacement with annular enlargement vs. conventional replacement surgery. Methods: A retrospective cohort study was performed including patients with small aortic annulus undergoing valve replacement from January 2011 to December 2015. Two groups were selected: Group AAE consisting of patients in whom aortic annular enlargement was necessary and Group RVA19 involving patients in whom a #19 mm prosthetic valve was conventionally implanted. Results: Postoperative gradients (within the first 3 months and at one year) were significantly lower in the group with aortic annular enlargement. Median cardiopulmonary bypass time increased 14 minutes in Group AAE. Bioprostheses were used in most cases. There was no statistically significant difference in mortality between the groups. Conclusions: Aortic annular enlargement improves postoperative, short-term and at one year follow-up transvalvular gradients.