!Eres Absurdo!


aortic barbosa

Eres Absurdo!

I’ve heard that several times since I’ve been here – but it’s not exactly as it sounds.  It’s slang: like saying “goofy-footed” when referring to snowboarders.  It means that I am left-handed, or left-hand dominant, since the operating room requires you to be somewhat ambidextrous.

So this week – that was one of the things I set out to do – to become more proficient with suturing with my right hand.  It wasn’t as hard as I expected but I certainly don’t have the speed I have with my left hand (which sadly, isn’t that fast).

Barbosa aortic

Monday

Today wasn’t a great day. Everything went well – harvested vein, closed incisions, in the operating room so it should have been another fantastic day – but…. I just a felt, a little lonely today, I guess.  Or maybe lonely is the wrong term – since I live with three other people here in Sincelejo.  I guess what I meant to say is it’s the first time I’ve really felt alone since I’ve been here – and it was kind of surprise to feel that way.

I guess because I am used to traveling frequently and in making unfamiliar surroundings my home that it came as an unexpected pang when I suddenly missed the camaraderie I have had at other hospitals.  Everyone has been fantastic here – particularly Iris, who I consider to be a good friend, but it’s not quite the same.

My name is Kristin.. Kristina is someone else

Here in Colombia, many people struggle to pronounce my name so it’s usually simplified to “Kristina”.  But that’s not me.  Just like my name, I feel like a bit part of my personality just doesn’t translate into Spanish well.  Not as a cultural metaphor or anything ‘deep’ like that – but literally.  When something that you take for granted – like having an extensive vocabulary at your disposal, is redacted, it kind of changes how you express yourself.  It also changes peoples’ perceptions of you.

Just for five minutes – I desperately wanted at least one person who really “knew” me to be there.

Dr. Barbosa is a fantastic teacher and a very intelligent and kind person – but we don’t have the kind of friendship that I had with either Dr. Embrey (in Virginia) or Dr. Ochoa (in Mexicali).  Part of that is probably due to the fact that I just haven’t been here all that long.  I worked with Dr. Embrey for almost three years.  Dr. Ochoa and I were together five to six times a week for months.

aortic valve 010

The other part is Dr. Barbosa himself.  Our perspectives are fairly different, so that tends to complicate things.  He is always friendly but still a bit reserved with me.  That might be due to the fact that I am still lacking fluency in Spanish.  (I understand a heck of a lot more that I can speak – but even so, colloquial phrases and subtle nuances in speech are usually a complete mystery to me).  So I miss most of the jokes in the operating room, or figure it out about five minutes too late to be part of the conversation.

But after a little while that feeling of intense ‘alone’ dissipated – and everything went back to normal, whatever that is.

aortic valve 012

Tuesday

This morning I went by the Cancer Institute of Sucre.  I had written to them last week, but received no reply, so I decided to stop in.  After about an hour, I was able to talk to one of the administrators but she said that I had to submit all my questions about their cancer treatment programs in writing, in advance.  I explained that is not how it usually works, and left my card.  I am sure that will be the last I hear from them.  It’s a shame because the facility is beautiful, sparkling and new.  They advertise a wide variety of cancer treatments including brachiotherapy and thoracic surgery so I would have liked to know more.  (The website looks like something circa 1996, so it’s not really possible to get information from there.)

Another case today – another saphenectomy!  But this one came with a potent reminder.   While I still need practice, I feel more capable of performing the procedure that I did before.  Things proceeded well, if slowly (still need a headlamp!) but then it turned out that the internal mammary wasn’t useable so Dr. Barbosa needed more vein conduit.  Which he proceeded to harvest himself, in about five minutes.  So – I still plenty to aim for.

The holiday week started mid-week, but I am still hopefully for a few new consults tomorrow.  I know we probably won’t have any surgeries over the ‘Semana Santa” period, but I can’t help but keep my fingers crossed anyway.

Wednesday

Aortic valve replacement*** today.  Dr. Salgua showed up early today – and looked pretty determined, so I decided just to stay out-of-the-way.  I figured since it wasn’t a vein harvesting case, I shouldn’t make a fuss.  After all, I am just a visitor here – and I’ll be leaving soon.

aortic valve 027

Not my best photo by far – but my favorite part of this surgery – placing the new aortic valve into position

Instead, I stayed behind the splash guard and took pictures – since aortic replacement is the “prettiest” of all cardiac surgeries.  Unfortunately, my position was a little precarious, balanced in two steps – and still barely above the splash guard.  So many of the best shots – ended up partially obscured.  (But I don’t want to give up any more surgeries to get better photos.)

Received a consult from the cath lab today but surgery will probably be delayed due to the Easter week holiday.  (The team is willing to operate 24/ 7 – but few else are.)

Both our patients from earlier this week are doing great.  Monday’s patient passed me several times doing laps on the med-surg floor.  He’ll probably go home tomorrow or Friday.

Thursday

No surgery scheduled for today.  Rounded on the patients from this week and spent some time explaining medications, post-discharge instructions and other health information with the patients and their families.  While I love the operating room – this is the part I enjoy the most: getting to know my patients, and getting to be part of their lives for just the briefest of moments.  It is this time with patients – before and after surgery that makes them people, families – not legs or valves or bypasses.  Without this part, I am not sure I would have the same satisfaction and gratification in my work*.  I love seeing patients when they return to the clinic for their first post-operative visit – to see how good they look, and how much better many of them already feel.

This afternoon – was exactly that as one of my first patients returned to the clinic after surgery.  The patient looked fantastic!  All smiles, and stated that they already felt better.

After seeing patients in the clinic, we packed up and headed for home.  Since we currently have no surgery scheduled for next week (Semana Santa), and our other consults are pending insurance authorization, I don’t know when or if I will be returning to Sincelejo before I depart for the United States.

*As I say this, ironically, I am hoping for a ‘straight surgery’ position for one of my future contracts, so I can refine/ improve my surgical skills for future contracts in different settings that encompass a variety of duties.

***More Aortic Valve articles, including my famous “Heinz 57” post can be found here:

Aortic Stenosis and Heinz 57 : (what is Aortic stenosis?)

Aortic Valve Replacement and the Elderly

Aortic Stenosis : More patients need surgery

Cardiac surgery and valvular heart disease: More than just TAVR

There is a whole separate section on TAVI/ TAVR.

 

 

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The Sincelejo Diaries


 

Sincelejo from the balcony

Sincelejo from the balcony

 

Since I have very limited wi-fi while in Sincelejo, I have been keeping a diary of my time on the cardiac surgery service of Dr. Cristian Barbosa.  But then again, maybe I should explain why I am here.

I came to Colombia to learn how to perform skip harvesting saphenectomies with Dr. Barbosa.  As I mentioned previously, we’ve kept in contact since we first met, and he was gracious enough to offer to teach me.

Before I ever left Virginia, it took a lot of paperwork and diplomacy, but we were able to secure administrative permissions for me to study sapheneous vein harvesting with Dr. Barbosa at the hospital in Sincelejo.  While this isn’t medical tourism, I thought my readers might enjoy hearing about daily life as part of Dr. Barbosa’s cardiac surgery service.

 

 Cardiac Surgery in Sucre, Colombia

 

outside the operating room

outside the operating room

While the cardiac surgery program is located in Hospital Santa Maria, Dr. Barbosa and his team often travel to nearby hospitals and clinics to see new consultations.  This program is the only program in the state of Sucre and patients come from all parts of the state.

Many of the patients come from tiny pueblos of a few hundred (or thousand people).  Many others come from impoverished backgrounds.  (Colombia has a tiered health care system with a national health care plan for people from lower socio-economic classes, kind of similar to the Medicaid concept.)

We arrive in Sincelejo on Monday, March 24th in the evening.  We have a busy day tomorrow and the doctor wants to get started early (without facing the 3 hour drive in the morning.)

En Familia

In Sincelejo, we live en familia, in a large airy apartment with big windows that overlook much of Sincelejo.  There are four of us here, the surgeon, the anesthesiologist (who is Director of the program), the perfusionist and myself.  Iris and I share a large room with a private balcony.  Meals are shared and we usually travel as a group to the hospital and on errands.

After our arrival Monday evening, the doctor, the perfusionist and I head to the largest grocery store and shopping center in town.  We shop as a family, picking out fruit, arepa corn flour, coffee and other essentials.   We then head to the food court.  (They are treating me to Corral, due to my proclaimed love of Corral’s famed hamburgers).   

It sounds like it could be uncomfortable – this domestic scene with my boss and the cardiac surgery team, but surprisingly it isn’t.  Iris, the perfusionist (and my roommate both here and in Cartagena) always says they are a “cardiac surgery family,” and it feels that way – in a comforting, cozy way.

I joke and call Dr. Barbosa, “Papa” as he is the natural father figure of the group, and somehow it feels appropriate.

 

'Papa' of our cardiac surgery team

‘Papa’ of our cardiac surgery team

25 March 2014 – Tuesday

Today we travelled to Corozal to see two consultations in the intensive care unit.  Then we returned to Sincelejo to see another patient at another hospital, Maria Reina.  We eat lunch at the apartment, en familia .  Afterwards, we go back to the office to see patients before heading off to surgery.  (We had to delay surgery for several hours because the patient decided to eat breakfast.  I guess s/he was hungry too).

barbosa 081

 

Finally after this delay (to prevent anesthesia complications), we head to the operating room.  There are the typical delays while the patient is being prepped and prepared.  This gives me a chance to get to know the rest of the crew, Anita (the instrumentador or surgical tech) who runs the operating room table, Raquel, an experienced instrumentador who is training to work in the cardiac suite, and the two circulating nurses,  Patricia and Estebes.

Raquel (right) and Anita, the instrumentadors

Raquel (right) and Anita, the instrumentadors

The circulating nurses are responsible for taking care of all the duties that fall outside of the sterile field, like fetching additional supplies, medications or instruments.  They also control the environment by regulating the temperature, and adjust the electronic machinery (like the electrocautery unit, or the sternal saw) according to the surgeon’s immediate needs and specifications.

Patricia and Estebes, circulating nurses

Patricia and Estebes, circulating nurses

Dr. Salgua is the medical doctor who works in the office, seeing patients and assessing their medical (nonsurgical needs.) For the last year, she has also worked as Dr. Barbosa’s First Assistant in Surgery.  If there is any chance for friction in the operating room, most likely it will come from her.  I am cautiously nice but optimistic when I realize she is fairly quiet, and not overly aggressive.  (I relax, but just a bit.  I am still nervous about how the team will take to me, even though the common Oops! “accidental” needle stick scenario seems unlikely here.

Dr. Salgua

Dr. Salgua

 

Everyone is very friendly and welcoming and even before starting the actual surgery, I am breathing easier and starting to think that maybe I could belong here, with this group.

The surgery went well (valve replacement and annuloplasty).  After the surgery, we transport the patient to the intensive care unit and give report to the doctors and nursing waiting to assume care of the patient.

Note: patient did well and went home on POD # 3 on 3/28/2014.

 

26 March 2014 – Wednesday

More surgery today, but still no coronaries (and thus no saphenectomies).  It was a great day in the operating room – I closed the sternal incision..  (BTW, surgery went beautifully).  I am already starting to feel more at home with the operating room staff, and I feel like they don’t mind having me around.  Dr. Salgua has been very kind in assisting me during procedures, which is a relief.  She still stays pretty quiet during the cases, but I think maybe sometimes she is a bit nervous too.

 

with the team

with the team

After transferring the patient to the ICU, our second visit to the patient from yesterday finds her over in the general surgery ward.  (This morning she had been sitting up in a chair in the ICU when we arrived.)  She looks good and states she is sore, but otherwise fine.

barbosa 082

The cardiac catheterization lab calls; there are four cath films they want us to review, and patients to discuss regarding surgery.  The patients themselves are resting in the recovery area after the cath procedure, so our administrative assistant, Paola makes appointments for each of them and instructs them to bring their families, medications and any questions.

The most interesting part of the cath lab is who is doing the caths.  It’s a nurse, while the cardiologist sits behind the protective radiation shielded glass enclosure viewing the films and calling out for additional views.  I wonder if the nurse knows that in the United States, a similar position would pay over 100,000 dollars.  But this is one of the things that I see a lot of her in Colombia and in Mexico.  Well trained nurses being essentially nurse practitioners (making diagnoses, treating disease, performing invasive procedures) but without the status or the compensation.

My roommate and I talk about this disparity sometimes.  She’s a master’s trained nurse herself, so it makes for some very interesting discourse and insights. (She doesn’t like to have her picture taken, so I haven’t.)

We finish seeing patients and head home.  The doctors head off for a siesta.  Dr. Barbosa has been up since before five for his daily exercise before surgery.

As for me – after some scouting of the immediate areas around the hospital and the apartment, I went on my motorcycle tour.  It was great fun but I got an important reminder of the perils of motorcycles just a few days later.

Note: After and uneventful surgery (defect repair), patient recuperated quickly, and was discharged 3/29/2014.

 

27 March 2014 – Thurday

The week is really flying by.  I’ve been having fun with the operating room team.  They are a great group. Everyone has been extremely nice and welcoming.  (You can never be sure how your presence is going to be tolerated or change the existing dynamic.)   Dr. Melano and I have a couple of animated discussions over current practices, literature and recent meta-analyses.  It’s an enjoyable discourse even though my vocabulary often fails me.  I hear myself making grammatic mistakes and repeated errors in Spanish but it seems with some much going on (reviewing my anatomy, practicing my suture ties, assisting in the operating room and trying to keep up on my writing )- I just can’t seem to remember as much as I should in Spanish.  I inwardly cringe when I substitute ‘conocer’ for ‘saber’ yet again, but the word is out of my mouth in reply to a question before I can corect myself.

Dr. Salgua assists Dr. Barbosa

Dr. Salgua assists Dr. Barbosa

I sit out this surgery (still no coronaries) and spend some time taking pictures to document my experiences here.  I got a couple of shots that I really like, including one of Dr. Barbosa, Dr. Salgua and Raquel.

one of my favorite pictures from that day

one of my favorite pictures from that day

 Note:  Patient discharged home 3/29/2014.

28 March 2014 Friday (and coronaries!)

Today is my big day – and I am excited and a little scared too.  I got up at five this morning and went with Dr. Barbosa to the exercise park, so I would have a place to walk while he played tennis.  It helped me get ready for the day, and I got to see where Dr. Barbosa uses up all of his pent-up aggression.  He turns it into a power slam. (I don’t know tennis terms, but whatever swing he was doing – it must be responsible for his tranquil overall demeanor.)

After breakfast, we head to the hospital.  We check on our hospitalized patients before going to see today’s surgical patient in pre-op.

Our patient is a bit fragile-looking so (of course!) I worry about her and how she will do with surgery.   I also worry that I might not sew straight, now that it’s time for me to get to work.

Some of my previous OR “lessons” have been brutal, including several at a troubled facility that sent me running away from cardiac surgery (of all kinds) for several months*.  This is what fuels my anxiety.  (I am not anxious by nature).

But here in Sucre, in this OR,  this experience is nothing of the sort – Dr. Barbosa is an excellent teacher.  I don’t know why it’s a surprise.  He’s always been a bit of a  Clark Kent of the operating room; pleasant, calm and methodical.**  This is just the same.  In his soft burring voice he goes over the procedure with Dr. Salgua and I.  The he oversees our attempts, gently encouraging and coaxing.  It is yet again, a comfortable experience, instead of a traumatizing, horrible one.

a pretty great teacher

a pretty great teacher

 

I don’t have any pictures which would show my twinkling eyes which are the main indication of my happy grin beneath my mask as I finished closing the last leg incision.

We wrap the leg when we finish and move up to the ‘top’ of the operating room table.  (I’ve learned that the top and the bottom of the operating room table are two very different places.)

I close the chest incision – surgery is over.   We transfer the patient to the ICU.  She remains a little fragile but has no immediate problems.

barbosa 047

After making sure the patient is stable, the team heads over to Clinica Maria Reina.  We have received a call that a trauma patient is being placed on ECMO (to support his lungs) after developing a fat embolism.  We are standing by to help, as needed.

As I look around, and talk to the staff, I find that there are three patients in the small ICU, all young men in their twenties, all intubated with critical injuries, all due to motorcycle accidents.  One patient, just barely an adult has lost a limb as well.  He is awake and hitting the siderails with his remaining hand to capture the nurse’s attention.  She holds his hand and speaks soft to him and he calms down.  Watching this, along with the patient struggling to survive as doctors rush to connect ECMO is a sobering reminder of how devastating my joyride could have been.

The patient is connected to ECMO without incident.  As a weary unit, all four of us return home.

Cartagena 004

The view from my private dance floor..

Everyone is exhausted – but I am exhilarated!  I just want to dance – so I do, by myself, on the balcony with my phone blaring out some music.  Later that evening, we go out for dinner to celebrate a successful week.  I am still in a joyous dancing mood which probably drives my companions a little crazy but it’s been such a great day..  so when we return home, I dance some more.

March 29th, 2014 – Saturday

In the morning after my dancing spree – Dr. Barbosa and I walk down to the hospital.  Our fragile patient from yesterday is doing okay, and our other two patients are ready to go home.  I review discharge instructions with each patient, and hope that I am not mangling my Spanish too badly. But they seem to understand me, so maybe I am doing alright.  The doctor is nearby, writing prescriptions, to clarify anything I have trouble explaining.

One patient asks about getting out of a chair without using his arms (and stressing the sternal incision) so I demonstrate my favorite technique, and together we practice.

After we finish, we head back to the apartment to eat breakfast, finish packing and head back to Cartagena.  Dr. Melano is staying behind (along with Dr. Salgua, who lives in Sincelejo) to check on our remaining patient.

The ride back is pleasant, but I start to feel some of the fatigue from all of the excitement of the week.  I also feel a little sad to be leaving our little cardiac ‘family’ for a few days, which is probably crazy considering how much time we’ve all spent together.  I guess it’s because I know it’s just temporary.

Iris and I head back to ‘our’ Cartagena apartment where the neighborhood cat, Ximena is waiting for us.

Now we will relax, write and get ready for the return trip on Tuesday.

* A deliberate elbow to the face was just the beginning of a series of humiliations at a previous facility.

**Pulling on his superman cape when needed.

Talking with Dr. Sergio Franco, Cardiac surgeon


Dr.  Sergio Franco wrote the book on heart surgery.

It was exciting and illuminating to talk to Dr. Sergio Franco, who is one of Colombia’s most prolific writers and professors of cardiac surgery.  The 50 year-old cardiac surgeon has authored multiple textbooks for surgeons and edited ten others, making him one of the nation’s definitive experts on cardiac surgery.

Dr. Franco stands near a collection of his textbooks

Dr. Franco stands near a collection of his textbooks

Currently he is the Medical Director of the Cardiopulmonary and Peripheral Vascular Center of the Fundacion San Vicente in Rio Negro, as well as Chief of Cardiothoracic Surgery at the Clinica de Medellin.  For the last 12 years, he has also been the program director for post-graduate studies at the Universidad CES medical school.  Between the two clinics, and the five other surgeons he works with (2 at Clinica de Medellin and 2 at Rionegro), he estimates that the cardiac programs see volumes of 700 – 750 cases per year.

For our first interview, we meet at the Clinica de Medellin to talk. He later invites me to see the hospital at Rionegro.

Education/ Training / Experience

Dr. Franco attended medical school, general surgery residency and cardiac surgery fellowship at the Universidad Pontifica Boliviarana.  He finished his fellowship in 1996.  As part of his fellowship, he spent nine months training in heart and lung transplantation at Loyola University Medical Center in Chicago, Il. During his heart and lung tranplantation training, he received an award as “Best Foreign Medical Fellow.”  He graduated with high honors due to his exemplary grade point average.

He has additional training in thoracic and thoracoabdominal aortic surgery (Missouri Baptist, 1998), and minimally invasive valvular surgery (Cleveland Clinic).

Selected awards and special recognition

He was also the first surgeon to perform endovascular harvesting of the saphenous vein in Colombia in 1997.  He received second place for a poster presentation based on this technique at the Colombian Congress of Cardiology and Cardiovascular Surgery, Cartagena, 8 to 11 February 2006.

He received the Cesar Uribe Piedrahita Medal from the Colombian Medical Federation and the Antioquia Medical College in 2003 for academic and clinical excellence, in addition to several other awards for academic achievement.

He was the chapter president of the Colombian Society of Cardiovascular Surgery and the Colombian Surgical Consensus for multiple terms. He was also the Chairman, and Medical Advisory of the first Latin American Forums on cardiovascular surgery.

He has received several awards including “The best of 2006” from Hospital General de Medellin for his assistance in the development, creation and commissioning of the cardiovascular services unit at that facility.  He has also presented his work at numerous national and international conferences.

He speaks English in addition to his native Spanish.

Dr Sergio Franco

San Vicente Fundacion

Cardiovascular Surgery

Medical Director, Cardiopulmonary and Vascular Surgery

Rionegro, Antioquia

Tele: 574 444 8717 Ext. 3502

Cell: 310 424 4884

Email: sfsx@sanvicentefundacion.com

Website: http://www.sanvicentefundacion.com

While I requested a visit to the operating room, an invitation was not forthcoming.

Selected writings of Dr. Sergio Franco

Book chapters:

1. Franco S., Restrepo G.  Momento Quirúrgico óptimo en el paciente con enfermedad valvular cardiaca. Libro Tópicos selectos en enfermedades cardiovasculares 2000. Unidad cardiovascular Clínica Medellín.  1 Edición. Página. 101-112.  ISBN 958-33-1541-9

2. Franco S.   Endocarditis Infecciosa: Visión Quirúrgica – Indicaciones de Cirugía. Libro Tópicos selectos en enfermedades cardiovasculares 2000. Unidad cardiovascular Clínica Medellín.  1 Edición.  Páginas 201-211. ISBN 958-33-1541-9

3. Franco, S. Estenosis Mitral – Tratamiento Quirúrgico.  En: Franco, S. (Ed) Enfermedad valvular cardiaca.  Sociedad Colombiana de Cardiología. Editorial Colina, 1 edición, Pgnas 111-116 Abril 2001. ISBN : 958-33-2244-X

4. Franco, S., Giraldo, N. , Vélez JF.  Uso e Indicaciones de Homoinjertos – Cirugía de Ross. En: Franco, S (Ed) Enfermedad Valvular Cardiaca.  Sociedad Colombiana de Cardiología.  Editorial Colina, 1 edición, Pgnas  70 – 77,  Abril 2001. ISBN : 958-33-2244-X

5. Alzate L., Franco SFactores hemodinámicos y físicos de las válvulas cardiacas artificiales. En: Franco, S. (Ed) Enfermedad Valvular Cardiaca – Sociedad Colombiana de Cardiología.  Editorial Colina, 1 edición, Pgnas 222 – 228 Abril 2001. ISBN : 958-33-2244-X

6. Franco, S., Vélez, J.  Revascularización Quirúrgica del Miocardio: Estado actual.  En: Tópicos selectos en terapéutica cardiaca y vascular 2001.  Cardiología Clínica Medellín. P: 108 –120. Primera edición, Octubre 2001. ISBN : 958-33-2607-0

7.  Vélez, JF,   Franco, S., Tamayo L. Tratamiento quirúrgico de la enfermedad coronaria.   En: Enfermedad Coronaria. Pineda M, Matiz H, Rozo R. (Ed), septiembre 2002.  Capitulo 36, pgnas 609-630. ISBN : 958-33-3945-8

8. Franco, S.  Intervencion Quirúrgica de los síndromes coronarios agudos. En: Tópicos selectos en enfermedades cardiovasculares, 2002. Pgna 177-192 (Velásquez D, Uribe W, editores) Ed. Colina, Departamento de Cardiología Clínica Medellín 2002.   ISBN 958-33-3663-7

9. Franco, S.  Cardiopatías Congénitas del Adulto.  En: Tópicos selectos en cardiología de consultorio  2003. Pgnas 193-211. (Restrepo G., Uribe W., Velásquez D., editores).  Ed. Colina, Cardiología Clínica Medellín, 2003.  ISBN : 958-33-4858-9

10. Franco, S.  Enfermedad Valvular Cardiaca: Indicaciones de Cirugía. En: Libro II Congreso medicina cardiovascular y torácica. .  Hospital Departamental Santa Sofía de Caldas,  2003 (Jaramillo O., Editor)    Editorial  Tizan.   Pgnas  87-104

11. Franco, S. Tratamiento Quirúrgico de la Fibrilación Atrial. En: Libro II Congreso medicina cardiovascular y torácica. Hospital Departamental Santa Sofía de Caldas,  2003. (Jaramillo O., Editor) Editorial  Tizan.  Pgnas  123-131

12. Franco, S.  Endocarditis Infecciosa. En: Enfermedad Valvular Cardiaca.  Pgnas 39 – 56.  (Franco, S., Editor). Editorial Colina.  Primera Edición 2004. 227 paginas.  ISBN 958-33-6218-2

13. Franco, S.  Estenosis Mitral. Tratamiento Quirúrgico. En: Enfermedad Valvular Cardiaca.   Paginas 70 – 74.  (Franco, S., Editor). Editorial Colina.  Primera Edición 2004. 227 paginas.  ISBN 958-33-6218-2

14. Franco, S., Giraldo, N.  Tratamiento Quirúrgico del Paciente Valvular en Falla Cardiaca. En: Enfermedad Valvular Cardiaca. Paginas 169 – 176.  (Franco, S., Editor). Editorial Colina.  Primera Edición 2004. 227 paginas.  ISBN 958-33-6218-2

15. Franco, S.  Jiménez A.  Factores Físicos y Hemodinámicos de las Prótesis Valvulares Cardiacas.  En: Enfermedad Valvular Cardiaca.  Pgnas 223-227.  (Franco, S., Editor). Editorial Colina.  Primera Edición 2004. 227 paginas. ISBN 958-33-6218-2

16. Franco, S. Guías de manejo de las valvulopatias aorticas.  En: Tópicos Selectos en Guías de Manejo en Enfermedades Cardiacas y Vasculares 2004.  Pgnas 143-149. (Uribe, W, Velásquez D, Restrepo G., Editores).  Editorial Colina.  Primera edición, 2004. 195 paginas.  ISBN 958-33-6285-9

17. Franco, S. Guías de manejo de las valvulopatias mitrales.  En: Tópicos Selectos en Guías de Manejo en Enfermedades Cardiacas y Vasculares 2004.  Pgnas 149-155. (Uribe, W, Velásquez D, Restrepo G., Editores).  Editorial Colina.  Primera edición, 2004. 195 paginas. ISBN 958-33-6285-9

18. Franco, S. Tratamiento Quirúrgico de la Fibrilación Atrial. En: Falla Cardiaca, Diagnostico y manejo Actual. 2004.  Pgnas  271- 287.. (Castro, H; Cubides, C.  Editores) Editorial  Blanecolor,  Primera edición, 2004.  431 pgnas. ISBN 33-6689-7

19. Escobar, A. Franco, S. Trauma de grandes vasos torácicos. En: Tópicos Selectos en guías de manejo en enfermedades cardiacas y vasculares – 2005. (Velásquez D., Uribe W. editores) 1 Edición, editorial colina, 2005.  pgnas 160- 169. 193 paginas. ISBN : 958-33-7698-1

20. Franco, S., Vélez, A. Trauma cardiaco. En: Tópicos Selectos en guías de manejo en enfermedades cardiacas y vasculares – 2005. (Velásquez D., Uribe W. editores)  1 Edición, editorial colina, 2005.  pgnas 154- 159. ISBN : 958-33-7698-1

21. Franco, S., Jaramillo, J. Tumores cardiacos. En: Tópicos Selectos en guías de manejo en enfermedades cardiacas y vasculares – 2005. (Velásquez D., Uribe W. editores)  1 Edición, editorial colina, 2005.  pgnas 117 – 123. 193 paginas. ISBN : 958-33-7698-1

22. Franco, S., Vélez, A. Trauma cardiaco. En: Tópicos Selectos en guías de manejo en enfermedades cardiacas y vasculares – 2005. Manual Condensado. (Velásquez D., Uribe W. editores)  1 Edición, editorial colina, 2005.  pgnas 362- 366. 388 paginas. ISBN : 958-33-7698-1

23. Franco, S. Guías de manejo de las valvulopatias aorticas.  En: Tópicos Selectos en Guías de Manejo en Enfermedades Cardiacas y Vasculares 2005. Manual condensado.  Pgnas 177-182. (Uribe, W, Velásquez D, Restrepo G., Editores).  Editorial Colina.  Primera edición, 2005. 388 paginas. ISBN : 958-33-7698-1

24. Franco, S. Guías de manejo de las valvulopatias mitrales.  En: Tópicos Selectos en Guías de Manejo en Enfermedades Cardiacas y Vasculares 2005. Manual condensado.  Pgnas 183-188. (Uribe, W, Velásquez D, Restrepo G., Editores).  Editorial Colina.  Primera edición, 2005. 388 paginas. ISBN : 958-33-7698-1

25. Jaramillo, J.S., Franco, S. Implante Quirúrgico del Electrodo Epicárdico en el Ventrículo Izquierdo Mediante Cirugía. En: Duque, M., Franco, S.  Editores.  Tratamiento no Farmacológico de la Falla Cardiaca. Sociedad Colombiana de Cardiología y Cirugía Cardiovascular. Primera Edición, Editorial Colina, Pgnas 89-92, Abril 2006. ISBN : 958-33-8661-8

26. Franco, S. Cirugía de Remodelación Ventricular en Falla Cardiaca. En: Duque, M., Franco, S.  Editores.  Tratamiento no Farmacológico de la Falla Cardiaca. Sociedad Colombiana de Cardiología y Cirugía Cardiovascular. Primera Edición, Editorial Colina, Pgnas 168 – 182, Abril 2006. ISBN : 958-33-8661-8

27. Jaramillo, JS., Franco, S., Vélez, JF. Revascularización Coronaria Quirúrgica. En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores.  Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte.  Primera Ed, 2006, Editorial Colina. Pgnas 559-576. ISBN : 958-33-9493-9

28. Franco, S., Vélez, JF, Jaramillo, JS., Cirugía en Enfermedad Valvular Aortica.   En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores.  Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte.  Primera Ed, 2006, Editorial Colina. Pgnas 588 – 595. ISBN : 958-33-9493-9

29. Franco, S., Vélez, JF, Jaramillo, JS., Valvulopatia Mitral.   En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores.  Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte.  Primera Ed, 2006, Editorial Colina. Pgnas 596 – 603. ISBN : 958-33-9493-9

30. Franco, S., Vélez, JF, Jaramillo, JS., Cirugía en Enfermedad Valvular Pulmonar y Tricúspidea.   En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores.  Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte.  Primera Ed, 2006, Editorial Colina. Pgnas 604 – 606. ISBN : 958-33-9493-9

31. Jaramillo, JS., Franco, S., Vélez, JF, Disección Aortica.   En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores.  Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte.  Primera Ed, 2006, Editorial Colina. Pgnas 607 – 617. ISBN : 958-33-9493-9

32. Franco, S., Vélez, A., Trauma de Corazón y Grandes Vasos.   En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores.  Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte.  Primera Ed, 2006, Editorial Colina. Pgnas 618 – 625. ISBN : 958-33-9493-9

33. Franco, S., Jaramillo, JS., Vélez, JF., Tumores Cardiacos.   En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores.  Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte.  Primera Ed, 2006, Editorial Colina. Pgnas 626 – 635. ISBN : 958-33-9493-9

34. Vélez, JF, Franco, S., Jaramillo, JS., Cardiopatías Congénitas del Adulto.   En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores.  Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte.  Primera Ed, 2006, Editorial Colina. Pgnas 649 – 659. ISBN : 958-33-9493-9

35. Uribe, W., Franco, S., Gil, E. Fibrilacion Auricular. En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores.  Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte.  Primera Ed, 2006, Editorial Colina. Pgnas 441 – 466. ISBN : 958-33-9493-9

36. Restrepo, G., Franco, S.  Endocarditis Infecciosa.  En :  Texto de Cardiologia.  Sociedad Colombiana de Cardiologia y Cirugia Cardiovascular.  Legis, S.A. 1 Ed, 2007; Capitulo VI, pgnas 614-30. ISBN : 958-97065-7-6

37. Franco, S., Sandoval, N.  Tratamiento Quirurgico de la Fibrilacion Atrial.    En :  Texto de Cardiologia.  Sociedad Colombiana de Cardiologia y Cirugia Cardiovascular.  Legis, S.A. 1 Ed, 2007; Capitulo IX, pgnas 835-842. ISBN : 958-97065-7-6

38. Franco, S., Jaramillo JS.  Trauma Cardiaco.  En :  Texto de Cardiologia.  Sociedad Colombiana de Cardiologia y Cirugia Cardiovascular.  Legis, S.A. 1 Ed, 2007;  Capitulo XVI, pgnas 1442-49. ISBN : 958-97065-7-6

39. Franco, S., Velez, A. Trauma Vascular Cervical.  En : Guias de Manejo en Enfermedades Cardiacas y Vasculares 2007.  Manual Condensado, 3 Edicion, Cardiologia Clinica Medellin; 2007.  Capitulo 31, P 425 – 433. ISBN : 979-958-98111-9-1

40. Franco, S., Velez, A., Jaramillo JS.  Trauma Cardiaco.  En : Guias de Manejo en Enfermedades Cardiacas y Vasculares 2007.  Manual Condensado, 3 Edicion, Cardiologia Clinica Medellin; 2007.  Capitulo 30, P 419 – 423. ISBN : 979-958-98111-9-1

41. Franco, S. Guias de Manejo de las Valvulopatias Aorticas.  En : Guias de Manejo en Enfermedades Cardiacas y Vasculares 2007.  Manual Condensado, 3 Edicion, Cardiologia Clinica Medellin; 2007.  Capitulo 25, P 379 – 385.  ISBN 978-958-98111-9-1

42. Franco, S. Guias de Manejo de las Valvulopatias Mitrales.  En : Guias de Manejo en Enfermedades Cardiacas y Vasculares 2007.  Manual Condensado, 3 Edicion, Cardiologia Clinica Medellin; 2007.  Capitulo 26, P 387 – 392. ISBN : 979-958-98111-9-1

43. Jaramillo, J.S., Franco, S. Guias de Manejo de la Revascularizacion Coronaria Quirurgica.   En : Guias de Manejo en Enfermedades Cardiacas y Vasculares 2007.  Manual Condensado, 3 Edicion, Cardiologia Clinica Medellin. Capitulo 24, P 369 – 377. ISBN : 979-958-98111-9-1

44. Franco, S.; Velez, JF.; Jaramillo,JS. Complicaciones mecanicas del infarto agudo del miocardio.  En : Topicos Selectos en Enfermedad Coronaria – 2008. Velasquez, D. ed; Distribuna Ed, Cardiologia Clinica Medellin, 2008. P. 115-126. ISBN 978-958-8379-09-8

45. Jaramillo,JS.;  Franco, S.; Velez, JF. Guias de manejo de la revascularizacion coronaria quirurgica.  En : Topicos Selectos en Enfermedad Coronaria – 2008. Velasquez, D. ed; Distribuna Ed, Cardiologia Clinica Medellin, 2008. P. 197- 218. ISBN 978-958-8379-09-8

46. Franco, S.; Jaramillo, J.S. Guías de Manejo de la revascularización Coronaria Quirúrgica. En: Guias de manejo en enfermedades cardiacas y vasculares.  Manual Condensado 2009. Velásquez, D. Ed. Editorial Distribuna, 1 edicion 2009, 503 paginas.  P. 429-440. ISBN : 978-958-8379-19-7

47. Franco, S.; Jaramillo, J.S. Guias de Manejo de las valvulopatias aorticas. En: Guias de manejo en enfermedades cardiacas y vasculares.  Manual Condensado 2009. Velásquez, D. Ed. Editorial Distribuna, 1 edicion 2009, 503 paginas.  P. 441-448. ISBN : 978-958-8379-19-7

48. Franco, S.; Jaramillo, J.S. Guias de Manejo de las valvulopatias mitrales. En: Guias de manejo en enfermedades cardiacas y vasculares.  Manual Condensado 2009. Velásquez, D. Ed. Editorial Distribuna, 1 edicion 2009, 503 paginas.  P. 449-456. ISBN : 978-958-8379-19-7

49. Franco, S.; Jaramillo, J.S. Trauma Cardiaco. En: Guías de manejo en enfermedades cardiacas y vasculares.  Manual Condensado 2009. Velásquez, D. Ed. Editorial Distribuna, 1 edición 2009, 503 paginas.  P. 487-492. ISBN : 978-958-8379-19-7

50. Franco, S.; Jaramillo, J.S. Trauma Vascular Cervical. En: Guías de manejo en enfermedades cardiacas y vasculares.  Manual Condensado 2009. Velásquez, D. Ed. Editorial Distribuna, 1 edición 2009, 503 paginas.  P. 493 – 503. ISBN : 978-958-8379-19-7

51. Franco, S.; Jaramillo, J.S. Trauma Vascular Cervical. En: Guías de manejo en enfermedades cardiacas y vasculares.  Manual Condensado 2010. Velásquez, D. Ed. Editorial Distribuna, 2 edición 2010, 511 paginas.  P. 501 – 511. ISBN : 978-958-8379-29-6

52. Franco, S.; Jaramillo, J.S. Trauma Cardiaco. En: Guías de manejo en enfermedades cardiacas y vasculares.  Manual Condensado 2010. Velásquez, D. Ed. Editorial Distribuna, 2 edicion 2010, 511 paginas.  P. 495 – 500. ISBN : 978-958-8379-29-6

53. Franco, S.; Jaramillo, J.S. Guías de Manejo de las Valvulopatias Mitrales. En: Guías de manejo en enfermedades cardiacas y vasculares.  Manual Condensado 2010. Velásquez, D. Ed. Editorial Distribuna, 2 edición 2010, 511 paginas.  P. 457 – 463. ISBN : 978-958-8379-29-6

54. Franco, S.; Jaramillo, J.S. Guías de Manejo de las Valvulopatias Aorticas.  En: Guías de manejo en enfermedades cardiacas y vasculares.  Manual Condensado 2010. Velásquez, D. Ed. Editorial Distribuna, 2 edición 2010, 511 paginas.  P. 449 – 456. ISBN : 978-958-8379-29-6

55. Franco, S.; Jaramillo, J.S. Guías de Manejo de la Revascularización Coronaria Quirúrgica. En: Guías de manejo en enfermedades cardiacas y vasculares.  Manual Condensado 2010. Velásquez, D. Ed. Editorial Distribuna, 2 edición 2010, 511 paginas.  P. 437 – 447. ISBN : 978-958-8379-29-6

56. Franco, S.; Bucheli, V. Anatomía Quirúrgica de la Válvula Mitral. En : Enfermedad Valvular Cardiaca. Franco, S. Ed., Editorial Colina, Primera Edición 2010, 440 paginas.  P. 26 – 31.  ISBN : 978-958-44-7706-4

57. Franco, S.; Bucheli, V. Anatomía Quirúrgica de la Válvula Aortica. En : Enfermedad Valvular Cardiaca. Franco, S. Ed., Editorial Colina, Primera Edición 2010, 440 paginas.  P. 33 – 38.  ISBN : 978-958-44-7706-4

58. Franco, S.   Endocarditis Infecciosa. En : Enfermedad Valvular Cardiaca. Franco, S. Ed., Editorial Colina, Primera Edición 2010, 440 paginas.  P. 85 – 113.  ISBN : 978-958-44-7706-4

59. Franco, S.   Criterios para la Selección de una Prótesis Cardiaca. En : Enfermedad Valvular Cardiaca. Franco, S. Ed., Editorial Colina, Primera Edición 2010, 440 paginas.  P. 433 – 440.  ISBN : 978-958-44-7706-4

60. Franco, S., Atehortua, M.    Endocarditis Infecciosa.  En : Estado Actual en Enfermedades Cardiacas y Vasculares 2011.  Ed. Editorial Distribuna, 1 Edición 2011, 744 pnas.   Pgna 153 – 184.  ISBN : 978-958-8379-46-3

61.  Franco, S., Atehortua, M.    Valvulopatia Mitral.  En : Estado Actual en Enfermedades Cardiacas y Vasculares 2011.  Ed. Editorial Distribuna, 1 Edición 2011, 744 pnas.   Pgna 717 – 727.  ISBN : 978-958-8379-46-3

62. Franco, S., Atehortua, M.    Cirugía Valvular Aortica.  En : Estado Actual en Enfermedades Cardiacas y Vasculares 2011.  Ed. Editorial Distribuna, 1 Edición 2011, 744 pnas.   Pgna 707 – 717.  ISBN : 978-958-8379-46-3

63.  Atehortua, M.,  Franco, SRevascularización Coronaria Quirúrgica.  En : Estado Actual en Enfermedades Cardiacas y Vasculares 2011.  Ed. Editorial Distribuna, 1 Edición 2011, 744 pnas.   Pgna 675 – 690.  ISBN : 978-958-8379-46-3

64. Atehortua, M.,  Franco, SEvaluación y Momento Optimo de Intervención en el Paciente con Enfermedad Valvular Cardiaca.  En : Estado Actual en Enfermedades Cardiacas y Vasculares 2011.  Ed. Editorial Distribuna, 1 Edición 2011, 744 pnas.   Pgna 691 – 707.  ISBN : 978-958-8379-46-3

65. Atehortua, M.,  Franco, SCirugía en Enfermedad Valvular y Tricuspidea.  En : Estado Actual en Enfermedades Cardiacas y Vasculares 2011.  Ed. Editorial Distribuna, 1 Edición 2011, 744 pnas.   Pgna 727 – 744.  ISBN : 978-958-8379-46-3

66. Atehortua, M.,  Franco, S., Velez, L.A.  Guias de Manejo de Revascularizacion Coronaria.  En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012.  Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas.   Pgna 619 – 630.  ISBN : 978-958-8379-60-9

67. Velez, L.A., Franco, S., Atehortua, M.  Guias de Manejo de las Valvulopatias Aorticas.  En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012.  Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas.   Pgna 631 – 642.  ISBN : 978-958-8379-60-9

68. Atehortua, M.,  Franco, S., Velez, L.A.  Guias de Manejo de las Valvulopatias Mitrales.  En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012.  Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas.   Pgna 643 – 653.  ISBN : 978-958-8379-60-9

69. Velez, L.A.,  Atehortua, M.,  Franco, S. Cirugia en Enfermedad Valvular Pulmonar y Tricuspidea.  En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012.  Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas.   Pgna 655 – 661.  ISBN : 978-958-8379-60-9

70. Franco, S., Bucheli, V., Atehortua, M., Velez, L.A.  Guias de Manejo en Endocarditis Infecciosa  En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012.  Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas.   Pgna 671 – 690.  ISBN : 978-958-8379-60-9

71.  Franco, S., Bucheli, V., Atehortua, M., Velez, L.A.  Guias de Manejo de los Sindromes Aorticos Agudos.   En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012.  Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas.   Pgna 691 – 702.  ISBN : 978-958-8379-60-9

72. Franco, S., Atehortua, M., Velez, L.A.  Trauma Cardiaco.   En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012.  Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas.   Pgna 703 – 708.  ISBN : 978-958-8379-60-9

Journal articles

1. Franco  Sergio, Hincapié  Miriam, Mejía  Olga.   Estudio Epidemiológico de Teníasis. Cisticercosis, San Vicente Antioquia – Colombia, 1985-1986.   En: Medicina Tropical y Parasitología Vol. 2 No 1, Ecuador, Diciembre 1985.

2. Franco Sergio, Hincapié  Miriam, Mejía  Olga.   Estudio Epidemiológico de Epilepsia y Neurocisticercosis.    En: “Revista Universidad Industrial de Santander –  Medicina¨ Vol. 14 No 1, Mayo 1986, p 143- 74.

3. Botero  D.,   Franco S.,   Hincapié  M., Mejía O.  Investigaciones Colombianas  Sobre Cisticercosis.  En: Acta Neurológica.   Vol. 2 No 2 Septiembre 1986, p. 3-6.

4. Franco Sergio; Londoño Juan.    Dermatopoliomiositis – Reporte de un caso – Revisión del Tema.    En: Medicina – U.P.B.   Vol.  7 No 2, Noviembre  1988. p. 115.

5. Franco Sergio;  Vásquez Jesús; Ortiz Jorge.     Infarto Segmentario Idiopático  del Epiplón Mayor – Presentación de dos casos y revisión del tema.    En: Medicina – U.P.B.  Vol. 10 No 2. Octubre. 1991, p. 109.

6. Franco Sergio.   Choque Hipovolémico.  Medicina  U.P.B., Vol. 13 No 2, Octubre, 1994.  P. 139-160.

7.  Montoya A.,   Franco S.,.   Lung Transplantation for Bronchoalveolar Cell Carcinoma.    First Case Report in the Word Literature.  1996 –  Loyola University Chicago Annual Report Magazine.

8. Franco S. Autopsy Results in Patients Following Lung Transplantation. Department of Pathology at Loyola University Medical Center. 1996 – Loyola University Chicago Annual Report Magazine.

  9.  Franco S.,  Giraldo N., Flórez M. Tratamiento Quirúrgico de la Coartación  Aórtica Seguimiento a Largo Plazo  – 8 años.     Revista Colombiana de Cardiología. Vol. 5 No 5, Diciembre 1996.

10.  Franco S,  Giraldo N.   Trauma Cardíaco: Revisión del Tema.    Revista Colombiana de Cardiología.  Marzo  de 1997.

11.  Franco  S., Giraldo N., Ramírez C., Vallejo C., Castro H. Revascularización Miocárdica en pacientes con fracción de eyección menor del 30%.  Departamento de Cirugía Cardiovascular. Unidad Cardiovascular Clínica Medellín.  XVIII Congreso Colombiano de Cardiología.  Medellín, 1999.  Revista Colombiana de Cardiología, 1999, Vol. 7(6): 301.

12. Franco S., Giraldo N., Fernández H., Ramírez C., Vallejo C., Castro H.  Transección Aórtica Traumática: Presentación de tres casos, revisión de la literatura. Departamento de Cirugía Cardiovascular. Unidad Cardiovascular Clínica Medellín.  XVIII Congreso Colombiano de Cardiología.  Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 330.

13.  Franco S., Giraldo N., Vélez S. et al.  Fístula de la arteria coronaria derecha al tracto de salida del ventrículo derecho.   Reporte de un caso – revisión del tema.  Departamento de Cirugía Cardiovascular. Unidad Cardiovascular Clínica Medellín.  XVIII Congreso Colombiano de Cardiología.  Medellín, 1999.  Revista Colombiana de Cardiología, 1999, Vol. 7(6): 319.

14. Giraldo N., Franco S., Ramírez C., Vallejo C., Castro H.   CIV y Banding de la arteria pulmonar en un paciente adulto.  Departamento de Cirugía Cardiovascular. Unidad Cardiovascular Clínica Medellín.  XVIII Congreso Colombiano de Cardiología.   Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 333.

15.   Giraldo N., Franco S., Ramírez C., Vallejo C., Castro H.   Ruptura Ventricular post implantación de válvula mitral.   Departamento de Cirugía Cardiovascular. Unidad Cardiovascular Clínica Medellín.  XVIII Congreso Colombiano de Cardiología.  Medellín, 1999.  Revista Colombiana de Cardiología, 1999, Vol. 7(6): 340.

16. Castro H., Ramírez C., Franco S.,  Mesa J. et al.  Anestesia y técnica quirúrgica en pacientes sometidos a implantación percutánea de endoprótesis en aneurismas de la aorta abdominal.  Reporte de tres casos y revisión de la literatura.  Departamento de Cirugía y Anestesia Cardiovascular.  Departamento de Hemodinámica. Unidad Cardiovascular Clínica Medellín.  XVIII Congreso Colombiano de Cardiología.  Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 331.

17. Vallejo C., Castro H., Ramírez C., Franco S., Duque M.  et al. Anestesia y técnica quirúrgica en pacientes sometidos a implante de cardiodesfibrilador automático.  Reporte de 20 casos.  Departamento de Cirugía y Anestesia Cardiovascular.  Departamento de Electrofisiología y Arritmias. Unidad Cardiovascular Clínica Medellín.  XVIII Congreso Colombiano de Cardiología.  Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 336.

18. Ramírez C., Vallejo C., Castro H., Franco S., Giraldo N. et al.  Protección Miocárdica: Solución de HTK en Cirugía Cardiaca.   Departamento de Cirugía y Anestesia Cardiovascular. Unidad Cardiovascular Clínica Medellín.  XVIII Congreso Colombiano de Cardiología.  Medellín, 1999.  Revista Colombiana de Cardiología, 1999, Vol. 7(6): 336.

19.   Ramírez C., Vallejo C., Castro H., Franco S., Giraldo N. et al.  Protección Miocárdica: Comparación entre la Solución de HTK y la Solución de Buckberg en Cirugía Cardiaca.   Departamento de Cirugía y Anestesia Cardiovascular. Unidad Cardiovascular Clínica Medellín.  XVIII Congreso Colombiano de Cardiología.  Medellín, 1999.  Revista Colombiana de Cardiología, 1999, Vol. 7(6): 336.

20. Vallejo C., Ramírez C., Castro H., Giraldo N., Franco S.  Hipotiroidismo y enfermedad cardiaca: Administración de hormona tiroidea vía oral en pacientes sometidos a cirugía cardiaca.  Departamento de Cirugía y Anestesia Cardiovascular. Unidad Cardiovascular Clínica Medellín.  XVIII Congreso Colombiano de Cardiología.  Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 334.

21. Franco, S., Giraldo, N., Fernández H., Escobar A., Ramírez, C., Vallejo, C., Castro H.   Revascularización miocárdica con arteria radial: Estudio de Casos y Controles.  Departamento de Cirugía Cardiotorácica, Clínica Medellín.  XIX Congreso Colombiano de Cardiología.  Noviembre 27 – Diciembre 1, 2001. Revista Colombiana de Cardiología, 2001, Vol. 9(2): 197.

22. Giraldo, N., Franco, S.,  Fernández H., Escobar A., Ramírez, C., Vallejo, C., Castro H.   Revascularización miocárdica Off Pump: Requerimiento de derivados sanguíneos.  Departamento de Cirugía Cardiotorácica, Clínica Medellín.  XIX Congreso Colombiano de Cardiología.  Noviembre 27 – Diciembre 1, 2001. Revista Colombiana de Cardiología, 2001, Vol. 9(2): 238.

23. Giraldo, N., Franco, S.  Fernández H., Escobar A., Ramírez, C., Vallejo, C., Castro H. Endarterectomia Coronaria del tronco principal izquierdo.  Departamento de Cirugía Cardiotorácica, Clínica Medellín.  CES Medicina Vol. 16  # 1, página 39-44.   Enero-Marzo  2002.

24. Franco, S., Giraldo, N., Fernández H., Escobar A., Ramírez, C., Vallejo, C., Castro H.   Cierre tardío del esternón en el manejo del sangrado mediastinal post cirugía cardiaca.  Departamento de Cirugía Cardiotorácica, Clínica Medellín.  CES –  Medicina.  Vol.  16 # 1, página 27-34.  Enero-Marzo 2002.

25. Franco, S., Giraldo, N., Fernández H., Escobar A., Ramírez, C., Vallejo, C., Castro H.   Cambio valvular mitral con preservación total del aparato valvular: Técnica quirúrgica, resultados y seguimiento.  Departamento de Cirugía Cardiotorácica, Clínica Medellín.  CES Medicina.  Volumen 16  # 1,  página 9-18.  Enero-Marzo 2002.

26. Franco S, Giraldo N, Escobar A, Fernández H, Vallejo C, Ramírez C. Cambio valvular mitral con preservación total del aparato valvular: técnica quirúrgica, resultados y seguimiento. Revista  Colombiana De Cardiología. 2003. pp. 368 – 74

27. Giraldo N, Franco S, Escobar A, Fernández H, Vallejo C, Ramírez C. Cierre    tardío del esternón en el manejo del sangrado mediastinal post cirugía cardiaca. Revista Colombiana De Cardiología 2003. pp.  95 – 99

28. Escobar A., Giraldo N., Franco S., Jaramillo J., Orozco A. Taquiarritmias supraventriculares postcirugia cardiaca con y sin el uso de circulación extracorpórea.  En : CES Medicina Volumen 17 # 1, Enero-julio 2003, Pgnas 23-31

29.  Echeverri JL, Gonzáles M, Franco S., Vélez LA.  Ruptura traumática de la aorta.  Reporte de dos casos y revisión de la literatura.  Medicina Crítica y Cuidados Intensivos.  Enero – Junio 2004, 2 (1) : 31-35

30. Franco, S. Giraldo, N., Gaviria, A. et al.  Aneurismas y seudoaneurismas de injertos venosos coronarios.  Revista Colombiana de cardiología, Vol. 11 # 8, Abril 2005. Pgna 401- 404.

31. Franco, S.; Uribe, W.; Velez, JF. et al.  Tratamiento quirurgico curativo de la fibrilacion atrial mediante tecnica de ablacion con radiofrecuencia monopolar irrigada : resultados a corto y mediano plazo.  Revista Colombiana de Cardiologia. 2007.  Vol 14, # 1.  Pnas 43 – 55.

32. Escobar, A., Franco,S., Giraldo,N., et al.  Tecnica de perfusion selectiva cerebral via subclavia para la correccion de patologias del arco aortico.  Revista Colombiana de Cardiologia Volumen 14, numero 4, agosto 2007.  P 232-237

33. Franco, S. Tratamiento quirurgico de la fibrilacion atrial. Revista Colombiana de Cardiologia – Guias de Diagnostico y Tratamiento de la Fibrilacion Auricular.   Vol 14,  Suplemento 3, Octubre 2007. P. 133 – 143.

34. Franco, S. Velez, A., Uribe, W., Duque, M., Velez, JF, et al.  Tratamiento quirurgico de la fibrilacion atrial mediante radiofrecuencia.  Revista Medica Sanitas 2008, Volumen 11, Numero 1, pgnas 8 – 20. Febrero –  Abril, 2008.

35. Franco,S., Herrera, AM., Atehortua, M. et al. Use of Steel bands in sternotomy closure : implications in high-risk cardiac surgical population. Interactive CardioVascular and Thoracic Surgery  8 (2009) : 200-205.

36. Franco, S. Tratamiento Quirurgico para el manejo de las arritmias ventriculares. Guias Colombianas de Cardiologia.  Artitmias Ventriculares y Muerte Subita.  Revista Colombiana de Cardiologia. Volumen 18, Suplemento 1. Pgnas  160 – 163.  Febrero 2011.

37. Miranda, A. ; Franco, S.,; Uribe, W. et al. Tromboembolismo Pulmonar Masivo de Alto Riesgo.  Medicina ( Buenos Aires),  72 :  2012; Pgnas 128-130.

38. Miranda, A., Duque, M., Franco, S., Velasquez, J. et al. Tromboembolismo Pulmonar Masivo.  Indicaciones de Cirugia – Reporte de caso. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1.  Marzo de 2012.

39.  Franco, S.; Eusse, A.; Atehortua, M., Vélez, L., et al. Endocarditis Infecciosa : Análisis de Resultados del Manejo Quirúrgico Temprano. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1, pgna 66.  Marzo de 2012.

40. Franco, S.; Bucheli, V.; Atehortua, M., Vélez, L.; Eusse, A et al. Tratamiento Quirurgico : El “Gold Estándar” en el manejo de los defectos del septum interauricular. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1.  Marzo de 2012.

41. Franco, S.; Atehortua, M., Vélez, L.; Castro, H., et al. Anomalías coronarias del Adulto. Origen anómalo de la arteria coronaria izquierda de la arteria pulmonar (ALCAPA).  Reporte de caso. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1, pgna 61.  Marzo de 2012.

42. Franco, S.; Atehortua, M., Vélez, L.; Castro, H., et al. Metástasis cardiaca de carcinoma anaplasico de tiroides. Reporte de caso. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1, pgna 70.  Marzo de 2012.

43. Franco, S.; Giraldo, N.; Atehortua, M., Vélez, L.; Castro, H., et al. Endarterectomia coronaria del tronco principal izquierdo : Seguimiento a 15 años.  Reporte de caso. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1, pgna 66.  Marzo de 2012.

44. Franco, S.; Atehortua, M., Vélez, L.; Castro, H., Bucheli, V.; et al. Implante de válvulas biológicas : evaluación de libertad de reoperación por deterioro valvular estructural. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1, pgna 69.  Marzo de 2012.

45.  Miranda, A. Franco, S. Uribe, W., Duque, M. et al.  Tromboembolismo Pulmonar Masivo de Alto Riesgo Asociado a Foramen Ovale Permeable.  Medicina (Buenos Aires)  72 : 128 – 130.  2012.

46.  Franco, S.  Criterios Para la Selección de Una Protesis Cardiaca.  Rev Fed Arg Cardiol.  2012; 41(3): 156 – 160.

Special topics in Cardiac Surgery: (Monographs)

1. Franco Sergio Manejo Básico Inicial del Paciente Con Trauma CortoPunzante    En: Monografía. Hospital San Vicente de Paúl – Prado  (Tolima)  1989.

2. Franco S; Montoya A.    Transplante Pulmonar: Indicaciones, Criterios  de Selección y rechazo, Técnica Quirúrgica,  Manejo de Donante y receptor, Complicaciones.   Protocolo  para la realización de transplante  pulmonar en nuestro medio.   Comité  de transplantes de corazón y pulmón. 1996.  Clínica Cardiovascular Santa María,  Biblioteca Médica – Facultad de Medicina, Universidad  Pontificia Bolivariana

3.  Giraldo N., Franco S.,  Estudiantes X Semestre Instituto de Ciencias de la Salud  – CES.   Tratamiento Quirúrgico de la Endocarditis Infecciosa.  Monografía. Investigación realizada en la Clínica Cardiovascular Santa Maria.   Publicación Monográfica.   Enero 1997.

4.  Franco S. Safenectomía Videoendoscópica.  Realización de video  con descripción de la técnica quirúrgica. Descripción Monográfica.  Departamento de Cirugía Cardiovascular. Unidad Cardiovascular Clínica Medellín. Diciembre de 1997.

5. Franco S., Giraldo N., Fernández H.  Tratamiento Quirúrgico de la Enfermedad Pulmonar Obstructiva Crónica.  Cirugía de Reducción de Volumen Pulmonar.  Monografía, Departamento de Cirugía Cardiovascular  – Unidad Cardiovascular Clínica Medellín.  Octubre  1999.

6. Franco S., Escobar A.   Trauma de  Tórax.  Revisión  del  tema.  Monografía.  Departamento de Cirugía Cardiovascular / Unidad Cardiovascular Clínica Medellín.  Octubre de 1999.

7. Franco S., Jaramillo J.C.  Cirugía en el paciente con Angina. Consenso Nacional sobre el Manejo de la Angina de Pecho.  Sociedad  Colombiana de Cardiología.  Bogota, 11-12 agosto 2000.

8. Franco, SFibrilación Atrial: Tratamiento Quirúrgico. I Actualización del Consenso Nacional Sobre Fibrilación Atrial.  Capitulo de Electrofisiología, Sociedad Colombiana De Cardiología.  Abril 2002.

9. Franco, S, Jaramillo JS, Vélez JF, Castro H.  Infecciones Mediastinales.  Monografía.  Departamento de Cirugía Cardiovascular. Hospital Departamental Santa Sofía de Caldas, Manizales.  Mayo de 2003.

10. Guias Colombianas de Cardiologia.   Fibrilacion Atrial – Guias de bolsillo.

Duque, M, Marin, J, ed. Franco, S. Cirugia  de fibrilacion atrial.  Sociedad      Colombiana de Cardiologia y Cirugia Cardiovascular.   2008.

11.  Franco, S.  Long-Term Effectiveness of HIFU on Atrial Fibrillation in High Risk Valvular Surgery Patients. A Clinical Interview from Epicor- Cardiac Ablation System – St Jude Medical.  March 2009.

 

Looks like they forgot something.


Dr. Diego Pineros, cardiac surgeon

Nice article in the Los Angeles Times about the strong work Bogotá physicians do in bringing care to the more remote areas of Colombia.  Too bad they forgot to mention the efforts of Dr. Diego Pineros – one of the cardiac surgeons at the Clinica San Rafael Institute of Cardiology and Cardiac Surgery.  We interviewed him last year about his humanitarian efforts.

(If you remember – the kind-hearted, and gracious surgeon shrugged off any accolades during our interview – and said he and his team travel to these remote areas to prevent further hardships for his patients.)  He also shrugged off any concerns for his own welfare despite the fact that some of these areas are close to / are located in areas with a heavy FARC presence.

So even if the Los Angeles Times doesn’t congratulate Dr. Pineros and his team for all their amazing work – we here at Bogota Surgery haven’t forgotten..

Dr. Diego Pineros (second from left) and his surgical residents at Clinica San Rafael in Bogotá

Heart Surgery Abroad – coming to the big screen?


Too bad, the independent filmmaker from Tennessee elected to travel to India rather than closer to home (like Latin America.)  Still – it places a lot of what we talk about into context – the affordability (or lack of) life-saving treatments in the United States versus numerous countries abroad..

Interestingly enough – despite making the choice to travel thousands of miles for a huge operation – it doesn’t sound like he throughly researched his surgeons, facilities  etc.  That is certainly troubling as medical tourism has not yet reached the Kayak, or Expedia level for interested travellers.  While I am very happy, relieved, pleased that everything worked out well – this could have easily been a cautionary tale (and loss for medical tourism) as a well-publicized win.

But, I will continue to hope that stories like his will help promote safe medical tourism, through the establishment of standards and regulations for medical tourism promoters.

Clinica Shaio & Dr. Hernando Santos


Fundacion Clinica Shaio – the first cardiac hospital in Colombia has recently unveiled the updated english-language version of their website, as part of an effort to aid international travelers, and attract medical tourists.  As long time readers know, I spent quite a bit of time at Clinica Shaio, with the Doctors Santos, (and several others).    Now as part of our new podcasting project – we will be sharing one of my favorite surgery videos from the operating room of Dr. Hernando Santos.  (If you’ve spent time here at www.BogotaSurgery.org than this video will be familiar to you.)  To my new readers from iTunes – welcome & enjoy!

Brief introduction to Dr. Hernando Santos, MD.

In the OR with Dr. Diego Pineros, cardiac surgeon


Dr. Diego Pineros, cardiac surgeon

Spent an enjoyable morning with Dr. Diego Pineros in the operating room at Clinica San Rafael, watching him operate on a four-month old girl. Surgery went well, with no intra-operative or post-operative problems.

Spent the remainder of the morning talking about cases, the history of cardiac surgery and seeing patients.

Like many of his counterparts here in Bogota, Dr. Pineros spends his “leisure time” in ways we might not expect. Right now, he is coordinating and arranging for his surgical team to fly to Tolima (300 miles away) to perform several pediatric cases over the weekend. The team will spend several days to make sure their little patients are well on the road to recovery before returning to Bogota, and to another full week of surgery.  When asked about this, Dr. Pineros quickly shrugs off any praise – stating, “they need surgery, and there is no one [at that hospital] to do it.  It’s hard on the families that travel to Tolima [from outlying rural communities] for care.”

Dr. Diego Pineros

Cardiac Surgeon, Clinica San Rafael