[Aortic valve replacement and concomitant coronary artery bypass: assessing the morbi-mortality and recent outcomes]. / Substituição valvular aórtica combinada com cirurgia coronária: morbi-mortalidade e resultados contemporâneos.

Combined coronary artery bypass and aortic valve replacement ( AVR-CABG ) carries increased perioperative risk, and tends to have higher-risk patients. The impact of pre-operative comorbidities on outcomes after AVR-CABG has not been sufficiently evaluated. The purpose of the present study was to analyze risk factors, concomitant diseases, postoperative complications and mortality rate in patients undergoing AVR-CABG. We retrospectively reviewed all patients who underwent AVR-CABG ( n=115, 8.2 % ) at our institution between June 2008 and June 2011 ( total=1399 ). The average age was 72.8±0.7 years-old and 66.1 % were male. Preoperative risk factors were: arterial hypertension ( 80.0 % ), diabetes ( 34.8 % ), dyslipidemia ( 74.8 % ), smoking ( 19.1 % ), renal failure ( 10.4 % ), chronic obstructive pulmonary disease ( 6.1 %) and arterial disease ( 17.4 % ). Presenting diagnosis was severe aortic stenosis in 73.9 % and acute coronary syndrome in the remaining.Biological valves were implanted in 90.4 % patients and 69.6 %patients received only one aorto-coronary bypass. The stay in hospital was 9,4±0,6 days. The most important complications were: postoperative bleeding ( 6.1 % ), mediastinitis ( 5.2 % ), heart failure ( 5.2 % ), pulmonary insufficiency ( 5.2 % ) and acute renal failure ( 7.0 % ). Operative mortality was 2.6 %.Our results suggest that AVR-CABG is an effective treatment associated with low rates of morbimortality, although presented to higher-risk patients.

[Primary myxoma of the pulmonary artery. Clinical report]. / Mixoma do tronco daartéria pulmonar. Caso clínico.

The cardiac myxoma is a benign clinical entity, characterised by the growth of a gelatinous mass composed by primary connective tissue and stroma, representing the most common cardiac tumour. Usually found within one of the cardiac chambers, it affects the left atrium in 75% of the cases. Rare cases in literature describe extra-cardiac locations of myxomas. In this paper, the authors report the clinical case of a patient with a primary myxoma of the pulmonary artery.

Syphilitic aneurysm of the ascending aorta.

Syphilitic aortic aneurysm is a rare occurrence in the antibiotic era, making the diagnose assumption even more infrequent. Nonetheless, this pathology can appear and should be suspected in patients with aortic aneurysm. We report a case of a 57-year old patient who presents with neurosyphilis and, in the following study, a large ascending aorta aneurysm is identified. The authors discuss the diagnostic challenge, the epidemiologic concerns, surgical indication and treatment and subsequent follow-up.