Christian Muñoz-Guijosa

Long term outcome of mechanical valve prosthesis in the pulmonary position

OBJECTIVES Assessment of the long term outcome of mechanical valve prosthesis at pulmonary position in a population of grown-up congenital heart disease patients from a tertiary referral center. METHODS From 1977 to 2007, 22 consecutive patients underwent a total of 25 pulmonary valve replacements with mechanical prosthesis. The most frequent underlying cardiac condition was tetralogy of Fallot (n=16, 64%) and the mean age at the time of pulmonary valve replacement was 32 ± 11 years (range 14-50 years). RESULTS The postoperative mortality rate was 4% (n=1) with no late deaths documented after a mean follow-up of 7.6 ± 7.6 years (range 0.29-24 years). No major bleeding episodes occurred. Three patients presented with valve thrombosis in the setting of long term anticoagulation withdrawal and required valve re-replacement. Two of these patients, both with poor right ventricular function and overt clinical signs of right heart failure at the time of valve re-replacement, experienced further episodes of thrombosis despite correct anticoagulation. All episodes resolved with thrombolysis. After addition of antiplatelet treatment in one case and anticoagulation self-control, in the other, no further thrombosis has been documented. CONCLUSIONS Mechanical valve prosthesis may be an alternative to tissue valve prosthesis in patients with congenital heart disease requiring pulmonary valve replacement. Optimal anticoagulation is crucial and additional antiplatelet treatment should be considered. Our data also suggest that patients with severe right ventricular dysfunction and congestive heart failure might be at particular risk for valve thrombosis.

Anomalous origin of right coronary artery from the left coronary sinus: sudden death and successful surgical reimplantation

A 39-year-old man with no clinical relevant data, elite long-distance runner, was admitted to our institution with the diagnosis of ventricular fibrillation while participating in a half-marathon competition. He was resuscitated at the site of the event with electrical cardioversion, and at his admission, he was clinically stable. Electrocardiogram demonstrated regular …

Orthotopic heart transplantation in a patient with situs invs, transposition of the great arteries and Mustard operation.

Orthotopic heart transplantation has become standard treatment for end-stage cardiomyopathy, but experience with this technique for complex congenital heart diseases is limited. We report a patient with visceroatrial situs invs, transposition of the great arteries and previous Mustard correction, who successfully underwent orthotopic heart transplantation.

The Sorin Freedom SOLO stentless aortic valve: easier implantation technique with potentially less risk of complications

Aortic valve replacement by bioprosthesis is increasingly being used. Among these, stentless bioprosthesis is becoming a valid choice due to its potential hemodynamic improvement. The Sorin Freedom SOLO stentless aortic valve (FS) (Sorin Biomedica Cardio, Saluggia, Italy) is widely used, with initial and midterm promising results. It is designed to be deployed in a straightforward manner in the supraannular position with a single running suture due to its reproducible implantation technique. Few specific valve-related complications, such as transient thrombocytopenia or rare thrombotic events, are known. Our experience, after the implantation of 33 Freedom SOLO, suggests that using the classical implantation technique, the noncoronary sinus adopts a conformation that increases the difficulty of the implant. Besides, it could also be distorted increasing the risk of periprosthetic leakage and hypothetically becoming the origin of thrombus. We present an easy and safe variation in the implantation technique of the FS that decreases the technical difficulty of the implantation, reduces the risk of periprosthetic leakage, and may additionally reduce the risk of thrombosis.

Right atrium traumatic rupture presenting as chronic tamponade

Non-penetrating cardiac traumatisms can cause cardiac rupture, myocardial contusion or, rarely, commotio cordis. In cases of rupture of a cardiac cavity, acute and severe cardiac tamponade almost invariably occurs. This paper presents an exceptionally unusual case of non-penetrating cardiac trauma resulting in right atrium rupture contained by the pericardial cavity. A situation of exceptional hemodynamic balance was established with subacute, progressive cardiac tamponade that evolved during three months, presenting gradual right-heart failure instead of the expected acute and severe cardiac tamponade. The rupture of the atrium was successfully repaired.

Giant Circumflex Coronary Artery Fistula to the Superior Vena Cava in Patient With Multiple Valvular Disease

3 68-year-old man was admitted to our hospital with a history of dyspnea and considerable fatigue with xercise. Transthoracic echocardiography showed severe itral, aortic, and tricuspid regurgitation. The patient nderwent coronary angiography before surgery, which evealed a giant coronary artery fistula arising from the ircumflex artery (Fig 1). A multi-sliced computed tomoraphic scan was performed to delineate the fistula and ocalize its drainage. Three-dimensional reconstruction howed a tortuous course with multiple loops in the ateral wall (Fig 2) that seemed to end in the pulmonary rtery. Intravenous contrast enhancement allowed the ocation of the drainage orifice in the superior vena cava, ear the right atrium. The patient was operated on through a midline ternotomy. On opening the pericardium, the dilated essel (arrow) was seen to course from the lateral wall f the left ventricle through the transverse sinus, and it nished at the superior vena cava (Fig 3). It measured 5 mm in diameter. Cardiopulmonary bypass was stablished (with bi-caval cannulation) after occlusion f the fistula near its drainage. After mitral valve epair, aortic valve replacement, and tricuspid ring nnuloplasty, the superior vena cava was opened and

Trasplante cardiaco ortotópico en pacientes con trasposición de grandes vasos

Debido a la evolucion de la cirugia cardiaca y la cardiologia, los pacientes pediatricos que antano fallecian a causa de cardiopatias congenitas actualmente llegan a la edad adulta. Los pacientes con transposicion de grandes vasos y reparacion fisiologica en el seguimiento pueden evolucionar hacia la insuficiencia cardiaca, como consecuencia del fallo progresivo del ventriculo derecho en posicion sistemica. En esta situacion, el trasplante cardiaco aparece como una posible alternativa terapeutica. Las alteraciones anatomicas y la presencia de conductos intraauriculares hacen que el trasplante precise de una serie de variaciones tecnicas. Presentamos la experiencia en nuestro centro. Entre 1992 y 2004 se han realizado cuatro trasplantes cardiacos en transposicion de grandes vasos y correccion fisiologica. No hubo mortalidad quirurgica. Durante el seguimiento (media, 75 meses), se produjo una muerte por rechazo cronico. Los demas pacientes presentan clase I de la NYHA, con injerto normofuncionante.

Tricuspid valve replacement with mechanical prostheses: Short and long-term outcomes

Tricuspid valve replacement has been associated with high mortality and poor long‐term outcomes. We report the preoperative risk factors associated with short and long‐term outcomes following tricuspid valve replacement with mechanical prostheses.

Hemorragia masiva después de anticoagulación con bivalirudina en 2 casos de pacientes con trasplante cardiaco

Heparin-induced thrombopenia is a common autoimmune complication. It is a prothrombotic state due to the formation of antibodies against heparin/platelet factor 4 complexes. In this situation drugs other than heparin must be used for anticoagulation during extracorporeal circulation (bypass) surgery. Two cases of heart transplantation are presented in whom bivalirudin was used as an anticoagulant during the cardiopulmonary bypass. Severe bleeding complications were observed in both patients. The diagnosis of heparin-induced thrombopenia needs to be improved, as well as the development of protocols for using new drugs other than heparin. For this reason, we have reviewed current protocols and alternative therapies to heparin.

212. Descripción y resultados del circuito ambulatorio para implantación de marcapasos de forma electiva

Objetivos Comparar los resultados (prevalencia de complicaciones, estancia hospitalaria y coste economico) entre el nuevo circuito ambulatorio y el circuito antiguo con ingreso para pacientes tributarios a implante de marcapasos de forma electiva. Material y metodos Desde enero de 2008 - mayo de 2012 se recogieron los datos de los pacientes intervenidos de forma electiva (remitidos desde el dispensario de arritmias) de implantacion de marcapasos definitivo y se dividieron en dos grupos: grupo 1, circuito antiguo (dos noches de ingreso) y grupo 2, nuevo circuito ambulatorio (sin ingreso). Resultados Disminucion de la estancia hospitalaria, de la lista de espera y del coste economico en el nuevo circuito ambulatorio, sin hallarse diferencia significativa en la prevalencia de complicaciones comparado con los marcapasos implantados de forma electiva con ingreso. Conclusiones El circuito ambulatorio a traves de cirugia sin ingreso para implantacion de marcapasos electivos es un modelo seguro, eficaz y mas barato.