Primary cardiac angiosarcoma of left atrium.

Cardiac angiosarcoma usually arises from the right atrium. We report an extremely rare case of primary angiosarcoma originating from the left atrium in a 70-year-old woman. This represents the ninth reported case of left-sided cardiac angiosarcoma in the English literature. Analysis of all nine cases shows that this malignant neoplasm occurs more in female patients with a mean age of 60 years, unlike the right-sided one which typically affects male patients in their early 40s. The prognosis of this tumor is extremely poor with life expectancy lying between 3 to 34 months despite early diagnosis by imaging and multimodality treatment.

Impact of diabetes on early and mid-term survival after coronary artery bypass graft surgery in the Hong Kong Chinese population.

OBJECTIVE: To determine the impact of diabetes on early and mid-term survival in the Hong Kong Chinese population undergoing coronary artery bypass graft surgery. DESIGN: Prospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: A total of 904 consecutive patients following coronary artery bypass graft surgery from November 1999 to December 2003 were prospectively analysed. Among them, 377 (42%) diabetic and 527 (58%) non-diabetic patients were evaluated. MAIN OUTCOME MEASURES: Hospital mortality, mid-term mortality, and percutaneous coronary intervention-free survival. RESULTS: The diabetic group had a higher risk score than the non-diabetic group (mean+/-standard deviation: EuroSCORE 4.7+/-3.4 and 3.6+/-3.4, respectively; P<0.001). Hospital mortality was 3.4% in the diabetic group compared to 2.8% in the non-diabetic group (P=0.698). Multiple logistic regression analysis identified left ventricular ejection fraction of less than 30% and preoperative intubation as independent risk factors for early hospital death. There were 81 late deaths and the actuarial survival at 48 months for the diabetic and non-diabetic patients were 86% and 90%, respectively (P=0.298). The angina-free survival and percutaneous coronary intervention-free survival at 48 months for the diabetic and non-diabetic patients yielded no statistically significant difference. CONCLUSIONS: Diabetes mellitus was not a predictor of early and mid-term mortality after coronary artery bypass graft surgery in our Chinese population. Furthermore, diabetes did not affect angina recurrence or intervention free-survival up to 4 years.

Mortality prediction in adult cardiac surgery patients: comparison of two risk stratification models.

OBJECTIVE: To assess and compare the two commonly applied models--EuroSCORE and Parsonnet--in our local adult cardiac surgery patients, according to risk factor quantification related to mortality using a risk stratification protocol to assess the quality of cardiac surgical care. DESIGN: Prospective study. SETTING: Cardiac surgery centre in a regional hospital in Hong Kong. PATIENTS: All adult patients undergoing coronary artery bypass graft and heart valve surgery at the Grantham Hospital were evaluated prospectively from November 1999 to July 2005. MAIN OUTCOME MEASURES: In-hospital mortality was the defined end-point. Statistical analyses consisted of observed against expected mortality, Hosmer-Lemeshow goodness-of-fit test for calibration accuracy, and receiver operating characteristic curve for discrimination performance. RESULTS: During the study period, 1247 patients underwent coronary artery bypass graft surgery and 1406 underwent heart valve surgery. Observed mortality rates in these two patient groups were 2.9% and 4.8% respectively. The expected mortality rates as predicted by the EuroSCORE were (mean+/-standard deviation) 4.0+/-3.3% and 5.2+/-3.0% respectively, and by the Parsonnet model were 5.9+/-4.2% and 7.3+/-4.4% respectively. EuroSCORE performed better than the Parsonnet model at predicting in-hospital mortality assessed by the Hosmer-Lemeshow goodness-of-fit test. The areas under the receiver operating characteristic curves in coronary artery bypass graft surgery were 0.76 for EuroSCORE and 0.74 for Parsonnet. The receiver operating characteristic curve areas in valve surgery were 0.77 for EuroSCORE and 0.79 for Parsonnet. CONCLUSION: Despite significant geographic and demographic differences between European and Asian patients, in our local adult cardiac surgery patients, the EuroSCORE performed well with good calibration and discrimination in predicting mortality. There was a tendency for both models to over predict. However, the EuroSCORE can serve as a baseline for the development of a local risk model.

Coronary artery fistulas: long-term results of surgical correction.

BACKGROUND: Opinions vary as to whether operation should be offered patients with coronary artery fistula, particularly to those who are asymptomatic. Published studies lacked long-term follow-up data. METHODS: We studied 41 patients with coronary artery fistula operated in our unit in the past 30 years with restudies including coronary angiograms in those who agreed to the investigation. RESULTS: There was no operative mortality and operative morbidity was low. The mean duration of follow-up was 9.1 years and 96.9% of the patients were asymptomatic. Twenty-one patients had a coronary angiogram. The native coronary artery either remained dilated and tortuous, or more frequently had thromboses with a short proximal stump. (None of these patients had evidence of myocardial ischemia.) Four patients had demonstrable recurrence fistula but without hemodynamic disturbance. CONCLUSIONS: We advocate operation for all patients with coronary artery fistulas and demonstrable shunting in view of minimal operative risks. Small asymptomatic fistulas without demonstrable shunting should be left alone. The relatively high incidence of residual or recurrent fistula makes long-term follow-up mandatory.

Repair of ruptured sinus of valsalva aneurysm: determinants of long-term survival.

BACKGROUND: Ruptured sinus of Valsalva aneurysm is a rare cardiac anomaly and long-term survival after surgical treatment is not well established. This study was designed to investigate the determinants of long-term survival after repair of ruptured sinus of Valsalva aneurysm. METHODS: From April 1978 to April 1996, 53 patients underwent operation for ruptured sinus of Valsalva aneurysm. The incidence among our cardiac surgical population was 0.56%. Long-term survival was investigated in 46 patients (13 to 65 years) who survived the operation, with 96.2% follow-up completeness (mean+/-standard deviation, 6.5+/-4.9 years; maximum, 17.2 years), by univariate and multivariate analyses. RESULTS: There was no early operative death and no recurrence after the initial repair. Actuarial survival was 83.8%+/-8.4% at 15 years. Reoperation, aneurysm draining into the left ventricle, aortic prosthetic dehiscence, bacterial endocarditis, and aortic cross-clamp time (<70 minutes) were significant factors in long-term survival (p < 0.05). Multivariate analysis revealed that only aortic prosthesis dehiscence was the significant factor influencing late survival (p = 0.0001). CONCLUSIONS: Surgical treatment for ruptured sinus of Valsalva aneurysm is safe and has satisfactory results. Aortic prosthesis dehiscence is the independent determinant for long-term survival. Other factors including bacterial endocarditis, concomitant ventricular septal defect repair, and aortic valve replacement did not independently influence long-term survival.