José María Mesa García

Impacto del tipo de hospital en el tratamiento y evolución de los pacientes con síndrome coronario agudo sin elevación del ST

Introduccion y objetivos Las guias de practica clinica del sindrome coronario agudo sin elevacion del ST (SCASEST) no valoran la infraestructura hospitalaria y la facilidad de acceso a la sala de hemodinamica. Este estudio analiza la influencia del tipo de hospital, con o sin sala de hemodinamica, en la forma de tratamiento de pacientes con SCASEST y su posible impacto en el pronostico a medio plazo. Metodos El GYSCA es un registro multicentrico (15 hospitales) que analiza la aplicacion de las guias en pacientes con SCASEST: 6 con sala de hemodinamica (hospitales centrales) y 9 sin hemodinamica (hospitales comarcales). Se realizo seguimiento clinico al alta y a los 3 y a los 12 meses. Resultados Se recluto a 1.133 pacientes consecutivos; 599 (52,9%) en hospitales centrales y 534 (47,1%) en hospitales comarcales. El uso de intervenciones de clase I fue mayor en los centrales (aspirina, clopidogrel, bloqueadores beta, IECA y estatinas; p Conclusiones Los pacientes que ingresan por SCASEST en hospitales que no disponen de sala de hemodinamica son tratados de forma menos invasiva y con un tratamiento farmacologico menos ajustado a lo recomendado en las guias. Junto con los conocidos factores predictivos del pronostico, el tipo de hospital puede tener un impacto adicional en la evolucion.

Influencia del desajuste paciente-prótesis en el octogenario operado de recambio valvular aórtico por estenosis severa

INTRODUCTION AND OBJECTIVES The clinical impact of patient-prosthesis mismatch on the outcome in octogenarians who undergo surgery for aortic valve replacement due to severe stenosis is unknown. Our objective was to quantify the frequency of some degree of patient-prosthesis mismatch and its impact on mortality and life quality. METHODS We analyzed all the octogenarian patients who underwent surgery for aortic valve replacement due to severe stenosis in our center from February 2004 to April 2009. Patient-prosthesis mismatch was considered to exist when the indexed effective orifice area was ≤ 0.85 cm²/m². The influence of patient-prosthesis mismatch on in-hospital mortality, medium-term survival, and New York Heart Association functional class was studied using an analysis adjusted for propensity score. RESULTS Of 149 patients studied, 61.7% had some degree of patient-prosthesis mismatch (mean follow-up was 32.71 ± 14.42 months). After adjusting for propensity score, there were no differences in in-hospital mortality (odds ratio=0.75; 95% confidence interval, 0.15-3.58; P=.72), medium-term survival (hazard ratio=1; 95% confidence interval, 0.36-2.78; P=.99) or functional class during follow-up (odds ratio=1.46; 95% confidence interval, 0.073-29.24; P=.8). CONCLUSIONS Although moderate patient-prosthesis mismatch is a very common finding in octogenarian patients who undergo aortic valve replacement, its influence on mortality and quality of life does not seem to be relevant. The biological profile of elderly patients with lower metabolic requirements and limited physical activity could justify the results obtained.

Late Presentation of an Unruptured and Calcified Pseudoaneurysm of The Atrioventricular Groove

A 68-year-old woman who had undergone mitral valve replacement 7 years ago developed severe aortic stenosis. Coronal contrast-enhanced chest computed tomography (Figure 1) and 3D volume-rendered magnetic resonance imaging (Figure 2) revealed an unruptured and calcified pseudoaneurysm of the atrioventricular groove. The red arrow shows the pseudoaneurysm, and the red star shows fistulae between the left ventricle and the pseudoaneurysm. The patient underwent transcatheter aortic valve replacement; the procedure was uneventful, and the patient showed successful outcomes.

“Malignant” Chronic Constrictive Pericarditis

A 32-year-old woman who suffered from acute myopericarditis after an upper respiratory infection when she was 15 years old was diagnosed 4 years later with restrictive cardiomyopathy. Ten years later, she became symptomatic, with episodes of right-sided heart failure, lower extremity edema, hepatosplenomegaly, and mild ascites. Echocardiography revealed normal right and left ventricular function without tricuspid regurgitation but with severe dilation of both atrial chambers. Cardiac catheterization revealed the presence of the square root sign with equalization of right and left ventricular end-diastolic pressures, together with modest elevation in right ventricular systolic pressure (40 mmHg) and absence of respiratory variations. Finally, contrastenhanced thoracic computed tomography revealed severe concentric pericardial calcification with partial infiltration of the myocardial free wall of the right ventricle with a maximum width

Evaluación de los resultados de la cirugía reconstructiva del esqueleto mitroaórtico en la endocarditis infecciosa activa

Introduction Surgical intervention of active infective endocarditis with multiple abscesses and destruction of the intervalvular fibrous body represents a technically demanding procedure with a difficult postoperative management. The experience is presented with an original technique for radical resection and subsequent reconstruction using bovine pericardium.

Cirugía cardiovascular del adulto − Artículo originalEvaluación de los resultados de la cirugía reconstructiva del esqueleto mitroaórtico en la endocarditis infecciosa activaEvaluation of the results of surgical reconstruction of the mitroaortic skeleton in active infective endocarditis

Introduction Surgical intervention of active infective endocarditis with multiple abscesses and destruction of the intervalvular fibrous body represents a technically demanding procedure with a difficult postoperative management. The experience is presented with an original technique for radical resection and subsequent reconstruction using bovine pericardium.

Giant inferior vena cava aneurysm

A 31-year-old female was diagnosed with acute myocarditis at age 15 and subsequently developed a restrictive cardiomyopathy. She presented with symptoms of right heart failure including lower extremity edema, hepatosplenomegaly, and ascites. Echocardiography showed normal right and left ventricular function without tricuspid regurgitation, but there was severe dilatation of both atria and the inferior vena cava and suprahepatic veins. Cardiac catheterization showed equalization of right and left ventricular end-diastolic pressures anda right ventricular systolic pressure of 40mmHg.A thoracicCT scan revealed severe concentric pericardial calcification and a giant inferior vena cava aneurysm measuring 6.0 × 5.7 cm (Figs. 1 and 2).

Gender differences in negative mood states in secondary school students: health survey in Catalonia (Spain)

Objetivos Determinar la prevalencia del estado de animo negativo entre alumnos adolescentes segun sexo, analizar la variabilidad entre escuelas y evaluar los factores asociados. Metodos Estudio transversal basado en un muestreo por conglomerados bietapico. Administramos una encuesta de salud a 9340 estudiantes de tercero y cuarto curso de Educacion Secundaria Obligatoria de 14 a 16 anos de edad, en Cataluna, durante el curso escolar 2005-06. La variable principal fue el estado de animo negativo. Se uso un modelo de regresion logistica multinivel estratificado por sexo para identificar los factores asociados al estado de animo negativo y determinar la variabilidad entre las diferentes escuelas. Resultados Aproximadamente el 19% de los adolescentes refirieron un estado de animo negativo, siendo mas prevalente entre las chicas (25%). En ellas, los factores asociados significativamente con estados de animo negativo fueron «tomar tranquilizantes» y tener trastornos alimentarios, mientras que en los chicos fueron no realizar deporte y tener una mala percepcion de su estado de salud. Hay variabilidad en la prevalencia del estado de animo negativo segun las escuelas en ambos sexos (chicas: varianza = 0,078, p <0,001; chicos: varianza = 0,079, p = 0,012). Conclusiones La prevalencia del estado de animo negativo entre los adolescentes fue alta. Se observaron diferencias entre sexos respecto a los factores relacionados con este estado de salud. Destaco la asociacion del uso de tranquilizantes con el estado de animo negativo. Se observo una variabilidad de la prevalencia del estado de animo negativo entre las diferentes escuelas no explicada por las variables de estudio.