Publications by authors named "Ángel González Pinto"

20 Publications

  • Page 1 of 1

Inflammatory myofibroblastic tumour in the right ventricle of a 66-year-old man.

Interact Cardiovasc Thorac Surg 2019 12;29(6):967-968

Cardiovascular Surgery Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Herein, we present the case of a 66-year-old man with an inflammatory myofibroblastic tumour. An inflammatory myofibroblastic tumour is an extremely rare entity, with only 60 cases having been reported to date in the literature. The origin of this type of tumour is unknown and the treatment of choice is surgical resection. We present the surgical technique of our case and a review of the literature regarding this tumour. This is the first case described in a man above 60 years of age with a tumour located in the right ventricle.
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http://dx.doi.org/10.1093/icvts/ivz189DOI Listing
December 2019

Percutaneous Closure of Mitral Paravalvular Leaks Generating Refractory Heart Failure in the Immediate Postoperative Period.

J Invasive Cardiol 2019 Aug;31(8):E259-E260

Unidad de Hemodinámica y Cardiología Intervencionista, HM Hospitales-Hospital Universitario HM Montepríncipe, Avenida de Montepríncipe, 25, 28668 Boadilla del Monte, Madrid, Espaņa.

We present two patients with refractory heart failure due to mitral paravalvular leak (PVL) in whom percutaneous PVL closure was performed in the immediate postoperative period.
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August 2019

"Double-barrel endocarditis".

J Card Surg 2019 Oct 27;34(10):1100-1102. Epub 2019 Jun 27.

Cardiac Surgery, Hospital GU Gregorio Marañón, Madrid, Spain.

We report a case of an 18-year-old woman who presented with infective endocarditis (IE), in two conduits percutaneously delivered in the right ventricle outflow tract ("double-barrel endocarditis"). The patient's clinical presentation, echocardiogram findings, infectious agent, clinical management, surgical approach, and follow-up assessment are described. Percutaneous pulmonary valve implantation has emerged as a viable therapy for conduit dysfunction in the right ventricular outflow tract. Although the percutaneous approach has several advantages, this strategy and the valves used are not complication-free. IE after transcatheter valve deployment has evoked the growing concern, as there is a higher incidence in these patients compared with patients with surgically repaired pulmonary valves. As a result, this type of surgical treatment is especially important.
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http://dx.doi.org/10.1111/jocs.14141DOI Listing
October 2019

Perceval Less Invasive Aortic Replacement Register: multicentric Spanish experience with the Perceval S bioprosthesis in moderate-high-risk aortic surgery.

Interact Cardiovasc Thorac Surg 2018 04;26(4):596-601

Department of Cardiac Surgery, Hospital Germans Trias i Pujol, Badalona, Spain.

Objectives: The development of new percutaneous and surgical techniques has reduced the risk associated with aortic valve replacement procedures. We present the results of a Spanish register after initiating a programme for sutureless prostheses in moderate-high-risk patients.

Methods: This prospective multicentre study was carried out from November 2013 to November 2016. Data were obtained from 448 patients in whom a Perceval S prosthesis was implanted.

Results: The mean age was 79.24 (standard deviation [SD] 4.1) years, and 61.2% were women. The estimated EuroSCORE I log risk was 11.15% (SD 7.6), with an observed mortality of 4.4% (20 patients). Isolated aortic valve replacement was performed on 69.26% of patients, with 64% involving ministernotomy. The incidence of neurological events was 2%, with 2 permanent cerebrovascular accidents, and 41 (9.2%) patients were implanted with a permanent endocavitary pacemaker. At discharge, 12 (2.6%) patients presented minimal periprosthetic leakage, and 4 (0.89%) patients had moderate leakage. There were 3 reinterventions during follow-up (2 endocarditis and 1 dysfunction due to periprosthetic leak progression). The mean gradient at discharge, 6 months and 1 year was 12.94 (SD 5.3) mmHg, 12.19 (SD 4.7) mmHg and 11.77 (SD 4.7) mmHg, respectively; 59.4% of the patients were octogenarians, with a survival rate of 98% at both 6 months and 1 year at discharge. There was neither valve migration nor early structural degeneration. The mean follow-up was 12 ± 3 months. The 6-month and 1-year mortality was 1.4% and 2.1%, respectively.

Conclusions: This is a prospective multicentric study on the largest cohort of patients with sutureless valves conducted in Spain to date. It is a reproducible procedure that has enabled surgery on patients with a moderate-high risk with low morbidity and mortality, providing good haemodynamic results.
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http://dx.doi.org/10.1093/icvts/ivx384DOI Listing
April 2018

Use of the Perceval Sutureless Valve in Active Prosthetic Aortic Valve Endocarditis.

Ann Thorac Surg 2018 04 9;105(4):1168-1174. Epub 2017 Dec 9.

Department of Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

Background: Surgical treatment of active prosthetic aortic valve endocarditis presents a challenge for cardiac surgeons because of tissue friability and destruction caused by infection. Sutureless prostheses, such as the Perceval S (LivaNova, Saluggia, Italy), have emerged as an option among the different surgical approaches for these complicated cases.

Methods: This study presents data from 9 patients who underwent aortic valve re-replacement with the Perceval S because of active prosthetic aortic valve endocarditis between January 2014 and August 2016. Hemodynamic performance (mean transprosthetic gradient and type of aortic regurgitation) was assessed intraoperatively after weaning from cardiopulmonary bypass, at discharge, and to 6 months postoperatively.

Results: After weaning from cardiopulmonary bypass, cases 1 and 3 through 6 had no or trivial aortic regurgitation, cases 7 and 8 presented with trivial to mild regurgitation, case 9 showed mild intraprosthetic regurgitation, and case 2 had mild periprosthetic regurgitation. Cases 4 and 7 died of septic shock and multiorgan failure in the perioperative period. In the remaining patients, severity of aortic regurgitation maintained practically invariable at discharge compared with intraoperative results. These 7 patients did well at 6-month follow-up, with good clinical and hemodynamic performance of the Perceval S prosthesis. The median of mean transprosthetic gradient was 11 mm Hg (interquartile range: 10 to 12 mm Hg). Only patient 2 showed mild periprosthetic regurgitation; patient 9 showed mild intraprosthetic insufficiency, and the remaining patients had no or trivial regurgitation.

Conclusions: The sutureless Perceval S valve is a reasonable alternative for surgical treatment of prosthetic aortic valve endocarditis.
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http://dx.doi.org/10.1016/j.athoracsur.2017.11.031DOI Listing
April 2018

Rationale and design of a multicentre, prospective, randomised, controlled clinical trial to evaluate the efficacy of the adipose graft transposition procedure in patients with a myocardial scar: the AGTP II trial.

BMJ Open 2017 Aug 4;7(8):e017187. Epub 2017 Aug 4.

ICREC Research Program, Fundació Institut d´Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain.

Introduction: Cardiac adipose tissue is a source of progenitor cells with regenerative capacity. Studies in rodents demonstrated that the intramyocardial delivery of cells derived from this tissue improves cardiac function after myocardial infarction (MI). We developed a new reparative approach for damaged myocardium that integrates the regenerative properties of cardiac adipose tissue with tissue engineering. In the adipose graft transposition procedure (AGTP), we dissect a vascularised flap of autologous pericardial adipose tissue and position it over the myocardial scarred area. Following encouraging results in acute and chronic MI porcine models, we performed the clinical trial (NCT01473433, AdiFLAP trial) to evaluate safety in patients with chronic MI undergoing coronary artery bypass graft. The good safety profile and trends in efficacy warranted a larger trial.

Study Design: The AGTP II trial (NCT02798276) is an investigator initiated, prospective, randomised, controlled, multicentre study to assess the efficacy of the AGTP in 108 patients with non-revascularisable MI. Patients will be assigned to standard clinical practice or the AGTP. The primary endpoint is change in necrotic mass ratio by gadolinium enhancement at 91 and 365 days. Secondary endpoints include improvement in regional contractibility by MRI at 91 and 365 days; changes in functional MRI parameters (left ventricular ejection fraction, left and right ventricular geometric remodelling) at 91 and 365 days; levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) at 7, 91 and 365 days; appearance of arrhythmias from 24 hour Holter monitoring at 24 hours, and at 91 and 365 days; all cause death or re-hospitalisation at 365 days; and cardiovascular death or re-hospitalisation at 365 days.

Ethics And Dissemination: The institutional review board approved the trial which will comply with the Declaration of Helsinki. All patients will provide informed consent. It may offer a novel, effective and technically simple technique for patients with no other therapeutic options. The results will be submitted to indexed medical journals and national and international meetings.

Trial Registration Number: ClinicalTrials.gov: NCT02798276, pre-results.
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http://dx.doi.org/10.1136/bmjopen-2017-017187DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724153PMC
August 2017

Recurrent Cardiac Fibroelastoma. Is It Really a Benign Tumor?

Rev Esp Cardiol (Engl Ed) 2018 Aug 11;71(8):685-687. Epub 2017 Jul 11.

Servicio de Cardiología, Hospital Universitario Madrid Montepríncipe, Boadilla del Monte, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2017.04.031DOI Listing
August 2018

Two Different Sites of Membrane Rupture in the Berlin-Heart EXCOR Ventricular Assist Device.

Rev Esp Cardiol (Engl Ed) 2016 May 21;69(5):525-7. Epub 2016 Mar 21.

Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2016.01.021DOI Listing
May 2016

Transapical Valve-in-valve Implantation in Failed Mitral Bioprostheses.

Rev Esp Cardiol (Engl Ed) 2015 Sep 21;68(9):810-1. Epub 2015 Jul 21.

Servicio de Cirugía Cardiovascular, Hospital Universitario Gregorio Marañón, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2015.04.009DOI Listing
September 2015

Giant posterior left ventricular pseudoaneurysm.

Rev Esp Cardiol (Engl Ed) 2014 Feb 26;67(2):145. Epub 2012 Nov 26.

Servicio de Cirugía Cardiaca, Hospital de Montepríncipe, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2012.08.008DOI Listing
February 2014

Direct injury to right coronary artery in patients undergoing tricuspid annuloplasty.

Ann Thorac Surg 2014 Apr 14;97(4):1300-5. Epub 2014 Feb 14.

Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.

Background: Direct injury to the right coronary artery as a result of reparative operation on the tricuspid valve is a rare, probably underdiagnosed, but serious complication, which often involves dramatic clinical consequences. So far, only five cases have been described in the literature.

Methods: We describe our single-center experience of this complication, and review and analyze relevant clinical and anatomic considerations related to this entity. Cases previously reported in the literature were also reviewed.

Results: We describe four cases of direct injury to the right coronary artery in patients undergoing tricuspid annuloplasty (DeVega annuloplasty, 3; ring annuloplasty, 1) in our institution since 2005. All patients had right ventricular dilatation and severely dilated tricuspid annulus. Right coronary artery occlusion always occurred between the right marginal artery and the crux of the heart. Patients presented with hemodynamic or electrical instability. Coronary flow could be restored in 2 patients (percutaneously 1; surgically 1), both of whom finally survived, while it was not technically possible in the other 2 (1 died).

Conclusions: Occlusion of the right coronary artery in patients undergoing tricuspid annuloplasty is a rare complication that may occur if great annulus dilatation is present, thus altering both normal annular geometry and the relationship between the right coronary artery and the tricuspid annulus, particularly when DeVega annuloplasty is performed. Such an entity should be considered in the immediate postoperative period in an unstable patient, especially when complementary tests support this diagnosis. Prompt recognition and treatment can positively affect the patient's outcome, most often by means of an emergency revascularization strategy.
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http://dx.doi.org/10.1016/j.athoracsur.2013.12.021DOI Listing
April 2014

Synchrony relationships between the left ventricle and a left ventricular assist device: an experimental study in pigs.

Int J Artif Organs 2012 Apr 13;35(4):272-8. Epub 2012 Apr 13.

Department of Cardiac Surgery, Gregorio Marañon General University Hospital, Madrid - Spain.

Background: Synchronization between the left ventricle and a left ventricular assist device (LVAD) may be important for ventricular unloading and coronary perfusion. We assessed the synchrony between cardiac and LVAD cycles by increasing delays in steps of 100 msec throughout the cycle, under conditions of total and partial left ventricular support.

Methods: We studied 7 healthy minipigs weighing 30-40 kg. A 60-cc Berlin Heart Excor LVAD was implanted and connected to a BCM 1200 console, making it possible to synchronize the LVAD systole and the EKG signal with a prefixed delay. We recorded hemodynamic parameters (including aortic, pulmonary, and left ventricular pressure) and LVAD flow for each delay.

Results: Intraventricular pressure during LVAD systole was minimized with delays of around 40-80% of one cycle. In addition, total flow was higher under these conditions.

Conclusions: This study shows that the synchronous mode of LVAD operation is feasible. Moreover, a delay in device contraction until the second half of the cardiac cycle optimizes ventricular unloading and may eventually improve myocardial recovery.
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http://dx.doi.org/10.5301/ijao.5000086DOI Listing
April 2012

[Surgical echocardiography of the mitral valve].

Rev Esp Cardiol 2011 Dec 26;64(12):1169-81. Epub 2011 Oct 26.

Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, Nueva York, NY 10029, Estados Unidos, USA.

In the western world, the prevalence of mitral regurgitation-particularly that due to degenerative disease-has gradually increased despite a substantial decrease in rheumatic disease. If present, secondary ventricular dysfunction, potentially irreversible when clinically diagnosed, requires close echocardiographic follow-up in order to establish a subclinical diagnosis. Thus, echocardiography has become an essential tool in managing patients with mitral valve regurgitation. As well as assessing parameters of ventricular geometry, in the hands of an expert echocardiography offers systematic documentation of lesion in each segment, which together with the dysfunction type should give an accurate idea of the complexity involved in the valve repair. This is increasingly relevant given the growing number of asymptomatic patients referred for mitral valve surgery. Consequently, the echocardiographic study performed prior to referral is crucial to successful mitral valve repair and cardiologists, cardiac imaging experts, and surgeons should be guided by results when referring patients to specialists with the skills necessary to undertake adequate repair of the lesions found.
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http://dx.doi.org/10.1016/j.recesp.2011.06.025DOI Listing
December 2011

Plasma levels and vascular effects of vasopressin in patients undergoing coronary artery bypass grafting.

Eur J Cardiothorac Surg 2007 Jul 15;32(1):69-76. Epub 2007 May 15.

Departamento de Fisiología, Facultad de Farmacia, Universidad Complutense, 28040 Madrid, Spain.

Objective: Recent studies have suggested that endogenous vasopressin (AVP) acts as a spasmogen during coronary artery bypass grafting (CABG). Given that AVP could induce vasospasm in the grafted vessel, we assessed the release of this peptide during and after CABG, and explored ways of counteracting its contractile effect on the internal mammary artery (IMA).

Methods: Plasma levels of AVP were determined by radioimmunoassay in 16 patients before, during and after CABG. Using isometric force recording techniques, we also investigated the mechanisms involved in the contractile effect of AVP in ring preparations of IMA specimens taken from 95 patients.

Results: Plasma AVP levels peaked after the start of cardiopulmonary bypass (CPB) and correlated well with serum osmolality (Pearson's r=0.9490; P<0.0001; n=16). An inverse correlation was observed between plasma AVP levels recorded at this stage and the maximal contraction induced in vitro by AVP in vascular rings from the same patients (Pearson's r=-0.6968; P<0.01; n=16). No change in the AVP response was produced by endothelium removal, exposure to the NO precursor (3 x 10(-4)M L-arginine), inhibition of nitric oxide (NO) synthase (3 x 10(-5) M L-NAME) or soluble guanylate cyclase (3 x 10(-6) M 1H-[1,2,4]oxadiazol [4,3,-alpha]quinoxalin-1-one (ODQ)), removal of the superoxide anion (100 U/ml superoxide dismutase (SOD) plus 1200 U/ml catalase) or hydroxyl radical (10(-4) M deferoxamine), or specific alpha1 - (10(-6) M prazosin) or endothelin (10(-5) M bosentan) receptor antagonism. In contrast, adenylate cyclase activation (3 x 10(-8) M forskolin) reduced the contractile response to AVP, while prostanoid synthesis (3 x 10(-6) M indomethacin) inhibition and blockade of Ca2+ -activated potassium channels (KCa) (10(-3) M tetraethylammonium (TEA)) enhanced AVP contraction. Age, gender and smoking also modified the AVP response.

Conclusion: Our findings suggest a role for AVP as a modulator of vascular tone in human IMA. The effect of AVP is dependent on prostanoids and Ca2+ -activated K+ channels, so its dysfunction in pathophysiological cardiovascular processes could mean that AVP, among other factors, produces vasospasm in IMA grafts.
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http://dx.doi.org/10.1016/j.ejcts.2007.03.047DOI Listing
July 2007

[Percutaneous closure of pseudoaneurysm of the mitral-aortic intervalvular fibrosa].

Rev Esp Cardiol 2005 Dec;58(12):1473-5

Unidad de Hemodinámica y Cardiología Intervencionista, Hospital de Madrid Montepríncipe, Madrid, Spain.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is an uncommon event, which is usually secondary to endocarditis of the aortic valve. Its clinical evolution is variable and potentially serious complications can occur. Therefore, surgical treatment is usually recommended. To the best of our knowledge, this is the first description of percutaneous treatment of this disease.
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December 2005

[Pseudoaneurysm of the ascending aorta due to coronary anastomosis leaks].

Rev Esp Cardiol 2004 Jun;57(6):576

Servicio de Hemodinámica. Hospital de Madrid-Montepríncipe. Madrid. España.

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June 2004

[Aortic root homograft in the surgical treatment of aortic valve disease with dilated ascending aorta].

Rev Esp Cardiol 2004 May;57(5):412-6

Servicio de Cirugía Cardíaca, Hospital Madrid Montepríncipe, Boadilla del Monte, Madrid, España.

Introduction And Objectives: Patients with aortic valve disease and a dilated ascending aorta are usually treated with a composite graft comprising a valve and conduit. We review here the results of treatment with an aortic root homograft as a valid alternative.

Patients And Method: Twenty-two consecutive patients with a mean age of 64.8 (8.8) years were studied. Mean ascending aorta dilation was 54.55 mm, aortic valve insufficiency was present in 16 patients, and a combined lesion was present in 6. In all cases a cryopreserved aortic root homograft was used to replace the aortic valve and ascending aorta. In 9 cases a Dacron conduit was used beyond the sinotubular junction to restore continuity between the homograft and the native aorta.

Results: All patients survived surgery. One patient had postoperative systemic inflammatory response syndrome and one patient was re-explored for excessive bleeding. Mean duration of follow-up was 12.1 months (range 2-36 months). No patient was given anticoagulants, and one had an early transient cerebrovascular accident followed by complete recovery. At one month postsurgery the left ventricular systolic (P<.001) and diastolic (P<.009) diameters had decreased significantly on echocardiography, and these decreases persisted throughout follow-up. The caliber of the ascending aorta was normal in all patients (< or =30 mm) except one.

Conclusions: Aortic root homografts are a valid alternative in the treatment of aortic valve disease with ascending aorta dilation. The main advantages of this therapy are that permanent anticoagulation is not needed, and that left ventricular dimensions recover rapidly.
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May 2004

Periannular extension of infective endocarditis.

J Am Coll Cardiol 2002 Apr;39(7):1204-11

Hospital Universitario San Carlos, Madrid, Spain.

Objectives: This prospective study was designed to assess the current clinical course, risk factors, microbiologic profile and echocardiographic findings of patients with left-sided endocarditis and perivalvular complications.

Background: Periannular complications worsen the prognosis of patients with endocarditis. The relation between these complications and the clinical and microbiologic data has not been clearly defined.

Methods: In this clinical cohort study, 211 patients with left-sided endocarditis, according to the Duke criteria, were prospectively recruited. All patients underwent conventional and transesophageal echocardiography. The mean follow-up interval was 151 days.

Results: Perivalvular complications were detected in 78 patients (37%). The incidence of periannular extension of infection in native and prosthetic valves was 29% and 55%, respectively. The presence of prosthesis (relative risk [RR] 1.88, 95% confidence interval [CI] 1.35 to 2.64) and previous endocarditis (RR 1.78, 95% CI 1.16 to 2.7) were the only pre-existing heart conditions associated with perivalvular complications. Aortic infection (RR 1.8, 95% CI 1.23 to 2.66) and the development of atrioventricular (AV) block (RR 2.55, 95% CI 1.91 to 3.41) were related with the existence of these complications. Coagulase-negative staphylococci were very common in patients with perivalvular complications (RR 1.77, 95% CI 1.21 to 2.59), and small vegetations were more frequent in these patients (RR l.45, 95% CI 0.95 to 2.22). An operation was more frequently performed in patients with perivalvular complications, but mortality was similar in patients with and without these complications.

Conclusions: Aortic infection, prosthetic endocarditis, new AV block and coagulase-negative staphylococci were independent risk factors of periannular complications. The period between symptom onset and diagnosis, the incidence of pericardial effusion and persistent signs of infection were similar between patients with and without perivalvular complications. Patients with perivalvular complications did not demonstrate a difference in the presence or size of vegetations or the frequency of embolism. An operation was more frequently performed in these patients, but mortality was similar in both groups.
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http://dx.doi.org/10.1016/s0735-1097(02)01747-3DOI Listing
April 2002