Browsing by Author "Bulnes Muzard, Juan Francisco"

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    Coronary-subclavian steal syndrome: A case series and review of the literature
    (2024) González Urquijo, Mauricio; Valdés Echenique, José Francisco; Bulnes Muzard, Juan Francisco; Torres Álvarez, Josemaría; Vargas Serrano, José Francisco; Bergoeing Reid, Michel Paul; Mertens Martin, Renato Alfonso; Marine Massa, Leopoldo Ario Fernando
    Objective: To report a case series of three patients with symptomatic coronary-subclavian steal syndrome (CSSS) and to review the literature on published case series. Methods: We retrospectively reviewed three cases of CSSS patients treated with open and endovascular surgery at a single center over a period of three decades (1996–2024). A comprehensive review of case series involving more than three patients was also performed. Results: The first patient was a 65-year-old male with a 12-year history of coronary artery bypass grafting (CABG), presenting with unstable angina. Coronary angiography revealed a patent left internal mammary artery (LIMA) graft with retrograde flow through the left subclavian artery (LSA) and occlusion at the LSA ostium. He underwent a successful carotid-subclavian bypass, which significantly improved his symptoms. He died 6 years later from heart failure. The second patient was a 73-year-old woman with a 15-year history of CABG and balloon angioplasty of the grafts. She presented with dyspnea, stable angina, and progressive functional decline. Critical stenosis in the LSA was identified, and her symptoms resolved after successful stent placement. She died 6 years later from progressive heart failure. The third patient was a 75-year-old woman with diabetes, hypertension, and heart failure, who also had a history of CABG. She presented with worsening dyspnea, orthopnea, and edema. Imaging revealed occlusion of the circumflex artery graft and severe LSA stenosis. Successful stenting of the LSA alleviated her symptoms and restored normal blood flow from the LIMA graft. She was discharged after 2 days and remains well at the six-month follow-up. Conclusion: CSSS should be considered in the differential diagnosis of patients with a history of CABG who present with angina or heart failure. Prompt treatment can lead to significant symptom improvement.
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    Reversible Biventricular Dysfunction Due to Right Ventricular Pacing in a Patient With Prior Cancer Treatment
    (2025) Sanhueza Zamorano, Sebastián Ignacio; Castillo, Josefina; Chiliquinga Morales, David Hernan; Bulnes Muzard, Juan Francisco; Paredes, Alejandro
    Background: We report the case of a 54-year-old woman with a history of breast cancer treated with chemotherapy, surgery, and thoracic radiotherapy in 2007, who developed pacing-induced cardiomyopathy (PICM) after right ventricular pacing.Case Summary: The patient initially presented with symptomatic trifascicular block and underwent single-chamber pacemaker implantation due to bilateral subclavian vein stenosis, with atrial sensing (VDD mode). Eight months postimplantation, she presented with heart failure symptoms and new-onset biventricular systolic dysfunction. Ventricular pacing was 100% owing to complete atrioventricular block. Coronary angiography was unremarkable, and catheterization confirmed elevated filling pressures without pericardial constrictive physiology.Discussion: Given the patient's lack of candidacy for cardiac resynchronization therapy, medical treatment was optimized, leading to significant functional improvement and recovery of biventricular function within 6 months.Take-Home Message: This case highlights the potential reversibility of pacing-induced cardiomyopathy with optimal medical therapy when cardiac resynchronization therapy is not feasible.