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[Simultaneous cardiac and thoracic operations].

BACKGROUND: Optimal surgical strategy in patients with combined disease of heart (mainly ischemic heart disease or critical valve disease) and other thoracic organs (mainly pulmonary carcinoma) is still controversial. METHODS: From 1997 to 2004, 13 simultaneous cardiac and thoracic operations were performed in 13 patients. Most of them were necessary for combinations of symptomatic coronary artery disease (CAD) and bronchogenic carcinoma (BCA). PATIENT CHARACTERISTICS: 11 patients showed CAD, mean preoperative LVEF was 44 %. SURGICAL PROCEDURE: Surgical exposure was performed via sternotomy in 10 patients, the rest of the patients underwent thoracotomy. Seven patients were operated on cardiopulmonary bypass, the others underwent an off-pump procedure. Eleven patients underwent CABG, mean number of anastomoses were 2.1 (range 1-4), two patients underwent aortic valve replacement. One patient underwent radical removal of pulmonary adenocarcinoma with local expansion into the left atrium. For the lung cancer lobectomy was necessary in 8, pneumectomy in 1, extirpation of multiple metastases in 1, resection of the trachea in 1 patient. Histological diagnosis was epidermoid carcinoma in 6, adenocarcinoma in 3, undifferentiated carcinoma in 1, metastasis of Grawitz tumor in 1, pneumoconiosis in 1 patient. RESULTS: No patient died in hospital. One patient had to be re-explored for bleeding. Mean blood loss, duration of intubation and length of hospital stay were not different from other patients who underwent cardiac operation only. CONCLUSION: In accordance with the majority of the data published in the literature, combined procedures did not negatively influence hospital morbidity and mortality. Simultaneous operations eliminate the necessity of a second operation and do not delay the postoperative oncological therapy. Long-term results are primarily determined by histological diagnosis and by the extent of the tumor.

Aged↗

[Lipomatous hypertrophy of the atrial septum. Cardiac-induced syncope in hamartoma of the right heart atrium].

A previously well 40-year-old woman suddenly collapsed and had to be resuscitated by an emergency physician. Admitted to hospital she remained unconscious and needed artificial respiration. Diagnostic tests failed to find evidence for pulmonary embolism, myocardial infarction or myocarditis. ECG monitoring in the intensive care unit merely revealed occasional unifocal ventricular premature systoles. Echocardiography was within normal limits. She remained in coma without spontaneous respiration. Cranial computed tomography and serial electroencephalograms indicated brain death. Autopsy revealed lipomatous hypertrophy (hamartoma) of the atrial septum with extensive bleeding into it as the most likely cause of (unrecorded) malignant cardiac arrhythmias.

Adult↗

Differential diagnosis of intracavitary tumors obstructing the right ventricular outflow tract.

Three cases of right ventricular outflow tract obstruction caused by 3 distinct tumors-myxoma, sarcoma, and presumed metastatic tumor-diagnosed by transthoracic and transesophageal echocardiography are presented. The differences among these 3 types of tumors with similar clinical and echocardiographic findings are highlighted, and a review of the pertinent literature is discussed. By applying the approximate frequencies of cardiac tumors categorized by type and site, statistically, an intracavitary right ventricular outflow tract tumor is 70 to 140 times more likely to be malignant than benign; furthermore, if it is a primary cardiac tumor, it is approximately 2 times more likely to be a sarcoma than a myxoma.

Aged↗

Two-dimensional transthoracic contrast echocardiographic assessment of metastatic left ventricular tumors.

To illustrate the usefulness of contrast echocardiography in the assessment of cardiac tumors, we present an 81-year-old female with pathological fracture of the right clavicle in whom biopsy showed poorly differentiated carcinoma. Two-dimensional transthoracic echocardiography found two masses in the left ventricle attached to mid-ventricular septum consistent with metastases. Echo contrast study with octafluoropropane (Optison) showed contrast enhancement of both the masses consistent with high vascularity seen in a malignant tumor.

Aged, 80 and over↗

Obstruction of right ventricular outflow tract by solitary ovarian metastasis.

We report a case in whom there was right ventricular outflow tract obstruction by a solitary metastatic deposit from an ovarian primary. The patient presented with signs of right ventricular overload and the outflow tract obstruction was recognised at cardiac catheterisation, but the final diagnosis was only revealed at necropsy.

Carcinoma↗

Transient asymmetric ventricular septal hypertrophy in the newborn unassociated with maternal diabetes.

Severe hypertrophy of the interventricular septum was found by echocardiography in a 15 day old infant without symptoms whose mother was not diabetic. The electrocardiogram showed pronounced intraventricular conduction disturbances. Both echocardiographic and electrocardiographic findings showed no abnormality after 27 months, the explanation for which could be the spontaneous regression of an intracardiac rhabdomyoma.

Cardiomyopathies↗

Carney complex: report of three cases.

The authors report three patients with features of the Carney complex: cardiac myxomas (n = 2), multicentric (n = 1) or recurrent (n = 1); pigmented skin lesions (n = 2); cutaneous myxomas (n = 2); melanotic schwannoma (n = 2); and sonographic evidence of multicentric, large cell, calcifying Sertoli cell tumors of the testes (n = 1). The initial component of the complex was cutaneous myxoma (n = 1), cardiac myxoma (n = 1), or psammomatous melanotic schwannoma (n = 1). Two patients died of metastatic schwannoma.

Adult↗

Sarcomatous pleural mesothelioma metastatic to left ventricular endocardium.

A 71-year-old man, a cigarette smoker with long-term asbestos exposure, developed multifocal malignant sarcomatous pleural mesothelioma that metastasized to the left ventricular endocardium without invading pericardium, myocardium, or the contiguous pulmonary vein. This is the first reported case of malignant pleural mesothelioma to metastasize in such a manner.

Aged↗

Intracardial mesotheliomas and a gastric papilloma in a giant grouper, Epinephelus itajara (Lichtenstein).

A giant grouper, Epinephelus itajara (Lichtenstein), was found dead in its tank. The principal necropsy findings consisted of multiple tumors in the ventricle of the heart, a tumor mass in the stomach, and protozoa-like organisms in the heart tumor, bile ducts and kidney collecting ducts. The heart tumors were identified as mesotheliomas the stomach tumor as a papilloma. The morphology of the protozoan-like organisms was similar to that of Rhabdospora thelohani (Languesse).

Animals↗

Primary cardiac tumor presenting as obstruction of the left ventricular outflow tract.

A transthoracic echocardiogram revealed 3 tumors in the left atrium of a 64-year-old woman, who died suddenly 8 months after resection of the tumors. Primary cardiac tumors are unusual and a case of postoperative left ventricular metastases of the atrial tumors resulting in left ventricular outflow tract obstruction is very rare occurrence.

Echocardiography, Doppler↗

Intracardiac extension of intravenous leiomyomatosis in a pregnant woman: A case report and review of the literature.

Intravenous leiomyomatosis is an uncommon clinical entity characterized by the growth of a benign, smooth muscle tumour within the venous system. Intracardiac extension of this tumour is rare, and approximately 35 cases have been reported in the literature. The second case of massive intracardiac extension of intravenous leiomyomatosis is reported in a pregnant patient diagnosed after the unusual presentation of seizure activity. Tumours were successfully removed from the right internal iliac vein, inferior vena cava, and right atrium and ventricle in a single-stage operation using cardiopulmonary bypass and circulatory arrest. Concomitant total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Nine months after diagnosis, the patient was evaluated for recurrent disease. A review of the literature from 1994 to 1998 is presented.

Adult↗

[Valvular tumor: diagnostic trap. Report of a case of marastic endocarditis].

Marastic endocarditis is a rare clinical condition described in cases of cancer or other severe inflammatory diseases. The authors report the case of a young patient in good general condition, admitted after a cerebro-vascular accident. Investigations showed an isolated mitral valvular mass on transoesophageal echocardiography which, after unsuccessful medical therapy, was operated. It was, in fact, a case of marastic endocarditis, and a pulmonary tumour was discovered one month after surgery. The bronchopulmonary adenocarcinoma had remained infraclinical beforehand. The advances in echocardiographic imaging will probably lead to an increase in such cases of early diagnosed thrombotic non-bacterial endocarditis (ETNB. This case suggests that it is justified to carry out an aetiological investigation of thrombotic non-bacterial endocarditis in all cases of isolated mitral valve masses.

Adenocarcinoma↗