Tercera revascularización miocárdica quirúrgica. Único paciente presentado en Cuba

A 49 years old male, white, smoker patient is presented. A severe coronary disease was demonstrated by means of coronariography. Surgical myocardial revascularization was necessarily performed in three opportunities.Se presenta un paciente de 49 años de edad, masculino, blanco, fumador. Se demostró por coronariografía la presencia de una enfermedad coronaria severa y se determinó necesario realizar revascularización miocárdica quirúrgica en tres oportunidades

Los cirujanos cardíacos y los dinosaurios

Cardiac surgeons and dinosaursLos cirujanos cardíacos y los dinosaurio

Efectividad de las alternativas terapéuticas para la solución quirúrgica de las mediastinitis después de una cirugía cardíaca

Introduction: The longitudinal median sternotomy is a widely employed incision in cardiovascular surgery. The infections of the surgical wound are a serious health problem, but in this type of surgery, the deep infection, the postoperative mediastinitis, has high morbidity and mortality and it is a diagnostic and therapeutic challenge. Initially, surgical treatment protocols were open, but their evolution has stimulated the appearance of closed methods.Objective: To assess the effectiveness of therapeutic alternatives for the surgical solution of mediastinitis after a cardiac surgery.Method: A cross-sectional assessment study of health technology was conducted under application, with the information between the years 2000 and 2016, with its prior determination of indicators and its cutoffs. Results: An incidence of 1.54% of postoperative mediastinitis was found. Being 40.9% of patients treated with open methods and 59.1% with closed, by the use of irrigation to the mediastinum with dilute povidone iodine. The application of the open method had an effectiveness of 57.1%, evaluated by seven predetermined indicators, and the closed method presented a complete effect (100%), after the evaluation of nine indicators. Conclusions: The postoperative mediastinitis has a similar incidence of that in other centers. It has been treated with open and closed methods. The closed technique was more utilized and it achieved excellent therapeutic effectiveness, superior to the open one.Introducción: La esternotomía mediana longitudinal es una incisión ampliamente empleada en la cirugía cardiovascular. Las infecciones de la herida quirúrgica constituyen un serio problema de salud; pero en este tipo de cirugía, la infección profunda, la mediastinitis posoperatoria, presenta elevadas morbilidad y mortali-dad, y constituye un desafío diagnóstico y terapéutico. Inicialmente los protocolos de tratamiento quirúrgico eran abiertos, pero su evolución ha estimulado que apa-rezcan los métodos cerrados.Objetivo: Evaluar la efectividad de las alternativas terapéuticas para la solución quirúrgica de las mediastinitis después de una cirugía cardíaca.Método: Se realizó un estudio de evaluación de tecnología sanitaria en fase de aplicación, de corte transversal, con la información contenida entre los años 2000 y 2016, con la previa determinación de los indicadores para ello y sus puntos de corte.Resultados: La incidencia de mediastinitis posoperatoria fue de 1,54%. El 59,1% de los pacientes fue tratado con métodos cerrados, mediante el empleo de irrigación al mediastino con yodo povidona diluida. La aplicación del método abierto tuvo una efectividad de 57,1%, evaluada mediante 7 indicadores previamente determi-nados, y el método cerrado presentó una efectividad total (100%), tras la evalua-ción de 9 indicadores.Conclusiones: La mediastinitis posoperatoria tiene una incidencia similar a otros centros, y ha sido tratada con métodos abiertos y cerrados. La técnica cerrada fue la más utilizada y alcanzó una excelente efectividad terapéutica, superior a la abierta

REVASCULARIZACIÓN MIOCÁRDICA CON AMBAS ARTERIAS MAMARIAS INTERNAS, UN RETO PARA LOS CIRUJANOS CARDIOVASCULARES ACTUALES

The left internal mammary artery is currently the most common graft in surgical myocardial revascularization. However, in spite of the works showing the effectiveness of the use of both mammary arteries, this technique remains a controversial topic in medical literature nowadays. Among the factors discouraging its use we have the good results of the myocardial revascularization with left internal mammary artery and with saphenous vein, a greater technical difficulty and a prolonged surgical time; as well as an increase in sternal complications. The advantages and disadvantages in the use of this procedure are discussed in this work, as well as the results presented by several authors. The surgical technique is also described.La arteria mamaria interna izquierda es, actualmente, el injerto más utilizado en las revascularizaciones miocárdicas quirúrgicas; sin embargo, aunque existen trabajos que demuestran la eficacia del uso de ambas arterias mamarias, esta técnica continúa siendo un tema controvertido en la literatura médica actual. Entre los factores que desestimulan su uso se encuentran los buenos resultados de la revascularización miocárdica con arteria mamaria interna izquierda y vena safena, mayor dificultad técnica y el tiempo quirúrgico prolongado; además de un incremento de las complicaciones esternales. En este trabajo se comentan las ventajas y desventajas del empleo de este tipo de procedimiento, se discuten varios resultados de diversos autores y se describe la técnica quirúrgica

Complicaciones gastrointestinales encontradas en fallecidos después de una cirugía cardiovascular. Experiencia de

Background and Objectives: Gastrointestinal complications in heart surgery are low, between 0.4 to 2.9%; however, its diagnosis is of vital importance because it is associated with high mortality rates. An investigation was conducted to determine the frequency of these complications in those who died after cardiac surgery. Method: A retrospective study of 5 years (1999-2003) was performed in the Cardiovascular Surgery Department. Autopsy reports and medical records were analyzed to study gastrointestinal complications according to their frequency and their possible relationship to the cause of death. Results: There were a total of 57 deaths, 38.6% were valve replacements, 54.4% coronary artery bypass grafting and 7.0% vascular prostheses. Multi-organ failure was predominant (38.6%), followed by stroke (26.3%) and shock (17.5%). 26 complications were found, of which 15 (57.7%) in deaths from multiple organ failure, 6 (23.1%) in patients with an infarct, 4 (15.4%) in the shock and 1 (3.8 %) in a dead from a pulmonary embolism. The acute hemorrhagic gastroenteropathy was the most frequent 61.6%, acute cholecystitis and pancreatitis shared 11.5%, just as mesenteric thrombosis and peptic ulcer disease with 7.7% each. Conclusions: The acute hemorrhagic gastroenteropathy was the most frequent complication. Most complications appeared in the diseased from multi-organ failure and stroke. The identification of risk factors, use of appropriate prophylaxis and the constant evaluation of these patients may help with early diagnosis and the establishment of the most successful therapy.trointestinales en cirugía cardíaca son escasas, entre 0,4-2,9 %; sin embargo, su diagnóstico es de vital importancia porque se asocia con elevados índices de mortalidad. Se realizó una investigación para determinar la frecuencia de estas complicaciones en los fallecidos, después de la cirugía cardíaca. Método: Se realizó un estudio retrospectivo de 5 años (1999-2003) en el Servicio de Cirugía Cardiovascular. Se analizaron los informes de necropsias y las historias clínicas para estudiar las complicaciones gastrointestinales de acuerdo a su frecuencia y su posible relación con la causa de muerte. Resultados: Hubo un total de 57 defunciones, 38,6 % fueron sustituciones valvulares; 54,4 %, revascularización miocárdica quirúrgica y 7,0 % prótesis vasculares. Predominó el fallo multiorgánico (38,6 %), seguido del infarto (26,3 %) y el shock (17,5 %). Se encontraron 26 complicaciones, de ellas 15 (57,7 %) en fallecidos por insuficiencia de múltiples órganos, 6 (23,1 %) en casos con infarto, 4 (15,4 %) en el shock y 1 (3,8%) en un fallecido por tromboembolismo pulmonar. La gastroenteropatía aguda hemorrágica fue la más frecuente 61,6 %; la pancreatitis y colecistitis agudas compartieron 11,5 %; al igual que la trombosis mesentérica y la úlcera péptica con 7,7 % cada una. Conclusiones: La gastroenteropatía aguda hemorrágica fue la complicación más frecuente. La mayoría de las complicaciones aparecieron en fallecidos por insuficiencia de múltiples órganos e infarto. La identificación de factores de riesgo, la utilización de profilaxis adecuada y la evaluación constante de estos pacientes pueden ayudarnos al diagnóstico precoz y al establecimiento de la terapéutica más acertada

COMPLICACIONES GASTROINTESTINALES ENCONTRADAS EN FALLECIDOS DESPUÉS DE UNA CIRUGÍA CARDIOVASCULAR. EXPERIENCIA DE CINCO AÑOS / Gastrointestinal complications found in deceased patients after cardiovascular surgery. Five years of experience.

Background and Objectives: Gastrointestinal complicationsin heart surgery are low, between 0.4 to 2.9%;however, its diagnosis is of vital importance because itis associated with high mortality rates. An investigationwas conducted to determine the frequency of thesecomplications in those who died after cardiac surgery.Method: A retrospective study of 5 years (1999-2003)was performed in the Cardiovascular Surgery Department.Autopsy reports and medical records were analyzedto study gastrointestinal complications accordingto their frequency and their possible relationship tothe cause of death. Results: There were a total of 57deaths, 38.6% were valve replacements, 54.4% coronaryartery bypass grafting and 7.0% vascular prostheses.Multi-organ failure was predominant (38.6%),followed by stroke (26.3%) and shock (17.5%). 26complications were found, of which 15 (57.7%) indeaths from multiple organ failure, 6 (23.1%) in patientswith an infarct, 4 (15.4%) in the shock and 1 (3.8 %) ina dead from a pulmonary embolism. The acute hemorrhagic gastroenteropathy was the most frequent61.6%, acute cholecystitis and pancreatitis shared11.5%, just as mesenteric thrombosis and peptic ulcerdisease with 7.7% each. Conclusions: The acutehemorrhagic gastroenteropathy was the most frequentcomplication. Most complications appeared in thediseased from multi-organ failure and stroke. The identificationof risk factors, use of appropriate prophylaxisand the constant evaluation of these patients may helpwith early diagnosis and the establishment of the mostsuccessful therapy

Reconstrucción ósea con neoesternón a partir de tejidos adyacentes a la herida quirúrgica

Bone reconstruction using neo-sternum from tissues adjacent to the surgical woundReconstrucción ósea con neoesternón a partir de tejidos adyacentes a la herida quirúrgic

Aneurisma gigante del apéndice auricular izquierdo

Los aneurismas de la aurícula izquierda son raros y pueden ser congénitos o adquiridos. Los que interesan la pared libre o el apéndice auricular son entidades más raras aún, hasta 2002 sólo existían 49 casos reportados en la aurícula izquierda y 8 en la derecha. La manifestación clínica más frecuente es la aparición de arritmias auriculares incesantes o recurrentes y pueden presentarse embolias sistémicas que pueden dar al traste con la vida del paciente. Presentamos el caso de una paciente adolescente que presentó una embolia cerebral en el curso de una fibrilación auricularytenía un aneurisma gigante del apéndice auricular izquierdo que fue exitosamente extirpado. Se muestran las imágenes de la tomografía computada y el aneurisma durante la intervención quirúrgica

LESIONES VASCULARES TRAUMÁTICAS DE CUELLO, TÓRAX Y ABDOMEN / Traumatic vascular injuries of the neck, thorax and abdomen

Introduction and Objectives: Vascular injuries have been described since the ancient times. They represent 3 percent of traumatisms; and the most worrisome aspect is their dangerousness, because more than half of the patients die within the first 24 hours due to the hemorrhages they cause. This investigation was carried out with the objective of determining the incidence of the different types of vascular injuries at the Arnaldo Milian Castro Hospital. Method: A retrospective study in 21 patients who were hospitalized with diagnoses of vascular injuries in the neck, thorax and abdomen was carried out. The medical histories of the patients were analyzed, as well as the surgery reports and the necropsy protocols in the case of the deceased. Results: There was a predominance of penetrating wounds in the abdomen (38.9 %) and in the thorax (19.05 %), as well as thoracic and abdominal closed traumas. The accidental cause was present in 57.2 percent of the patients. The most affected anatomical region was the abdomen (42.86 %), and the most used surgical procedure was the exploratory laparotomy (76.2 %). An average of 1.21 procedures per patient was carried out. The hypovolemic shock was the complication with the highest incidence, because it appeared in 11 patients (52.38 %), this represents 68.75 percent of all complications. Eleven patients (52.38 %) stayed less than 3 days in hospital. The lesions of the spleen and its vascular pedicle appeared in 23.81 percent of the patients. Conclusions: Penetrating wounds in the abdomen, accidents as a cause of them, and the exploratory laparotomy were predominant. The most affected anatomical area was the abdomen and the hypovolemic shock was the most common complication