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Aneurysm of the left atrial appendage (LAA) is very infrequent. We present the case of 24-year-old man in functional class I with atrial fibrillation but no other symptoms. Radiology showed an abnormality in the outline of the heart. Echocardiography revealed left appendage aneurysm. After median sternotomy, aneurysmectomy was performed under cardiopulmonary bypass without cross clamping. Atrial fibrillation ceased as soon as the aneurysm had been removed. There were no postoperative complications. Three months later the patient remained asymptomatic and in sinus rhythm.

We evaluated our results over 13 years with the aortic-position Medtronic Intact bioprosthesis. Our study involved 91 consecutive patients with isolated aortic valve replacement with the Medtronic Intact bioprosthesis. The follow-up was complete for 95%. Mean follow-up was 6.61 years (range 16 days-13 years), 590 patient years. Early mortality rate was 3.3%. Late mortality was 23 patients. Survival at 13 years was 53.52% (SD = 7.63%). The linearized rate of major thromboembolism was 0.34% per patient year; rate of major bleeding events was 0.33% per patient year. The rate of nonstructural dysfunction was 0.16% per patient year. Rate of reoperation was 0.53% and rate of structural valve deterioration was 0.16% per patient year. New York Heart Association (NYHA) postoperative classes were I to II in 92.21%. Gradients were as follows: 21 to 23.87 mm Hg, 23 to 18 mm Hg, 25 to 15.5 mm Hg, and 27 to 16.50 mm Hg. Structural valve deterioration was low during the 13 years of follow-up. Valve gradients and areas remained the same over the follow-up period. The Medtronic Intact bioprosthesis shows excellent clinical and hemodynamic performance at 13 years of follow up.

Background and Aim of the Study: Our aim was to compare the CarboMedics (CM) and Monostrut (M) mechanical heart valve prostheses in the aortic position. These prostheses have been studied extensively in the past, both have well-defined characteristics, and have not been modified for many years., Methods: This randomized, prospective study included 200 consecutive patients; 100 received the CM prosthesis and 100 the M prosthesis. Both groups were statistically similar in terms of age, aortic valve lesion, and preoperative clinical and surgical characteristics. Mean follow up was 5.58 years (range: 2 months to 11 years); total follow up was 1095 patient-years (pt-yr) (CM 5.33 years, 528 pt-yr; M 5.85 years, 567 pt-yr)., Results: Early mortality rates were 1% in the CM group and 3% in the M group. Late mortality rates were 7% and 9%, respectively. Mean (+/- SD) survival rates at 11 years were 80.51 +/- 7.36% for the CM group and 79.62 +/- 5.59% for the M group. There were no cases of mechanical valve failure in either group. The linearized rates of major thromboembolism were 1.03% and 0.20% per pt-yr for the CM and M groups, respectively; the rates of major bleeding-events were 0.71% and 0.61% per pt-yr, respectively. The rate of paravalvular leak was 0.35% and 0% per pt-yr in the CM and M groups, respectively. Postoperative NYHA class was I-II in 95.83% of CM patients, and in 94.37% of M patients., Conclusion: Clinical results with CarboMedics and Monostrut prostheses are highly satisfactory, but no superiority of one valve over the other can be identified.

Rupture of the left ventricular wall is an infrequent but lethal complication after mitral valve replacement. We present the case of a patient in whom such a rupture was successfully repaired in the intensive care unit with a patch of Teflon felt stuck in place with glue.

Patency of coronary by-pass grafts is a challenge for the surgeon in order to reduce graft obstructions due to technical reasons. We analyze different published methods and show our experience with 1,010 coronary grafts whose flow was measured using a electromagnetic flowmeter. We also show our experience with infra-red angiography. We consider these two methods more practical and feasible than others because it is possible to save between 3 to 4% of the coronary grafts and to make an immediate record and to determine the relative prognosis of the grafts patency.

We report a case that, to the best of our knowledge, is the only published instance of infection of a pacemaker and its leads by Brucella melitensis. Furthermore, this case suggests that B. melitensis may be able to persist around pacemaker devices despite its having been eliminated from the rest of the body. The patient was a sheep shearer who had just undergone a 45-day course of antibiotic therapy for brucella and had been considered cured on the basis of negative blood cultures.

We present a case of survival as a result of surgical intervention after perforation of the left ventricle during the insertion of a pleural drainage tube. Surgical intervention was facilitated by the fact that the drainage tube responsible for the suspected perforation of the cardiac cavity was clamped and fastened, as opposed to withdrawn. The location of the perforation was established by measuring the pressure curve through the drainage tube.

Since 1988, the Spanish Society of Cardiovascular Surgery has been enjoying through its National Intervention Registry a complete information about the number and type of cardiovascular surgical operations, yearly performed all over the country. However a computerized National Data Bank would probably offer a more specific, quick and complete information, although its organization is more complex. We want to demonstrate that the creation of a National Data Bank is possible in our country. The following condition has been essential to carry out this initial work on the National Data Bank: The previous existence of a National Intervention Registry, the edition of an universally accepted questionnaire of 33 questions with multiple answers for each question, which includes quantitative and qualitative aspects like mortality, the acquisition of the software Pats Programme by most cardiovascular centers, and finally the enthusiastic dedication of 6 surgical groups. The results of this work also shown in multiples figures, are the final product of the computerized fusion of 6 cardiovascular centers data on operations performed through the year 1991. The results clearly offer a more specific, detailed and extensive information about quantitative and qualitative aspects of the surgical data, than that obtained through the National Intervention Registry. These results should not be extrapolated at national level, as the surgical groups involved in this work are not homogeneous and its number is quite small. This initial study shows that the creation of the National Data Bank of the Spanish Society of Cardiovascular Surgery or other scientific society is possible in our country. Its usefulness is beyond any doubt.

Of 284 patients undergoing open mitral commissurotomy for mitral stenosis from January 1978 to December 1985, 81 patients had a densely scarred or partly calcified valve. In this study, we evaluated the postoperative results in these 81 patients. There were no operative or late deaths. Seventy-seven patients (95%) are in Functional Class I or II. Three patients required reoperation 3, 30, and 50 months after the initial procedure because of moderate or severe residual mitral regurgitation. After valvotomy there were four episodes of embolism. The actuarial rate of freedom from any complication (mortality, reoperation, congestive heart failure, and thromboembolic events) was 89.3% +/- 3.9% (mean +/- standard error of the mean) 8 years after operation. We conclude that for a follow-up period of 8 years, the stenotic mitral valve with anatomical deformities can be salvaged with satisfactory results. Therefore, we believe that this approach, at present, is a better alternative than prosthetic replacement with any type of valve presently available.

We have used contrast two-dimensional echocardiography in the intraoperative evaluation of aortic and mitral regurgitation in 35 patients undergoing cardiac operations. All of them underwent previous cardiac catheterization in order to document the presence and severity of regurgitation. With the pericardium open, a catheter was introduced into the left ventricle (to document mitral regurgitation) or into the ascending aorta (to document aortic regurgitation). The two-dimensional echocardiographic probe was placed on the anterior surface of the right ventricle to obtain a basal image, equivalent to a conventional parasternal longitudinal view. Dextrose in water (5 ml) was rapidly hand-injected through the catheter, while echocardiograms were recorded on videotape. The observation of contrast medium (microbubbles) flowing in the retrograde direction through the incompetent valve was carefully evaluated with the same scoring system used in the hemodynamic laboratory. In 34 cases there was agreement between angiographic and echocardiographic evaluation of the presence and severity of mitral and aortic regurgitation. Only one case was evaluated as mild aortic regurgitation by angiography and moderate aortic regurgitation by echocardiography. There were no false positives or false negatives in the study. In view of the high degree of correlation between contrast two-dimensional echocardiography and hemodynamic data, we suggest that our method is an important tool for the cardiac surgeon. In addition, the present approach overcame the disadvantages of the conventional intraoperative methods, most of which are performed in a nonbeating or fibrillating heart.

In this study of 46 patients with mitral valve prostheses, we report on the accuracy of the left ventricular maximum filling velocity (LVMFV) index as a diagnostic tool for valve dysfunction. Echocardiographic left ventricular internal dimensions were measured every 0.05 seconds, and every measure was transferred to an axis system. The tangent to this curve was traced at the point of maximum rate of increase of dimension, and the slope in mm/sec represents the LVMFV index. Six patients, each with an obstructed mitral valve prosthesis, had a reduced LVMFV index (p < 0.001). On the other hand, eight patients with a paravalvular leak showed a LVMFV index significantly higher (p < 0.05) than patients with a normally functioning mitral valve prosthesis. The results of this study suggest that analysis of the LVMFV index can be a useful and reliable substitute for other noninvasive diagnostic techniques in evaluating certain patients with suspected prosthetic mitral valve malfunction.

A retrospective study was designed to define the independent determinants of late results in 282 consecutive patients operated on for mitral stenosis between 1978 and 1985. A total of 25 variables were investigated by multivariate discriminant analysis for their possible influence on symptomatic outcome, subsequent reoperation, postoperative thromboembolism, and death. All the patients underwent a conservative mitral valve operation. In addition, 25 patients required concomitant tricuspid annuloplasty. The surgical mortality rate was 1.4% and the late mortality, reoperation, and thromboembolism rates were, respectively, 0.14%, 0.80%, and 0.95%/pt-yr. Actuarial probability of complication-free survival at 8 years was 83% +/- 3.7%. Left atrial size on the M-mode echocardiograms, tricuspid annuloplasty, mitral annuloplasty, presence of left atrial thrombus, male gender, and separation of subvalvular apparatus portended a significantly higher likelihood of poor postoperative symptomatic status (p less than 0.0005). Preoperative mild mitral regurgitation, E to F slope on the M-mode echocardiogram, and tricuspid annuloplasty had significant influence on the need for late reoperation (p less than 0.05). Postoperative atrial fibrillation, mitral valve amplitude on the M-mode echocardiogram, preoperative embolism, and residual mitral incompetence had an independent predictive power for postoperative thromboembolism (p less than 0.05). Finally, preoperative atrial fibrillation, preoperative cardiothoracic ratio, postoperative left atrial size, and postoperative atrial fibrillation all influenced the probability of long-term complications. These results suggest that earlier operation should be considered in patients with mitral stenosis, to increase the complication-free survival rate.

Because of its excellent durability, low-flow gradient and low incidence of valve-related complications, the Björk-Shiley prosthesis is one of the most widely used valve prostheses in the world. Component failures are rare with this prosthesis. The following report, however, described a case of early disc dislodgement of a mitral Björk-Shiley prosthetic valve.

We review 109 patients with congenital heart disease under (two year of life, surgically treated between June 1978 and October 1981; 44% were under six months and 71% were under one year. Fifty six patients were operated under cardio-pulmonary by-pass, in 41 we used deep hypothermia with total cardio-respiratory arrest, 21% of them were under three months of life an 53% under one year. We present the morbidity and mortality together with the pulmonary management. Eighty five percent of the cases remained intubated postoperative by for less than 12 hours. The postoperative pulmonary evolution was quite similar for different types of congenital heart disease, such as T. Fallot, A-V canal, transposition, etc., and there was no statistically significant difference between them in terms of respiratory assistance and pulmonary complications. Eleven patients died (19%), all of them under six months of life. In 53 patients operated, without extracorporeal circulation, 38 had total correction and 15 palliative procedures. The mortality in this group was 9% (5 cases), all of the under one month of life. The global mortality was 14%. We discuss our present surgical indications in view of our results.