This study investigated the efficacy of postoperative ticlopidine as antiplatelet therapy in pati... more This study investigated the efficacy of postoperative ticlopidine as antiplatelet therapy in patients shortly after heart valve repair or replacement. Between 1990 and 1995, 235 consecutive patients underwent either valve repair (n = 67) or replacement with a bioprosthesis (n = 168). The bioprostheses used were Carpentier-Edwards porcine or pericardial (n = 158) valves, Prima stentless valves (n = 3) and cryopreserved homografts (n = 7). Types of repair were aortic (one), mitral annuloplasty with Carpentier ring (65) and tricuspid repair (one). Mean patient age was 67 (range: 16 to 83) years for valve replacement and 57 (range: 32 to 74) years for repair (p < 0.01). Atrial fibrillation occurred in 34% of patients. The hospital mortality rate was 11% (26 patients). Of the 209 survivors, 137 were assigned to antiplatelet treatment with ticlopidine for the first three months of follow up. The other 72 received either oral anticoagulation (coumadin; n = 40), aspirin (n = 14) or no me...
CLINICAL CASE PRESENTATION: Male, 62 years old with progressive angina. Positive stress test. At ... more CLINICAL CASE PRESENTATION: Male, 62 years old with progressive angina. Positive stress test. At catheterization a proximal 90% stenosis of the LAD was found. Not suitable for PTCA. Double lumen endotracheal tube was inserted. Position was 30 degrees right lateral decubitus. The thoracoscope was introduced through the 7th intercostal space and a minithoracotomy was done. The internal mammary artery (IMA) was dissected partially through direct vision and partially with the help of the thoracoscope. The IMA graft was implanted to the LAD without cardiopulmonary bypass with a segmentary occlusion of the vessel with tourniquets. Thoracic drainage 575 cc, CK/MB 311/5, final hematocrit 37%. No blood transfusion. Dismissed on the 5th postoperative day.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 1991
We present a clinical case of chronic dissection of the anterior tibial artery leading to acute a... more We present a clinical case of chronic dissection of the anterior tibial artery leading to acute aneurysmal dilatation. Our patient, a 22-year-old man, had a history of trauma at the middle third of his left leg. Because of impending ischemia, he was diagnosed by emergency arteriography. We ligated the proximal and distal ends of the dissection and used a reversed saphenous vein for a short end-to-end bypass. Although the evolution of this dilatation had been silent, its clinical presentation was spectacular. The case is worthy of attention because of its extreme rarity, both as a dissection of a peripheral artery caused by trauma and as an aneurysmal dilatation at tibial level.
We report the case of a three-month-old infant with an infective endocarditis of the aortic valve... more We report the case of a three-month-old infant with an infective endocarditis of the aortic valve, showing perforation of two valve leaflets and a perivalvular abscess. The patient was operated on using a cryopreservated homograft with anastomosis of both coronary arteries. The outcome is good two years after surgery. This is the youngest patient operated on using this technique in our country.
We report a case of one young patient with symptoms of palpitations and ventricular and supravent... more We report a case of one young patient with symptoms of palpitations and ventricular and supraventricular arrhythmias documented in the 24-hours Holter record. He had a deformity of silhouette and pericardial calcification in the chest roentgenogram. In the computed tomography and the magnetic resonance employed in the evaluation of structural anomalies, dates compatible with ventricular herniation, across one parcel of pathologically calcified pericardium, were present. The probable etiology, operatory findings and the management of those patients are discussed.
Between January 1976 and December 1989, 28 patients with fixed subaortic stenosis underwent surgi... more Between January 1976 and December 1989, 28 patients with fixed subaortic stenosis underwent surgical correction. Twenty-one were male and seven female. The mean age when surgery was performed was 7.4 years (range 14 months to 14 years). Angiography was not done in 8 patients (28.5%). Fourteen had a subaortic stenosis due to a fibrous shelf and the other 14 to a fibromuscular one. Fifteen had associated anomalies, seven aortic stenosis, three aortic regurgitation and four mitral disturbances. Three surgical procedures were carried out: resection in 16 patients (57.1%), resection and myotomy in ten (35.7%), and resection with myectomy in two (7.1%). In 5 patients a residual stenosis was detected, one of whom required repeated surgery, and 2 other patients developed recidive of the stenosis (both required repeated surgery). Prosthetic valves (five aortic and one mitral) were inserted in 6 patients (21.4%). One of these required an aortic valve conduct. Pacemaker was placed in other 4 p...
Overtraining may be one frequent cause of stagnation or decrease in performance capacity of athle... more Overtraining may be one frequent cause of stagnation or decrease in performance capacity of athletes. Israel (19) differentiates between addisonoid (parasympathetic) and basedowoid (sympathetic) overtraining, characterized by inhibition or excitation. We tried to induce an overtraining syndrome in 8 experienced middle- and long-distance runners, based on an increase in training volume from an average 85.9 km (week 1) to 115.1 km (week 2) and 143.1 km (week 3) to 174.6 km per week (week 4). The influence of this training on cardiovascular, metabolic and hormonal parameters was examined with special respect to plasma and urinary catecholamines. Laboratory testing including graded treadmill running was performed on the days 0, 14 and 28. Training was held six days each week, with nearly 30 km per day in the fourth week. A stagnation in endurance performance capacity (running velocity at the aerobic-anaerobic transition range) and a decrease in maximum working capacity were observed in ...
World journal for pediatric & congenital heart surgery, 2011
The authors report a case of a neonate that was operated on with the diagnosis of right aortic ar... more The authors report a case of a neonate that was operated on with the diagnosis of right aortic arch and aberrant left subclavian artery and anomalous origin of right pulmonary artery from ascending aorta. Computed tomography (CT) scan suggested double aortic arch and cardiac catheterization suggested anomalous origin of right pulmonary artery from ascending aorta versus aorto-pulmonary window. The final diagnosis was made at the operation. There was a right aortic arch and aberrant left subclavian artery and persistent ductus arteriosus. Surgical repair consisted of section of the ductus arteriosus and reimplantation of the right pulmonary artery in the main pulmonary artery.
Interactive CardioVascular and Thoracic Surgery, 2013
We present an unusual variant of the sinus venosus defect in which an obvious window is formed be... more We present an unusual variant of the sinus venosus defect in which an obvious window is formed between a single pulmonary vein and the superior vena cava, the pulmonary vein retaining its connection to the left atrium. Two patients were operated on via right anterior minithoracotomy. A large single right pulmonary vein was found connecting to the left atrium. There was a large side-to-side communication between the superior vena cava and the pulmonary vein resulting in partially anomalous pulmonary venous drainage. A side-biting clamp was applied in the superior vena cava and the pulmonary vein at both sides of the communication, and the vein was divided. The incision in both veins was closed with a running suture.
... DOI: 10.1177/153857449302700904 1993 27: 673 VASC ENDOVASCULAR SURG Antonana José I. Aramendi... more ... DOI: 10.1177/153857449302700904 1993 27: 673 VASC ENDOVASCULAR SURG Antonana José I. Aramendi, Enrique Castellanos, Alvaro Ortiz de Salazar, Agustin Onate, Fernando Munoz and Mikel Myocardial Revascularization with the Gastroepiploic Artery Published by: ...
Interactive CardioVascular and Thoracic Surgery, 2006
Between January 1988 and December 2003, 898 patients with rheumatic heart disease (mean age 22.4"... more Between January 1988 and December 2003, 898 patients with rheumatic heart disease (mean age 22.4"10.1 years) underwent mitral valve (MV) repair. Five hundred and sixty-five patients (63%) had pre-operative atrial fibrillation. Six hundred and ten (68%) patients were in NYHA class III or IV. Four hundred and twelve (45.9%) had pure mitral regurgitation (MR) and 486 (54.1%) had mixed mitral stenosis and MR. The pathology was leaflet prolapse (ns270, 30%), annular dilatation (ns717, 79.8%) and calcification (ns39, 4.3%). Reparative procedures included annuloplasty (ns793, 88%), commissurotomy (ns530, 59%), chordal shortening (ns225, 25%), cusp excisionyplication (ns41, 4.5%), cuspal thinning (ns325, 36%), cleft suture (ns142, 16%), decalcification (ns30, 3.3%), chordal transfer (ns13, 1.4%), and neo chordae construction (ns3, 0.3%). Early mortality was 32 (3.6%). Follow-up ranged from 6 to 180 months (mean 62.7"31.8 months) and was 96% complete. Six hundred and twenty-one patients (69%) had no, or trivial, or mild MV. Two hundred and seventy-seven of the 866 survivors had MR which was moderate in 153 (18%) and severe in 124 (14%) patients. Thirty-five patients underwent re-operation. There were 21 late deaths (2.4%). Actuarial and re-operation-free survival at 10 years were 92"1.1% and 81"5.2%, respectively. Freedom from moderate or severe MR was 32"3.9%. MV repair in the rheumatic population is feasible with acceptable long-term results.
Objective: Antiplatelet agents are used for prevention of thromboembolism in surgical patients an... more Objective: Antiplatelet agents are used for prevention of thromboembolism in surgical patients and in patients with chronic atrial fibrillation. Up to date, however, results of randomized studies comparing antiplatelet agents and oral anticoagulation have not been reported. The aim of this study was to compare the efficacy and safety of triflusal (an antiplatelet agent) versus acenocoumarol for primary prevention of thromboembolism in the early postoperative period after implantation of a bioprosthesis. Methods: In this prospective, multicentric, randomized, open pilot trial, patients were assigned to treatment with triflusal (600 mg/d) or acenocoumarol (target INR 2.0-3.0). Study medication was started 24-48 h after valve replacement with a bioprosthesis, and continued for 3 months. Four follow-up visits were scheduled: baseline, and at 1, 3 and 6 months thereafter. The primary end-point was a composite of the rate of thromboembolism, severe hemorrhage and valve-related mortality. Results: A total of 193 patients were included (97 received triflusal and 96 acenocoumarol), with a mean age of 72.5 years. Half were men. Aortic valve replacement was performed in 181 patients (93.8%), mitral valve replacement in 10 patients (5.2%) and double valve replacement in 2 (1.0%). Hospital mortality was 11 (5.7%). Primary outcome was recorded in 9 patients with triflusal (9.4%) and in 10 patients with acenocoumarol (11%). There were nine episodes (4.7%) of thromboembolism, six in the triflusal group and three in the acenocoumarol group, and three episodes of permanent neurological deficits, one in the triflusal group and two in the acenocoumarol group. Severe hemorrhage: nine episodes, six in the acenocoumarol group and three in the triflusal group. None of the observed differences in efficacy were statistically significant. Regarding safety, three patients in triflusal group reported at least one hemorrhage, compared to 10 in acenocoumarol group (PZ0.048). Conclusions: There were no significant differences in efficacy between both groups, however, triflusal showed a significantly lower incidence of bleeding episodes. Q
We discuss our early experience in 2 patients with a patch enlargement technique for treating chr... more We discuss our early experience in 2 patients with a patch enlargement technique for treating chronic ischemic mitral regurgitation due to restricted motion of the posterior mitral leaflet. This technique corrects the restricted motion and offers better coaptation without compromising the mitral orifice.
The combination of right cervical aortic arch, aberrant retroesophageal left subclavian artery or... more The combination of right cervical aortic arch, aberrant retroesophageal left subclavian artery originating from a Kommerell&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s diverticulum, and a ligamentum arteriosum, constitutes a rare form of vascular ring. Two patients aged 21 days and 54 years, who were diagnosed by multislice 3-dimensional computed tomography and magnetic resonance imaging, underwent surgical division of a vascular ring. The adult required resection of a Kommerell&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s aneurysm and subclavian artery reimplantation.
Although no-patch repair was the first surgical treatment for complete atrioventricular canal, pa... more Although no-patch repair was the first surgical treatment for complete atrioventricular canal, patch repairs are currently more widely used. We assessed the safety of forgoing a patch during the correction of complete atrioventricular canal in 8 consecutive patients. The complete atrioventricular canal was repaired using sutures placed on the right of the ventricular septal defect crest, passed through the bridging leaflet, and to the facing part of the ostium primum defect. There were no early deaths; all patients were in sinus rhythm without left ventricular outflow tract obstruction. This no-patch technique produces results comparable with the modified single-patch repair, while reducing ischemic time.
Call for participation in the Fourteen Razi Research Festival on Medical Sciences
128 far no other controlled study has addressed this problem. Joining all together, the still sca... more 128 far no other controlled study has addressed this problem. Joining all together, the still scanty papers published up to now are currently challenging old thinking on this particularly complex issue. Some other recent non-randomized studies are concluding in a similar way that antiplatelet therapy is useful in preventing embolic events with no increased risk of hemorrhage. 14, 15 A very recent abstract also indicates, despite some problems in methodology and follow-up, that no oral anticoagulation may eventually be required. 16 ...
This study investigated the efficacy of postoperative ticlopidine as antiplatelet therapy in pati... more This study investigated the efficacy of postoperative ticlopidine as antiplatelet therapy in patients shortly after heart valve repair or replacement. Between 1990 and 1995, 235 consecutive patients underwent either valve repair (n = 67) or replacement with a bioprosthesis (n = 168). The bioprostheses used were Carpentier-Edwards porcine or pericardial (n = 158) valves, Prima stentless valves (n = 3) and cryopreserved homografts (n = 7). Types of repair were aortic (one), mitral annuloplasty with Carpentier ring (65) and tricuspid repair (one). Mean patient age was 67 (range: 16 to 83) years for valve replacement and 57 (range: 32 to 74) years for repair (p < 0.01). Atrial fibrillation occurred in 34% of patients. The hospital mortality rate was 11% (26 patients). Of the 209 survivors, 137 were assigned to antiplatelet treatment with ticlopidine for the first three months of follow up. The other 72 received either oral anticoagulation (coumadin; n = 40), aspirin (n = 14) or no me...
CLINICAL CASE PRESENTATION: Male, 62 years old with progressive angina. Positive stress test. At ... more CLINICAL CASE PRESENTATION: Male, 62 years old with progressive angina. Positive stress test. At catheterization a proximal 90% stenosis of the LAD was found. Not suitable for PTCA. Double lumen endotracheal tube was inserted. Position was 30 degrees right lateral decubitus. The thoracoscope was introduced through the 7th intercostal space and a minithoracotomy was done. The internal mammary artery (IMA) was dissected partially through direct vision and partially with the help of the thoracoscope. The IMA graft was implanted to the LAD without cardiopulmonary bypass with a segmentary occlusion of the vessel with tourniquets. Thoracic drainage 575 cc, CK/MB 311/5, final hematocrit 37%. No blood transfusion. Dismissed on the 5th postoperative day.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 1991
We present a clinical case of chronic dissection of the anterior tibial artery leading to acute a... more We present a clinical case of chronic dissection of the anterior tibial artery leading to acute aneurysmal dilatation. Our patient, a 22-year-old man, had a history of trauma at the middle third of his left leg. Because of impending ischemia, he was diagnosed by emergency arteriography. We ligated the proximal and distal ends of the dissection and used a reversed saphenous vein for a short end-to-end bypass. Although the evolution of this dilatation had been silent, its clinical presentation was spectacular. The case is worthy of attention because of its extreme rarity, both as a dissection of a peripheral artery caused by trauma and as an aneurysmal dilatation at tibial level.
We report the case of a three-month-old infant with an infective endocarditis of the aortic valve... more We report the case of a three-month-old infant with an infective endocarditis of the aortic valve, showing perforation of two valve leaflets and a perivalvular abscess. The patient was operated on using a cryopreservated homograft with anastomosis of both coronary arteries. The outcome is good two years after surgery. This is the youngest patient operated on using this technique in our country.
We report a case of one young patient with symptoms of palpitations and ventricular and supravent... more We report a case of one young patient with symptoms of palpitations and ventricular and supraventricular arrhythmias documented in the 24-hours Holter record. He had a deformity of silhouette and pericardial calcification in the chest roentgenogram. In the computed tomography and the magnetic resonance employed in the evaluation of structural anomalies, dates compatible with ventricular herniation, across one parcel of pathologically calcified pericardium, were present. The probable etiology, operatory findings and the management of those patients are discussed.
Between January 1976 and December 1989, 28 patients with fixed subaortic stenosis underwent surgi... more Between January 1976 and December 1989, 28 patients with fixed subaortic stenosis underwent surgical correction. Twenty-one were male and seven female. The mean age when surgery was performed was 7.4 years (range 14 months to 14 years). Angiography was not done in 8 patients (28.5%). Fourteen had a subaortic stenosis due to a fibrous shelf and the other 14 to a fibromuscular one. Fifteen had associated anomalies, seven aortic stenosis, three aortic regurgitation and four mitral disturbances. Three surgical procedures were carried out: resection in 16 patients (57.1%), resection and myotomy in ten (35.7%), and resection with myectomy in two (7.1%). In 5 patients a residual stenosis was detected, one of whom required repeated surgery, and 2 other patients developed recidive of the stenosis (both required repeated surgery). Prosthetic valves (five aortic and one mitral) were inserted in 6 patients (21.4%). One of these required an aortic valve conduct. Pacemaker was placed in other 4 p...
Overtraining may be one frequent cause of stagnation or decrease in performance capacity of athle... more Overtraining may be one frequent cause of stagnation or decrease in performance capacity of athletes. Israel (19) differentiates between addisonoid (parasympathetic) and basedowoid (sympathetic) overtraining, characterized by inhibition or excitation. We tried to induce an overtraining syndrome in 8 experienced middle- and long-distance runners, based on an increase in training volume from an average 85.9 km (week 1) to 115.1 km (week 2) and 143.1 km (week 3) to 174.6 km per week (week 4). The influence of this training on cardiovascular, metabolic and hormonal parameters was examined with special respect to plasma and urinary catecholamines. Laboratory testing including graded treadmill running was performed on the days 0, 14 and 28. Training was held six days each week, with nearly 30 km per day in the fourth week. A stagnation in endurance performance capacity (running velocity at the aerobic-anaerobic transition range) and a decrease in maximum working capacity were observed in ...
World journal for pediatric & congenital heart surgery, 2011
The authors report a case of a neonate that was operated on with the diagnosis of right aortic ar... more The authors report a case of a neonate that was operated on with the diagnosis of right aortic arch and aberrant left subclavian artery and anomalous origin of right pulmonary artery from ascending aorta. Computed tomography (CT) scan suggested double aortic arch and cardiac catheterization suggested anomalous origin of right pulmonary artery from ascending aorta versus aorto-pulmonary window. The final diagnosis was made at the operation. There was a right aortic arch and aberrant left subclavian artery and persistent ductus arteriosus. Surgical repair consisted of section of the ductus arteriosus and reimplantation of the right pulmonary artery in the main pulmonary artery.
Interactive CardioVascular and Thoracic Surgery, 2013
We present an unusual variant of the sinus venosus defect in which an obvious window is formed be... more We present an unusual variant of the sinus venosus defect in which an obvious window is formed between a single pulmonary vein and the superior vena cava, the pulmonary vein retaining its connection to the left atrium. Two patients were operated on via right anterior minithoracotomy. A large single right pulmonary vein was found connecting to the left atrium. There was a large side-to-side communication between the superior vena cava and the pulmonary vein resulting in partially anomalous pulmonary venous drainage. A side-biting clamp was applied in the superior vena cava and the pulmonary vein at both sides of the communication, and the vein was divided. The incision in both veins was closed with a running suture.
... DOI: 10.1177/153857449302700904 1993 27: 673 VASC ENDOVASCULAR SURG Antonana José I. Aramendi... more ... DOI: 10.1177/153857449302700904 1993 27: 673 VASC ENDOVASCULAR SURG Antonana José I. Aramendi, Enrique Castellanos, Alvaro Ortiz de Salazar, Agustin Onate, Fernando Munoz and Mikel Myocardial Revascularization with the Gastroepiploic Artery Published by: ...
Interactive CardioVascular and Thoracic Surgery, 2006
Between January 1988 and December 2003, 898 patients with rheumatic heart disease (mean age 22.4"... more Between January 1988 and December 2003, 898 patients with rheumatic heart disease (mean age 22.4"10.1 years) underwent mitral valve (MV) repair. Five hundred and sixty-five patients (63%) had pre-operative atrial fibrillation. Six hundred and ten (68%) patients were in NYHA class III or IV. Four hundred and twelve (45.9%) had pure mitral regurgitation (MR) and 486 (54.1%) had mixed mitral stenosis and MR. The pathology was leaflet prolapse (ns270, 30%), annular dilatation (ns717, 79.8%) and calcification (ns39, 4.3%). Reparative procedures included annuloplasty (ns793, 88%), commissurotomy (ns530, 59%), chordal shortening (ns225, 25%), cusp excisionyplication (ns41, 4.5%), cuspal thinning (ns325, 36%), cleft suture (ns142, 16%), decalcification (ns30, 3.3%), chordal transfer (ns13, 1.4%), and neo chordae construction (ns3, 0.3%). Early mortality was 32 (3.6%). Follow-up ranged from 6 to 180 months (mean 62.7"31.8 months) and was 96% complete. Six hundred and twenty-one patients (69%) had no, or trivial, or mild MV. Two hundred and seventy-seven of the 866 survivors had MR which was moderate in 153 (18%) and severe in 124 (14%) patients. Thirty-five patients underwent re-operation. There were 21 late deaths (2.4%). Actuarial and re-operation-free survival at 10 years were 92"1.1% and 81"5.2%, respectively. Freedom from moderate or severe MR was 32"3.9%. MV repair in the rheumatic population is feasible with acceptable long-term results.
Objective: Antiplatelet agents are used for prevention of thromboembolism in surgical patients an... more Objective: Antiplatelet agents are used for prevention of thromboembolism in surgical patients and in patients with chronic atrial fibrillation. Up to date, however, results of randomized studies comparing antiplatelet agents and oral anticoagulation have not been reported. The aim of this study was to compare the efficacy and safety of triflusal (an antiplatelet agent) versus acenocoumarol for primary prevention of thromboembolism in the early postoperative period after implantation of a bioprosthesis. Methods: In this prospective, multicentric, randomized, open pilot trial, patients were assigned to treatment with triflusal (600 mg/d) or acenocoumarol (target INR 2.0-3.0). Study medication was started 24-48 h after valve replacement with a bioprosthesis, and continued for 3 months. Four follow-up visits were scheduled: baseline, and at 1, 3 and 6 months thereafter. The primary end-point was a composite of the rate of thromboembolism, severe hemorrhage and valve-related mortality. Results: A total of 193 patients were included (97 received triflusal and 96 acenocoumarol), with a mean age of 72.5 years. Half were men. Aortic valve replacement was performed in 181 patients (93.8%), mitral valve replacement in 10 patients (5.2%) and double valve replacement in 2 (1.0%). Hospital mortality was 11 (5.7%). Primary outcome was recorded in 9 patients with triflusal (9.4%) and in 10 patients with acenocoumarol (11%). There were nine episodes (4.7%) of thromboembolism, six in the triflusal group and three in the acenocoumarol group, and three episodes of permanent neurological deficits, one in the triflusal group and two in the acenocoumarol group. Severe hemorrhage: nine episodes, six in the acenocoumarol group and three in the triflusal group. None of the observed differences in efficacy were statistically significant. Regarding safety, three patients in triflusal group reported at least one hemorrhage, compared to 10 in acenocoumarol group (PZ0.048). Conclusions: There were no significant differences in efficacy between both groups, however, triflusal showed a significantly lower incidence of bleeding episodes. Q
We discuss our early experience in 2 patients with a patch enlargement technique for treating chr... more We discuss our early experience in 2 patients with a patch enlargement technique for treating chronic ischemic mitral regurgitation due to restricted motion of the posterior mitral leaflet. This technique corrects the restricted motion and offers better coaptation without compromising the mitral orifice.
The combination of right cervical aortic arch, aberrant retroesophageal left subclavian artery or... more The combination of right cervical aortic arch, aberrant retroesophageal left subclavian artery originating from a Kommerell&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s diverticulum, and a ligamentum arteriosum, constitutes a rare form of vascular ring. Two patients aged 21 days and 54 years, who were diagnosed by multislice 3-dimensional computed tomography and magnetic resonance imaging, underwent surgical division of a vascular ring. The adult required resection of a Kommerell&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s aneurysm and subclavian artery reimplantation.
Although no-patch repair was the first surgical treatment for complete atrioventricular canal, pa... more Although no-patch repair was the first surgical treatment for complete atrioventricular canal, patch repairs are currently more widely used. We assessed the safety of forgoing a patch during the correction of complete atrioventricular canal in 8 consecutive patients. The complete atrioventricular canal was repaired using sutures placed on the right of the ventricular septal defect crest, passed through the bridging leaflet, and to the facing part of the ostium primum defect. There were no early deaths; all patients were in sinus rhythm without left ventricular outflow tract obstruction. This no-patch technique produces results comparable with the modified single-patch repair, while reducing ischemic time.
Call for participation in the Fourteen Razi Research Festival on Medical Sciences
128 far no other controlled study has addressed this problem. Joining all together, the still sca... more 128 far no other controlled study has addressed this problem. Joining all together, the still scanty papers published up to now are currently challenging old thinking on this particularly complex issue. Some other recent non-randomized studies are concluding in a similar way that antiplatelet therapy is useful in preventing embolic events with no increased risk of hemorrhage. 14, 15 A very recent abstract also indicates, despite some problems in methodology and follow-up, that no oral anticoagulation may eventually be required. 16 ...
Uploads
Papers by J. Aramendi