Rosai-Dorfman Disease of Right Atrium Mimicking Myxoma.

Rosai-Dorfman disease, or sinus histiocytosis with massive lymphadenopathy, is a rare multisystemic disorder that was first reported by Rosai and Dorfman in 1969. It is a distinct histioproliferative disorder due to overproduction of histiocytes, which accumulate in lymph nodes. The cardiac involvement of this disease is extremely rare, and until now, only 18 cases have been reported. We report the case of a 53-year-old woman with right atrial mass mimicking myxoma, which the histopathologic evaluation revealed to be Rosai-Dorfman disease of the right atrium.

Concomitant coronary bypass and below knee amputation in a diabetic patient.

A 57-year-old man presented with unstable angina and uncontrolled diabetes with diabetic foot. It was decided to perform right below knee amputation with coronary revascularization in a single stage. Right below knee amputation was carried out first. The left anterior descending artery, ramus intermedius, and second obtuse marginal branch of the circumflex were bypassed on a beating heart, using saphenous vein grafts. The patient was discharged on the 7th postoperative day after a course of antibiotics.

Surgical correction of Lutembacher's syndrome in a patient with severe pulmonary artery hypertension.

Lutembacher's syndrome is an uncommon combination of a congenital ostium secundum atrial septal defect (ASD) with acquired mitral stenosis (MS). The incidence of this condition is very rare. The symptoms are dependent upon the size of the ASD, severity of the MS, compliance of the right ventricle and pulmonary artery hypertension. We describe a patient with Lutembacher's syndrome with severe pulmonary hypertension who underwent successful surgical repair.

Management of a patient with unstable angina, left main coronary artery disease, and respiratory insufficiency due to eventration of the diaphragm.

The incidence of eventration of diaphragm before cardiac surgery is rare. We describe the management of a patient with eventration of the diaphragm who underwent a coronary artery bypass grafting (CABG) for left main coronary artery disease followed by left diaphragm plication with video-assisted thoracic surgery (VATS) for the postoperative respiratory insufficiency.

Predictors of early outcome after coronary artery surgery in patients with severe left ventricular dysfunction.

BACKGROUND: The surgical survival in patients with severe myocardial dysfunction is critically dependent on the selection of patients. The present study was undertaken to identify the prognostic factors in such patients. METHODS: We analyzed the data of 176 consecutive patients (161 men, 15 women), aged 29 to 88 years (mean 58.43), with a left ventricular ejection fraction (LVEF) < 30% who underwent isolated coronary artery bypass grafting. The LVEF ranged from 15% to 30% (mean 27.18%). Preoperatively, 33% had angina, 19.9% had recent myocardial infarction, and 21.6% had congestive heart failure. The mean number of grafts was 2.5/patient. The intra-aortic balloon was used prophylactically in 20.5% of patients and therapeutically in 4.0% of patients. RESULTS: The hospital mortality was 2.3%. The complications occurred as follows: perioperative myocardial infarction in two (1.1%), intractable ventricular arrhythmias in two (1.1%), prolonged ventilation in four (2.3%) and peritoneal dialysis in 1 (0.6%). The mean ICU and hospital stay were 2.46 +/- 0.76 and 7.57 +/- 2.24 days, respectively. The predictors of survival on univariate analysis were New York Heart Association (NYHA) class (x2 = 14.458, p < 0.001), recent myocardial infarction (x2 = 5.852, p = 0.016), congestive heart failure (CHF) (x2 = 5.526, p = 0.019), and left ventricular end-systolic volume index (LVESVI) (x2 = 25.833, p < 0.001). However, on multivariate analysis, left ventricular end-systolic volume index was the only independent left ventricular function measurement predictive of survival (x2 = 10.228, p = 0.001). CONCLUSION: Left ventricular end-systolic volume index is the most important predictor of survival after coronary artery bypass surgery in patients with severe myocardial dysfunction.