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Se presenta en caso de un varón de 55 años con diagnóstico de insuficiencia mitral severa por ruptura de músculo papilar; los hallazgos operatorios mostraron vegetaciones múltiples en la cabeza del musculo papilar anterolateral con ruptura total del mismo y velos valvulares normales. La histopatología mostró infiltrado inflamatorio polimorfonuclear en el tejido endocárdico y miocárdico, además vegetaciones fibrinosas en la superficie del musculo papilar, el cultivo del tejido resultó positivo a K. pneumoniae, concluyéndose como endocarditis aislada por infección directa del músculo papilar. El paciente recibió tratamiento antibiótico por seis semanas y fue dado de alta a los 45 días del ingreso con grado funcional I.

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El 19% de los pacientes con patología mitral reumática presenta aurícula izquierda gigante (diámetro mayor a 65mm), esta patología ha sido asociada con incremento del riesgo de stroke y de muerte súbita. La indicación de reducción auricular se establece cuando existe compresión de las extructuras vecinas, antecedentes de fenómenos tromboembólicos o en pacientes asintomáticos para restablecer el ritmo sinusal (Cirugía de Maze). Se presenta el caso de una mujer de 63 años con estenosis e insuficiencia mitral reumáticas severas, atrio izquierdo gigante (diámetro mayor a 90 mm) y fibrilación auricular permanente, a quien se le realizó mediante técnica de autotrasplante, reemplazo de válvula mitral y reducción de aurícula izquierda. En el postoperatorio la paciente presentó insuficiencia renal que requirió diálisis y soporte ventilatorio con intubación orotroqueal po...

El mixoma es la tumoración cardíaca más frecuente en el adulto, constituyendo aproximadamente el 50% de las mismas. En la edad pediátrica el tumor cardíaco más frecuente es el rabdomioma, generalmente asociado a esclerosis tuberosa. La presentación del mixoma en pacientes pediátricos es muy rara y más aun en la etapa neonatal. Presentamos el caso de una paciente de sexo femenino que fue sometida a cirugía a los 8 días de nacida por presentar dos tumoraciones intracardiacas diagnosticadas en la etapa intrauterina a las 38 semanas de gestación. La cirugía se realizó mediante esternotomía media, con circulación extracorpórea y arresto circulatorio. Las tumoraciones, que eran de aspecto polipoide se localizaban en la aurícula derecha, los estudios de patología fueron compatibles con mixoma. La evolución postoperatoria fue satisfactoria y la paciente fue dada de alta a los...

Introduction: Coronary artery bypass graft (CABG) surgery is one of the main strategies in the treatment of coronary heart disease. The benefit of using the left internal mammary artery (IMA) to revascularize the anterior descending artery is greatly demonstrated, improving long-term survival in patientsreceiving this graft. On the other hand there are variable currents about the use of two internal mammary arteries, although several studies have already demonstrated the superiority of the use of two mammary arteries over one. Methodology: Retrospective study of Coronary artery bypass graft surgeries with bilateral mammary artery, performed at Instituto Nacional Cardiovascular - INCOR EsSalud between January 2012 and June 2018. The objective was to determine the mortality rate and major adverse cardiovascular events in a medium term follow-up of 30 months. Results: 121 patients were oper...

Introducción: La cirugía de revascularización quirúrgica de miocardio es una de las principales estrategias en el tratamiento de la enfermedad coronaria. Está ampliamente demostrado el beneficio del uso de la arteria mamaria interna (AMI) izquierda para revascularizar la arteria descendente anterior, mejorando la supervivencia a largo plazo. Por otro lado, existen aún corrientes variables acerca del uso de dos arterias mamarias internas, a pesar de que también está demostrada la superioridad del uso de dos arterias mamarias sobre una. Metodología: Investigación retrospectiva de las cirugías de revascularización quirúrgica de miocardio con AMI bilateral, realizadas en el Instituto Nacional Cardiovascular - INCOR EsSalud entre enero de 2012 y junio de 2018. Los objetivos fueron determinar la tasa de mortalidad y definir la tasa de eventos adversos mayores cardiovasculares en u...

Introduction: Coronary artery bypass graft (CABG) surgery is one of the main strategies in the treatment of coronary heart disease. The benefit of using the left internal mammary artery (IMA) to revascularize the anterior descending artery is greatly demonstrated, improving long-term survival in patientsreceiving this graft. On the other hand there are variable currents about the use of two internal mammary arteries, although several studies have already demonstrated the superiority of the use of two mammary arteries over one. Methodology: Retrospective study of Coronary artery bypass graft surgeries with bilateral mammary artery, performed at Instituto Nacional Cardiovascular - INCOR EsSalud between January 2012 and June 2018. The objective was to determine the mortality rate and major adverse cardiovascular events in a medium term follow-up of 30 months. Results: 121 patients were oper...

Objectives: To identify the clinical characteristics, analyze the results and show the efficacy of surgical treatment of hypertrophic obstructive cardiomyopathy (HOC), in a national reference institute. Methods: A descriptive, retrospective, case series of patients with the diagnosis of HOC operated at the National Cardiovascular Institute, was performed between December 2016 and January 2019. We analyzed the postoperative evolution of symptomatology, functional class (FC), left ventricular outflow tract gradient (LVOTG) and mitral regurgitation (MR). Results: Thirteen cases with HOC undergoing extended septal myectomy were evaluated. 31% were women and the average age was 39.6 years. Before surgical treatment, 85% were in functional class (FC) III-IV, 85% of patients had severe MR, the mean septum thickness was 27 mm (range from 19 to 39 mm), and mean LVOTG was 111 mmHg (range from 60 t...

Objetivos: Identificar las características clínicas, analizar los resultados y mostrar la eficacia del tratamiento quirúrgico de la miocardiopatía hipertrófica obstructiva (MHO), en un hospital de referencia nacional. Material y método: Se realizó un estudio descriptivo, retrospectivo, tipo serie de casos, de pacientes operados en el Instituto Nacional Cardiovascular con el diagnóstico de MHO, entre diciembre del 2016 y enero del 2019. Se analizó la evolución posoperatoria de la sintomatología, clase funcional (CF), gradiente del tracto de salida del ventrículo izquierdo (GTSVI) y de la insuficiencia mitral (IM). Resultados: Se evaluaron 13 casos con MHO sometidos a miectomía septal extendida. Un 31% fueron mujeres y la edad media fue de 39.6 años. Antes del tratamiento quirúrgico 85% se encontraba en CF III-IV, 85% de pacientes presentaba IM severa, el grosor medio del se...

Objectives: To identify the clinical characteristics, analyze the results and show the efficacy of surgical treatment of hypertrophic obstructive cardiomyopathy (HOC), in a national reference institute. Methods: A descriptive, retrospective, case series of patients with the diagnosis of HOC operated at the National Cardiovascular Institute, was performed between December 2016 and January 2019. We analyzed the postoperative evolution of symptomatology, functional class (FC), left ventricular outflow tract gradient (LVOTG) and mitral regurgitation (MR). Results: Thirteen cases with HOC undergoing extended septal myectomy were evaluated. 31% were women and the average age was 39.6 years. Before surgical treatment, 85% were in functional class (FC) III-IV, 85% of patients had severe MR, the mean septum thickness was 27 mm (range from 19 to 39 mm), and mean LVOTG was 111 mmHg (range from 60 t...

We present the case of a 38-year-old male with a diagnosis of Stanford A aortic dissection and associated coarctation of the thoracic aorta. Acute dissection associated with coarctation of the aorta is a rare problem and difficult to manage surgically. Establishing a cardiopulmonary bypass (CPB) with adequate flows is the main objective of the procedure; optimal cannulation ensures the protection of cerebral and visceral organs. We successfully performed aortic valve re-implantation surgery (T. David Surgery), replacement of the ascending aorta and aortic arch, as well as debranching of the supra-aortic trunks. The cannulation technique was axillary and femoral to guarantee flows through the coarctation area.

Coronary artery bypass using bilateral internal thoracic artery (BITA) has been related to survival benefits in patients with coronary artery disease, but data is not conclusive. In South America, several centers reported their own experience with good results in survival, minimal postoperative cardiovascular events, and a low degree of mediastinal infection, however, the number of cases is low, and the absence of publications in several countries is a matter of concern. We review the leading publications on BITA grafting in our region, assessing how far we have advanced in coronary surgery.

Coronary artery bypass using bilateral internal thoracic artery (BITA) has been related to survival benefits in patients with coronary artery disease, but data is not conclusive. In South America, several centers reported their own experience with good results in survival, minimal postoperative cardiovascular events, and a low degree of mediastinal infection, however, the number of cases is low, and the absence of publications in several countries is a matter of concern. We review the leading publications on BITA grafting in our region, assessing how far we have advanced in coronary surgery.

The combination of aortic valve regurgitation, rheumatoid aortitis, and subaortic stenosis is not frequent in patients with rheumatoid arthritis. Moreover, the surgical treatment of these entities may be challenging with non-adequate results. We report a case of a patient with severe aortic valve regurgitation, inaccessible aortic root secondary to rheumatoid aortitis, and severe subaortic stenosis initially treated by aortic valve replacement. We reoperated the patient due to acute prosthetic valve failure performing an aortic valve reconstruction using bovine pericardium and Ozaki’s technique with good outcomes.

The combination of aortic valve regurgitation, rheumatoid aortitis, and subaortic stenosis is not frequent in patients with rheumatoid arthritis. Moreover, the surgical treatment of these entities may be challenging with non-adequate results. We report a case of a patient with severe aortic valve regurgitation, inaccessible aortic root secondary to rheumatoid aortitis, and severe subaortic stenosis initially treated by aortic valve replacement. We reoperated the patient due to acute prosthetic valve failure performing an aortic valve reconstruction using bovine pericardium and Ozaki’s technique with good outcomes.

Coronary artery bypass using bilateral internal thoracic artery (BITA) has been related to survival benefits in patients with coronary artery disease, but data is not conclusive. In South America, several centers reported their own experience with good results in survival, minimal postoperative cardiovascular events, and a low degree of mediastinal infection, however, the number of cases is low, and the absence of publications in several countries is a matter of concern. We review the leading publications on BITA grafting in our region, assessing how far we have advanced in coronary surgery.

We present the case of a 38-year-old male with a diagnosis of Stanford A aortic dissection and associated coarctation of the thoracic aorta. Acute dissection associated with coarctation of the aorta is a rare problem and difficult to manage surgically. Establishing a cardiopulmonary bypass (CPB) with adequate flows is the main objective of the procedure; optimal cannulation ensures the protection of cerebral and visceral organs. We successfully performed aortic valve re-implantation surgery (T. David Surgery), replacement of the ascending aorta and aortic arch, as well as debranching of the supra-aortic trunks. The cannulation technique was axillary and femoral to guarantee flows through the coarctation area.

Presentamos el caso de un varón de 38 años con diagnóstico de disección aórtica Stanford A y coartación asociada de aorta torácica. La disección aguda asociada con la coartación de la aorta es un problema raro y difícil de manejar quirúrgicamente. Establecer un bypass cardiopulmonar (CEC) con flujos adecuados es el principal objetivo del procedimiento; La canulación óptima asegura la protección de los órganos cerebrales y viscerales. Realizamos con éxito cirugía de reimplantación valvular aórtica (Cirugía T.David), reposición de aorta ascendente y arco aórtico, así como desramificación de troncos supraaórticos. La técnica de canulación fue axilar y femoral para garantizar flujos por la zona de coartación.