Juan Jesús Cantillo Duarte

Bloodless Cardiac Surgery in Jehovah's Witnesses: Outcomes Compared With a Control Group

INTRODUCTION AND OBJECTIVES Some patients, such as Jehovahs Witnesses, refuse to use blood products, which can make it difficult to achieve the same outcomes as in the general population. The objective of this study was to determine whether clinical characteristics and surgical outcomes in Jehovahs Witnesses undergoing cardiac surgery are similar to those in other patients. METHODS Paired-group retrospective cohort study. All Jehovahs Witnesses undergoing cardiac surgery between January 1998 and September 2006 were included (n=59). Cases were matched on a 1:1 basis according to sex, age (5) years, year and type of surgery, and need for repeat surgery. Preoperative, intraoperative and postoperative data were analyzed. RESULTS The mean age of cases was 62.5 (11.1) years with 57.6% being female. Some 30.5% had had at least one previous cardiac intervention. The clinical characteristics of the two groups were similar. Hemoglobin and hematocrit levels were higher in Jehovahs Witnesses both before (13.6 g/dL vs 12.9 g/dL; P=.01, and 40.7% vs 39%; P=.09) and after (11 g/dL vs 10 g/dL; P=.003, and 34.2% vs 30.7%; P=.001) surgery. Jehovahs Witnesses experienced significantly less bleeding, were intubated for fewer hours, and had shorter stays in both intensive care and the hospital. There was no difference in the rate of postoperative complications or mortality. CONCLUSIONS The clinical characteristics of Jehovahs Witnesses were similar to those of the control group. The complication rate was also similar in these patients, though the number of hours of mechanical ventilation was less, 24-hour bleeding was less, and the hospital stay was shorter. Mortality was similar in the two groups.

Chronic prosthetic valve endocarditis due to Propionibacterium acnes: an unexpected cause of prosthetic valve dysfunction.

INTRODUCTION AND OBJECTIVES To determine the characteristics of Propionibacterium acnes prosthetic valve endocarditis (PAPVE). METHODS Prospective descriptive study of 16 consecutive cases of PAPVE. RESULTS Seven patients developed PAPVE early and 9 developed it late. In all those who developed PAPVE late, there was a history of mucocutaneous barrier manipulation. The delay in diagnosis was >3 months in 75%. The clinical presentation was asymptomatic prosthetic valve dysfunction in 31%, heart failure in 19%, coronary syndrome in 12.5%, fever in 25%, and neurological deficits in 19%. At diagnosis, 62.5% had heart failure and 44% had fever. The predominant echocardiographic finding was prosthesis dysfunction due to dehiscence of metallic aortic valves (6 out of 7) or stenosis of metallic mitral valves (4 out of 7). In 2 of the 3 biological aortic prostheses, dysfunction was due to leaflet distortion. Blood cultures and surgical specimens tested positive after a mean of 11.6 and 12.2 days, respectively. In 2 cases, the diagnosis was confirmed by PCR. The principle intraoperative finding was the presence of abundant grayish pannus. Histology demonstrated the absence of acute inflammatory features. Twelve patients received antibiotic treatment with valve replacement: 7 were cured, 4 experienced early prosthesis dehiscence and 1 relapsed. All 3 patients who were initially treated with antibiotics alone suffered relapses. CONCLUSIONS Generally, PAPVE presents as prosthetic valve dysfunction with few symptoms of infection. Prolonged incubation of cultures is essential for diagnosis. Antibiotic treatment provides clinical control but does not eradicate the infection, and valve replacement is necessary for a cure. The postoperative course can be complicated by prosthesis dehiscence.

Endocarditis crónica sobre válvula protésica por Propionibacterium acnes: una causa insospechada de disfunción protésica

Introduccion y objetivos Describir las caracteristicas de la endocarditis infecciosa sobre valvula protesica por Propionibacterium acnes (EIVPPA). Metodos Descripcion prospectiva y consecutiva de 16 casos de EIVPPA. Resultados Siete pacientes presentaron EIVPPA precoz y 9 tardias. Las tardias siempre tenian el antecedente de algun tipo de manipulacion de la barrera mucocutanea. El retraso diagnostico fue > 3 meses en el 75%. La presentacion clinica fue fundamentalmente disfuncion protesica asintomatica (31%), insuficiencia cardiaca (19%), sindrome coronario (12,5%), fiebre (25%) y deficits neurologicos (19%). Al ingreso diagnostico el 62,5% presentaba insuficiencia cardiaca y el 44% fiebre. Ecocardiograficamente, predomino la disfuncion protesica por dehiscencia en las metalicas aorticas (6 de 7), o por estenosis en las metalicas mitrales (4 de 7). Las biologicas presentaron disfuncion por distorsion de velos (2 de 3). Los cultivos de sangre y muestras quirurgicas fueron positivos tras 11,6 y 12,2 dias de media respectivamente. En 2 casos la PCR confirmo el diagnostico. El hallazgo intraoperatorio principal fue la presencia de abundante pannus grisaceo. La histologia mostro ausencia de datos de actividad aguda. Doce pacientes recibieron antibioterapia mas recambio valvular, 7 curaron, 4 presentaron dehiscencia precoz y 1, recaida; 3 pacientes fueron inicialmente tratados solo con antibioticos, y los 3 recayeron. Conclusiones La EIVPPA se presenta generalmente con disfuncion valvular y escasos sintomas infecciosos. Es imprescindible la larga incubacion de los cultivos para su diagnostico. La antibioterapia controla la clinica, pero no elimina la infeccion, y es necesaria la sustitucion valvular para la curacion. La evolucion posquirurgica puede verse complicada por la presencia de dehiscencia protesica.

Mid term results after bone marrow laser revascularization for treating refractory angina

BackgroundTo evaluate the midterm results of patients with angina and diffuse coronary artery disease treated with transmyocardial revascularization in combination with autologous stem cell therapy.MethodsNineteen patients with diffuse coronary artery disease and medically refractory class III/IV angina were evaluated between June 2007 and December 2009 for sole therapy TMR combined with intramyocardial injection of concentrated stem cells. At the time of surgery, autologous bone marrow (120cc) was aspirated from the iliac crest. A cardiac MRI and an isotopic test were performed before and after the procedure. Follow-up was performed by personal interview.ResultsThere were no perioperative adverse events including no arrhythmias. Mean number of laser channels was 20 and the mean total number of intramyocardially injected cells per milliliter were: total mononuclear cells(83.6 × 106), CD34+ cells(0.6 × 106), and CD133+ cells(0.34 × 106). At 12 months mean follow-up average angina class was significantly improved (3.4 ± 0.5 vs 1.4 ± 0.6; p = 0.004). In addition, monthly cardiovascular medication usage was significantly decreased (348 ± 118 vs. 201 ± 92; p = 0.001). At six months follow up there was a reduction in the number of cardiac hospital readmissions (2.9 ± 2.3 vs. 0.5 ± 0.8; p < 0.001). MRI showed no alterations regarding LV volumes and a 3% improvement regarding ejection fraction.ConclusionsThe stem cell isolator efficiently concentrated autologous bone marrow derived stem cells while the TMR/stem cell combination delivery device worked uneventfully. An improvement in clinical status was noticed in the midterm follow-up. Images test showed no morphological alterations in the left ventricle after the procedure.

Adjustable Segmental Tricuspid Annuloplasty: Technical Advantages and Midterm Results

BACKGROUND Adjustable segmental tricuspid annuloplasty is a new recently published procedure. The purpose of this prospective study was to present the technical advantages of this new tricuspid annuloplasty and analyze its early and midterm results. METHODS Between January 2004 and December 2006, 17 patients who had moderate or severe pure functional tricuspid regurgitation (TR) underwent adjustable segmental tricuspid annuloplasty. The mean age of the patients was 64.3 +/- 10.4 years and the majority were female (94%). All patients had recent preoperative transthoracic echocardiography (TTE). Three postoperative TTE were performed: (I) before the hospital discharge; (II) between 3 and 6 months after surgery; and (III) at a mean 30.4 +/- 13.8 months of follow-up. We studied the tricuspid valve, right ventricle, and left ventricle. RESULTS No hospital mortality was reported. Progressive overall clinical improvement was observed. Serial postoperative TTE revealed the following: (1) 13 patients with mild or less than mild TR, 1 patient with residual moderate TR, 1 patient with early moderate TR related to poor left ventricular function, and 1 patient with late severe TR due to a transvenous pacemaker lead; (2) the indexed tricuspid annulus diameter normalized in all patients; (3) pulmonary hypertension gradually regressed; and (4) right ventricular end-diastolic diameter and inferior vena cava diameter gradually decreased throughout the study. CONCLUSIONS Adjustable segmental tricuspid annuloplasty is an improved and efficient procedure for functional TR because it is more selective, more adjustable and more resistant. It may be adversely influenced by poor left ventricular function and by the presence of a pacemaker lead.

Fracture of the Carpentier-Edwards Ring in Tricuspid Position: A Report of Three Cases

Three cases of fracture of a Carpentier-Edwards ring in tricuspid position are presented. In all three cases the shape of the ring was shown to be abnormal by roentgenogram examination; there was an abrupt bend in the middle portion of each ring. At the time of operation, fracture of the ring skeleton at this midpoint was found in all three instances. Roentgenogram examination seems to be a reliable method of diagnosing this uncommon entity, and tricuspid valve replacement is required for its correction.

Bone marrow laser revascularisation for treating refractory angina due to diffuse coronary heart disease

To increase the angiogenic response and clinical efficacy of TMR, the potential synergy and safety of combining TMR with concentrated autologous bone marrow derived stem cells was evaluated. Fourteen patients with diffuse coronary artery disease and medically refractory class III/IV angina who were not candidates for conventional therapies were treated using TMR in combination with intramyocardial injection of concentrated stem cells. At the time of surgery, autologous bone marrow (120 cc) was aspirated from the iliac crest and processed over 15 min into 20 cc of concentrated mononuclear cells using a centrifugal system (HARVEST, Boston, MA). A single device performed holmium: YAG:TMR (CardioGenesis, Irvine, CA) with injection of 1 cc of concentrated stem cells through three multi-holed needles into the border zone around each laser channel. There were no perioperative adverse events including no arrhythmias. Mean number of injected cells per milliliter were: total mononuclear cells (81.3 x 10(6)), CD34(+) cells (0.6 x 10(6)), and CD133(+) cells (0.37 x 10(6)). At 7 months mean follow-up average angina class was significantly improved (3.5+/-0.5 vs 1.4+/-0.5; p=0.004). There was no death during the follow-up. Efficient delivery of stem cells combined with TMR in a single device seems to be safe and effective for treating unmanageable angina.

Restoration of atrial contractility after surgical cryoablation: clinical, electrical and mechanical results

To assess the electrical sinus rhythm (SR) recovery and the mechanical effectiveness of the atrial contraction by echocardiography is essential in patients undergoing atrial fibrillation (AF) surgery. Between September 2006 and May 2008, patients with chronic AF (n=33; permanent=23 or paroxysmal=10) underwent mitral surgery and surgical cryoablation for AF. Exclusion criteria were: AF that has persisted for 10 years and left atrium (LA) >65 mm. Echocardiography study was performed at six months after surgery. Mean age was 62 years (22 female, 11 male). Mean AF duration was three years (range 0.5-7.4). Mean atria size was 52.4+/-5.6 mm. Mitral valve surgery involved 32 prosthetic replacements and one mitral valve repair. There was no surgical mortality. Success rate for SR at three and six months was 90% and 82%, respectively. The only predictor of conversion to SR at six months was being at SR when discharge from the hospital. In patients in SR, echocardiographic study provided mechanical effectiveness of the atria in 100% of right atrium and 70% of the LA. Cryoablation for AF is an effective technique to recover electrocardiographic SR while being able to recover atrial contraction effectiveness.

Leiomiomatosis intravenosa con extensión a cavidades cardíacas

La leiomiomatosis intravenosa es una patologiatumoral uterina muy poco frecuente, caracterizadapor ser histologicamente benigna aunque puede enocasiones extenderse a traves de las venas gonadalese iliacas hasta la vena cava inferior y llegar hastalas cavidades cardiacas. Describimos un caso deuna paciente con clinica de insuficiencia cardiacaderecha y que fue diagnosticada por ecocardiografiatransesofagica de un leiomioma intravenoso conextension hasta ventriculo derecho. Se realizo excisioncompleta del tumor en un mismo acto operatorioque conllevo esternotomia y laparotomia bajocontrol ecocardiografico.

Charged lepton mixing processes in 331 Models

Processes τ→lγ, τ→lll with l = e, μ and μ(τ) →e (μ) γ are evaluated in the framework of a model based on the extended symmetry gauge SU(3)c ⊗SU(3)L ⊗U(1)Y with a leptonic sector consisting of five triplets. Lepton flavor violating processes are allowed at tree level in this model through the new Z′ gauge boson. We obtained bounds for the mixing angles in the leptonic sector of the model, considering the experimental measurements of the processes from the BELLE and the BABAR collaborations.