RESUMEN
The long-term follow-up of patients with bioprosthetic valves manufactured at the Instituto Nacional de Cardiología Ignacio Chávez is presented. From February 1983 to May 1990, 1068 patients were operated and 1252 valves were replaced. Eighty two percent had rheumatic heart disease with one or more injured valves. In 17% it was a replacement of a failing valve. Seventy three percent of the patients had a low or medium-low socioeconomical status. There were 176 perioperative deaths in the first month after the operation and 150 patients were lost to follow-up. The rest (740) are the subject of this report. Mortality associated with valve related complications had a probability of 0.74 +/- 0.05, it had a significative increase after month 70th, with a 88% survival at that time. The functional class in the whole group improved 90%, with confidence limits for binomial distribution between 85 and 97%. There was also a significant reduction in heart enlargement. There were 161 prosthesis dysfunctions due to valve calcification or rupture, 50 were replaced. Twenty-three patients had hemolysis, and 19 infective endocarditis. There were 6.5% with systemic embolism in spite that only one half of those in which there was an indication, different of the valve replacement, received anticoagulant medication. The use of this prosthesis is on economical and medical satisfactory solution for the problem of a great number of our population of patients.
Asunto(s)
Bioprótesis , Prótesis Valvulares Cardíacas , Academias e Institutos , Adolescente , Adulto , Anciano , Válvula Aórtica , Bioprótesis/efectos adversos , Bioprótesis/estadística & datos numéricos , Cardiología , Niño , Preescolar , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/mortalidad , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/mortalidad , Prótesis Valvulares Cardíacas/estadística & datos numéricos , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Válvula Mitral , Diseño de Prótesis , Falla de Prótesis , Válvula TricúspideRESUMEN
Among contemporary problems of cardiovascular therapy, pain management in the cardiac patient is an important issue. Correct selection of a suitable analgesic drug is important in the acute phase of myocardial infarction because pain relief prevents adrenergic response which aggravates unbalance between myocardial oxygen supply and demands. Until today morphine has been the best choice, nevertheless its side effects and limited availability demands pharmacological alternatives. Meperidine has been used for this purpose although its anticholinergic and narcotic profiles do not fulfill the therapeutic requirements. Conorphone is a codeine derivative which retains analgesic potency without other narcotic side effects and which presents an antagonistic profile for the remainder of opiate effects. Preliminary studies demonstrate that conorphone lacks cardiovascular side effects. Conorphone also shows antiarrhythmic effects in experimental models such as in rat in which arrhythmias were induced by coronary ligation. In this paper a morphologic analysis with electron microscopy was done on adjacent myocardial tissue next to an area of infarct. Experimental myocardial infarction was induced by ligation of descendant branch of left coronary artery, four hours prior to rat sacrifice and suitable samples for ultrastructure study were obtained. The experiments demonstrate that a group of rats that received 3.1 mg/kg of conorphone had less expressions of cellular damage when compared with similar myocardial areas of a control group of rats.