Biomedical subjects

Rafael Calderón

Publications and source records attributed to Rafael Calderón.

6 recordsLinked to original sources

PubMed2006

Coexistent congenital aortic defects, aneurysm of sinus of valsalva, atrial septal defect and infective endocarditis: a case report.

Coarctation of the Aorta is frequently associated with bicuspid aortic valve. This is a risk factor for infective endocarditis. Aneurysm of a sinus of Valsalva is a rare defect with a prevalence of 0.09%. They are associated in 10% of cases with a bicuspid aortic valve and less frequently with coarctation of the aorta and atrial septal defect. It is extremely rare the association of coarctation of the aorta with an atrial septal defect. This is one of the first cases reported in Puerto Rico of an adult patient with coarctation of the aorta in association with a bicuspid aortic valve, a ruptured aneurysm of a sinus of Valsalva and an atrial septal defect. The patient is a 22 year old male with coarctation of the aorta diagnosed since childhood who was admitted at the Cardiovascular Center of Puerto Rico with signs of heart failure due to infective endocarditis secondary to a teeth infection. Upon evaluation with transthoracic and transesophageal echos, he was found to have a coarctation at the aortic isthmus, aortic root dilatation, bicuspid aortic valve with vegetation, severe aortic and tricuspid regurgitation, aneurysm of the non coronary sinus of Valsalva with perforation to the right atrium, biatrial enlargement and a dilated right ventricle. Successful antibiotic treatment of endocarditis was achieved followed by surgical replacement of the aortic valve and ascending aorta with closure of the non coronary sinus of Valsalva was done. An secundum atrial septal defect was found and was also closed. Surgical correction of the coarctation of the aorta was postponed for a future time. The patient had a successful postsurgical recovery and was discharged home with anticoagulation treatment.

Abnormalities, Multiple↗

PubMed2004

Selection of congestive heart failure patients for heart transplant.

Heart failure is one of the most common causes of hospitalization in adult patients. With the recent technological advances and the use of new medications for controlling rejection, heart transplant has been established as a definite therapeutic measure for properly selected patients with advanced congestive heart failure. As there is an active transplant program in the Cardiovascular Center of Puerto Rico and the Caribbean, this review is intended to acquaint the practicing physician with the required work up and management of patients referred for cardiac transplant. Emphasis is given to indications, clinical and psychosocial evaluation, optimization of medical therapy and to the absolute and relative contraindications.

Clinical Trials as Topic↗

PubMed2004

The cardiomyopathies, a review for the primary physician.

The cardiomyopathies constitute a group of diseases with direct involvement of the heart muscle itself, and is a significant cause of morbidity and mortality. The World Health Organization (WHO) and the International Society and Federation of Cardiology (ISFC) have promulgated a classification taking into consideration the etiology and pathophysiology, which includes dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, restrictive cardiomyopathy, and unclassified cardiomyopathies. Over 25 causes are associated with the development of the cardiomyopathies. The classification of the diseases affecting the heart and causing the cardiomyopathies is presented including the highlights of the most important data for diagnosis and management of each one.

Cardiomyopathies↗

PubMed2002

Neonatal prefrontal cortex lesion using CO2 laser technique.

Prefrontal cortex (PFC) is a large area of the brain and its neonatal lesion with ibotenic or kainic acid is used to study the early abnormalities in neurodevelopment that lead to behavioral changes linked to schizophrenia. However, these exitotoxic drugs produce a large and asymmetric damage in the PFC. We produced the bilateral lesions of the dorsal part of the PFC of neonatal Sprague-Dawley rats (postnatal day 7, P7) at the anteroposterior +2.5 mm and mediolateral +/-0.4 coordinates by the new laser technique that employ the confined radiation of the CO(2) laser in the pulsed mode. The laser was used because its coherent radiation can be focused in a very small spot and as small as of several tens of micrometers in diameters. The CO(2) laser radiation is strongly absorbed by water that is present in any soft tissue. Thereafter, the configuration of the heated zone and, consequently, that of the lesion does not depend on the morphological non-homogeneity of particular structures. We obtained the symmetric, conical in shape and small-size bilateral lesions of the PFC. The size of the lesion depended on the beam spot-size and could be as small as several dozens of micrometers in diameter. Our data suggests that the laser technique will be used for the anatomical-functional studies of the PFC in the brain.

Animals↗

PubMedDate not supplied

Heart transplantation in females: the experience in Puerto Rico.

BACKGROUND: Heart transplantation is the procedure of choice for a selected group of patients with end stage heart disease. Gender related differences have been observed in the heart transplant field: less women than men are recipients of heart transplants, more risk of rejection in female recipients, and a perception toward reduced survival in women. We report our experience of heart transplantation in females in Puerto Rico. METHODS: We studied the data bank of 69 heart transplant recipients in the Puerto Rico Heart Transplant Program from June 1999 to June 2005. Gender related differences in the number of recipients: males or females, incidence of rejection, survival, and other outcomes were analyzed. RESULTS: 69 patients received an orthotopic heart transplant from June 1999 to June 2005, in a single center in Puerto Rico. The mean age of the patients was 47 (11-62) years. Fifty patients (72%) were men, and 19 patients (28%), were women. Survival in the female group at 3 months, 1, 2, 3, 4, and 5 years was 100%, 100%, 100%, 100%, 90%, and 90% respectively. The survival in the male group at 3 months, 1, 2, 3, 4 and 5 years was 97%, 97%, 97%, 94%, 86 and 79% respectively. There was an early, higher incidence of rejection in women during the first three months post transplant; 1.5 vs. 0.75, (P=0.04) episodes per patient in the female, and male group respectively. After the third month post transplant there was no significant difference in rejection incidence. The incidence of infectious episodes was significantly more frequent in female than in male recipients, 2.8 vs. 1 (P=0.02) per patient respectively. CONCLUSIONS: There were more male than female heart transplant recipients at a ratio of 3:1, without a significant gender difference in survival. The risk of rejection was higher in females in the early period post transplantation, but thereafter this risk showed no signinificant statistical difference. The incidence of infection was more frequent in female than in male recipients.

Adolescent↗

PubMedDate not supplied

Bilobulated atrial myxoma originating from low interatrial septum.

Myxomas are the most common type of primary cardiac tumors. Around 70% of patients who have them are females, 86% occur in the left atrium and more than 90% are solitary. In the left atrium the usual site of attachment is in the fossa ovalis. Less common sites within the left atrium are the mitral valve or in areas near it. This patient, with a left atrial myxoma originating low in the interatrial septum near the mitral valve, is one of the first cases reported in Puerto Rico. The patient is a 41 year old female with no previous history of systemic illnesses who one month prior to admission developed episodes of chest pain and shortness of breath. A 2D echo, done by a local physician, revealed a mobile left atrial mass causing diastolic obstruction of the valve. She was referred to our institution for further evaluation. A transesophageal echo was done showing a large bilobulated mass connected to the lowermost portion of the atrial septum, close to the mitral annulus, specially to the anterior leaflet. It also showed concurrent mitral regurgitation caused by the mass. The tumor was successfully resected without major complications and it was proven to be connected to the septum 1 cm above the mitral annulus. Pathological examination confirmed it to be a myxoma.

Adult↗