Archivos Peruanos de cardiologia y cirugia cardiovascular最新文献

Objectives: Mediastinitis is an unusual postoperative complication in pediatric cardiovascular surgery, associated with high morbidity and mortality. Case reports are limited, especially in Latin America, where cardiac surgery has advanced significantly.

Materials and methods: A retrospective study of mediastinitis post-cardiac surgery cases at a high-complexity center in Colombia, between January 2015 and June 2023, was conducted. A detailed description of the clinical characteristics and therapeutic approaches was provided.

Results: A population of 16 children with mediastinitis was characterized, predominantly male (68.7%); 62.5% were aged 1-3 months. The most common defects were transposition of the great arteries and univentricular heart. Gram-negative bacteria (37.5%) were the most common isolates, followed by gram-positive bacteria (25%). Vacuum-assisted closure (VAC) was required in 43.7% of cases.

Conclusion: Advances in congenital heart disease management have led to complications such as mediastinitis, prompting the development of therapeutic strategies that would benefit from better characterization in high-complexity centers to improve outcomes.

The diagnostic approach to pulmonary hypertension using cardiac imaging, particularly echocardiography, provides a practical, accessible, and highly valuable tool. It helps establish the initial diagnostic probability, offers prognostic information, and supports aetiological assessment. The agitated saline contrast test, also referred to as bubble contrast echocardiography, can aid not only in confirming the diagnosis but also in characterising the condition and identifying various underlying causes of pulmonary hypertension.

We report a case of systemic light chain amyloidosis with cardiac involvement, preceded by a monoclonal IgG lambda gammopathy. The clinical diagnosis was based on signs of heart failure, elevated cardiac biomarkers, and characteristic imaging findings. The diagnosis was confirmed by increased levels of free light chains in blood and urine, as well as the presence of amyloid deposits in periumbilical fat and multiple segments of the gastrointestinal tract. Treatment with daratumumab, bortezomib, and dexamethasone was initiated, followed by autologous hematopoietic stem cell transplantation 22 months after diagnosis, resulting in a favourable clinical outcome.

We present the case of a 39-year-old man with a history of progressive dyspnea. Transthoracic and transesophageal echocardiography revealed severe mitral valve (MV) regurgitation due to P2 flail as well as severe tricuspid valve (TV) regurgitation. The patient underwent surgical treatment, including MV repair and TV annuloplasty, performed through a totally endoscopic periareolar approach. Postoperative evolution was satisfactory.

We present the case of a 42-year-old male patient with a history of bilateral lung transplantation and chronic graft dysfunction. The patient presented to the adult emergency department due to acute heart failure. During his stay in the emergency room and in outpatient follow-up, cardiac multi-imaging led to the diagnosis of double-chambered right ventricle with associated hypertrophic cardiomyopathy. Given the presence of advanced lung disease and poor adherence to immunosuppressant medication as well as clinical follow-ups, the patient was deemed unsuitable for re-lung transplantation. The optimization of his immunosuppressive medication was prioritized, and beta-blockers were added as part of the treatment for dynamic right ventricular outflow obstruction. He was referred to pulmonary rehabilitation, currently showing a partially favorable evolution to functional class II.

Objectives: To evaluate the prognostic role of functional status in older adults hospitalized for acute coronary syndrome (ACS) and the implications of the coronary event on functional decline during follow-up.

Materials and methods: This was a single-center, prospective cohort study including patients aged ≥65 years hospitalized for ACS with (STEMI) or without ST-segment elevation in 2022. Patients with total dependence or lacking a care network were excluded. Functional status was assessed using the Barthel Index and the Lawton and Brody scales at admission, 30 days, and one year post-discharge. The association between initial functional status and major adverse cardiovascular events (MACE) was analyzed, as well as the impact of ACS on functional status over the short and long term.

Results: A total of 110 patients older than 65 years were included (mean age 78.8±4.6 years; 61.8% male). At admission, 94.3% presented mild functional dependence according to the Barthel Index, with similar findings on the Lawton and Brody scales. At 30 days, a significant functional decline was observed (Barthel: 71.2±11.3, p<0.001; Lawton: 4.8±2.5, p=0.02), which persisted at one year. Initial functional status was not associated with MACE. ST-segment elevation ACS (STEMI) was an independent predictor of short-term functional decline (adjusted OR 1.75; p=0.04).

Conclusions: In older adults with ACS, initial functional status did not predict adverse events; however, significant functional decline was observed, particularly after STEMI. This underscores the importance of personalized strategies for managing this vulnerable population.

Objective: To compare the epidemiological, clinical and diagnostic characteristics of patients with native valve infective endocarditis (NVIE) and prosthetic valve infective endocarditis (PVIE) treated in a Peruvian reference center.

Materials and methods: A retrospective, descriptive study was conducted on patients diagnosed with NVIE and PVIE at the Instituto Nacional Cardiovascular (INCOR), EsSalud, between 2017 and 2023.

Results: A total of 65 NVIE and 55 PVIE cases were identified, with community-acquired infections predominating (92.3% in NVIE, 83.6% in PVIE). PVIE patients were older (mean age: 63.7 vs. 46.1 years, p<0.001) and had more comorbidities. The key predisposing factor in PVIE was prior endocarditis (20.0%) and valve repair (14.5%), while congenital heart disease (41.5%) and valvular disease (21.5%) predominated in NVIE. Fever and dyspnea were the most common symptoms in both groups. The aortic valve was the most frequently affected (78.5% in NVIE, 87.3% in PVIE). NVIE was associated with vegetation (92.3%) and leaflet perforations (41.5%), while PVIE showed more abscesses (34.5%) and pseudoaneurysms (36.4%). Cardiac computed tomography identified vegetations and pseudoaneurysms in both groups. Blood cultures were positive in 49.2% of NVIE and 65.5% of PVIE, with Streptococcus species predominant in NVIE and Staphylococcus species in PVIE. Surgical treatment was performed in 96.7% of NVIE and 82.6% of PVIE cases.

Conclusions: NVIE predominantly affected younger patients with congenital heart disease, while PVIE was more common in older patients with comorbidities. Transesophageal echocardiography and microbiological findings were essential for diagnosis.

Objective: Determine postoperative mortality and postoperative complications of patients undergoing cardiac surgery in the Cardiovascular Surgery Service of the Instituto Nacional Cardiovascular, EsSalud, Lima, Peru, in the year 2023.

Materials and methods: We carried out a descriptive, retrospective study of the patients' medical records.

Results: In 2023, 538 cardiac surgeries were performed in our center; overall mortality was 5.6%; however, mortality from elective surgeries was 4.1%. The mortality of isolated coronary surgery was 1.9% and of isolated valve surgery was 0.7%. Stroke occurred in 1.5% of patients; re-operation due to bleeding was performed in 8.1% of cases. The most frequently performed surgery was valve surgery (either isolated or multivalvular) with 40.1% of cases, followed by coronary surgery with 28.6%. The hospital stay for coronary surgery had a median of 9.9 days (8-12), and for isolated valve surgery it was 12.8 days (10-14).

Conclusions: The postoperative results of cardiac surgery at the National Cardiovascular Institute are acceptable and comparable to those of other international high-volume surgical centers.