Archivos Peruanos de cardiologia y cirugia cardiovascular最新文献

Objectives: To analyse factors associated with the rejection of heart donor offers referred to Clínica Guayaquil and to compare these findings with national data from the Instituto Nacional de Donación y Trasplante de Órganos, Tejidos y Células, in order to identify trends influencing organ acceptance.

Materials and methods: We conducted an observational, retrospective study of heart donor offers received between September 2021 and July 2025. Demographic, clinical, anthropometric, and logistical variables were extracted from the institutional database and the National Information System for Donation and Transplantation (SINIDOT). Reasons for organ rejection were classified into eight predefined categories. Univariate and multivariate analyses were performed to identify factors associated with donor acceptance or rejection.

Results: A total of 196 heart donor offers were received, of which 75% were rejected. Accepted donor organs were from younger donors, were more frequently male, and had higher predicted heart mass (PHM). Traumatic brain injury was the leading cause of death (49.5%). The most common reasons for rejection were classification as a non-standard risk donor (39.5%), logistical constraints (30.6%), and blood group incompatibility (15.6%). In multivariate analyses, older donor age and origin outside Guayaquil were associated with higher rejection rates, whereas male sex and higher PHM were associated with increased acceptance. Logistical problems rose from 0% in 2021 to more than 40% in 2024-2025, largely driven by limited availability of air transport.

Conclusions: The high rate of donor heart rejection reflects substantial underutilisation of potentially viable organs. Strengthening transport logistics and broadening donor acceptance criteria could increase graft utilisation, reduce waiting-list mortality, and improve the overall efficiency of national heart transplantation programmes.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect, with an estimated incidence of 1 in 300,000 live births and a mortality rate approaching 90% within the first year of life if left untreated. We present the case of a three-year-old boy with progressive dyspnea, paroxysmal tachycardia, and poor weight gain, initially diagnosed with severe left ventricular dilatation and severe mitral regurgitation. Transthoracic echocardiography and cardiac computed tomography angiography confirmed the diagnosis of ALCAPA. Surgical correction included left coronary artery reimplantation and mitral valve repair. The patient was discharged without complications. At a two-year follow-up, he remained asymptomatic, with preserved left ventricular function and mild mitral regurgitation. This case highlights the importance of advanced imaging in the diagnosis and the role of surgical intervention in improving outcomes in this potentially fatal condition.

Objective: To determine the prevalence and describe the clinical and echocardiographic characteristics of adults with atrial septal aneurysm (ASA).

Materials and methods: A cross-sectional, descriptive study was conducted. The population consisted of patients diagnosed with ASA by transthoracic echocardiography.

Results: The prevalence was 2%. The median age was 71 years, and females predominated (58.8%). ASA with right bulging represented 74.8%. The most frequent comorbidity was hypertension (64.1%). Atrial tachyarrhythmias were the most prevalent arrhythmias, and the most common valvular disease was mitral regurgitation (26.7%).

Conclusions: The prevalence of ASA was similar to that reported in the literature; females predominated, the most prevalent comorbidity was hypertension, atrial tachyarrhythmias were the most frequent arrhythmias, ASA with right bulging was the most common, and mitral regurgitation was the most prevalent valvulopathy.

Objetivo: El tratamiento endovascular de los aneurismas aórticos toracoabdominales y paraviscerales complejos, con el desarrollo de nuevos dispositivos, representa uno de los aspectos más desafiantes de la cirugía endovascular. El objetivo de este estudio fue describir la mortalidad perioperatoria a 30 días, las complicaciones mayores posoperatorias y las reintervenciones de los pacientes tratados por aneurismas aórticos complejos mediante dispositivos de endoprótesis ramificadas off-the-shelf (t-BRANCH) y Physician Modified Endografts (PMEGs).

Materiales y métodos: El presente trabajo es un estudio observacional, retrospectivo y unicéntrico sobre una base de datos prospectivamente recolectada de cada paciente tratado por aneurisma aórtico complejo registrado en la historia clínica de nuestro centro aórtico de referencia, entre enero de 2020 y diciembre de 2024.

Resultados: Se analizaron 51 pacientes con una media de edad de 69,6 ± 10,3 años, siendo varones el 90,2%. El diámetro medio del aneurisma fue de 66,1 ± 15,2 mm. La mortalidad global fue del 9,8%, siendo la mortalidad intrahospitalria temprana en t-BRANCH del 23,1% en comparación con PMEGs del 5,3% (p=0,0977). Dentro de los predictores de mortalidad intrahospitalaria se encontraron el estado físico según la clasificación del estado físico de la Sociedad Americana de Anestesiólogos (ASA) IV (OR = 11.98; IC95%: 1.46-98.7; p = 0.022) y el antecedente de accidente cerebrovascular (ACV) (OR = 13.07; IC95%: 1.06-161.5; p = 0.043).

Conclusiones: La reparación endovascular de aneurismas complejos de aorta mediante endoprótesis con PMEGs y dispositivos t-BRANCH muestra resultados favorables con respecto a la mortalidad y las complicaciones mayores posoperatorias, asociadas a una baja tasa de reintervenciones.

The anomalous origin of the right pulmonary artery is a rare congenital cardiac malformation that leads to early development of pulmonary vascular disease, heart failure, and death. Therefore, surgical correction should be performed as soon as the diagnosis is established. A high index of clinical suspicion and the use of non-invasive imaging studies play a crucial role in early diagnosis and timely intervention, thereby reducing the high mortality rates associated with this congenital heart disease. We present two cases of this rare entity, both with clinical manifestations of heart failure from the neonatal period. In both cases, surgical correction was performed through direct anastomosis of the right pulmonary artery to the main pulmonary artery. Both patients showed a favorable postoperative course, with no clinical or echocardiographic evidence of anastomotic stenosis or pulmonary hypertension.

We present the case of a 51-year-old male with non-ischemic dilated cardiomyopathy and complete atrioventricular block, who was previously implanted with a cardiac resynchronization therapy defibrillator. The patient developed signs of pocket infection with a high risk of extrusion. Partial system extraction was performed, followed by 14 days of intravenous antibiotic therapy. Due to a history of ventricular fibrillation and permanent pacing dependency, and in the absence of viable transvenous access, a sequential implantation strategy was adopted using a leadless pacemaker (Micra AV, Medtronic) and a subcutaneous implantable cardioverter-defibrillator (EMBLEM, Boston Scientific). Both procedures were completed without complications, and the patient showed favorable recovery, with effective pacing, no arrhythmic recurrences, and no signs of infection at the six-month follow-up. This case illustrates the feasibility of a fully leadless approach in high-risk patients with contraindications to conventional transvenous systems.

Atherosclerotic renal artery stenosis may present with resistant hypertension, hypertensive crisis, ischemic nephropathy, and cardiac destabilization. Although early studies of renal artery stenting showed promise, later trials found no benefit over medical therapy-yet often excluded high-risk, acute cases. We describe an 85-year-old male with cardiovascular risk factors who developed a hypertensive crisis, acute kidney injury, and flash pulmonary edema. An angiogram revealed severe ostial right renal artery stenosis. Stenting resulted in the rapid resolution of the acute crisis and restoration of baseline renal function. This case underscores the potential benefit of revascularization in select high-risk presentations of renal artery stenosis.

Objectives: To compare the ability of the HEART and EDACS scores to predict major adverse cardiovascular events (MACE) at 30 days of follow-up in patients with acute chest pain presenting to an emergency department.

Materials and methods: Retrospective study of patients older than 18 years treated for acute chest pain, excluding ST-elevation acute coronary syndrome (ACS), trauma, and infections. The HEART and EDACS scores were assessed at admission. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value, and negative predictive value of both scores were calculated for the prediction of 30-day MACE.

Results: A total of 249 patients were evaluated; 62.2% were male, with a mean age of 66.5 years. There were 25 MACEs (10%). The HEART score classified patients as low risk (43.4%), moderate risk (47.4%), and high risk (9.2%). Using the EDACS, patients were classified as low risk (38.6%) and not low risk (61.4%). Regarding MACE, the HEART score had an AUC of 0.91 (95% CI: 0.87-0.95) and EDACS had an AUC of 0.70 (95% CI: 0.60-0.79). The HEART score demonstrated better performance than EDACS, especially when a score ≥4 was obtained.

Conclusions: The HEART score has higher diagnostic performance than EDACS for predicting MACE in patients with acute chest pain presenting to a tertiary emergency department.

Congenitally corrected transposition of the great arteries (ccTGA) is a rare and complex cardiac malformation often associated with additional anomalies. We present a 23-year-old patient with ccTGA, a supravalvular stenosing ring, and an Ebsteinoid tricuspid valve who developed severe systemic atrioventricular valve (SAVV) stenosis and regurgitation. Preoperative evaluation revealed tricuspid valve abnormalities, a dilated systemic right ventricle (sRV) with a reduced sRV ejection fraction (42%). The patient underwent bioprosthetic SAVV replacement and excision of the supravalvular membrane. Postoperatively, valve function was preserved, and recovery was favorable despite transient complications. This case emphasizes the surgical challenges and individualized decision-making required in ccTGA with rare anatomical variants, highlighting the value of timely intervention, multidisciplinary care, and long-term follow-up to optimize outcomes.

A double aortic arch is a rare congenital vascular anomaly with clinical significance in the pediatric population due to its potential to cause extrinsic compression of the trachea and esophagus. It should be suspected in infants with persistent respiratory and gastrointestinal symptoms refractory to conventional treatment. We report the case of a 2-year-7-month-old boy presenting with recurrent stridor, repeated respiratory infections, and progressive dysphagia. Cardiac CT angiography revealed a complete vascular ring causing tracheoesophageal compression. Dominance of the left aortic arch was identified, and surgical section and distal ligation of the non-dominant right arch were performed, without direct intervention on the tracheoesophageal structures. At the 12-month follow-up, there was complete resolution of symptoms and nutritional recovery. This case highlights the importance of maintaining high clinical suspicion and ensuring timely referral. Even when surgical correction is delayed, appropriate intervention can reverse symptoms and improve quality of life.