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Objetivo. Valorar con resonancia magnética cardíaca (RMC) el resultado de la endoventriculoplastia y compararlo con los hallazgos prequirúrgicos en pacientes con miocardiopatía dilatada isquémica y aneurisma ventricular. Material y métodos. Revisamos retrospectivamente 21 pacientes consecutivos con miocardiopatía dilatada isquémica sometidos a endoventriculoplastia entre enero de 2007 y marzo de 2013. En 12 de ellos se realizó RMC pre- y posquirúrgica. En las RMC diagnóstica y posquirúrgica se hizo un análisis cuantitativo de la fracción de eyección (FEVI), volúmenes telediastólico (VTDVI) y telesistólico (VTSVI) del ventrículo izquierdo indexados, y se valoraron las valvulopatías y trombos intracavitarios. El tiempo transcurrido entre la intervención quirúrgica y los estudios de control con RMC osciló entre 3 y 24 meses. Resultados. La FEVI y los VTDVI y VTSVI pre- y posquirúrgicos fueron significativamente diferentes. La mediana de la FEVI aumentó el 10% (rango intercuartílico: 2-15) (p = 0,003); la mediana del VTDVI disminuyó 38 ml/m2 (rango intercuartílico: 18-52) (p = 0,006), y la mediana del VTSVI disminuyó 45 ml/m2 (rango intercuartílico: 12-60) (p = 0,008). La reducción del volumen posquirúrgico fue mayor en pacientes con VTSVI basal > 110 ml/m2 (59 ml/m2 y 12 ml/m2, p = 0,006). Conclusión. En pacientes con cardiopatía isquémica candidatos a endoventriculoplastia, la RMC es una técnica incruenta, reproducible y fiable para estudiar la cicatriz miocárdica antes de la intervención y los volúmenes ventriculares y su evolución tras la endoventriculoplastia (AU)

Purpose. To assess pre and post-operative cardiac MRI (CMR) findings in patients with left endoventriculoplasty repair for ventricular aneurysm due to ischemic heart disease. Material and methods. Data were retrospectively gathered on 21 patients with diagnosis of ventricular aneurysm secondary to ischemic heart disease undergoing left endoventriculoplasty repair between January 2007 and March 2013. Pre and post-operative CMR was performed in 12 patients. The following data were evaluated in pre-operative and post-operative CMR studies: quantitative analysis of left ventricular ejection fraction (LVEF), left ventricular end-diastolic (LVEDV) and end-systolic (LVESV) volume index, presence of valvular disease and intracardiac thrombi. The time between surgery and post-operative CRM studies was 3-24 months. Results. Significant differences were found in the pre and post-operative LVEF, LVEDV and LVESV data. EF showed a median increase of 10% (IQR 2-15) (p = 0.003). The LVEDV showed a median decrease of 38 ml/m2 (IQR 18-52) (p = 0.006) and the LVESV showed a median decrease of 45 ml/m2 (IQR:12-60) (p = 0.008). Post-operative ventricular volume reduction was significantly higher in those patients with preoperative LVESV >110 ml/m2 (59 ml/m2 and 12 ml/m2, p = 0.006). Conclusion. In patients with ischemic heart disease that are candidates for left endoventriculoplasty, CMR is a reliable non-invasive and reproducible technique for the evaluation of the scar before the surgery and the ventricular volumes and its evolution after endoventricular surgical repair (AU)

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PURPOSE: To assess pre and post-operative cardiac MRI (CMR) findings in patients with left endoventriculoplasty repair for ventricular aneurysm due to ischemic heart disease. MATERIAL AND METHODS: Data were retrospectively gathered on 21 patients with diagnosis of ventricular aneurysm secondary to ischemic heart disease undergoing left endoventriculoplasty repair between January 2007 and March 2013. Pre and post-operative CMR was performed in 12 patients. The following data were evaluated in pre-operative and post-operative CMR studies: quantitative analysis of left ventricular ejection fraction (LVEF), left ventricular end-diastolic (LVEDV) and end-systolic (LVESV) volume index, presence of valvular disease and intracardiac thrombi. The time between surgery and post-operative CRM studies was 3-24 months. RESULTS: Significant differences were found in the pre and post-operative LVEF, LVEDV and LVESV data. EF showed a median increase of 10% (IQR 2-15) (p=0.003). The LVEDV showed a median decrease of 38 ml/m(2) (IQR 18-52) (p=0.006) and the LVESV showed a median decrease of 45 ml/m(2) (IQR:12-60) (p=0.008). Post-operative ventricular volume reduction was significantly higher in those patients with preoperative LVESV >110 ml/m(2) (59 ml/m(2) and 12 ml/m(2), p=0.006). CONCLUSION: In patients with ischemic heart disease that are candidates for left endoventriculoplasty, CMR is a reliable non-invasive and reproducible technique for the evaluation of the scar before the surgery and the ventricular volumes and its evolution after endoventricular surgical repair.

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The median sternotomy is still the gold standard of cardiac surgery approaches. The main disadvantages of this cardiac access are osteomyelitis and mediastinitis which are infrequent but very serious; the aesthetic impact of a large and visible scar from the median lane and lastly respiratory failure consecutive to pain and sternal dehiscence. Other pathways have been developed in trying to reduce these complications and lessen the length of stay, pain and costs. From the many variants described up until now, the "J" ministernotomy seems to be the most accepted of these techniques. Although there are many published series describing these different cardiac approaches, the lack of prospective, randomized studies comparing conventional and minimally invasive surgery precludes the demonstration of the benefits of the new technique. In spite of this, we think the "J" ministernotomy undoubtedly has aesthetic advantages, smaller complications in patients with respiratory failure, easier repair in case of mediastinitis or osteomyelitis and fewer adhesions in surgical redos.

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OBJECTIVE: To evaluate our initial experience in the combination of two less invasive procedures for myocardial revascularization, coronary artery bypass grafting without cardiopulmonary bypass and immediate posterior angioplasty, on untreated lesions (hybrid revascularization) as an alternative treatment to conventional surgery in selected patients. MATERIAL AND METHODS: From october 1996 to September 1998, 19 patients received hybrid revascularization. The mean age was 64 (47-76). Two patients underwent urgent surgery. Two patients had left main coronary disease, and 9 three-vessel disease. In general, we considered this procedure for patients with high-risk factors for cardiopulmonary bypass and two or more vessel disease. The internal mammary artery was connected to the left anterior descending artery in all 19 patients. All patients were moved to the hemodynamic ward immediately after surgery in 7 cases and before 48 h in the rest, 24 angioplasties were performed. A mean of 2.6 vessels per patient were revascularized and revascularization was complete in 15 patients (79%). RESULTS: One patient had perioperative myocardial infarction. There was no hospital mortality. Length of stay in the intensive care unit was 44 h (IQR = 49) and global postoperative stay was 8 days (IQR = 3.5). In the postoperative angiographic study, before the angioplasty, 95% of mammary arteries (CI 95% 74-100%) and 100% of saphenous grafts (CI 95% 59-100%) were patent. CONCLUSIONS: Combined revascularization allows almost complete revascularization, avoiding complications of cardiopulmonary bypass and minimizing surgical aggression. At the same time, it secures the graft of internal mammary artery to left anterior descending artery.

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UNLABELLED: The increase in the mean populational age has increased the number of elderly people eligible for cardiac surgery. The aortic pathology represents the most common valvular pathology, mainly of degenerative etiology. The efficiency of the aortic valve replacement in people aged over 75 years was studied, with evaluation of hospital mortality, survival and functional class (NYHA). MATERIALS AND METHODS: A total of 51 patients (25 males and 26 females, mean age 76.4 years [range: 75-83]) underwent aortic valve replacement from October 1989 to February 1997. The most common condition was aortic stenosis (62.7%), followed by aortic insufficiency (19%) and double aortic lesion (17%). Moreover, 31.3% of patients required also coronary surgery with a mean of 1.1 grafts per patient. In 13.7% of cases surgery on mitral valve was performed (1 commissurotomy, 1 mitral prosthesis, 5 valve prostheses). In 10% of patients the procedure had to be performed on an emergency basis. The functional class of patients prior to surgery was NYHA grade III for 37% and grade IV for 10% of cases. The clinical symptoms corresponded to angor in 15 cases (29.4%) and syncope in four cases (7.8%). In nine patients the left ventricular ejection fraction prior to surgery was below 50%. Aortic bioprostheses were implanted in 86.2% of cases. RESULTS: The hospital fatality rate was 13.7% (7 cases). In the univariate analysis the following mortality risk factors reached statistical significance: left ventricular ejection fraction prior to surgery below 50%, associated surgery and size of aortic prosthesis. In the multivariate analysis the following risk factors were significant: left ventricular ejection fraction prior to surgery below 50% and associated mitral surgery. The follow-up was performed in 100% of patients, with a mean time of 29.6 months. One patient died during follow-up. The functional class was NYHA grade I in 95.2% of cases. The actuarial survival, including hospital mortality, was 84.2% at 5 years. CONCLUSIONS: Despite a higher mortality in the aortic valve replacement surgery in patients aged over 75 years compared with general population, results, long-term survival and life quality of patients, renders surgery a non refusable first option as therapy for aortic valve pathology in this age group. Nevertheless, avoiding the deterioration of preoperative left ventricular function is imperative, mainly in those cases with concomitant mitral pathology, as both factors significantly contribute to an increase in mortality in this group.

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Parameters of flow, temperature and perfusion, and modifications in body fluids secondary to surgery with extracorporeal circulation do not imply an increase in maternal risk during pregnancy but they eventually considerably increase fetal morbimortality. We present the case of a 22 week pregnant woman with severe aortic stenosis who underwent extracorporeal surgery for valve replacement without fetal mortality during the procedure. Literature about the use of extracorporeal surgery in the treatment of valve pathology in pregnancy, the parameters in which the reduction of fetal morbimortality is based and alternative treatments are broadly reviewed.

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