A multi-disciplinary approach to the management of intra-venous and intra-cardiac leiomymatosis: A case report.

We herein report a rare presentation of leiomyoma in a 46-year-old female who presented with complaints of shortness of breath on exertion associated with palpitations for the past one year with a history of irregular menstrual bleeding. Ultrasonography of the abdomen and pelvis revealed an enlarged, distorted uterus with multiple intramural fibroids. A trans-thoracic echocardiography was then performed which showed a large right atrial mass. To investigate further, a contrast enhanced computed tomography was performed covering entire chest and upper abdomen. It showed a large lesion in the right atrium of the heart measuring 6x5cm. The lesion appeared hypo dense and was abutting the tricuspid valve and posterior wall of the Right Atrium. It revealed the Right Atrial lesion extending into the Inferior Vena Cava and lower down into the Common Iliac Confluence, Left Common Iliac and External Iliac Veins. A multi-disciplinary approach was undertaken; the patient underwent a single stage procedure involving a total abdominal hysterectomy with bilateral Salpingo-Oophorectomy followed by excision of the intra-cardiac tumour. Recovery was uneventful and the patient was successfully discharged on the 5th post-operative day. Due to the lack of literature and low incidence of this disease, this case report presents a rare opportunity to define management guidelines for such occurrences in the future.

The effect of ejection fraction on mortality in Coronary Artery Bypass Grafting (CABG) patients.

BACKGROUND AND OBJECTIVES: Patients with low ejection fraction undergoing isolated CABG surgery are at a higher risk for postoperative complications and mortality. This study was conducted to evaluate the impact of ejection fraction on the outcome of isolated Coronary Artery Bypass Grafting (CABG). METHODS: Between July, 2017 to May, 2019 total 1214 patients underwent isolated CABG. Patients were divided into three groups based on their pre-operative Ejection Fraction (EF). Group-I included 625 patients with EF >50% [Normal EF], Group-II included 484 patients with EF 35-50% [Mild to Moderately Reduced EF], and Group 3 included 105 patients with EF<35% [Severely Reduced EF]. RESULTS: The mean age of Group-I was 57.58 ± 9.206, Group-II was 58.38±9.124 and Group-III was 58.81± 8.663. The male gender was the predominant gender in all three groups: 194(41.1%) in Group-I, 201(52.6%) in Gp2, 52 (61.9%) in Group-III. 231(36.9) patients in Group-I, 234(48.3)in Group-II and 59(56.2) in Group-III had raised creatinine pre operatively. 5(0.8%) patients in Group-I, 2(0.4%) in Group-II and 3(2.9%) in Group-III had history of CVA. Hypertension was present in approximately 60% of all our patients. In the per-operative period 20(3.2%) patients in Group-I required an IABP as compared to 73(15.1%) in Group-II and 41(39.0%) in Group-III. The mean post-operative mortality in Group-I was 19 (3%), Group-II was 24(5.0%) and low EF group was 9(8.6%). CONCLUSIONS: The results clearly indicate that worsening pre-operative ejection fraction is associated with a higher mortality post-operatively in patients undergoing isolated CABG. In addition, use of IABP increases as pre-operative LVEF decreases.

Diffuse Coronary Artery Disease - A Challenge To Revascularize And The Role Of Coronary Endarterectomy.

Coronary endarterectomy is a useful adjunct procedure in patients with diffuse coronary artery disease when isolated coronary artery bypass grafting does not permit adequate revascularization. The primary aim of this procedure is to enable ample blood flow by removing the obstructing plaque. Herein we discuss the case of a middle-aged patient who underwent coronary endarterectomy.