José M. Domínguez de Rozas

Resultados de la pericardiectomía por pericarditis constrictiva crónica

The aim of this study was to assess early and late outcomes following treatment of chronic constrictive pericarditis by pericardiectomy. A retrospective analysis was carried out in 31 consecutive patients who underwent surgery between 1982 and 2005. The mean follow-up period was 6.7 years. In-hospital mortality was 16% (5/31 patients). The cause of death was low cardiac output syndrome in three patients, septic shock in one, and hemorrhage in the remaining patient. In six of the 26 surviving patients, functional class did not substantially improve and, in one patient, it worsened. The cumulative actuarial survival probability was 82% at 6 months, 82% at 1-9 years, and 64% at 10 years. In conclusion, pericardiectomy improved symptomatology in the majority of patients during late follow-up. A subgroup of patients did not experience an amelioration in clinical symptoms, probably because myocardial function did not completely recover.

Perforación coronaria complicada con taponamiento cardíaco sellada mediante coils metálicos

La perforacion coronaria con la guia de angioplastia es una complicacion rara que puede ocasionar taponamiento cardiaco, infarto, arritmias e incluso la muerte. La utilizacion de farmacos inhibidores de los receptores glucoproteicos IIb/IIIa de las plaquetas aumenta considerablemente el riesgo de complicaciones agudas y dificulta el manejo terapeutico. Describimos el caso de un paciente tratado con abciximab que durante la angioplastia presento una perforacion en una rama distal de la arteria coronaria derecha producida con la punta de la guia, que se complico con taponamiento cardiaco agudo. El sangrado al pericardio se resolvio mediante la liberacion de 2 coils o espirales metalicas en la luz distal del vaso perforado, y se evito la cirugia emergente.

Cardiac perforation complicated by cardiac tamponade and sealed with metallic coils

Distal coronary artery perforation with an angioplasty guidewire is a rare complication that may cause cardiac tamponade, myocardial infarction, arrhythmia, and even death. The use of platelet IIb/IIIa glycoprotein receptor inhibitors increases the risk of potentially fatal complications that are difficult to manage. We report a patient on treatment with abciximab who presented coronary perforation in a distal branch of the right coronary artery caused by the coronary guidewire tip, and complicated by acute cardiac tamponade. Blood extravasation to the pericardium was stopped by releasing two metallic coils into the distal vessel, thereby avoiding the need for emergent cardiac surgery.

Effects of thrombolysis in the evolution of right bundle-branch block complicating an acute anterior myocardial infarction.

Introduction — There is scant information about the effects of thrombolysis in the evolution of right bundle-branch block (RBBB) in the setting of acute anterior myocardial infarction.The aim of this study has been to analyse these effects and its impact on prognosis. Methods —We studied 54 patients who presented a RBBB related to an acute anterior myocardial infarction.We defined two groups: those who received thrombolytic treatment and those who did not.We analysed the evolution of RBBB (transience, moment of onset, moment of disappearance) and its relationship with in-hospital mortality.Twenty-one patients (39%) received thrombolytic treatment (group T) and 33 patients (61%) (group NT) did not. Results — The incidence of late appearance (> 6 h) of RBBB was less frequent in group T compared with group NT (10% vs. 33%, p = 0.04). The incidence of transient block was similar in the two groups (57% vs. 45%, p ns). However, early disappearance of RBBB (in < 6 hours) was more common in group T than in group NT (33% vs. 9%, p = 0.04). Mortality was higher in patients with RBBB present at 24 h after admission) than in those with RBBB resolved in less than 24 hours (in group NT, 55% vs. 8%, p = 0.02 and in group T 50% vs. 0%, p = 0.02, respectively). Conclusions — Thrombolysis seems to influence the moment of onset and disappearance of RBBB by promoting its early disappearance and avoiding its late appearance.Disappearance of RBBB is associated with a better prognosis.