Manuel J. Irarrazaval | Pontificia Universidad Catolica de Chile (original) (raw)
Papers by Manuel J. Irarrazaval
Brazilian Journal of Cardiovascular Surgery, 1999
Realizou-se estudo retrospectivo de pacientes submetidos a revascularizacao do miocardio com hist... more Realizou-se estudo retrospectivo de pacientes submetidos a revascularizacao do miocardio com historia de infarto do miocardio. Trinta e sete pacientes foram analisados. Constituimos dois grupos para estudo comparativo; o primeiro formado por pacientes operados ate 30 dias do infarto e o segundo formado por aqueles operados apos esse periodo. Foi observado que os grupos se assemelhavam quanto a idade, sexo, regiao do coracao em que ocorreu o infarto presenca ou nao de diabete, hipertensao arterial, choque cardiogenico. A mortalidade operatoria global foi de 13,5% (4 obitos em 18 pacientes para o Grupo I; 1 obito em 19 pacientes para o Grupo II - p = 0,180). Excluidos aqueles operados com ate 72 h de evolucao do infarto e comparando-se os dois grupos, a mortalidade global foi de 5,9% (1 obito em 15 pacientes para o Grupo I; 1 obito em 19 pacientes para o Grupo II - p = 1,0). Acreditamos, baseados na literatura, que a operacao de revascularizacao do miocardio possa ser feita com seguranca, especialmente apos as primeiras 72 horas do evento isquemico.
Survey of Anesthesiology, Oct 1, 1996
circulation is now very different, including membrane oxygenators, hemodilution, hypothermia, and... more circulation is now very different, including membrane oxygenators, hemodilution, hypothermia, and a closer surveillance of physiologic variables (10-16). The present study was designed to ascertain the changes in glomerular filtration rate, effective renal plasma flow, and tubular function in elective coronary surgical patients with normal preoperative renal function. Methods Under approval by the Medical School Review Board and previous informed consent, 14 patients scheduled Anesthesia Research Society
Revista Medica De Chile, Dec 1, 2001
In 1991, a technique to exclude aortic aneurysms from circulation inserting an endoluminal graft ... more In 1991, a technique to exclude aortic aneurysms from circulation inserting an endoluminal graft through the femoral artery, was described. This procedure, usually used for elective abdominal aneurysms, can also be used in the thoracic aorta. We report a 41 years old male with a Marfan syndrome, presenting with a descending aorta aneurysm that ruptured to the mediastinum and pleural cavity. He was compensated hemodynamically and an endovascular stent-graft was deployed at the ruptured zone, through the femoral artery. The postoperative evolution of the patient was uneventful. This technique will allow a less invasive treatment of ruptured aortic aneurysms (Rev Med Chile 2001; 129: 1439-43)
PubMed, Dec 1, 1996
Atherosclerosis is a systemic disease that may involve more than one territory. Myocardial infarc... more Atherosclerosis is a systemic disease that may involve more than one territory. Myocardial infarction can occur after carotid endarterectomy and stroke is a well documented morbidity of coronary artery bypass grafting. To optimize results, we have performed concomitant carotid endarterectomy and myocardial revascularization in selected cases, with severe disease in both territories. During a 13-year period, 27 patients were submitted for this procedure, 21 (77.8%) were male and the average age was 67.6 years (range 59-81). All patients had high-grade internal carotid artery stenosis, five (18.5%) were symptomatic. Coronary artery disease symptoms were: unstable angina in 12 patients (44.4%) and effort angina in 15 (55.6%). Two patients (7.4%) required reintervention for postoperative bleeding. Two cases (7.4%) had transient renal dysfunction. One patient, with multiple organ failure, died on the 16th postoperative day (3.7%). Follow up was obtained in 26 patients (96.3%). Survival at 5 years was 80.6%, 95.7% of those patients were free of any neurologic symptom. Combined carotid and coronary surgery is a safe treatment option for atherosclerosis of multiple territories in selected patients; long term benefits are also obtained.
Revista Medica De Chile, 1993
PubMed, Apr 1, 1993
Between January 1980 and December 1990, 16 patients with acute mitral insufficiency were operated... more Between January 1980 and December 1990, 16 patients with acute mitral insufficiency were operated on an emergency basis at our institution. They represented 1.8% of all mitral surgical cases. All of them were in acute pulmonary edema and 7 in cardiogenic shock. The etiology was ischemic in 6, degenerative in 4, infectious in 3, degenerative and infectious in 2 and traumatic in 1. The pathologic mechanism was chordal rupture in 8 patients (5 anterior) and papillary muscle rupture in the other 8 (5 posterior). A mitral valve replacement was performed in all cases. Two patients died and 7 had morbidity in the postoperative period. One patient died 6 months after surgery of congestive heart failure. Ten patients are in NYHA functional class I at a mean follow-up of 48.1 months. Acute mitral insufficiency has different etiologies and pathologic mechanisms. In spite of the severe clinical condition of these patients, mitral valve replacement has good immediate and long-term results.
Revista chilena de cardiología, 2014
La CIVPI tiene elevada mortalidad operatoria, especialmente en pacientes intervenidos de urgencia... more La CIVPI tiene elevada mortalidad operatoria, especialmente en pacientes intervenidos de urgencia y en los que requirieron balón de contra pulsación, pero la supervivencia alejada de los sobrevivientes es muy satisfactoria.
Springer eBooks, 1985
Recurrent angina after primary myocardial revascularization has resulted in an increasing number ... more Recurrent angina after primary myocardial revascularization has resulted in an increasing number of patients undergoing a second revascularization procedure. At The Cleveland Clinic the number of these operations done in 1983 reached 276 cases which represents more than 11% of our total myocardial revascularization work.
Revista Medica De Chile, Jul 1, 2012
Pelvic intravenous leiomyomatosis with intracardiac extension. Report of two cases Intravenous le... more Pelvic intravenous leiomyomatosis with intracardiac extension. Report of two cases Intravenous leiomyomatosis with extension into the heart is an infrequent entity described in 1907. Its clinical presentation is non-specifi c, although cardiac symptoms predominate. Diagnosis is based on clinical fi ndings and appropriate imaging. We report two females, aged 35 and 51 years. One of them presented with a pelvic mass and dyspnea, the other patient had severe cardiac failure on admission. Computed axial tomography scan allowed an accurate preoperative diagnosis on both patients. Successful one stage resection of the tumor was performed under cardiopulmonary bypass. Both patients are asymptomatic on follow up at 6 months and 25 years.
PubMed, Feb 1, 1995
We report nine patients with acute mitral regurgitation secondary to post-infarction papillary ru... more We report nine patients with acute mitral regurgitation secondary to post-infarction papillary rupture operated between 1980 and 1992. Seven cases had posterior papillary muscle rupture. All patients were in critical conditions with pulmonary edema at the moment of surgery. In eight cases, mitral valve replacement was performed (4 with mechanical prostheses) and in one, the valve was repaired with papillary muscle reimplantation. Six cases were also subjected to myocardial revascularization with sapheneous vein grafts. Two patients (22%) died during the postoperative period and 4 had postoperative complications. The seven survivors have been followed during 6 to 115 month. Of theses, one died six month after surgery due to congestive heart failure, three are in functional class I and the rest in functional class II. It is concluded that, although mitral valve replacement for papillary muscle rupture has a high operative mortality and morbidity, long term results are satisfactory.
American Journal of Cardiology, Feb 1, 1978
Emergency revascularization for unstable angina (defined according to criteria of the National Co... more Emergency revascularization for unstable angina (defined according to criteria of the National Cooperative Study Group) was performed in 100 consecutive patients. The mean interval from onset of pain to operation was one day. Nineteen patients had single-vessel narrowing of greater than 70% of lumen diameter, 32 double-vessel obstruction and 49 triple-vessel disease. Fourteen of these patients had left main trunk obstruction. Four patients died within 30 days, three from complications of myocardial infarction. Seventeen of 96 (18%) early survivors sustained perioperative infarction. After a mean follow-up of 42 months, four late deaths and three late infarctions occurred. Postoperative angiography in 47 patients (mean interval 14 months) showed 86% graft patency. Of 92 survivors, 72 are symptom-free. Three of the four operative deaths occurred within 24 hours postoperatively; in each of these, postmortem examination confirmed a recent myocardial infarction which antedated the operation, despite the absence of new infarction in the preoperative electrocardiogram or elevation of cardiac enzymes. Results from this emergency series suggest that, although myocardium may be salvaged in some instances, in other cases infarction has already occurred and treatment might better be directed toward alleviation of acute ischemia to provide a stable period in which diagnostic studies are performed and acute myocardial infarction may be ruled out.
PubMed, Jun 1, 1997
Sepsis from an infected cardiac valve can lead to bacterial seeding and destruction of the arteri... more Sepsis from an infected cardiac valve can lead to bacterial seeding and destruction of the arterial wall with formation of a mycotic aneurysm. The natural history of these lesions is the rupture. We report the case of a 20 year old female who was admitted to our institution with massive mitral regurgitation and emboli of the central nervous system and both lower extremities. She underwent emergency valve replacement and then, staged treatment of her ischemic legs and multiple asymptomatic mycotic aneurysms: Superior mesenteric, right common iliac and left superficial femoral arteries. A splenectomy was required to treat a splenic abscess. An aneurysm of a peripheral branch of the middle cerebral artery was medically treated, demonstrating reduction in size on subsequent angiogram. She recovered uneventfully and remains asymptomatic after 20 months of follow up. The development of new diagnostic and therapeutic tools has led to a decrease of these complications during infectious endocarditis. However, in the patient with late diagnosis and symptoms in different territories, the mycotic aneurysm must be kept in mind to provide the patient with appropriate treatment.
Revista Espanola De Cardiologia, 2000
Myocardial Revascularization of the Anterior Descending Artery with Classical Technique of Mammar... more Myocardial Revascularization of the Anterior Descending Artery with Classical Technique of Mammary Anastomosis Introduction and objectives. To establish the results obtained with the classical technique of mammary anastomosis of the anterior descending artery. Material and methods. Between January 1982 and July 1997, 154 patients received an anastomosis of the left internal mammary artery to the left anterior descending coronary artery with use of the classical technique (sternotomy and extracorporeal circulation). Results. There was no operative mortality in our group, nor paraoperational myocardial infarction, nor cephalic vascular accidents. One (0.6%) patient had sternal wound infection, and another (0.6%) required another reoperation for postoperational bleeding. All (100%) were followed-up from 3-183 months (average 64.4months). Actuarial global survival at 5, 10 and 15 years was 95.6% ± 2.1; 92.1% ± 4 and 85.5 ± 7.5 respectively, and the actuarial probability of being free from cardiac death was 99% ± 0.9; 99% and 99%. The actuarial probability of being free from myocardial infarction was 99% ± 0.9; 99% ± 0.9 and 99%; and from angina was 95% ± 2.2; 86.9% ± 4.9 and 74.5% ± 12.2 at 5, 10 and 15 years. Finally, the actuarial probability of being free from reoperation was 99% ± 0.9; 99%; 99% and from angioplasty 96.9% ± 1.7; 91.4% ± 4.1; 91.4% ± 4.1 at 5, 10 and 15 years, respectively. The average hospital charges in the last 10% of the patients was U$ 6.200. Conclusion. Revascularization of the left anterior descending with the left internal mammary artery and the classical technique (sternotomy and extracorporeal circulation) is a safe, minimal risk, effective, long lasting and cost efficient procedure with excellent results at 10 and 15 years.
Anaesthesia and Intensive Care, Oct 1, 1996
The aim of the study was to compare three anaesthetic agents in patients with ejection fraction b... more The aim of the study was to compare three anaesthetic agents in patients with ejection fraction below 0.40 subjected to coronary revascularization surgery. Twenty-five elective coronary surgical patients with ejection fraction below 0.40 were prospectively studied. Premedication was pethidine 1 mg/kg and induction was fentanyl 0.03 mg/kg and pancuronium 0.1 mg/kg. The patients were randomized to one of three maintenance techniques (fentanyl, isoflurane or halothane). Radial arterial pressure, heart rate, right atrial pressure, pulmonary arterial and occluded pressures, and thermodilution cardiac output were measured, and cardiac index and resistance calculated, at the following times: before induction; 5 min after intubation; 2 min after sternotomy; immediately after discontinuation of bypass; 15 min afterwards; immediately after sternal closure; during suture of the skin; 5 min after arrival in the postoperative care unit; and 60 min postoperatively. Mean arterial pressure decreased significantly in the isoflurane group and nonsignificantly in the halothane group after induction. Cardiac index decreased significantly in the isoflurane group and nonsignificantly in the halothane group after induction and after sternotomy. Neither pressure nor flow decreased in patients receiving fentanyl. Following weaning from cardiopulmonary bypass, systemic vascular resistance decreased significantly in all groups. Cardiac index, however, did not increase above control values and arterial pressure consequently decreased; there was no significant difference between groups.
Revista médica de Chile, 2007
Cryoablation of pulmonary veins as complementary treatment of atrial fibrillation in valvular sur... more Cryoablation of pulmonary veins as complementary treatment of atrial fibrillation in valvular surgery Background: The Cox MAZE III operation for the treatment of atrial fibrillation (AF) is complex and consumes significant operative time. Cryoablation of the pulmonary veins (CPV) is a simpler alternative for patients that require concomitant valvular surgery. Aim: To evaluate CPV in patients with AF submitted to valvular surgery. Patients and Methods: Twenty one patients had simultaneous valvular surgery and CPV, 81% of them had permanent AF for an average of 5 years. Twenty patients had mitral valve disease. The etiology was rheumatic in 14. Average left atrial diameter was 60 mm. In 7 patients the mitral valve was replaced, in 5 it was repaired, in 7 both mitral and aortic valve were replaced, in 1 the mitral valve was repaired and the aortic valve was replaced and in 1 only the aortic valve was replaced. A combined transeptal and superior approach was used for all patients. The CPV was performed after the valvular procedure with cryothermy at-60°C for 2 minutes with two 15 mm cryoprobes applied simultaneously. Results: CPV increased surgical time by 10 to 20 minutes. Operative mortality was 4.8% (1 patient). One patient developed a pericardial effusion and another a complete heart block that required a permanent pacemaker. All patients improved their functional class. At the end of an average 10.5 months of follow-up, 50% of patients were in normal sinus rhythm and 25% persisted in AF. The remaining patients were in some type of regular rhythm. Conclusions: CPV as a complementary procedure in patients with AF undergoing valvular surgery had good results to abate AF. It restored normal sinus rhythm in 50% of the cases, with low morbidity and mortality and little increment in surgical time (Rev Méd Chile 2007; 135: 871-8).
Revista médica de Chile, 2000
... El hecho que la fenoxibenzamina disminuya la liberación de NPY podría ser interpretado como u... more ... El hecho que la fenoxibenzamina disminuya la liberación de NPY podría ser interpretado como una indicación que la liberación de estos co-transmisores es diferencial, o que esta ... 1. LUNDBERG JM, TERENIUS L, HOKFELT T, MARTLING C, TATEMOTO K, MUTT V, ET AL. ...
Revista médica de Chile, 2005
Endovascular treatment of descending aorta trauma Background: Mortality of traumatic aortic lesio... more Endovascular treatment of descending aorta trauma Background: Mortality of traumatic aortic lesions is over 80%. A group of those who survive, develop a chronic pseudo aneurism, usually asymptomatic, that is detected during imaging studies. Since conventional surgical treatment of traumatic aortic lesions has a great mortality, endovascular treatment has been used as an alternative treatment in the last decade. Aim: To report our experience with endovascular treatment of traumatic aortic lesions. Patients and methods: Report of seven patients aged 22 to 65 years, with traumatic aortic lesions. Under general anesthesia an endovascular prosthesis was inserted through the femoral artery. Results: No complications were observed in the postoperative period, and after a follow up ranging from 4 to 40 months, no endoleaks or other complications have been detected. Conclusions: Endovascular treatment of traumatic aortic lesions has good immediate and midterm results (
Revista Medica De Chile, Dec 1, 2021
Open surgical treatment of thoracoabdominal aortic aneurysm. Experience in 45 patients Background... more Open surgical treatment of thoracoabdominal aortic aneurysm. Experience in 45 patients Background: Thoracoabdominal aortic aneurysm (TAAA) is an infrequent disease and demands a highly specialized and experienced management. Open repair (OR) is the gold standard but it is associated with significant morbidity and mortality. Paraplegia and renal failure are the most important complications. Aim: To report our results with OR treatment of TAAA. Material and Methods: Descriptive study including all patients with TAAA operated electively and consecutively by OR between 1983 and 2019. Main outcomes are operative mortality, renal and neurological morbidity, and long-term survival. Results: We report 45 operated patients aged 33 to 84 years, 74% males. Aneurysm extension according to Crawford classification was I in 18%, II in 18 %, III in 36% and IV in 29%. Operative mortality was 4%. The frequency of paraplegia or paraparesis at discharge was 9%. No patient was discharged on hemodialysis. Survival at 5 and 10 years were 60% and 40% respectively. Conclusions: OR of TAAA is a complex procedure. Our results show perioperative mortality rates comparable to highly experienced centers. Although being a major procedure, OR remains an alternative to treat this serious condition.
Brazilian Journal of Cardiovascular Surgery, 1999
Realizou-se estudo retrospectivo de pacientes submetidos a revascularizacao do miocardio com hist... more Realizou-se estudo retrospectivo de pacientes submetidos a revascularizacao do miocardio com historia de infarto do miocardio. Trinta e sete pacientes foram analisados. Constituimos dois grupos para estudo comparativo; o primeiro formado por pacientes operados ate 30 dias do infarto e o segundo formado por aqueles operados apos esse periodo. Foi observado que os grupos se assemelhavam quanto a idade, sexo, regiao do coracao em que ocorreu o infarto presenca ou nao de diabete, hipertensao arterial, choque cardiogenico. A mortalidade operatoria global foi de 13,5% (4 obitos em 18 pacientes para o Grupo I; 1 obito em 19 pacientes para o Grupo II - p = 0,180). Excluidos aqueles operados com ate 72 h de evolucao do infarto e comparando-se os dois grupos, a mortalidade global foi de 5,9% (1 obito em 15 pacientes para o Grupo I; 1 obito em 19 pacientes para o Grupo II - p = 1,0). Acreditamos, baseados na literatura, que a operacao de revascularizacao do miocardio possa ser feita com seguranca, especialmente apos as primeiras 72 horas do evento isquemico.
Survey of Anesthesiology, Oct 1, 1996
circulation is now very different, including membrane oxygenators, hemodilution, hypothermia, and... more circulation is now very different, including membrane oxygenators, hemodilution, hypothermia, and a closer surveillance of physiologic variables (10-16). The present study was designed to ascertain the changes in glomerular filtration rate, effective renal plasma flow, and tubular function in elective coronary surgical patients with normal preoperative renal function. Methods Under approval by the Medical School Review Board and previous informed consent, 14 patients scheduled Anesthesia Research Society
Revista Medica De Chile, Dec 1, 2001
In 1991, a technique to exclude aortic aneurysms from circulation inserting an endoluminal graft ... more In 1991, a technique to exclude aortic aneurysms from circulation inserting an endoluminal graft through the femoral artery, was described. This procedure, usually used for elective abdominal aneurysms, can also be used in the thoracic aorta. We report a 41 years old male with a Marfan syndrome, presenting with a descending aorta aneurysm that ruptured to the mediastinum and pleural cavity. He was compensated hemodynamically and an endovascular stent-graft was deployed at the ruptured zone, through the femoral artery. The postoperative evolution of the patient was uneventful. This technique will allow a less invasive treatment of ruptured aortic aneurysms (Rev Med Chile 2001; 129: 1439-43)
PubMed, Dec 1, 1996
Atherosclerosis is a systemic disease that may involve more than one territory. Myocardial infarc... more Atherosclerosis is a systemic disease that may involve more than one territory. Myocardial infarction can occur after carotid endarterectomy and stroke is a well documented morbidity of coronary artery bypass grafting. To optimize results, we have performed concomitant carotid endarterectomy and myocardial revascularization in selected cases, with severe disease in both territories. During a 13-year period, 27 patients were submitted for this procedure, 21 (77.8%) were male and the average age was 67.6 years (range 59-81). All patients had high-grade internal carotid artery stenosis, five (18.5%) were symptomatic. Coronary artery disease symptoms were: unstable angina in 12 patients (44.4%) and effort angina in 15 (55.6%). Two patients (7.4%) required reintervention for postoperative bleeding. Two cases (7.4%) had transient renal dysfunction. One patient, with multiple organ failure, died on the 16th postoperative day (3.7%). Follow up was obtained in 26 patients (96.3%). Survival at 5 years was 80.6%, 95.7% of those patients were free of any neurologic symptom. Combined carotid and coronary surgery is a safe treatment option for atherosclerosis of multiple territories in selected patients; long term benefits are also obtained.
Revista Medica De Chile, 1993
PubMed, Apr 1, 1993
Between January 1980 and December 1990, 16 patients with acute mitral insufficiency were operated... more Between January 1980 and December 1990, 16 patients with acute mitral insufficiency were operated on an emergency basis at our institution. They represented 1.8% of all mitral surgical cases. All of them were in acute pulmonary edema and 7 in cardiogenic shock. The etiology was ischemic in 6, degenerative in 4, infectious in 3, degenerative and infectious in 2 and traumatic in 1. The pathologic mechanism was chordal rupture in 8 patients (5 anterior) and papillary muscle rupture in the other 8 (5 posterior). A mitral valve replacement was performed in all cases. Two patients died and 7 had morbidity in the postoperative period. One patient died 6 months after surgery of congestive heart failure. Ten patients are in NYHA functional class I at a mean follow-up of 48.1 months. Acute mitral insufficiency has different etiologies and pathologic mechanisms. In spite of the severe clinical condition of these patients, mitral valve replacement has good immediate and long-term results.
Revista chilena de cardiología, 2014
La CIVPI tiene elevada mortalidad operatoria, especialmente en pacientes intervenidos de urgencia... more La CIVPI tiene elevada mortalidad operatoria, especialmente en pacientes intervenidos de urgencia y en los que requirieron balón de contra pulsación, pero la supervivencia alejada de los sobrevivientes es muy satisfactoria.
Springer eBooks, 1985
Recurrent angina after primary myocardial revascularization has resulted in an increasing number ... more Recurrent angina after primary myocardial revascularization has resulted in an increasing number of patients undergoing a second revascularization procedure. At The Cleveland Clinic the number of these operations done in 1983 reached 276 cases which represents more than 11% of our total myocardial revascularization work.
Revista Medica De Chile, Jul 1, 2012
Pelvic intravenous leiomyomatosis with intracardiac extension. Report of two cases Intravenous le... more Pelvic intravenous leiomyomatosis with intracardiac extension. Report of two cases Intravenous leiomyomatosis with extension into the heart is an infrequent entity described in 1907. Its clinical presentation is non-specifi c, although cardiac symptoms predominate. Diagnosis is based on clinical fi ndings and appropriate imaging. We report two females, aged 35 and 51 years. One of them presented with a pelvic mass and dyspnea, the other patient had severe cardiac failure on admission. Computed axial tomography scan allowed an accurate preoperative diagnosis on both patients. Successful one stage resection of the tumor was performed under cardiopulmonary bypass. Both patients are asymptomatic on follow up at 6 months and 25 years.
PubMed, Feb 1, 1995
We report nine patients with acute mitral regurgitation secondary to post-infarction papillary ru... more We report nine patients with acute mitral regurgitation secondary to post-infarction papillary rupture operated between 1980 and 1992. Seven cases had posterior papillary muscle rupture. All patients were in critical conditions with pulmonary edema at the moment of surgery. In eight cases, mitral valve replacement was performed (4 with mechanical prostheses) and in one, the valve was repaired with papillary muscle reimplantation. Six cases were also subjected to myocardial revascularization with sapheneous vein grafts. Two patients (22%) died during the postoperative period and 4 had postoperative complications. The seven survivors have been followed during 6 to 115 month. Of theses, one died six month after surgery due to congestive heart failure, three are in functional class I and the rest in functional class II. It is concluded that, although mitral valve replacement for papillary muscle rupture has a high operative mortality and morbidity, long term results are satisfactory.
American Journal of Cardiology, Feb 1, 1978
Emergency revascularization for unstable angina (defined according to criteria of the National Co... more Emergency revascularization for unstable angina (defined according to criteria of the National Cooperative Study Group) was performed in 100 consecutive patients. The mean interval from onset of pain to operation was one day. Nineteen patients had single-vessel narrowing of greater than 70% of lumen diameter, 32 double-vessel obstruction and 49 triple-vessel disease. Fourteen of these patients had left main trunk obstruction. Four patients died within 30 days, three from complications of myocardial infarction. Seventeen of 96 (18%) early survivors sustained perioperative infarction. After a mean follow-up of 42 months, four late deaths and three late infarctions occurred. Postoperative angiography in 47 patients (mean interval 14 months) showed 86% graft patency. Of 92 survivors, 72 are symptom-free. Three of the four operative deaths occurred within 24 hours postoperatively; in each of these, postmortem examination confirmed a recent myocardial infarction which antedated the operation, despite the absence of new infarction in the preoperative electrocardiogram or elevation of cardiac enzymes. Results from this emergency series suggest that, although myocardium may be salvaged in some instances, in other cases infarction has already occurred and treatment might better be directed toward alleviation of acute ischemia to provide a stable period in which diagnostic studies are performed and acute myocardial infarction may be ruled out.
PubMed, Jun 1, 1997
Sepsis from an infected cardiac valve can lead to bacterial seeding and destruction of the arteri... more Sepsis from an infected cardiac valve can lead to bacterial seeding and destruction of the arterial wall with formation of a mycotic aneurysm. The natural history of these lesions is the rupture. We report the case of a 20 year old female who was admitted to our institution with massive mitral regurgitation and emboli of the central nervous system and both lower extremities. She underwent emergency valve replacement and then, staged treatment of her ischemic legs and multiple asymptomatic mycotic aneurysms: Superior mesenteric, right common iliac and left superficial femoral arteries. A splenectomy was required to treat a splenic abscess. An aneurysm of a peripheral branch of the middle cerebral artery was medically treated, demonstrating reduction in size on subsequent angiogram. She recovered uneventfully and remains asymptomatic after 20 months of follow up. The development of new diagnostic and therapeutic tools has led to a decrease of these complications during infectious endocarditis. However, in the patient with late diagnosis and symptoms in different territories, the mycotic aneurysm must be kept in mind to provide the patient with appropriate treatment.
Revista Espanola De Cardiologia, 2000
Myocardial Revascularization of the Anterior Descending Artery with Classical Technique of Mammar... more Myocardial Revascularization of the Anterior Descending Artery with Classical Technique of Mammary Anastomosis Introduction and objectives. To establish the results obtained with the classical technique of mammary anastomosis of the anterior descending artery. Material and methods. Between January 1982 and July 1997, 154 patients received an anastomosis of the left internal mammary artery to the left anterior descending coronary artery with use of the classical technique (sternotomy and extracorporeal circulation). Results. There was no operative mortality in our group, nor paraoperational myocardial infarction, nor cephalic vascular accidents. One (0.6%) patient had sternal wound infection, and another (0.6%) required another reoperation for postoperational bleeding. All (100%) were followed-up from 3-183 months (average 64.4months). Actuarial global survival at 5, 10 and 15 years was 95.6% ± 2.1; 92.1% ± 4 and 85.5 ± 7.5 respectively, and the actuarial probability of being free from cardiac death was 99% ± 0.9; 99% and 99%. The actuarial probability of being free from myocardial infarction was 99% ± 0.9; 99% ± 0.9 and 99%; and from angina was 95% ± 2.2; 86.9% ± 4.9 and 74.5% ± 12.2 at 5, 10 and 15 years. Finally, the actuarial probability of being free from reoperation was 99% ± 0.9; 99%; 99% and from angioplasty 96.9% ± 1.7; 91.4% ± 4.1; 91.4% ± 4.1 at 5, 10 and 15 years, respectively. The average hospital charges in the last 10% of the patients was U$ 6.200. Conclusion. Revascularization of the left anterior descending with the left internal mammary artery and the classical technique (sternotomy and extracorporeal circulation) is a safe, minimal risk, effective, long lasting and cost efficient procedure with excellent results at 10 and 15 years.
Anaesthesia and Intensive Care, Oct 1, 1996
The aim of the study was to compare three anaesthetic agents in patients with ejection fraction b... more The aim of the study was to compare three anaesthetic agents in patients with ejection fraction below 0.40 subjected to coronary revascularization surgery. Twenty-five elective coronary surgical patients with ejection fraction below 0.40 were prospectively studied. Premedication was pethidine 1 mg/kg and induction was fentanyl 0.03 mg/kg and pancuronium 0.1 mg/kg. The patients were randomized to one of three maintenance techniques (fentanyl, isoflurane or halothane). Radial arterial pressure, heart rate, right atrial pressure, pulmonary arterial and occluded pressures, and thermodilution cardiac output were measured, and cardiac index and resistance calculated, at the following times: before induction; 5 min after intubation; 2 min after sternotomy; immediately after discontinuation of bypass; 15 min afterwards; immediately after sternal closure; during suture of the skin; 5 min after arrival in the postoperative care unit; and 60 min postoperatively. Mean arterial pressure decreased significantly in the isoflurane group and nonsignificantly in the halothane group after induction. Cardiac index decreased significantly in the isoflurane group and nonsignificantly in the halothane group after induction and after sternotomy. Neither pressure nor flow decreased in patients receiving fentanyl. Following weaning from cardiopulmonary bypass, systemic vascular resistance decreased significantly in all groups. Cardiac index, however, did not increase above control values and arterial pressure consequently decreased; there was no significant difference between groups.
Revista médica de Chile, 2007
Cryoablation of pulmonary veins as complementary treatment of atrial fibrillation in valvular sur... more Cryoablation of pulmonary veins as complementary treatment of atrial fibrillation in valvular surgery Background: The Cox MAZE III operation for the treatment of atrial fibrillation (AF) is complex and consumes significant operative time. Cryoablation of the pulmonary veins (CPV) is a simpler alternative for patients that require concomitant valvular surgery. Aim: To evaluate CPV in patients with AF submitted to valvular surgery. Patients and Methods: Twenty one patients had simultaneous valvular surgery and CPV, 81% of them had permanent AF for an average of 5 years. Twenty patients had mitral valve disease. The etiology was rheumatic in 14. Average left atrial diameter was 60 mm. In 7 patients the mitral valve was replaced, in 5 it was repaired, in 7 both mitral and aortic valve were replaced, in 1 the mitral valve was repaired and the aortic valve was replaced and in 1 only the aortic valve was replaced. A combined transeptal and superior approach was used for all patients. The CPV was performed after the valvular procedure with cryothermy at-60°C for 2 minutes with two 15 mm cryoprobes applied simultaneously. Results: CPV increased surgical time by 10 to 20 minutes. Operative mortality was 4.8% (1 patient). One patient developed a pericardial effusion and another a complete heart block that required a permanent pacemaker. All patients improved their functional class. At the end of an average 10.5 months of follow-up, 50% of patients were in normal sinus rhythm and 25% persisted in AF. The remaining patients were in some type of regular rhythm. Conclusions: CPV as a complementary procedure in patients with AF undergoing valvular surgery had good results to abate AF. It restored normal sinus rhythm in 50% of the cases, with low morbidity and mortality and little increment in surgical time (Rev Méd Chile 2007; 135: 871-8).
Revista médica de Chile, 2000
... El hecho que la fenoxibenzamina disminuya la liberación de NPY podría ser interpretado como u... more ... El hecho que la fenoxibenzamina disminuya la liberación de NPY podría ser interpretado como una indicación que la liberación de estos co-transmisores es diferencial, o que esta ... 1. LUNDBERG JM, TERENIUS L, HOKFELT T, MARTLING C, TATEMOTO K, MUTT V, ET AL. ...
Revista médica de Chile, 2005
Endovascular treatment of descending aorta trauma Background: Mortality of traumatic aortic lesio... more Endovascular treatment of descending aorta trauma Background: Mortality of traumatic aortic lesions is over 80%. A group of those who survive, develop a chronic pseudo aneurism, usually asymptomatic, that is detected during imaging studies. Since conventional surgical treatment of traumatic aortic lesions has a great mortality, endovascular treatment has been used as an alternative treatment in the last decade. Aim: To report our experience with endovascular treatment of traumatic aortic lesions. Patients and methods: Report of seven patients aged 22 to 65 years, with traumatic aortic lesions. Under general anesthesia an endovascular prosthesis was inserted through the femoral artery. Results: No complications were observed in the postoperative period, and after a follow up ranging from 4 to 40 months, no endoleaks or other complications have been detected. Conclusions: Endovascular treatment of traumatic aortic lesions has good immediate and midterm results (
Revista Medica De Chile, Dec 1, 2021
Open surgical treatment of thoracoabdominal aortic aneurysm. Experience in 45 patients Background... more Open surgical treatment of thoracoabdominal aortic aneurysm. Experience in 45 patients Background: Thoracoabdominal aortic aneurysm (TAAA) is an infrequent disease and demands a highly specialized and experienced management. Open repair (OR) is the gold standard but it is associated with significant morbidity and mortality. Paraplegia and renal failure are the most important complications. Aim: To report our results with OR treatment of TAAA. Material and Methods: Descriptive study including all patients with TAAA operated electively and consecutively by OR between 1983 and 2019. Main outcomes are operative mortality, renal and neurological morbidity, and long-term survival. Results: We report 45 operated patients aged 33 to 84 years, 74% males. Aneurysm extension according to Crawford classification was I in 18%, II in 18 %, III in 36% and IV in 29%. Operative mortality was 4%. The frequency of paraplegia or paraparesis at discharge was 9%. No patient was discharged on hemodialysis. Survival at 5 and 10 years were 60% and 40% respectively. Conclusions: OR of TAAA is a complex procedure. Our results show perioperative mortality rates comparable to highly experienced centers. Although being a major procedure, OR remains an alternative to treat this serious condition.