RESUMEN
Abstract: Background: Intramyocardial dissecting haematoma is a rare form of cardiac rupture that can occur as a complication following acute myocardial infarction or during the remodelling process, with very scarce reports in medical literature. Usually caused by a haemorrhagic dissection among the spiral myocardial fibres. Case report: Here we report the case of a 60-year-old man with a previous infarction in the inferior wall extended to the right ventricle, in whom a dissecting intramyocardial haematoma in the free wall of the right ventricle was identified using transthoracic and contrast echocardiography, corroborated with cardiac magnetic resonance. Results: By this imaging modalities, it was possible to see the various acoustic densities of the progressive clotting of the hematoma, its extension through the haemorrhagic dissection, as well as its independency in relation to ventricular cavities and extracardiac space by confirming intact epicardial and endocardial layers. Conclusion: The patient presented a gradual improvement and hemodynamic stability, and basing on the existent medical literature, it was decided the medical treatment as the therapeutic option, maintaining asymptomatic after three months of follow-up.
Resumen: Antecedentes: El hematoma intramiocárdico disecante es una forma rara de ruptura cardiaca que puede ocurrir como una complicación posterior al infarto agudo de miocardio o durante el proceso de remodelación del mismo, con informes muy escasos en la literatura médica. Generalmente causada por una disección hemorrágica entre las fibras espirales del miocardio. Caso clínico: Se presenta el caso de un hombre de 60 años con infarto previo en la pared inferior extendido al ventrículo derecho, en el que se identificó un hematoma intramiocárdico disecante en la pared libre del ventrículo derecho mediante ecocardiografía transtorácica y contrastada, corroborado con resonancia magnética cardiaca. Resultados: Por medio de estas modalidades de imagen se pudieron observar las distintas densidades acústicas de la coagulación progresiva del hematoma, su extensión a través de la disección hemorrágica, así como su independencia en relación con las cavidades ventriculares y el espacio extracardiaco, confirmando las capas epicárdicas y endocárdicas indemnes. Conclusión: El paciente presentó una mejoría gradual y estabilidad hemodinámica, y basándose en la literatura médica existente, se decidió el tratamiento médico como opción terapéutica, manteniéndose asintomático después de tres meses de seguimiento.
RESUMEN
OBJECTIVES: Throughout the world, 45 000 kidney transplants are performed per year. Graft and overall survival vary according to the type of donor (living or deceased donor). Anastomosis of a short renal vein with iliac vein or common external iliac vein has been associated with technical problems such as angulation of the vein or tension on the anastomosis, which could limit visualization and control of bleeding from the graft. The main objective of our study was to analyze patients undergoing deceased-donor kidney transplant and compare results in patients who had extension of the right renal vein with a patch of vena cava from the same donor versus patients who received the left kidney. MATERIALS AND METHODS: A prospective cohort study was performed from December 31, 2007 to December 31, 2009. We compared 2 patients groups. We used statistical software (R, Version 2.5.1). The analyzing team was blinded to the surgical technique, and informed consent was obtained from all patients. RESULTS: There was no statistically significant difference in surgical time (P > .85) or ultrasonographic parameters between groups, but it was possible to perform an easier vein anastomosis with the vena cava graft in right kidney transplant. CONCLUSIONS: We recommend considering our procedure with the vena cava graft in right kidney as an alternative option to decrease warm ischemia time, perform an easier vein anastomosis with the vena cava extension, and make the procedure comfortable for the surgeon.