Cardiac valve papillary fibro-elastoma: a report on three different clinical cases.

Cardiac papillary fibro-elastoma is a rare benign endocardial tumour predominantly affecting the aortic and mitral valves. We report three cases with different clinical presentations, and discuss the diagnostic and therapeutic strategies.

Operative outcome of minimal access aortic valve replacement versus standard procedure.

BACKGROUND: to determine the advantages and/or risks of minimal access aortic valve replacement compared to standard sternotomy procedure. METHODS: from January 1997 to December 2001, 271 consecutive adult patients underwent isolated aortic valve replacement of which 174 underwent a minimal access procedure (Group 1) and 97 a standard procedure (Group 2). The preoperative variables of both groups were comparable. Retrospective analysis of postoperative outcome was performed. RESULTS: follow-up was complete and ranged from 6 months to 4 years. Overall in-hospital mortality was 3.3% (respectively 2.8 and 4.1%). No statistical difference was noted regarding operative time variables, mortality rate and hospital stay. There was a significant higher incidence of revision (p = 0.018) and late pericardial effusion (p = 0.022) in the minimal access group. Also trends were in favour of the standard group for incidence of postoperative pneumothorax and pericarditis constrictiva. CONCLUSIONS: minimal access aortic valve replacement is a safe and reliable technique, but carries the risk of incision-related morbidity. Proper patient selection and perioperative management is mandatory.

Acute cardiac herniation following intrapericardial pneumonectomy.

Cardiac herniation is a rare but potentially fatal complication of intrapericardial pneumonectomy. It usually occurs within the first 24 hours postoperatively. Symptoms are side-related. It has a sudden onset and invariably evolves to cardio-vascular collapse. Clinical suspicion combined with plain chest X-ray and electrocardiographic changes must lead to a quick diagnosis. Definitive treatment requires prompt surgical action. Closure of the pericardial defect during initial operation does not exclude the possibility of cardiac herniation. We present a patient with a right-sided cardiac herniation after intrapericardial pneumonectomy. Patient was treated surgically and survived.

Paradoxical embolism through a patent foramen ovale.

The high prevalence of clinically silent venous thrombosis and the presence of a patent foramen ovale in up to 35% of the general population suggests that paradoxical embolism (PDE) may be the cause of an ischaemic stroke or a peripheral thrombo-embolic occlusion more often than is presently considered. We report an ante-mortem diagnosed case of PDE and a review of the literature. Contrast echocardiography with provocative manoeuvres is suggested as the key investigation for diagnosis and anticoagulation is the mainstay of therapy.

Muscle-saving lateral axillary thoracotomy.

Seventy-five consecutive thoracotomies through a lateral axillary thoracotomy incision are reviewed. The limited approach is a muscle-splitting incision with preservation of the Latissimus Dorsi and Pectoralis Major muscles and splitting of the Serratus Anterior muscle. Detailed description of the operative technique is given, and a review of morbidity and mortality is included. We conclude that the lateral axillary incision is a good alternative to the standard postero-lateral approach, as it provides excellent visibility and allows for all pulmonary surgical procedures, with minimal postoperative discomfort.