In recent years there has been some improvement in surgical and interventional techniques that have modified the classical indications making them more risky. Left main coronary stenoses are even more dreadful lesions, and the results of percutaneous management are odd with varying mortality (10-12% on average), and high morbidity. Moreover we have small number of cases in the literature. Comparing these results with surgery, we find the later to be safer with mortality under 4%, low morbidity and a long term experience in the management of this pathology. Results, moreover, tend to favor surgery in the coronary restenosis in spite of the use of stents. ( Rev Med Hered 2003; 14: 204-206).

Superior vena cava syndrome is a rare entity. The neoplastic etiology is the most relevant, as well as that related to invasive procedures with central venous catheter.A 32-year-old man consults the Emergency Department for sudden facial cyanosis, facial tightness, dry cough, odynophagia, dysphonia and vertigo without dyspnea. He presents colon neoplasia since 2019, with colostomy and left subclavian Port-catheter. At examination, facial and upper extremity edema, central cyanosis, multiple petechiae and nail bleeding on the hands. The angiotomography shows filling defect fort recent thrombosis in left internal jugular and brachiocephalic vein, right brachiocephalic vein, arch of the azygos vein and superior vena cava in its entire lumen.The surgical mechanical thromboaspiration allowed resection of the thrombus and restitution of circulation, with relative safety and low mortality.

The Acute Aortic Syndrome (ASS) imposes a diagnosis challenge for emergency physicians. Its very variable clinical presentation and poor symptomatic specificity makes it very difficult to diagnose, being the high clinical-suspicion index the clue for attaining it. Aortic dissection is the most common form of AAS,followed by intramural hematoma (IMH) and penetrating aortic ulcer (PAU). Congenital cardiovascular defects, genetic syndromes, and nonsyndromic genetic variants have all been linked with the development of AAS. The diagnosis of AAS in the clinic can be made using imaging modalities such as CT,echocardiography, and MRI. Medical and/or surgical treatment must be provided depending of the compromised aortic segment. We report two cases of AAS received medical care at the Emergency Department of Clínica Delgado during 2015.

The Acute Aortic Syndrome (ASS) imposes a diagnosis challenge for emergency physicians. Its very variable clinical presentation and poor symptomatic specificity makes it very difficult to diagnose, being the high clinical-suspicion index the clue for attaining it. Aortic dissection is the most common form of AAS,followed by intramural hematoma (IMH) and penetrating aortic ulcer (PAU). Congenital cardiovascular defects, genetic syndromes, and nonsyndromic genetic variants have all been linked with the development of AAS. The diagnosis of AAS in the clinic can be made using imaging modalities such as CT,echocardiography, and MRI. Medical and/or surgical treatment must be provided depending of the compromised aortic segment. We report two cases of AAS received medical care at the Emergency Department of Clínica Delgado during 2015.