1
|
Arnáiz García ME, González-Santos JM, Pérez-Losada ME, López-Rodríguez J, Arnáiz J. Unexpected entrapment during surgery of anomalous circumflex coronary artery arising from right coronary artery. Turk Kardiyol Dern Ars 2019; 47:239-242. [PMID: 30982823 DOI: 10.5543/tkda.2018.89757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A patient with advanced rheumatic heart valve disease underwent aortic and mitral valve replacement with tricuspid ring annuloplasty. There was an anomalous left circumflex coronary artery (LCCA) arising from the right coronary artery (RCA) running along the anterior surface of an enlarged right ventricle (RV). During the immediate postoperative course, signs of inferior and lateral myocardial ischemia developed. An emergent coronary angiography revealed LCCA entrapment. An additional suture placed in the RV outflow tract used to optimize exposition of the aortic root during the aortotomy was determined to be the origin of the coronary entrapment. No similar case of LCCA occlusion has previously been reported. This is a description of successful management of this complication.
Collapse
Affiliation(s)
| | | | | | | | - Javier Arnáiz
- Department of Radiology, Aspetar-Orthopaedic and Sports Medicine Hospital, Al Buwairda St, Doha, Qatar
| |
Collapse
|
2
|
Arnáiz-García ME, González-Santos JM, López-Rodríguez J, Arnáiz-García AM, Arnáiz J. The hemostatic power of fat: An effective, inexpensive, and biocompatible method to achieve hemostasis in cardiac surgery. Turk Kardiyol Dern Ars 2018; 46:151-154. [PMID: 29512618 DOI: 10.5543/tkda.2017.89803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Postoperative bleeding with its important socioeconomic cost is associated with an increased morbidity and mortality. It causes hemodynamic instability, increases blood loss, and multiplies the number of transfusions required. Especially in vascular or aortic surgery, postoperative bleeding can become a life-threatening complication due to anticoagulant or antiaggregation preoperative status or postoperative coagulation dysfunction after a high level of heparinization. Presently described is the case of a patient who underwent an aortic valve and ascending aorta replacement. A simple but effective method to achieve hemostasis, designed particularly for aortic surgery and the use of Dacron grafts, is presented. No residual adherence or contraindications exist, and it can potentially be applied to any kind of surgical process. This method offers a cheap, biocompatible, and highly effective means to achieve complete hemostasis without the use of extra sutures, or expensive synthetic or allogeneic hemostatic agents or sealants.
Collapse
|
3
|
Arnáiz-García ME, Arnáiz-García AM, Gutierrez-Diez F, Nistal JF, González-Santos JM, Pulitani I, Amado-Diago C, Arnáiz J. Mutilating Purpura Fulminans in an Adult with Meningococcal Sepsis. P R Health Sci J 2017; 36:179-182. [PMID: 28915308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report a dramatic case of meningococcal sepsis manifesting as purpura fulminans in an elderly diabetic woman. Hemodynamic instability and severe bilateral cutaneous lesions involving her hands and feet developed rapidly. Specific antibiotic therapy and the administration of inotropic and vasopressor drugs were initiated. The severity and extension of the cutaneous lesions (attributed to purpura fulminans) worsened because of the need for vasoconstrictors for the treatment of septic shock. Bilateral transmetatarsal and metacarpal amputations were required to stabilize the patient.
Collapse
Affiliation(s)
| | - Ana María Arnáiz-García
- Department of Infectious Diseases, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Francisco Gutierrez-Diez
- Department of Cardiovascular Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Juan Francisco Nistal
- Department of Cardiovascular Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | - Ivana Pulitani
- Department of Cardiovascular Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Carlos Amado-Diago
- Department of Pneumology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Javier Arnáiz
- Department of Radiology, Aspetar-Orthopaedic and Sports Medicine Hospital, Al Buwairda St. Doha, Qatar
| |
Collapse
|
4
|
Arnáiz-García ME, Arnáiz-García AM, González-Santos JM, López-Rodríguez J, Arnáiz J. Case Image: Extreme left diaphragm displacement in the context of tension pneumothorax after cardiac surgery. Turk Kardiyol Dern Ars 2017; 45:386. [PMID: 28595214 DOI: 10.5543/tkda.2016.99328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
5
|
González-Santos JM, Arnáiz-García ME, Dalmau-Sorlí MJ, Rodríguez-Collado J, López Rodríguez J. Primary coarctation-related isthmus aneurysm in an adult. Turk Kardiyol Dern Ars 2017; 44:697-699. [PMID: 28045418 DOI: 10.5543/tkda.2016.26796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 56-year-old female patient was transferred due to the presence of a left supraclavicular pulsatile mass. Further work-up was performed to confirm diagnosis. Angiography and computed tomography were also performed. The anatomy of the thoracic aorta suggested an unknown and untreated aortic coarctation. A second aortic narrowing was identified at the aortic arch, a result of elongation of the aorta. Endovascular approach was not possible, due to complexity of the aortic anatomy, and tortuosity. Open surgical repair was successfully performed. A primary coarctation-related isthmus aneurysm is an exceptional finding in adults, and is a life-threatening condition when diagnosis is delayed. Management and treatment are controversial and challenging.
Collapse
|
6
|
Arnáiz-García ME, González-Santos JM, Buriticá-Aguirre A, López-Rodríguez J. Coronary artery involvement in Kawasaki disease. Eur J Cardiothorac Surg 2015; 49:1533. [PMID: 26354960 DOI: 10.1093/ejcts/ezv306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 08/03/2015] [Indexed: 11/12/2022] Open
|
7
|
González-Santos JM, Arnáiz-García ME, Sastre-Rincón JA, Bueno-Codoñer ME, Dalmau-Sorlí MJ, Arévalo-Abascal A, López-Rodríguez J, Diego-Nieto A. Acute Right Coronary Artery Occlusion After Tricuspid Valve Ring Annuloplasty. Ann Thorac Surg 2015; 99:2213-6. [PMID: 26046883 DOI: 10.1016/j.athoracsur.2014.08.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 08/15/2014] [Accepted: 08/29/2014] [Indexed: 11/18/2022]
Abstract
A patient was submitted to mitral valve replacement and tricuspid ring annuloplasty. During immediate postoperative course, signs of inferior myocardial ischemia appeared. Acute entrapment of the right coronary artery due to tricuspid ring sutures was confirmed by coronary angiography. The patient was reoperated and a right coronary bypass graft was successfully performed. Tricuspid procedures have shown to be effective and secure with a low rate of complication. Few cases of right coronary artery occlusion have been described and the majority not treated. Exceptional cases of right coronary occlusion related to tricuspid ring annuloplasty have been reported with a favorable outcome, as the case described herein.
Collapse
|
8
|
Castaño M, González-Santos JM, López J, García B, Centeno JE, Aparicio B, Bueno MJ, Díez R, Sagredo V, Rodríguez JM, García-Criado FJ. Effect of preoperative oral pravastatin reload in systemic inflammatory response and myocardial damage after coronary artery bypass grafting. A pilot double-blind placebo-controlled study. J Cardiovasc Surg (Torino) 2015; 56:617-629. [PMID: 25968407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Statins exert pleiotropic effects that result in cardioprotective and antiinflammatory properties. There is a lack of information about the effect of preoperative reloading statin administration in surgical coronary patients regarding myocardial protection, systemic inflammatory response (SIR) attenuation and nitric oxide (NO) metabolism. METHODS Thirty consecutive dyslipidemic patients under chronic treatment with statins were randomized to orally receive pravastatin 80 mg (N.=10), 40 mg (N.=10) or placebo (N.=10) two hours before anesthetic induction for non-emergent on-pump coronary artery bypass grafting (CABG) procedures. Perioperative peripheral venous and intraoperative CS blood samples were collected for determination of drug-related adverse effects, NO metabolism and both myocardial damage and SIR biomarkers. RESULTS Pravastatin reloading resulted in a significant and dose-related intense attenuation of SIR, but no differences in cardiac damage biomarker levels were demonstrated. NO release and inducible nitric oxide synthase expression was significantly reduced in both treatment groups. Highest pravastatin doses significantly increased systemic creatine phosphokinase (CPK) concentration compared with intermediate doses but no other adverse effects were observed. CONCLUSION Oral pravastatin reloading before non-emergent CABG significantly attenuates postoperative SIR and systemic NO/iNOS concentrations with no effect in perioperative myocardial damage. Highest pravastatin doses increase CPK levels and must be avoided in susceptible patients.
Collapse
Affiliation(s)
- M Castaño
- Department of Cardiac Surgery, León University Hospital, León, Spain -
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Arnáiz-García ME, González-Santos JM, Arnáiz-García AM, López-Rodríguez J, Dalmau-Sorlí MJ, Bueno-Codoñer ME, Arévalo-Abascal A, Arnáiz J. [Pneumoperitoneum after cardiac surgery. A complete anamnesis is the clue]. Arch Cardiol Mex 2015; 85:238-42. [PMID: 25805556 DOI: 10.1016/j.acmx.2015.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 11/18/2022] Open
Abstract
Herein we present the case of an 82 year-old patient undergoing cardiac surgery for mitral valve replacement. Fifteen years earlier, the patient had undergone surgery to replace his aortic valve, so that it was now a cardiac reoperation. Through sternotomy, and release of pericardial adherences, there was an accidental opening of a small portion of the peritoneum, proceeding to repair with simple suture. Postoperatively, the presence of pneumoperitoneum alarmed about the possibility of an intra-abdominal complication but it was subsequently discarded with recent surgical process. Through this article we review what the pneumoperitoneum consist, its causes and management, as well as highlighting possible etiologies sometimes not considered as a recent cardiac surgery, simply because the patient in found in different contexts and we do not think about those possibilities.
Collapse
Affiliation(s)
| | | | - Ana María Arnáiz-García
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - Javier López-Rodríguez
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - María José Dalmau-Sorlí
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - María E Bueno-Codoñer
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - Adolfo Arévalo-Abascal
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - Javier Arnáiz
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| |
Collapse
|
10
|
Arnáiz-García ME, González-Santos JM, Bueno-Codoñer ME, López-Rodríguez J, Dalmau-Sorlí MJ, Arévalo-Abascal A, Arribas-Jiménez A, Diego-Nieto A, Rodríguez-Collado J, Rodríguez-López JM. Perivalvular pannus and valve thrombosis: Two concurrent mechanisms of mechanical valve prosthesis dysfunction. Revista Portuguesa de Cardiologia (English Edition) 2015. [DOI: 10.1016/j.repce.2014.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
11
|
Arnáiz-García ME, González-Santos JM, Bueno-Codoñer ME, López-Rodríguez J, Dalmau-Sorlí MJ, Arévalo-Abascal A, Arribas-Jiménez A, Diego-Nieto A, Rodríguez-Collado J, Rodríguez-López JM. Perivalvular pannus and valve thrombosis: Two concurrent mechanisms of mechanical valve prosthesis dysfunction. Rev Port Cardiol 2015; 34:141.e1-3. [DOI: 10.1016/j.repc.2014.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/16/2014] [Indexed: 11/29/2022] Open
|
12
|
Arnáiz-García ME, González-Santos JM, Arévalo-Abascal A, Bueno-Codoñer M, Dalmau-Sorlí MJ, López-Rodríquez J, Arribas-Jiménez A. [Subvalvular pannus as cause of late mismatch after aortic valve replacement]. Arch Cardiol Mex 2015; 85:168-9. [PMID: 25577550 DOI: 10.1016/j.acmx.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 09/09/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
| | | | - Adolfo Arévalo-Abascal
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - María Bueno-Codoñer
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - María José Dalmau-Sorlí
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - Javier López-Rodríquez
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | | |
Collapse
|
13
|
Arnáiz-García ME, González-Santos JM, Ortíz de Murúa JA, López-Rodríguez J. Massive mitral valve calcification. Eur J Cardiothorac Surg 2014; 48:174. [PMID: 25342850 DOI: 10.1093/ejcts/ezu409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 09/29/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Jose Antonio Ortíz de Murúa
- Department of Cardiology, Complejo Asistencial de Zamora. Hospital Clínico "Virgen de la Concha", Zamora, Spain
| | | |
Collapse
|
14
|
Arnáiz-García ME, González-Santos JM, Bueno-Codoñer ME, Sastre Rincón JA, Iscar-Galán A. Concomitant surgical repair of a perimembranous ventricular septal defect and mitral regurgitation in an adult. Kardiol Pol 2014; 72:841. [PMID: 25231419 DOI: 10.5603/kp.2014.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 03/19/2014] [Indexed: 11/25/2022]
|
15
|
Arnáiz-García ME, Arnáiz J, Pontón A, Pulitani I, González-Santos JM, Arévalo-Abascal A, Bueno-Codoñer ME, Arnáiz-García AM. A concealed atriopleural fistula resulting from a cardiac stab wound. Rev Port Cardiol 2014; 33:567.e1-3. [PMID: 25242676 DOI: 10.1016/j.repc.2014.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 03/13/2014] [Indexed: 11/16/2022] Open
Abstract
A young male presented with a right parasternal stab wound. The chest radiography was normal and transthoracic echocardiography ruled out pericardial tamponade. He remained hemodynamically stable until three hours later when signs of progressive anemia were observed. Chest computed tomography showed massive right-sided hemothorax. The patient underwent surgery, which revealed an active bleeding atriopleural fistula connecting the right atrium and draining into the right pleura resulting from the negative pressure generated during respiration. This mechanism prevented cardiac tamponade and maintained initial hemodynamically stability.
Collapse
Affiliation(s)
| | - Javier Arnáiz
- Radiology Department, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Alejandro Pontón
- Cardiac Surgery Department, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Ivana Pulitani
- Cardiac Surgery Department, University Hospital Marqués de Valdecilla, Santander, Spain
| | | | | | | | - Ana María Arnáiz-García
- Infectious Diseases Unit, Internal Medicine Department, University Hospital Marqués de Valdecilla, Santander, Spain
| |
Collapse
|
16
|
Arnáiz-García ME, Arnáiz J, Pontón A, Pulitani I, González-Santos JM, Arévalo-Abascal A, Bueno-Codoñer ME, Arnáiz-García AM. A concealed atriopleural fistula resulting from a cardiac stab wound. Revista Portuguesa de Cardiologia (English Edition) 2014. [DOI: 10.1016/j.repce.2014.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
17
|
Arnáiz-García ME, González-Santos JM, López-Rodriguez J, Dalmau-Sorli MJ, Bueno-Codoñer M, Arévalo-Abascal A, Fdez García-Hierro JM, Arnáiz-García AM, Arnáiz J. A bovine aortic arch in humans. Indian Heart J 2014; 66:390-1. [PMID: 24973853 DOI: 10.1016/j.ihj.2014.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 11/16/2013] [Accepted: 03/23/2014] [Indexed: 10/25/2022] Open
Abstract
We describe a curious congenital variation of human aortic arch (AA) branching pattern termed the "bovine aortic arch". Rather than arising directly from the AA as a separate branch as occurs in the most common AA branching pattern, the left common carotid artery moves to the right and merges from the brachiocephalic trunk. It is the normal AA branching pattern presented in a number of animals (canines, felines or Macaque monkeys) but it has nothing to do with anatomy of AA in ruminant animals, including cattle and buffalo. That is why it is one of the most widely misnomers used in medical literature whose origin is nowadays unknown.
Collapse
Affiliation(s)
- María Elena Arnáiz-García
- Cardiac Surgery Department, University Hospital of Salamanca, Paseo de San Vicente 58-182, Salamanca 37007, Spain.
| | - Jose María González-Santos
- Cardiac Surgery Department, University Hospital of Salamanca, Paseo de San Vicente 58-182, Salamanca 37007, Spain
| | - Javier López-Rodriguez
- Cardiac Surgery Department, University Hospital of Salamanca, Paseo de San Vicente 58-182, Salamanca 37007, Spain
| | - María José Dalmau-Sorli
- Cardiac Surgery Department, University Hospital of Salamanca, Paseo de San Vicente 58-182, Salamanca 37007, Spain
| | - María Bueno-Codoñer
- Cardiac Surgery Department, University Hospital of Salamanca, Paseo de San Vicente 58-182, Salamanca 37007, Spain
| | - Adolfo Arévalo-Abascal
- Cardiac Surgery Department, University Hospital of Salamanca, Paseo de San Vicente 58-182, Salamanca 37007, Spain
| | | | | | - Javier Arnáiz
- Radiology Department, University Hospital "Marqués de Valdecilla", Santander, Spain
| |
Collapse
|
18
|
Arnáiz-García ME, González-Santos JM, López-Rodríguez J, Dalmau-Sorlí MJ, Bueno-Codoñer M, Arévalo-Abascal A. Survival after major cardiac surgery: performance and comparison of predictive ability of EuroSCORE II and logistic EuroSCORE in a sample of Mediterranean population. Thorac Cardiovasc Surg 2014; 62:298-306; discussion 306-7. [PMID: 24871495 DOI: 10.1055/s-0034-1376255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II has been recently introduced to improve mortality prediction in cardiac surgery. We compare the predictive ability of the new EuroSCORE II with that of the original logistic EuroSCORE and we made an evaluation of a sample of our population submitted to major cardiac surgery in the context of a Mediterranean country. MATERIALS AND METHODS Predicted and observed mortality were recorded in 1,200 consecutive patients undergoing major cardiac surgery at our institution with both logistic EuroSCORE and EuroSCORE II. Patients were grouped according to type of surgery: isolated valvular (n = 538), isolated coronary (n = 322), combined (n = 192), and miscellaneous (n = 148). Predictive capacity of both scales was compared for overall population and for each group in terms of calibration and discrimination using the observed by expected mortality rate, Hosmer-Lemeshow test, and C-statistic. RESULTS Overall mortality was 6.8%, whereas that predicted by logistic EuroSCORE and EuroSCORE II was 9.7 and 3.7%, respectively. Mortality in our population was higher than mortality expected according to the original EuroSCORE II database. For all groups included in our population, logistic EuroSCORE overestimated mortality and EuroSCORE II underestimated the outcome even more. However, EuroSCORE II showed better calibration than logistic EuroSCORE for overall, valvular, and combined surgery. In contrast, logistic EuroSCORE demonstrated better calibration for coronary surgery. Discrimination capacity was good for both risk scores, but it was superior for logistic EuroSCORE than for EuroSCORE II in all considered subgroups unless combined surgery. CONCLUSION Mortality in our population was higher than the mortality that would have been expected by the new EuroSCORE II analysis. Although EuroSCORE II has good calibration and discrimination capacity, both are worse than those demonstrated by logistic EuroSCORE. Forthcoming evaluations are necessary when the new model will be widely used.
Collapse
Affiliation(s)
| | | | | | | | - María Bueno-Codoñer
- Department of Cardiac Surgery, University Hospital of Salamanca, Salamanca, Spain
| | | |
Collapse
|
19
|
Arnáiz-García ME, González-Santos JM, Dalmau-Sorlí MJ, López-Rodríguez J, Bueno-Codoñer M, Arribas-Jiménez A. Aortic stenosis in the background of a subaortic membrane and tunnel-like ventricular outflow tract septal hypertrophy. Arch Cardiol Mex 2014; 84:59-60. [PMID: 24641977 DOI: 10.1016/j.acmx.2013.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 07/08/2013] [Accepted: 07/10/2013] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | | | | | - María Bueno-Codoñer
- Cardiac Surgery Department, University Hospital of Salamanca, Salamanca, Spain
| | | |
Collapse
|
20
|
Arnáiz-García ME, González-Santos JM, López-Rodríguez J, Dalmau-Sorlí MJ. Case images: giant right atrial myxoma mimicking a thrombus. Turk Kardiyol Dern Ars 2014; 42:113. [PMID: 24481107 DOI: 10.5543/tkda.2014.62819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
21
|
González-Santos JM, Arnáiz-García ME, Arribas-Jiménez A, López-Rodríguez J, Rodríguez-Collado J, Vargas-Fajardo MDC, Dalmau-Sorlí MJ, Bueno-Codoñer ME, Arévalo-Abascal RA. Amplatzer Amulet Left Atrial Appendage Occluder Entrapment Through Mitral Valve. Can J Cardiol 2013; 29:1532.e5-7. [DOI: 10.1016/j.cjca.2013.07.675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 07/20/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022] Open
|
22
|
|
23
|
Arnáiz-García ME, González-Santos JM, López-Rodriguez J, Dalmau-Sorli MJ, Bueno-Codoñer M, Arévalo-Abascal A. Intramedullary cervical abscess in the setting of aortic valve endocarditis. Asian Cardiovasc Thorac Ann 2013; 23:64-6. [PMID: 24887857 DOI: 10.1177/0218492313495861] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Spinal cord tissue has a remarkable resistance to infection. An intramedullary abscess is an exceptional complication of infective endocarditis in the post-antibiotic era. We describe the case of a 42-year-old man who presented with fever and cephalea. Two days later, left-side numbness, lack of sphincter control, and a new aortic murmur were noticed. Magnetic resonance imaging demonstrated an 8 ×15-mm intramedullary cervical abscess. Transesophageal echocardiography revealed an aortic valve perforation as a result of infective endocarditis. Conservative management was decided for the intramedullary abscess.
Collapse
Affiliation(s)
| | | | | | | | - María Bueno-Codoñer
- Cardiac Surgery Department, University Hospital of Salamanca, Salamanca, Spain
| | | |
Collapse
|
24
|
González-Santos JM, Arnáiz-García ME, López-Rodriguez J, Fernández García-Hierro JM. Multifocal pulmonary outflow tract primary sarcoma presenting as syncope. Eur Heart J 2013; 34:2242. [PMID: 23729693 DOI: 10.1093/eurheartj/eht169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jose María González-Santos
- Cardiac Surgery Department, University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007 Salamanca, Spain
| | | | | | | |
Collapse
|
25
|
González-Santos JM, Arnáiz-García ME, Vargas-Fajardo MDC, Arribas-Jiménez A. Aortic wall papillary fibroelastoma. J Thorac Cardiovasc Surg 2013; 146:e1-3. [PMID: 23664692 DOI: 10.1016/j.jtcvs.2013.03.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/19/2013] [Indexed: 11/28/2022]
|
26
|
Dalmau MJ, González-Santos JM, López-Rodríguez J, Arribas A. The new carpentier-edwards perimount magna bioprosthesis: early clinical and hemodynamic performance. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
27
|
Vallejo JL, González-Santos JM, Guisasola JS, Albertos J, Castaño M, Ruiz M, Riesgo MJ, Bastida E, Rico MJ, Fortuny R, González de Diego F, Alvarez Valdivielso M. [Reoperations of myocardial revascularization]. Rev Esp Cardiol 1998; 51 Suppl 3:86-92. [PMID: 9717409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
UNLABELLED Coronary by-pass grafting is a well established procedure for ameliorating ischemic coronary disease. From time to time it is necessary to re-operate these patients. The objective of our paper is to present our experience in this field. Retrospective analysis of 128 patients operated on between February 1978 and November 1996, has been analyzed. The mean age was 57.4 +/- 0.7 years. 77.2 +/- 5 months elapsed between operations. Stable angina (20.4%) or unstable angina (76.3%), myocardial infarction (48%) and congestive heart failure (17%) were the predominant clinical manifestations. RESULTS Hospital mortality was 10.9% (14 patients) and in the follow-up there were 16 deaths (14%). Perioperative myocardial infarction was the main cause of in-hospital mortality. In the follow-up there were 4 deaths due to myocardial infarction and another 4 patients died from neoplasms. Perioperative myocardial infarction was present in 9.3% (12 patients) IN CONCLUSION a) Re-do coronary by-pass grafting is still a good procedure for solving myocardial ischemia in spite of a higher mortality and morbidity than in the original operation. b) There is no progression in the number of patients according to our experience, probably due to better techniques and the frequent actions by an intervention cardiologist. c) The long-term results are good enough, but with a higher mortality.
Collapse
Affiliation(s)
- J L Vallejo
- Servicio de Cirugía Cardiovascular, Hospital General Universitario Gregorio Marañón, Madrid
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
BACKGROUND Massive calcification of the atrial walls ("porcelain atrium") is a rare condition that usually has been reported as an incidental radiologic findings. METHODS Between January 1988 and June 1993, 971 patients underwent valvular operation at our institution; 21 patients showed extensive calcification of the left atrium. In 8 patients the calcification was massive, involving almost all the atrial surface. The diagnoses were established by radiology and were confirmed at operation. The mean age of these patients (4 men, 4 women) was 55 +/- 9.6 years. All had rheumatic valve disease, were on atrial fibrillation, and had undergone at least one operation previously. Pulmonary artery pressure was severely increased, even up to systemic levels, in all patients except 1. Total endoatriectomy of the left atrium and mitral valve replacement were performed. No patient was lost during the follow-up. RESULTS Hospital mortality rate was 12.5% (1 patient) and 2 patients died in the late postoperative period. None of these deaths are attributable to the surgical procedure. CONCLUSIONS In toto endoatriectomy of a massively calcified atrium is an easy to perform technique that helps to replace the mitral valve and close the atrial wall.
Collapse
Affiliation(s)
- J L Vallejo
- Department of Cardiovascular Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | |
Collapse
|
29
|
Merino CM, Albertos J, Ortega OA, González-Santos JM, Garrido P, Fortuny R, González-de Diego JF, Rico MJ, Vallejo JL, Arcas R. [The implantable endocavitary cardioverter-defibrillator: the initial and short-term results]. Arch Inst Cardiol Mex 1993; 63:303-9. [PMID: 8215700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Utilization of endocavitary defibrillation electrodes avoids thoracotomy used in implantable cardioverter-defibrillator procedures, reducing associated morbi-mortality. In our institution we have used this approach in 16 patients during a two years period (July 1990-July 1992). Fifteen were males, with a mean age of 56.9 +/- 10.6 (range 32-73). Nine patients suffered ischemic cardiomyopathy, 4 non ischemic cardiomyopathy and in three there was no structural heart disease. Mean ejection fraction was 44.3 +/- 18.3% (range 20-73%). Clinical arrhythmia was ventricular tachycardia in 8 cases, ventricular fibrillation in 6 cases and both types in 2. Endocavitary implantation procedure was not completed in 3 patients, thus an open trans-sternal approach was performed. In 13 patients it was completed successfully, using a total amount of 14 units (1 patient required two procedures due to sepsis in the generator pouch). Most important intraoperative incidences have been defibrillation thresholds between 20-24 J in 4 cases, displacement of defibrillation electrode from vena cava into coronary sinus in 4 cases, epicardial patch implantation via subcostal approach in 1 case and right ventricle perforation in 1 case. No operative mortality was registered. One patient suffered sudden death during follow-up. Surgical complications were few: 1 case of lead dislodgement and 1 infected wound in the generator's pouch. Non-surgical complications were also few: 1 case with superior vena cava syndrome and 1 patient with inadequate discharges. In conclusion, due to our early experience, we believe that endocavitary implantation of an implantable cardioverter-defibrillator is the procedure of choice at the present time.
Collapse
Affiliation(s)
- C M Merino
- Servicio de Cirugía Cardiovascular, Hospital Gregorio Marañón, Madrid, España
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
González-Santos JM, Bastida E, Vallejo JL, Fortuny R, Abukassem K, Ortega OA, Arcas R. Selective and adjustable pericardial flap to protect internal mammary artery grafts. Ann Thorac Surg 1990; 50:995-7. [PMID: 1978642 DOI: 10.1016/0003-4975(90)91145-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We describe the surgical technique of a localized and adjustable pericardial flap to protect internal mammary artery grafts. This flap allows selective pulmonary retraction, maintains pleural integrity, and saves most of the pericardium for later closure. This technique has proved to be simple and highly effective. We have used it in 80 patients and have not had any related complications.
Collapse
Affiliation(s)
- J M González-Santos
- Department of Cardiovascular Surgery, Hospital General Gregorio Marañón Universidad Complutense, Madrid, Spain
| | | | | | | | | | | | | |
Collapse
|
31
|
González-Santos JM, Bastida E, Riesgo M, Vallejo JL, Albertos JV, Fortuny R, Arcas R. Flow capacity of the human retrograde internal mammary artery: surgical considerations. Ann Thorac Surg 1990; 50:360-6. [PMID: 2400255 DOI: 10.1016/0003-4975(90)90475-l] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The diastolic flow of the retrograde internal mammary artery (IMA) was calculated in 30 patients and compared with the expected coronary flow of the left ventricle and that of specific branches. Arterial pressure and free flow were measured in the proximal and distal IMA as well as in the superior epigastric and musculophrenic arteries. Systolic and mean arterial pressure were significantly higher in the proximal IMA than in any other site, but diastolic pressure was comparable. Overall and diastolic antegrade IMA flows (77 +/- 6 and 44 +/- 3 mL/min) were significantly greater than the retrograde flows through the distal IMA (18.5 +/- 2 and 11.5 +/- 1 mL/min), musculophrenic artery (13.3 +/- 1 and 7.9 +/- 1 mL/min), and superior epigastric artery (5.3 +/- 0.4 and 3.1 +/- 0.2 mL/min). Only patient-size-related variables correlated significantly with retrograde IMA flow. Diastolic retrograde IMA flow represented 8.5% +/- 0.6% of the expected left ventricle coronary flow and in 12 patients (40%) was greater than the expected flow of at least one posteroinferior coronary artery. Based on these data, the retrograde IMA may adequately perfuse the posterior descending or other posterolateral coronary branches in select patients. Previous measuring of the retrograde flow is mandatory.
Collapse
Affiliation(s)
- J M González-Santos
- Department of Cardiovascular Surgery, Hospital General Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | | | | | | | | | | |
Collapse
|
32
|
González-Santos JM, Vallejo JL, Rico MJ, González-Santos ML, Horno R, García-Dorado D. Thrombosis of a mechanical valve prosthesis late in pregnancy. Case report and review of the literature. Thorac Cardiovasc Surg 1986; 34:335-7. [PMID: 2431509 DOI: 10.1055/s-2007-1022166] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A case of acute thrombosis of a mechanical mitral valve prosthesis (Medtronic-Hall) in a 34 weeks pregnant woman is reported. The clinical diagnosis was confirmed by Doppler echocardiography. Emergency surgery was performed starting with a cesarean section to save the fetus, followed by an obstetric hysterectomy. Valve thrombectomy could then be safely carried out. Both, the mother and child could be rescued by this combined intervention and were discharged from the hospital without further complications.
Collapse
|
33
|
González-Santos JM, González-Santos ML, Vallejo JL. Acute obstructive hydrocephalus: an unusual complication after cardiopulmonary bypass. Thorac Cardiovasc Surg 1986; 34:201-3. [PMID: 2426839 DOI: 10.1055/s-2007-1020411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A case of acute obstructive hydrocephalus in a patient undergoing an aortic valve replacement is presented. This condition came about as a result of massive left cerebellar hemisphere infarction, probably due to a calcific embolism from the aortic valve. The cerebrospinal fluid circulation was blocked by compression of the fourth ventricle and the Sylvius aqueduct secondary to ischemic edema. Following external ventricular drainage, the hydrocephalus resolved but a neurological deficit secondary to the cerebellar and brain stem infarction became evident. The diagnostic, prognostic and therapeutic implications of this unusual complication following cardiac surgery are discussed.
Collapse
|