A rare case of papillary fibroelastoma involving the tricuspid valve. A single center experience over a period of 22 years (1999-2021).

BACKGROUND AND AIM: Papillary fibroelastoma (PFE) represents only 16% of the benign cardiac tumor and approximately 15% of these are located on the tricuspid valve. MATERIALS AND METHODS: Over a period of 22 years (1999-2021) we observed 75 pts with cardiac tumors at our Center over 9650 pts operated on but only one case of a tricuspid valve PFE in a 69-year-old patient. Trans-thoracic echocardiography demonstrated a mobile mass (20 × 10 mm), adhering to the atrial side of the septal leaflet of the tricuspid valve of unknown origin. In consideration of the mobility of the mass and the consequent high embolic risk, surgical removal was made. The patient underwent surgery through a median sternotomy on CPBP. A 'gelatinous' mass adhering to the tricuspid leaflet was found and completely removed. The postoperative course was uneventful. The pathological diagnosis was PFE. CONCLUSIONS: PFEs of the tricuspid valve are rare entities being in most cases found incidentally. In our experience, the incidence of this tumor in this location is 1/10,000 cases of cardiac surgery. Although most patients are asymptomatic, surgical treatment is nevertheless recommended in consideration of the high embolic risk.

Vacuum-assisted sternal closure after a 'depression induced ischemic test' in severe mediastinitis.

We present a case of a 71-year-old patient with arterial myocardial revascularization and postoperative course complicated with sternal wound diastasis and subsequent mediastinitis. The patient underwent double revision of the mediastinum: the first in 13th and the second in 27th with total sternectomy. Although the resulting external exposure of pericardial cavity and grafts is a contraindication for using vacuum-assisted closure (VAC), we used it after a 'depression induced ischemic test' (DIIT) to evaluate ischemic threshold. After the VAC therapy period (from 32nd to 112th postoperative day), the sternal wound was ready to close. We think that VAC-therapy is a safe and economic approach in the treatment of serious substance loss even with pericardial cavity and graft exposure.