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Resumen: La endocarditis infecciosa es una enfermedad mortal, que a pesar de las mejoras en su manejo sigue estando asociada a gran mortalidad y complicaciones graves. Se presenta el caso clínico de un hombre de 35 años con cuadro neurológico asociado a masa valvular aórtica con doble lesión valvular. Sospechando endocarditis infecciosa, fue intervenido de sustitución valvular aórtica. El paciente tenía antecedentes de espondiloartropatía tratada con certolizumab y de betatalasemia. Presentó en el postoperatorio un taponamiento cardiaco tardío, complicaciones en la cicatrización de la herida quirúrgica y un bloqueo aurículo-ventricular que requirió de implante de marcapasos. Al cuarto mes postoperatorio fue reintervenido con el hallazgo de un seudoaneurisma subanular, encontrando una desestructuración del anillo aórtico nativo. Se realizó una nueva reintervención pasados 5 meses, decidiéndose implante de homoinjerto aórtico en posición subcoronaria. Se realizó un exhaustivo diagnóstico diferencial sin confirmación del agente etiológico hasta la positividad de Tropheryma whipplei en el material quirúrgico de la última cirugía. Abstract: Infective endocarditis is a fatal disease, which, despite improvements in its management, is still associated with high mortality and serious complications. A case is presented of a 35 year-old man with neurological symptoms associated with an aortic valve mass with a double valvular lesion. Suspecting infectious endocarditis, aortic valve replacement was performed. The patient had a history of spondyloarthropathy (treated with certolizumab) and beta-thalassaemia. In the postoperative period, he had a late cardiac tamponade, complications in the healing of the surgical wound, and anatrial-ventricular block requiring pacemaker implantation. He was re-intervened in the fourth post-operative month, with the finding of a sub-annular pseudoaneurysm, and a disruption of the native aortic ring. In a further intervention after 5 months it was decided to implant an aortic homograft in a sub-coronary position. An exhaustive differential diagnosis was made without confirmation of the aetiological agent until Tropheryma whipplei was found in the surgical material of the last surgery. Palabras clave: Endocarditis, Enfermedades de las válvulas cardiacas, Enfermedades reumáticas, Tropheryma, Keywords: Endocarditis, Heart valve diseases, Rheumatic diseases, Tropheryma

OBJECTIVES: In recent years, the percentage of heart transplantation (HT) with short/medium-term assistance devices has increased. This study aims at analyzing primary graft failure and in-hospital mortality according to the type of care. MATERIAL AND METHODS: From January 2013 to December 2017 all patients undergoing urgent HT with circulatory/ventricular assistance were retrospectively and consecutively recruited. Combined transplants, retransplantations and pediatric transplants were excluded. The sample was divided in 10 groups according to the type of shot/medium term assistance devices. RESULTS: A total of 53 patients were recruited, 79% men, average age 49 ± 13 years. 26 patients (51%) had mechanical ventilation at the time of the HT. Primary graft failure occurred in 20 patients (38.5%), whilst it was more frequent in patients assisted with ECMO (8 patients in group 1 (45%) and 7 in group 2 (54%), p 0.5). 14 deaths (27%) were registered, whereas a higher mortality was observed in the group assisted with ECMO (6 patients in group 1 (34%) and 4 in group 2 (31%), p 0.6). Mortality was 17% in the group of non-urgent Levitronix. CONCLUSIONS: Despite not showing statistical significance due to the low number of patients in some subgroups, hospital mortality was high in HT patients with circulatory assistance. A trend towards a higher incidence of primary graft failure and mortality in patients assisted with ECMO was observed. The direct implantation of a centrifugal pump as a bridge to urgent transplantation could identify a subgroup with a better prognosis.

ResumenEl manejo conservador con inotrópicos y vasopresores en el shock cardiogénico ha mostrado ser insuficiente en muchos pacientes para mantener una perfusión adecuada y prevenir el fallo multiorgánico irreversible, lo que ha llevado a la mejora y a la utilización cada vez mayor de diferentes dispositivos de asistencia mecánica circulatoria de corta duración (balón intraaórtico de contrapulsación, TandemHeart, Impella, oxigenación de membrana extracorpórea [ECMO] y CentriMag Levitronix). Por ser la ECMO el dispositivo más versátil —capaz de proporcionar soporte a pacientes con fallo cardíaco, fallo respiratorio o fallo combinado cardiopulmonar durante días a semanas—, sus indicaciones se han ido diversificando, con un uso e interés en adultos creciente durante los últimos años, gracias también al progreso tecnológico y a la mejora en sus resultados. Es por ello esencial familiarizarse con la fisiología, las indicaciones, las estrategias de canulación, los principios de manejo y la evidencia sobre esta terapia, en la que enfatizaremos especialmente en esta revisión.AbstractMedical therapy with inotropes and vasopresors in the treatment of cardiogenic shock has failed in many patients to maintain adequate perfusion and to prevent irreversible end-organ failure, leading to improvement and increasing utilization of temporary mechanical circulatory support devices (intra-aortic balloon pump, TandemHeart, Impella, extracorporeal membrane oxygenation [ECMO] and CentriMag Levitronix). ECMO provides days to weeks of support for patients with respiratory, cardiac, or combined cardiopulmonary failure, and its use in adults is increasing as well as indications have expanded, due to advances in technology and improved outcomes. In this article specific emphasis is placed on physiology, clinical indications, cannulation techniques, management and evidence for ECMO, as it is essential to become familiar with this device.

OBJECTIVES: The aim of this study was to evaluate outcomes in our department after surgery for obstructive hypertrophic cardiomyopathy and to establish the impact of a delay on the indication for surgery. METHODS: From January 1998 to February 2011, 69 patients with obstructive hypertrophic cardiomyopathy and left ventricular outflow tract obstruction at rest were operated on by the same team, and followed up for at least 1 year. We retrospectively analysed clinical data, echocardiography and ambulatory Holter electrocardiogram findings before surgery, early after surgery, at 3 months and annually at follow-up, to detect possible prognostic determinants. RESULTS: We performed isolated septal myectomy in 59 patients and a combined procedure in 10 patients. Mean outflow tract gradient decreased by 72.2 mmHg (SD 37.3) and there was a mean reduction in thickness of 8.2 mm (SD 5.8) in the interventricular septum. Functional capacity, measured as New York Heart Association class, and angina of effort improved significantly after surgery (P< 0.0001). In-hospital mortality rate was 1.44% for isolated myectomy and 4.35% for combined procedures. Global actuarial survival at 5-year follow-up was 87.4%, but if those patients who were in functional class II or less at the time of surgery were considered, survival rose to 100%. However, 43 patients (62.3%) with functional class III or higher were operated upon. CONCLUSIONS: Clinical, haemodynamic and mortality outcomes after surgery were excellent, especially in those patients with mild or few symptoms. However, in our location, surgery is still undertaken at an advanced stage of the natural history of the disease, which may adversely affect prognosis.