Aortic fat pad and atrial fibrillation: cardiac lymphatics revisited.

The lymphatics of the heart have not generated any broad or sustained interest among clinicians. Few publications on cardiac lymphatics are available, the anatomy is not routinely known and the true role of cardiac lymphatics remains doubtful. One important anatomical concept needing clarification is that of the lymphatic drainage of conduction tissue. The sinoatrial node lymphatic collector and right principal lymphatic trunk are both incorporated into the aortic fat pad of the ascending aorta and are the most frequently damaged lymphatic vessels during cardiac surgery. Thus, preservation of the aortic fat pad and its lymphatic collectors should reduce the incidence of new atrial fibrillation observed in patients after cardiac surgery. This review assesses current knowledge of cardiac lymphatics and shows their possible role in triggering arrhythmias in the postoperative period.

Primary cardiac paraganglioma.

We report a case of a 29-year-old male, who during workup of hypertension was found to have a malignant primary paraganglioma of the heart. The tumor arose from the site of the aortopulmonary window and right ventricular outflow tract (RVOT) and was removed with the aid of cardiopulmonary bypass. Reconstruction of the RVOT and pulmonary valve was necessary because of involvement by the tumor. The surgical course was uncomplicated, with normalization of catecholamine secretion and blood pressure.

Extralobar pulmonary sequestration simulates posterior neurogenic tumor.

We report a case of 19-year-old asymptomatic man with posterior mediastinal mass thought to be of neurogenic origin on computed tomography scan. During video-assisted thoracic surgery the mass appeared to be an extralobar pulmonary sequestration. Surgery was straightforward by division of vascular pedicle. Histopathology confirmed diagnosis.