David Rodrigo

Anomalías cardíacas en la ectopia cordis

Ectopia cordis is a rare disease that occurs in 5.5 to 7.9 per million live births. Only 267 cases had been reported as of 2001, most (95%) associated with other cardiac anomalies. We studied the cardiac malformations associated in 6 patients with ectopia cordis. Depending on where the defect was located, the cases of ectopia were classified into four groups: cervical, thoracic, thoraco-abdominal, and abdominal. All 6 patients died before the third day of life, 4 during delivery. Three of the patients were included in the thoracic group, whereas the other 3 belonged to the thoraco-abdominal group. All the patients had associated ventricular septal defects, 3 double-outlet right ventricle (50%) and the rest (50%) tetralogy of Fallotpulmonary atresia. Two patients with double-outlet right ventricle presented mitral-valve pathology, a parachute valve and an atresic mitral valve. None of these cardiac anomalies have been reported to date.

Patch Enlargement of the Posterior Mitral Leaflet in Ischemic Regurgitation

We discuss our early experience in 2 patients with a patch enlargement technique for treating chronic ischemic mitral regurgitation due to restricted motion of the posterior mitral leaflet. This technique corrects the restricted motion and offers better coaptation without compromising the mitral orifice.

Intramural cardiac myxoma in left ventricular wall: an unusual location.

A 27-year-old asymptomatic woman was investigated for an abnormal finding in the cardiac contour on routine chest radiography. Echocardiography revealed a heterogeneous mass in the anterolateral left ventricular wall. Excision of the tumor disclosed an absence of communication between the residual cavity and the left ventricular endocardium. Histological features of the tumor indicated an intramural myxoma.

Percutaneous Closure of Complex Fistula Between the Internal Mammary Artery and a Lobar Branch of a Pulmonary Artery

A through review of the literature identified only 20 reported cases of fistula involving the internal mammary (internal thoracic) artery and a lobar branch of a pulmonary artery. Surgical closure was frequently done to avoid complications associated with this anomaly. We report the first patient in whom percutaneous treatment was accomplished with a combined technique involving an Amplatzer Duct Occluder device and coils.

Cierre percutáneo de una fístula compleja entre la arteria mamaria interna y la arteria lobar pulmonar

Tras una revision exhaustiva de la literatura, hemos encontrado tan solo 20 casos reportados de fistulas entre la arteria mamaria interna (AMI) y las arterias pulmonares. Frecuentemente se indica su cierre quirurgico por las complicaciones que pueden acarrear. Presentamos el primer caso en el que el tratamiento se realiza de forma percutanea mediante una tecnica mixta con un dispositivo Amplatzer Duct Occluder (ADO) asociado a coils

Cierre vía transapical de leak sobre prótesis mitral mecánica

A 62-year-old woman with a history of rheumatic mitral valve disease and commissurotomy closed in 1969, implantation of a Shiley biological mitral prosthesis in 1978, and its replacement in 1998 by a No. 25 Bjork mechanical prosthesis, showed symptoms consistent with congestive heart disease and analytical findings indicating hemolytic anemia. Transesophageal echocardiography detected 2 mitral periprosthetic leaks, a severe one at P2 and a mild one at P3 (Fig. 1). A decision was made to close the P2 leak, but because the patient had undergone 3 previous heart surgeries, a minimally invasive approach by transapical route was chosen, this being the simplest technique. The procedure was carried out in the operating room with the patient under general anesthesia. A left minithoracotomy was performed (Fig. 2) with apical access, and an Amplatzer device was implanted over the P2 defect under radioscopic and transesophageal echocardiographic guidance (Fig. 3); the outcome was satisfactory. At hospital discharge 5 days later, the patient was asymptomatic and laboratory analyses showed no hemolysis. At 10 days, a transesophageal echocardiographic follow-up study showed that the procedure had been effective, with only a minimal residual leak. Periprosthetic leaks are a relatively common finding (2% to 3% of mitral prosthesis implantations). When they are severe, they tend to produce symptoms of congestive heart failure or hemolytic anemia. Percutaneous closure is usually contemplated in patients with a history of several previous heart surgeries or multiple comorbid conditions. An anterograde (transapical) or retrograde (trans-septal) approach can be performed, with success rates of 60% to 90%. Rev Esp Cardiol. 2012;65(10):956

Origen anómalo de la coronaria izquierda en la arteria pulmonar derecha con comunicación interventricular

Una lactante con coronaria izquierda naciendo anomala de la arteria pulmonar derecha, asociada a comunicacion interventricular y patologia mitral leve, fue intervenida a los 6 meses de edad, realizandose correccion con implante directo de la coronaria izquierda con un segmento pequeno de la arteria pulmonar en la pared posterior de la aorta ascendente y cierre de la comunicacion perimembranosa. La paciente esta asintomatica al ano de la intervencion.

Ventrículo único de morfología izquierda corregido a los 49 años con buena evolución

Presentamos el caso de una paciente de 51 anos con ventriculo unico izquierdo y camara rudimentaria anterior corregido en 1997 con la tecnica de Fontan. El estudio postoperatorio con ecocardiografia, Holter, gammagrafia de perfusion pulmonar, ventriculografia isotopica, resonancia magnetica y analitica no demostro alteraciones. La paciente esta asintomatica. Creemos que es el caso de mas edad corregido con esta anomalia.

Reapertura tardía del conducto arterioso tras cierre completo con la prótesis de Rashkind. Posible origen traumático

Se presenta un caso de persistencia del conductoarterioso en un adulto sintomatico que fue cerradomediante cateter con una protesis de Rashkind, demostrandosela ausencia de flujo mediante ecocardiografiaDoppler-color al mes de seguimiento y encontroles posteriores, reduciendose las dimensionesdel ventriculo izquierdo y desapareciendo susintomatologia. A los 13 meses de seguimiento, elpaciente sufrio un accidente laboral con caida desdeun andamio y en los controles posteriores se detectola aparicion de flujo ductal en la ecografiaDoppler-color, con progresivos aumentos de losdiametros del ventriculo izquierdo y reaparicion dela sintomatologia. Se realizo estudio hemodinamicodemostrandose una relacion flujo pulmonar/sistemicode 2 y un chorro de 3 mm, bien definido por laparte superior de la protesis. Se implanto una segundaprotesis de Rashkind, desapareciendo el flujoen la aortografia inmediata y en el estudio Doppler-color