Archivos Peruanos de cardiologia y cirugia cardiovascular最新文献

{"title":"Endovascular repair of complex aortic aneurysms: comparison between surgeon-modified endografts and commercial branched devices in a high-complexity center.","authors":"Roger Conde Moncada, Luis Mariano Ferreira, Ricardo La Mura, Oscar Dávila, W Samir Cubas","doi":"10.47487/apcyccv.v6i4.544","DOIUrl":"10.47487/apcyccv.v6i4.544","url":null,"abstract":"<p><strong>Objetivo: </strong>El tratamiento endovascular de los aneurismas aórticos toracoabdominales y paraviscerales complejos, con el desarrollo de nuevos dispositivos, representa uno de los aspectos más desafiantes de la cirugía endovascular. El objetivo de este estudio fue describir la mortalidad perioperatoria a 30 días, las complicaciones mayores posoperatorias y las reintervenciones de los pacientes tratados por aneurismas aórticos complejos mediante dispositivos de endoprótesis ramificadas <i>off-the-shelf</i> (t-BRANCH) y <i>Physician Modified Endografts</i> (PMEGs).</p><p><strong>Materiales y métodos: </strong>El presente trabajo es un estudio observacional, retrospectivo y unicéntrico sobre una base de datos prospectivamente recolectada de cada paciente tratado por aneurisma aórtico complejo registrado en la historia clínica de nuestro centro aórtico de referencia, entre enero de 2020 y diciembre de 2024.</p><p><strong>Resultados: </strong>Se analizaron 51 pacientes con una media de edad de 69,6 ± 10,3 años, siendo varones el 90,2%. El diámetro medio del aneurisma fue de 66,1 ± 15,2 mm. La mortalidad global fue del 9,8%, siendo la mortalidad intrahospitalria temprana en t-BRANCH del 23,1% en comparación con PMEGs del 5,3% (p=0,0977). Dentro de los predictores de mortalidad intrahospitalaria se encontraron el estado físico según la clasificación del estado físico de la Sociedad Americana de Anestesiólogos (ASA) IV (OR = 11.98; IC95%: 1.46-98.7; p = 0.022) y el antecedente de accidente cerebrovascular (ACV) (OR = 13.07; IC95%: 1.06-161.5; p = 0.043).</p><p><strong>Conclusiones: </strong>La reparación endovascular de aneurismas complejos de aorta mediante endoprótesis con PMEGs y dispositivos t-BRANCH muestra resultados favorables con respecto a la mortalidad y las complicaciones mayores posoperatorias, asociadas a una baja tasa de reintervenciones.</p>","PeriodicalId":72295,"journal":{"name":"Archivos Peruanos de cardiologia y cirugia cardiovascular","volume":"6 4","pages":"207-214"},"PeriodicalIF":0.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12825435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment of the anomalous origin of the right pulmonary artery from the ascending aorta: report of two cases.","authors":"Silvia Lisseth Ocampo Quito, Gabriela Susana López Lavado, Edwin Martin Bedoya Rivera, Luis Alfredo Pacheco Ramos","doi":"10.47487/apcyccv.v6i4.549","DOIUrl":"10.47487/apcyccv.v6i4.549","url":null,"abstract":"<p><p>The anomalous origin of the right pulmonary artery is a rare congenital cardiac malformation that leads to early development of pulmonary vascular disease, heart failure, and death. Therefore, surgical correction should be performed as soon as the diagnosis is established. A high index of clinical suspicion and the use of non-invasive imaging studies play a crucial role in early diagnosis and timely intervention, thereby reducing the high mortality rates associated with this congenital heart disease. We present two cases of this rare entity, both with clinical manifestations of heart failure from the neonatal period. In both cases, surgical correction was performed through direct anastomosis of the right pulmonary artery to the main pulmonary artery. Both patients showed a favorable postoperative course, with no clinical or echocardiographic evidence of anastomotic stenosis or pulmonary hypertension.</p>","PeriodicalId":72295,"journal":{"name":"Archivos Peruanos de cardiologia y cirugia cardiovascular","volume":"6 4","pages":"245-252"},"PeriodicalIF":0.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12870479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined leadless pacing and subcutaneous defibrillation strategy in a high-risk patient: first case report from Peru.","authors":"Alexis Vallejos-Barrientos, Diego Davila-Flores, Richard Soto-Becerra, Mario Cabrera-Saldaña, Carolina Guevara-Caicedo, Ana Cecilia Gonzales-Luna, Ángel Cueva-Parra, Marisel Payano-Rojas, Pío Zelaya-Castro","doi":"10.47487/apcyccv.v6i4.513","DOIUrl":"10.47487/apcyccv.v6i4.513","url":null,"abstract":"<p><p>We present the case of a 51-year-old male with non-ischemic dilated cardiomyopathy and complete atrioventricular block, who was previously implanted with a cardiac resynchronization therapy defibrillator. The patient developed signs of pocket infection with a high risk of extrusion. Partial system extraction was performed, followed by 14 days of intravenous antibiotic therapy. Due to a history of ventricular fibrillation and permanent pacing dependency, and in the absence of viable transvenous access, a sequential implantation strategy was adopted using a leadless pacemaker (Micra AV, Medtronic) and a subcutaneous implantable cardioverter-defibrillator (EMBLEM, Boston Scientific). Both procedures were completed without complications, and the patient showed favorable recovery, with effective pacing, no arrhythmic recurrences, and no signs of infection at the six-month follow-up. This case illustrates the feasibility of a fully leadless approach in high-risk patients with contraindications to conventional transvenous systems.</p>","PeriodicalId":72295,"journal":{"name":"Archivos Peruanos de cardiologia y cirugia cardiovascular","volume":"6 4","pages":"239-244"},"PeriodicalIF":0.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12825431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute cardiorenal decompensation in the setting of chronic renal artery stenosis treated with successful renal artery stenting. A case report.","authors":"Nehaal Ahmed, Jose Arriola-Montenegro, Saad Rashid, Ian R McPhail, Benjamin Bizer, Iasmina M Craici, Samy M Riad","doi":"10.47487/apcyccv.v6i4.515","DOIUrl":"10.47487/apcyccv.v6i4.515","url":null,"abstract":"<p><p>Atherosclerotic renal artery stenosis may present with resistant hypertension, hypertensive crisis, ischemic nephropathy, and cardiac destabilization. Although early studies of renal artery stenting showed promise, later trials found no benefit over medical therapy-yet often excluded high-risk, acute cases. We describe an 85-year-old male with cardiovascular risk factors who developed a hypertensive crisis, acute kidney injury, and flash pulmonary edema. An angiogram revealed severe ostial right renal artery stenosis. Stenting resulted in the rapid resolution of the acute crisis and restoration of baseline renal function. This case underscores the potential benefit of revascularization in select high-risk presentations of renal artery stenosis.</p>","PeriodicalId":72295,"journal":{"name":"Archivos Peruanos de cardiologia y cirugia cardiovascular","volume":"6 4","pages":"269-273"},"PeriodicalIF":0.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12825434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of major adverse cardiovascular events with two risk scales for acute chest pain in the emergency department.","authors":"Jocabed Miranda-Chávez, José Amado-Tineo","doi":"10.47487/apcyccv.v6i4.555","DOIUrl":"10.47487/apcyccv.v6i4.555","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the ability of the HEART and EDACS scores to predict major adverse cardiovascular events (MACE) at 30 days of follow-up in patients with acute chest pain presenting to an emergency department.</p><p><strong>Materials and methods: </strong>Retrospective study of patients older than 18 years treated for acute chest pain, excluding ST-elevation acute coronary syndrome (ACS), trauma, and infections. The HEART and EDACS scores were assessed at admission. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value, and negative predictive value of both scores were calculated for the prediction of 30-day MACE.</p><p><strong>Results: </strong>A total of 249 patients were evaluated; 62.2% were male, with a mean age of 66.5 years. There were 25 MACEs (10%). The HEART score classified patients as low risk (43.4%), moderate risk (47.4%), and high risk (9.2%). Using the EDACS, patients were classified as low risk (38.6%) and not low risk (61.4%). Regarding MACE, the HEART score had an AUC of 0.91 (95% CI: 0.87-0.95) and EDACS had an AUC of 0.70 (95% CI: 0.60-0.79). The HEART score demonstrated better performance than EDACS, especially when a score ≥4 was obtained.</p><p><strong>Conclusions: </strong>The HEART score has higher diagnostic performance than EDACS for predicting MACE in patients with acute chest pain presenting to a tertiary emergency department.</p>","PeriodicalId":72295,"journal":{"name":"Archivos Peruanos de cardiologia y cirugia cardiovascular","volume":"6 4","pages":"215-222"},"PeriodicalIF":0.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12825433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic atrioventricular valve replacement due to a supravalvular stenosing ring and ebsteinoid tricuspid valve in a patient with congenitally corrected transposition of the great arteries: a case report.","authors":"Nathalie Victoria Zacarías Mendoza, Milagros Elizabeth Napán Herrera, Diana Vanessa Carassa Rodríguez, Víctor Justo Robles Velarde","doi":"10.47487/apcyccv.v6i4.522","DOIUrl":"10.47487/apcyccv.v6i4.522","url":null,"abstract":"<p><p>Congenitally corrected transposition of the great arteries (ccTGA) is a rare and complex cardiac malformation often associated with additional anomalies. We present a 23-year-old patient with ccTGA, a supravalvular stenosing ring, and an Ebsteinoid tricuspid valve who developed severe systemic atrioventricular valve (SAVV) stenosis and regurgitation. Preoperative evaluation revealed tricuspid valve abnormalities, a dilated systemic right ventricle (sRV) with a reduced sRV ejection fraction (42%). The patient underwent bioprosthetic SAVV replacement and excision of the supravalvular membrane. Postoperatively, valve function was preserved, and recovery was favorable despite transient complications. This case emphasizes the surgical challenges and individualized decision-making required in ccTGA with rare anatomical variants, highlighting the value of timely intervention, multidisciplinary care, and long-term follow-up to optimize outcomes.</p>","PeriodicalId":72295,"journal":{"name":"Archivos Peruanos de cardiologia y cirugia cardiovascular","volume":"6 4","pages":"264-268"},"PeriodicalIF":0.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12825438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular ring due to double aortic arch as a cause of stridor and dysphagia in infancy: a case report.","authors":"Diego Davila-Flores, Christie Villasante-Villalta, Renee Montesinos-Segura, Juan Zúñiga-Meza, Henry Peralta-Santos, Luis Vera-Talledo","doi":"10.47487/apcyccv.v6i4.534","DOIUrl":"10.47487/apcyccv.v6i4.534","url":null,"abstract":"<p><p>A double aortic arch is a rare congenital vascular anomaly with clinical significance in the pediatric population due to its potential to cause extrinsic compression of the trachea and esophagus. It should be suspected in infants with persistent respiratory and gastrointestinal symptoms refractory to conventional treatment. We report the case of a 2-year-7-month-old boy presenting with recurrent stridor, repeated respiratory infections, and progressive dysphagia. Cardiac CT angiography revealed a complete vascular ring causing tracheoesophageal compression. Dominance of the left aortic arch was identified, and surgical section and distal ligation of the non-dominant right arch were performed, without direct intervention on the tracheoesophageal structures. At the 12-month follow-up, there was complete resolution of symptoms and nutritional recovery. This case highlights the importance of maintaining high clinical suspicion and ensuring timely referral. Even when surgical correction is delayed, appropriate intervention can reverse symptoms and improve quality of life.</p>","PeriodicalId":72295,"journal":{"name":"Archivos Peruanos de cardiologia y cirugia cardiovascular","volume":"6 4","pages":"253-257"},"PeriodicalIF":0.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12825437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic foot care and cardiovascular surgery in Peru: a looming crisis of centralism and unequal resource allocation.","authors":"W Samir Cubas","doi":"10.47487/apcyccv.v6i4.576","DOIUrl":"10.47487/apcyccv.v6i4.576","url":null,"abstract":"","PeriodicalId":72295,"journal":{"name":"Archivos Peruanos de cardiologia y cirugia cardiovascular","volume":"6 4","pages":"274-275"},"PeriodicalIF":0.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12825436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence and multimodal diagnostic approaches in cardiovascular disease.","authors":"Fernando A Ramos-Zaga","doi":"10.47487/apcyccv.v6i4.532","DOIUrl":"10.47487/apcyccv.v6i4.532","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the impact and clinical applicability of artificial intelligence (AI) models in cardiovascular diagnosis, assessing their potential to improve diagnostic accuracy, operational efficiency, and reliability compared with conventional methods.</p><p><strong>Materials and: </strong><b>Methods.</b> A critical review of the recent literature was conducted, encompassing retrospective studies, multicenter trials, and external validations that employed machine learning and deep learning algorithms applied to imaging modalities, electrocardiographic and phonocardiographic signals, as well as clinical and proteomic biomarkers.</p><p><strong>Results: </strong>Evidence indicates that in cardiac imaging, automated segmentation and ventricular dysfunction detection achieved accuracy metrics exceeding 90%, suggesting readiness for clinical integration. In cardiac signals, deep learning models demonstrated area under the ROC curve values of approximately 0.99 for predicting atrial fibrillation and ischemic heart disease, further supported by explainability techniques. Regarding biomarkers, ensemble models achieved diagnostic accuracies above 95%, and the integration of proteomic and clinical data substantially enhanced predictive performance. Nonetheless, decreased performance in external validations, limited generalizability to heterogeneous populations, and clinicians' reluctance due to insufficient explainability remain major barriers.</p><p><strong>Conclusion: </strong>Artificial intelligence in cardiovascular diagnostics holds transformative potential by improving accuracy, reducing interobserver variability, and expanding access in resource-limited settings. However, its consolidation into routine practice requires robust multicenter validations, seamless interoperability with clinical workflows, and strengthened explainability, prerequisites for incorporation into clinical guidelines and precision medicine strategies.</p>","PeriodicalId":72295,"journal":{"name":"Archivos Peruanos de cardiologia y cirugia cardiovascular","volume":"6 4","pages":"230-238"},"PeriodicalIF":0.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12825441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significant valvular heart disease in wild-type transthyretin amyloidosis: prevalence and impact on survival.","authors":"Santiago Decotto, Pilar Domenech, Pedro Touzas, María Adela Aguirre, Elsa Nucifora, María Lourdes Posadas-Martínez, Rocío Blanco, Mariano Falconi, Rodolfo Pizarro, Diego Pérez de Arenaza","doi":"10.47487/apcyccv.v6i3.524","DOIUrl":"10.47487/apcyccv.v6i3.524","url":null,"abstract":"<p><strong>Objective: </strong>There are limited data on the prevalence and prognostic impact of significant valvular heart disease in patients with wild-type transthyretin cardiac amyloidosis (ATTRwt). The aim of this study was to describe the prevalence of aortic stenosis (AS), mitral regurgitation (MR), and tricuspid regurgitation (TR) in this population and, secondarily, to evaluate their impact on survival.</p><p><strong>Methods: </strong>This was a retrospective, single-center cohort study including patients diagnosed with ATTRwt between 2011 and 2024. We calculated the prevalence of each significant valvular heart disease, and Kaplan-Meier survival curves were generated to estimate two-year all-cause mortality, stratified according to the presence or absence of each significant valvular disease. Finally, a multivariable Cox regression was performed to assess their association with survival.</p><p><strong>Results: </strong>We included 154 patients, with a mean age of 81 (±7) years; 85% (n=131) were male. Significant TR was the most prevalent valvular disease (27%, n=41), followed by significant MR (20%, n=30) and AS (13%, n=20). Patients with significant TR had a higher incidence of all-cause mortality compared to those without significant TR (41% vs. 16%, log-rank test, p=0.0007), whereas no differences were observed between patients with and without significant AS or MR. In multivariable Cox models, significant TR was independently associated with higher mortality, regardless of age, the presence of other valvular diseases, and NT-proBNP levels.</p><p><strong>Conclusions: </strong>Significant TR was the most prevalent valvular disease in patients with ATTRwt and was associated with lower survival in this population.</p>","PeriodicalId":72295,"journal":{"name":"Archivos Peruanos de cardiologia y cirugia cardiovascular","volume":"6 3","pages":"112-119"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12624473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}