Double Right Atrial Blood Cysts.

Blood cysts are exceedingly rare benign cardiac tumors, generally involving the cardiac valves. They are found mainly in the first month of life and in children and are very uncommon in adults. We present a rare case of double right atrium blood cysts, incidentally detected by transthoracic echocardiography in an 85-year old patient.

Outcome of cardiac and thoracic aortic operation in patients over 80 years old.

A retrospective analysis was performed to determine the early outcome of cardiac and thoracic aortic surgery in patients over 80 years old. Between 1994 and 2000, 41 octogenarians (mean age, 82.6 +/- 2.5 years) underwent coronary artery bypass grafting (25), valve surgery (8), thoracic aortic aneurysm repair (7), or combined valve and bypass surgery (1). Overall hospital mortality was 9.8%. Mortality rates for specific procedures were 12% for coronary bypass, 0% for valve surgery, and 14% for thoracic aortic aneurysm repair. Major postoperative complications affected 27% of patients and included severe low cardiac output, respiratory failure, and acute renal failure, with a low incidence of perioperative stroke (2.4%). Cardiac and thoracic aortic operations can be performed with acceptable mortality and morbidity when appropriately applied in selected octogenarians.

Emergency surgery results in life-threatening thoracic aortic disease.

OBJECTIVE: Emergency surgery for thoracic aortic aneurysm continues to involve high mortality. We review our experience in emergency surgery for life-threatening thoracic aortic disease. METHODS: Between September 1994 and June 2000, 65 consecutive patients--38 men and 27 women aged 18 to 84 years (mean: 64.3 years)--underwent emergency surgery for thoracic aortic disease. Of these, 40 (61%) were treated for acute type A dissection, 16 (25%) for aortic rupture, and 9 (14%) for impending aneurysmal rupture. Ascending aorta repair was conducted in 21, aortic arch repair in 30, distal arch repair in 2, descending aorta repair in 9, and thoracoabdominal aorta repair in 3. Of the 65, 42 were under 70 years old and 23 were 70 years of age and older. RESULTS: Overall, 8 (12%) died in the hospital--3 (7.5%) of acute type A dissection, 3 (19%) of ruptured aneurysm, and 2 (22%) of impending rupture. Of these, 3 (7.1%) were younger than 70 years and 5 (22%) 70 years and older. The following perioperative factors significantly influenced hospital mortality: pump time (p = 0.019), postoperative severe cardiac failure (p = 0.006), postoperative respiratory failure (p = 0.045), and postoperative acute renal failure (p = 0.0007). Of the 57 survivors followed up for an average of 2.8 years (1 month to 6 years), 3-year survival was 73% overall--88% in patients younger than 70 years and 38% in those 70 years and older (p = 0.0004). Seven of the 9 patients suffering strokes during surgery died in the hospital (2) or after discharge (5). Overall hospital and late deaths involved 2 of 4 patients younger than 70 years and all of 5 patients 70 years and older. CONCLUSION: The majority of patients undergoing emergency surgery for life-threatening thoracic aortic disease can undergo graft replacement with acceptable mortality, morbidity, and late survival, but early and late mortality for patients older than 70 remains extremely high.

Diagnosis of structural deterioration in an aortic bioprosthetic valve by multidetector row computed tomography: report of a case.

A 32-year-old female patient presented with shortness of breath. The patient had received aortic valve replacement with a 25-mm bioprosthetic valve at the age of 22, and had had two babies, postoperatively. Ten years later, echocardiography showed the calcifi ed bioprosthetic valve with a high peak pressure gradient (70 mmHg) and a reduced valve orifice area (0.46 cm(2)). Electrocardiographically gated multidetector row computed tomography (ECG-gated MDCT) clearly demonstrated calcifi ed bioprosthetic cusps with reduced mobility, and the valve orifi ce area was measured to be 0.64 cm(2) by direct planimetry. These fi ndings observed by ECG-gated MDCT were confi rmed at reoperation. This is the fi rst reported reoperation case of aortic structural valve deterioration clearly visualized by ECG-gated MDCT.

Dysfunction of an ATS valve in the aortic position: the first reported case caused by pannus formation.

A 64-year-old woman underwent aortic valve replacement with a 21-mm Advancing The Standard (ATS) open-pivot mechanical heart valve for bicuspid aortic valve stenosis. In addition to the appearance of a new cardiac murmur, echocardiography performed 3 years after surgery showed a high pressure gradient across the ATS valve and a reduction in the valve orifice area. Cineradiography of the valve revealed restricted leaflet opening. Subsequent multidetector-row computed tomography clearly demonstrated pannus overgrowth on the inflow aspect of the ATS valve. During a repeat operation, subvalvular overgrown pannus was confirmed and the ATS valve was replaced with a bioprosthetic valve. This is the first reported case of prosthetic valve dysfunction resulting from pannus formation in a patient with an ATS valve in the aortic position.