Lipoma of the right atrium.

The patient is a 54-year-old asymptomatic male with a tumor in the right atrium that was diagnosed on transesophageal echocardiography and confirmed as a lipoma of the right atrium on computerized tomography. The patient underwent surgical repair with extracorporeal circulation. The tumor was resected, and its base of implantation in the atrium was repaired with a flap of bovine pericardium. The diagnosis of lipoma was confirmed on histopathological examination. Locating of the tumor with the aid of transesophageal echocardiography was very useful in the strategy of cannulation of the venae cava for installation of the circuit of extracorporeal circulation. The patient had a good postoperative evolution.

[Myocardial revascularization surgery via a left minithoracotomy]. / Cirurgia de revascularização do miocárdio através de minitoracotomia esquerda.

PURPOSE: There is, today, a global tendency towards a surgical approach privileging very small incisions, the so-called minimally invasive intervention, which results in a less aggressive action. The introduction of this new technique makes it possible to dissect the left internal thoracic artery (LITA) and to perform in the anastomosis with the anterior interventricular artery (AIA) through a left minithoracotomy. METHODS: From May of 1996 to october of 1997, 11 patients with ischemic heart disease and a single proximal lesion of the AIA were submitted to a myocardial revascularization (MR). The surgical approach consisted of a left anterolateral thoracotomy through the 4th left intercostal space, of approximately 10 cm, and in the last 6 cases, resection of part of the cartilage of the 4th and 5th ribs, dissection of the LITA, as well as opening and repair of the pericardium adjacent to the AIA was done. All patients received a single bypass to the AIA with a graft of the LITA, without extracorporeal circulation. RESULTS: The patients' age varied between 46 and 76 years (mean = 58.55). Ten patients (90.90%) were males and 1 (9.09%) was a female. Hospital stay ranged from 4 to 8 days, with the average of 5.2 days. None of the patients presented any electrocardiographic change in the immediate post-operatory period. During the control period one patient developed a clot in the distal LITA, with important compromise of the flow. In another patient the stenosis was at the level of the anastomosis. Both were successfully submitted to angioplasty. There were no deaths in the groups studied. CONCLUSION: The absence of deaths suggests to us that MR surgery carried out with this minimally invasive technique, in selected groups and is an excellent alternative to the revascularization of the AIA.

[Modified Fontan's operation]. / Operação de Fontan Modificada.

Nine-year-old female patient presented with cianosis since she was born, fatique and dyspnea when sucking. The diagnosis was univentricular heart with left ventricular morphology, transposition of the great arteries, moderate pulmonary valve stenosis and atrial septal defect. Submitted to surgical correction with superior vena cava-right pulmonary artery anastomosis, inferior vena cava anastomosis using lateral tunnel, with cardiopulmonary bypass. After surgical correction, the clinical and laboratorial (echocardiogram and cardiac catheterization) evaluation showed Fontan operation with good surgical results. Total cavopulmonary connection was proposed as a modification of the Fontan procedure that might have greater benefits than previous proposed techniques. The results demonstrate that this modification provides excellent early definitive treatment, increasing hemodynamic profile, with low morbidity and mortality, for a variety of complex congenital heart lesions.

[Surgical treatment of congenital fistulas of the coronary artery]. / Tratamento cirúrgico de fístulas congênitas da artéria coronária.

PURPOSE: To evaluate the surgical result of the cases of congenital fistulae of the coronary artery. METHODS: Seven patients were surgically treated since January 80 until February 94. The ages ranged from 3 days to 52 years old. The diagnosis was suspected by echocardiogram and established by cardiac catheterization. RESULTS: Regarding the clinical status, 3 (42.85%) patients were asymptomatic, 3 (42.85%) presented congestive heart failure and 1 (14.28%) precordial pain and palpitation. The fistulae, located in inferior wall of the right ventricle in 1 (14.28%) patient, apex of the right ventricle in 1 (14.28%), right atrium in 3 (42.85%), and coronary sinus in 1 (14.28%), were isolated in 4 (57.17%), 1 (14.28%) also had fixed subaortic stenosis, 1 (14.28%) had previously undergone the ligate of the ductus arteriosus and 1 (14.28%) also had aortic coarctation and ductus arteriosus. After surgical treatment, 5 (85.72%) had follow up abnormalities, showing good clinical outcome; 1 (14.28%), that also had aortic and subaortic stenosis, followed with minimal aortic regurgitation and poor left ventricular performance; 1 (14.28%), that had aortic coarctation and ductus arteriosus, who had been operated on in unfavourable hemodynamic conditions, died 5 days after surgery. CONCLUSION: Surgical correction should be proposed as a treatment of the congenital fistulae of the coronary artery, since it is technically feasible, and has low in-hospital mortality and morbidity.

[Ebstein's anomaly associated with interventricular communication]. / Anomalia de Ebstein associada a comunicação interventricular.

Twelve-year-old patient, with congestive heart failure and mild, caused by Ebstein's anomaly with interventricular septal defect, was studied and submitted to surgical correction which consisted in covering the interventricular defect with a path of bovine pericardium and substituting for the tricuspid valve with a biological prosthesis (porcine). After surgical correction, the patient was submitted to strict clinical and laboratorial (echocardiogram and cardiac catheterization) evaluation which presented excellent adjustment of the cardiac antriums, with improvement of myocardial function index. The problems related to the diagnosis of the association of the Ebstein's anomaly with interventricular septal defect can be solved with a well done semiology, helped by accurate laboratorial procedures like echodopplercardiogram and cardiac catheterization. The total surgical correction can be achieved with results and, with this fact, change the natural development of the disease.