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Resumen: La pérdida de la geometría ventricular es la principal causa de progresión de la insuficiencia cardiaca y de riesgo en la morbimortalidad en pacientes con cardiomiopatía dilatada. La insuficiencia mitral ocurre secundariamente a la dilatación anular, a la geometría ventricular izquierda alterada y a la disfunción del músculo papilar. La cirugía de restauración ventricular (CRV) se introdujo como una opción terapéutica con la hipótesis que mejora el funcionamiento mitral al reducir los volúmenes del ventrículo izquierdo, las distancias de los músculos papilares y restaurar la geometría cardiaca. Este trabajo presenta el caso clínico de una paciente con insuficiencia cardiaca de etiología isquémica necrótica, que fue intervenida quirúrgicamente y se le realizó restauración ventricular, células madre y matriz de colágeno biodegradable. En el seguimiento a los dos años, la paciente no necesito más ingresos por descompensación, se observó que la clase funcional (CF) (NYHA) mejoró de CF III a I. La fracción de eyección del ventrículo izquierdo (FEVI) se incrementó de 20 a 27%, la insuficiencia mitral se redujo de grado IV a II, presentando estudios complementarios con mejora en el ejercicio. Los resultados de este caso sugieren que la técnica de restauración ventricular basada en el modelo de la banda miocárdica se aproxima a la anatomía y fisiología cardiaca normal, corrigiendo la insuficiencia mitral isquémica sin asociar cirugía valvular. Abstract: Loss of ventricular geometry is the main cause of progression of heart failure and risk of mortality in patients with dilated cardiomyopathies. Mitral regurgitation occurs secondary to annular dilatation, altered left ventricular geometry and papillary muscle dysfunction. Ventricular restoration surgery was introduced as a therapeutic option with the hypothesis that improves mitral functioning by reducing left ventricular volumes, papillary muscle distances and restoring cardiac geometry. This work presents a clinical case of a patient with heart failure of necrotic ischemic etiology, who underwent surgery and had ventricular restoration, stem cells and biodegradable collagen matrix. At the two-year follow-up, the patient did not need further hospitalizations due to decompensation, it was observed that the functional class (NYHA) improved from FC III to I. On the other hand, the ejection fraction improved from 20% to 27%, Mitral Insufficiency was reduced from grade IV to grade II presenting complementary studies with improvement in exercise. The results of this case suggest that the miocardial band and the restoration technique based on this model approximate normal cardiac anatomy and physiology, correcting ischemic mitral regurgitation without associating valvular surgery.

Purpose: To report a new surgical procedure using biodegradable collagen matrix (Ologen) implantation with conjunctival flap for reconstruction of scleromalacia after periocular surgery. Methods: A total of 26 areas of 25 eyes in 25 patients were included. We divided all eyes according to the preoperative extent of calcified plaque or scleral defect as follows: small, large, and large and severe. Morphologic outcomes were graded from 0 to 7, with higher scores indicating worse cosmetic outcomes. Results: Mean follow-up period was 8.3 ± 5.6 months. No eyes showed recurrence or specific complications related to Ologen such as implant extrusion or allergic reaction. Minor complications such as flap vessel engorgement and flap hypertrophy were easily treated. Mean morphologic outcome scores were 1.8, 2.4, and 5.3 in groups 1, 2, and 3, respectively. Discussion: The combined surgery may be an effective and safe procedure for the treatment of scleromalacia after periocular surgeries. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and safety of using a biodegradable collagen matrix in glaucoma filtering surgery Methods: We treated nine eyes of nine patients with moderate to advanced open angle glaucoma and uncontrolled intraocular pressure (IOP) on maximally tolerated medical treatment. Fornix-based trabeculectomy was performed in all patients and a biodegradable collagen matrix implant was inserted over the flap and underneath the conjunctiva. Results: Mean age was 37.9 years (range: 16-68). Mean follow up was 7.9 months (range: 3-18). With successful IOP control defined as IOP ≤ 21 mmHg with at least 20% reduction from baseline on the same or fewer number of pre-trabeculectomy medications, 8 out of 9 eyes (88%) fit the criteria for success over the course of follow up. Among all eyes with ≥ 3 months of follow up there was a significant drop in IOP from pre-trabeculectomy 3 months postoperatively (p ‹ 0.05). The percentage of patients requiring › 2 medications declined from 100 %( 9/9) at pre-trabeculectomy to 11% (1/9) at 3 months (p ‹ 0.05). The patient who did not meet the criteria of success regained successful IOP control with bleb needling done 6 weeks after the initial surgery. One eye developed postoperative hypotony for which bleb revision was required. Conclusion: The use of biodegradable collagen matrix implant appears to hold promise as a tool to increase success rate of glaucoma filtration surgery. Further studies are needed to evaluate the long term results and compare this against the use of antifibrotics in trabeculectomy. [ABSTRACT FROM AUTHOR]