Atrial myxoma: case report and a review of the literature.

Atrial myxomas are the most common benign primary tumor of the heart and occur in as many as 3 in 1000 patients. These tumors are a major cause of patient morbidity and mortality. Although the majority of atrial myxomas occur in the left atrium, 3 separate familial myxoma syndromes can result in multiple myxomas in atypical locations. Approximately 50% of patients with myxomas may experience symptoms due to central or peripheral embolism or intracardiac obstruction, but 10% of patients may be completely asymptomatic. Screening for myxomas should involve a thorough history and physical examination and a transthoracic and/or transesophageal echocardiogram. Transthoracic echocardiography is approximately 95% sensitive for the detection of cardiac myxomas, and transesophageal echocardiography approaches 100% sensitivity. Though the majority of atrial myxomas are sporadic, it is imperative that first-degree relatives of patients with documented myxomas undergo screening for occult myxomas. Surgical removal of the myxoma is the treatment of choice and usually curative; however, myxoma recurrence does occur and is most frequently associated with a familial syndrome.

Acute and chronic aortic dissection.

Each year acute aortic dissection is diagnosed in 2,000 individuals in the United States. Acute aortic dissection is no longer a catastrophic event because this problem can be rapidly diagnosed with current medical technology, and therefore promptly treated with medication and surgery. Consequently, patients with aortic dissection can survive for 10 to 20 or more years after the initial event. However, there is considerable current debate regarding the most optimal technique(s) for the diagnosis of aortic dissection. Moreover, little information is available on the best methods for the long-term assessment and treatment of patients who have been successfully treated for acute aortic dissection. This report reviews the current techniques that are available for the diagnosis of aortic dissection and discusses the important issues regarding the acute and long-term treatment of patients with this problem.