Recurrence of left atrial myxoma mimicking a mitral annuloplasty ring thrombosis.

Cardiac myxomas (CM) is by far the most common type of primary cardiac neoplasm that commonly arise within the left atria and is composed of primitive connective tissue cells and stroma. Despite the benign nature, the CMs are often surgically removed because they can lead to severe complications. Large, thin, and hypermobile forms are unusual. The frequency of recurrence is about 22% for complex forms and 12% for other familial forms and 1% to 3% for sporadic myxomas, which seldom recur after surgery. Although transesophageal echocardiography shows usually accurate imaging capabilities to detect the myxoma, further imaging methods including computed tomography, cardiovascular magnetic resonance imaging, and 18 F-fluorodeoxyglucose positron-emission tomography/computed tomography may be useful to diagnosis for it. Surgery is the mainstay of treatment.

Effects of patient-prosthesis mismatch on postoperative early mortality in isolated aortic stenosis.

BACKGROUND AND AIM OF THE STUDY: Small valve size and patient-prosthesis mismatch (PPM) generate high postoperative transvalvular gradients and may decrease both early and long-term survival. The study aim was to evaluate whether mismatch affected early mortality after aortic valve replacement (AVR) for isolated aortic stenosis (AS). METHODS: A total of 701 patients (437 males, 264 females; mean age 53.3 +/- 15.1 years; range: 14-84 years) with pure AS underwent AVR at the authors' institution between 1985 and 2005. The majority of patients (92%) received a mechanical valve. PPM was considered severe if the indexed effective orifice area was < or =0.65 cm2/m2, and moderate if > 0.65 but < or = 0.85 cm2/m2. RESULTS: Moderate-severe PPM was present in 47% of patients, and severe PPM in 13%. The early mortality was 5.4% (n=38). Multivariate analysis revealed age > or = 70 years (p < 0.001), female gender (p = 0.04) and severe PPM (p = 0.003) as independent predictors of early mortality. Moderate mismatch was not a predictor of early mortality on both univariate and multivariate analysis. Left ventricular dysfunction (ejection fraction < or = 40%) was a risk factor for early mortality only in patients with severe PPM. CONCLUSION: Patient-prosthesis mismatch should be prevented in patients undergoing AVR for isolated AS, especially in those with left ventricular dysfunction.

Extensive aortic surgery in Marfan syndrome: 16-year experience.

The aim of this study was to evaluate the clinical outcome of surgical treatment in patients with Marfan syndrome. Between 1985 and November 2001, 33 patients with Marfan syndrome were operated for chronic aneurysm of the aortic root with involvement of the ascending aorta in 20 patients and type A dissection in 13 patients. The patients comprised 24 males and 9 females with a mean age of 31.9 +/- 9.7 years (range, 18 to 54 years). The mean diameter of the ascending aorta was 6.6 +/- 1.6 cm and that of the aortic root was 5.4 +/- 1.2 cm. Hemodynamic instability was observed in 11 patients. The aortic arch was replaced in 7 patients. There was no hospital mortality. Late mortality was 6%, involving 2 patients who had aortic valve replacement. Actuarial freedom from death was 92.3% +/- 7.4% at 12 years and from late aortic complications was 86.4% +/- 9.4% at 13 years. Aortic aneurysm was a significant univariate adverse factor for late aortic complications. Aortic surgery can be performed in Marfan patients with low morbidity and mortality. Aggressive surgical intervention does not impair surgical outcome while it decreases reoperation risk.

Does conservative surgical approach improve early and late outcome in patients with acute type A aortic dissection?

OBJECTIVE: Acute type A aortic dissection (AAAD) represents an emergency in cardiac surgery that requires immediate treatment to prevent death due to its fatal complications. The surgical approach is dependent on the involvement of AAAD. METHODS: Sixty-one patients were operated for AAAD at our clinic. 48 (78.7%) were male and 13 (21.3%) were female with a mean age of 51+/-12.3 yr (range, 21-80 yr). Only the ascending aorta was replaced in 33 (54.1%) patients (Group I) and aortic arch replacement was included in 28 (45.9%) patients (Group II). The aortic valve was preserved in 43 (70.5%) patients (Group A) and replaced in 18 (29.5%) patients (Group B). RESULTS: Early mortality rate was 23% (14/61). Multivariate analysis revealed that previous cardiac operations (P=0.048), renal complications (P=0.024), pump time (P=0.024), and cardiac complications (P=0.017) were significantly factors increasing early mortality. Late mortality rate was 8.5% (4/47) and multivariate analysis revealed that pulmonary complication (P=0.015) was the only statistically significant independent risk factor. Arch replacement or aortic valve replacement was not a predictor for early or late mortality. Cumulative survival was 73.8+/-5.63% at 1 yr and 68.3+/-6.46% at 7.5 yr. Cumulative survival was not different between groups (P>0.05). CONCLUSIONS: Both radical and conservative surgical approaches in AAAD do not differ in mean of early or late results. Surgery before development of hemodynamic instability and prevention of other system complications improves the outcome of surgical treatment in AAAD.