Hernando Orjuela

Concomitant mitral valve or atrial septal defect surgery and the modified Cox-maze procedure

Atrial fibrillation (AF) is generally associated with rheumatic valve disease and atrial septal defects (ASD) in young adults. Surgical correction of both disorders fails to convert to sinus rhythm or prevent further episodes of paroxysmal or chronic AF in most patients. The role and efficacy of combining mitral valve surgery or ASD correction with AF surgery in this setting has not been widely addressed and remains to be established. The present study prospectively assessed the recovery of sinus rhythm, functional status, and atrial function in 21 patients (mean age 42 +/- 9.2 years) who underwent a modified Cox-maze procedure concomitant with mitral valve or ASD surgery at our institution between March 1993 and February 1995. Seventeen (81%) had chronic AF, and 4 (19%) had paroxysmal AF, with a mean AF duration of 3.5 +/- 3.6 years (range 0.6 to 15.3). Concomitant surgery was performed in 9 patients (42.9%) with mitral stenosis, 5 (23.8%) with mitral regurgitation, 1 (4.8%) with mitral and aortic regurgitation, and 3 (14.3%) with ASD. Eighteen patients (86%) were in New York Heart Association class II to IV before operation. Doppler echocardiography was performed in all patients before surgery, and 1 week, and 3 and 6 months after surgery in patients maintaining sinus rhythm. One patient with severe mitral stenosis and depressed ventricular function died in the immediate postoperative period. Sinus rhythm was restored in the immediate postoperative period in 7 patients (35%), and in another 10 patients (50%) before discharge (mean 5.8 +/- 2 days). Overall, sinus rhythm was restored before discharge in 17 patients (85%); 3 (15%) patients required antiarrhythmic therapy. Doppler echocardiography performed 3 months after surgery documented atrial contractility (A and E waves) in 12 patients (71%). After a mean follow-up period of 8 months (range 3 to 23), 18 (90%) remained in sinus rhythm. Sinus rhythm was successfully restored and maintained in most patients with drug refractory AF undergoing a concomitant Cox-maze procedure with mitral valve or ASD surgery improving atrial function and New York Heart Association class.

Anomalía del retorno venoso sistémico Drenaje anómalo de la vena cava superior derecha a la aurícula izquierda. Revisión de la literatura y reporte de caso

La anomalia total del retorno venoso sistemico tiene gran variedad de presentaciones; sin embargo, la patologia de mas baja frecuencia es el drenaje de vena cava superior derecha a la auricula izquierda, hecho de peso para que en el mundo se reporten pocos casos. En la Fundacion Clinica Abood Shaio se trato el caso de una paciente de seis anos de edad con drenaje venoso total de cava superior derecha a la auricula izquierda, mediante la tecnica de movilizacion de cava superior y anastomosis cavo-atrial, y se obtuvieron buenos resultados. El caso es mencion corresponde al numero 21 en la literatura mundial.

Aneurisma de la arteria coronaria derecha: Revisión de la literatura y reporte de casos

El aneurisma de la arteria coronaria derecha es una entidad rara, que se presenta principalmente en mujeres. Las causas mas frecuentes de muerte por aneurisma son en su orden: ruptura, trombosis, isquemia. La enfermedad aterosclerotica es la causa mas frecuente de aneurisma espontaneo. La mayoria de los pacientes son asintomaticos, y presentan soplo continuo o moderada cardiomegalia, y pletora en la radiografia de torax. En etapas avanzadas produce cardiopatia isquemica. Para su diagnostico es necesario un juicio clinico adecuado y examenes de rutina para enfermedad coronaria. Se exponen dos casos tratados en la Fundacion Clinica A. Shaio, con base en los cuales se analiza el diagnostico, las complicaciones y el tratamiento realizado.