Novel Strategies to Improve the Cardioprotective Effects of Cardioplegia.

The use of cardioprotective strategies as adjuvants of cardioplegic solutions has become an ideal alternative for the improvement of post-surgery heart recovery. The choice of the optimal cardioplegia, as well as its distribution mechanism, remains controversial in the field of cardiovascular surgery. There is still a need to search for new and better cardioprotective methods during cardioplegic procedures.

[Transcatheter aortic-valve implantation. A ten years clinical experience].

Background: Transcatheter aortic-valve implantation (TAVI) was introduced in 2002 and the first implants in our country were performed in 2010.

Aim: To review the TAVI experience in our hospital, considering the technology improvements and gained experience throughout this period.

Material And Methods: All patients undergoing TAVI in our center were included.

Preoperative soluble VCAM-1 contributes to predict late mortality after coronary artery surgery.

Background: Soluble vascular cell adhesion molecule-1 has been associated with long-term cardiovascular mortality in patients with stable coronary artery disease and to the development of new atrial fibrillation in subjects with cardiovascular risk factors but no evidence of cardiac disease.

Hypothesis: Preoperative soluble vascular cell adhesion molecule-1 predicts the risk of future all-cause death and cardiovascular death among patients submitted to elective coronary artery bypass surgery.

Methods: From a cohort of 312 patients who underwent elective coronary artery bypass surgery prospectively followed for a median of 6.

Early left atrial dysfunction is associated with suboptimal cardiovascular health.

Aims: Two-dimensional speckle-tracking echocardiography can assess left atrial (LA) function by measuring atrial volumes and deformation parameters (strain, strain rate). This cross-sectional analysis explores the association between ideal CV health (CVH), LA function, and systemic biomarkers in healthy individuals from the Chilean MAUCO Cohort.

Methods: We enrolled 95 MAUCO participants with different levels of CVH (mean age: 51 ± 8 years).

"Gigantic" biatrial myxoma with right heart functional impairment.

Cardiac myxomas are frequently located in the left or right atria, with multiple locations being rare. We report a 59-year-old healthy female with 5 months of cough and exertional dyspnea. A transthoracic echocardiography (TTE) exhibits a 9 × 5 cm nonpedunculated tumor arising from the interatrial septum (IAS) and inhabiting both atria, but was unable to depict the relation with the IAS.

Increased C-reactive protein plasma levels are not involved in the onset of post-operative atrial fibrillation.

Background: Increased inflammation biomarkers plasma levels, including C-reactive protein (CRP), have been associated with the initiation and perpetuation of atrial fibrillation (AF). However, it is not known whether an increased CRP plasma level, without concomitant inflammation, is sufficient to induce AF. We investigated whether higher CRP plasma levels, determined by the presence of +219G>A CRP gene polymorphism, is associated with an increased risk of post-operative AF.

Acute effect of iloprost inhalation on right atrial function and ventricular dyssynchrony in patients with pulmonary artery hypertension.

Background: Right atrium function and ventricular function have significant prognostic value in pulmonary arterial hypertension patients. Acute changes in right ventricular synchrony and right atrium function postiloprost inhalation have not been evaluated.

Methods: Cross-sectional study.

Defective insulin signaling and mitochondrial dynamics in diabetic cardiomyopathy.

Diabetic cardiomyopathy (DCM) is a common consequence of longstanding type 2 diabetes mellitus (T2DM) and encompasses structural, morphological, functional, and metabolic abnormalities in the heart. Myocardial energy metabolism depends on mitochondria, which must generate sufficient ATP to meet the high energy demands of the myocardium. Dysfunctional mitochondria are involved in the pathophysiology of diabetic heart disease.

[Tricuspid and pulmonary valve involvement in carcinoid syndrome. Report of two cases].

Carcinoid is a rare neuroendocrine tumor typically arising in the gastrointestinal tract that can cause heart valve involvement. We report two patients with carcinoid syndrome and tricuspid/pulmonary valve lesions. A 33-year-old male presenting with fatigue and weight loss: A tumor in the tail of the pancreas was found on an abdominal CAT scan.

[Influence of the referring health care systems and other factors on the results of mitral valve replacement].

Background: There is no consensus regarding which risk factors influence the outcome of mitral valve replacement.

Aim: To study the effects of the referring health care system and other factors on the results of mitral replacement.

Patients And Methods: We included 632 patients operated between 1990 and 2010 receiving the St Jude prosthesis.

[Reducing the incidence of ventilator-associated pneumonia following heart surgery: 13-year experience of epidemiologic surveillance in a teaching hospital].

Objectives: To report the results of 13 years worth of epidemiologic surveillance of ventilator-associated pneumonia (VAP) following heart surgery and the main interventions applied in order to reduce VAP incidence.

Methods: This is a retrospective and descriptive study of active epidemiologic surveillance of VAP. National diagnostic criteria were used.

Left atrial dysfunction is a predictor of postcoronary artery bypass atrial fibrillation: association of left atrial strain and strain rate assessed by speckle tracking.

Background: Even though atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass grafting (CABG), its etiology remains poorly understood. Several factors are linked to postoperative AF (POAF), including advanced age and systemic inflammation. However, left atrial (LA) contractile dysfunction has not been evaluated in the perioperative scenario.

Impaired cardiac autophagy in patients developing postoperative atrial fibrillation.

Objectives: Postoperative atrial fibrillation (POAF) is a common complication after on-pump heart surgery. Several histologic abnormalities, such as interstitial fibrosis and vacuolization, have been described in atrial samples from patients developing POAF. This ultrastructural remodeling has been associated with the establishment of a proarrhythmic substrate.

[Aortic valve replacement with bioprosthesis in patients 70 years old or older with aortic stenosis].

Background: Aortic valve stenosis is the most prevalent valvulopathy in the elderly, but it is frequently undertreated.

Aim: To assess early and long term results of valve replacement with bioprostheses in patients 70 years old or older with aortic stenosis.

Patients And Methods: A review of the database of the Cardiovascular Surgery Service of our hospital, for the period 1990-2007, identified 156 patients with aortic valve stenosis, aged 76.

Aortic stenosis and acquired von Willebrand disease: lack of association.

Objectives: The association between aortic stenosis (AS) and acquired von Willebrand disease type 2A has been described. It may be present in up to 90% of patients with AS. Shear stress has been proposed as the underlying mechanism; however, the physiopathology of this condition is not completely understood.

Systemic vascular cell adhesion molecule-1 predicts the occurrence of post-operative atrial fibrillation.

Background: Post-operative atrial fibrillation occurs in 30% of patients after on-pump heart surgery and is associated to elevated inflammatory markers. We have evaluated if the systemic biomarkers of inflammation and endothelial damage, vascular cell adhesion molecule-1 (VCAM-1) and soluble thrombomodulin may help in identifying patients prone to development of post-operative atrial fibrillation.

Methods: One hundred and forty-four patients in sinus rhythm submitted to elective coronary artery bypass surgery.

[Early and late morbidity and mortality of aortic valve replacement with mechanical or biological prostheses during the last decade: the gold standard].

Background: There is a growing interest in alternative techniques for aortic valve replacement (AVR). Therefore it is important to have updated results of conventional AYR as a valid comparative standard.

Aim: To evaluate both perioperative and late morbidity and mortality in patients undergoing conventional AVR, with either mechanical (RVAm) or biological (RVAb) prostheses.

[Circulatory mechanical support. State of the art].

Despite advances in medical treatment, the prognosis of advanced heart failure remains poor. The number of hospitalizations for heart failure exacerbations continues to increase and most patients will ultimately die of complications related to heart failure. Implantable left ventricular assist devices (LVAD) are currently in use throughout the world with increasing frequency.

[Ventricular assist device as a bridge to transplant in patients with cardiogenic shock. Preliminary experience in Chile with ABIOMED BVS 5000].

Hospitalization and death due to heart failure and cardiogenic shock is frequent and currently is increasing among the adult population. Although cardiac transplantation is the most effective treatment in patients with end-stage heart failure, its availability is limited. While waiting for transplantation, some patients become refractory to treatment and deteriorate progressively.

[Usefulness of sublingual isosorbide to assess the reversibility of pulmonary hypertension in cardiac transplant candidates].

Background: Continuous infusion of short life vasodilators are employed to test reversibility of pulmonary hypertension in cardiac transplant candidates. Sublingual isosorbide administration has not been described in the literature and it might be a simpler alternative.

Aim: To evaluate sublingual isosorbide administration as a test of reversibility of pulmonary hypertension in heart failure.

[Long-term results of repair versus replacement for degenerative mitral valve regurgitation].

Background: Mitral valve repair is considered better than mitral valve replacement for degenerative mitral regurgitation.

Aim: To evaluate late clinical results of mitral valve repair as compared to mitral valve replacement in patients with degenerative mitral regurgitation.

Patients And Methods: All patients subjected to open heart surgery for degenerative mitral regurgitation between 1990 and 2002 were assessed for surgical mortality, late cardiac and overall mortality, reoperation, readmission to hospital, functional capacity and anticoagulant therapy.

[Seed, youth, the land is fertile and the moment, unique!: it is not Neruda, but Gandulfo, the surgeon].

The second and definitive edition of "Crepusculario", the first book of Pablo Neruda, is dedicated by the poet "To Juan Gandulfo, this book of other times, Pablo". Juan Gandulfo, died tragically, at a very young age, in 1931. Juan Gandulfo, remembered in Neruda's memoirs, as the most formidable leader of the Anarchist movement of that time and that engraved in wood the cover and all the illustrations of the first edition of Crepusculario, published in 1923.

[Valve repair surgery for incompetent bicuspid aortic valves].

Background: Surgical valve repair is a good alternative for correction of incompetent bicuspid aortic valve.

Aim: To report the early and late surgical, clinical and ecochardiographic results of surgical repair of incompetent bicuspid aortic valves.

Patients And Methods: Retrospective review of medical records of 18 patients aged 19 to 61 years, with incompetent bicuspid aortic valve in whom a valve repair was performed.

[Valve repair surgery in infectious endocarditis].

Background: Valve replacement has been the treatment of choice for patients with valvular complications of infectious endocarditis (IE). However, excellent results with valve repair allowed it to become a new therapeutic alternative for these patients.

Aim: To evaluate the results of valve repair in patients with valvular complications of IE.

[Immediate results of palliative surgery for different forms of univentricular heart using the Norwood procedure].

Background: Norwood procedure is used as the first stage in the palliative treatment of the hypoplastic heart syndrome and can be used, with some technical modifications, in other forms of univentricular heart with aortic stenosis or hypoplasia. These patients have a high mortality (50%), derived from the procedure itself and from their abnormal physiological status.

Aim: To report our experience with the Norwood procedure.