Repair of coarctation of the aorta in adults with simultaneous aortic valve replacement and coronary artery bypass grafting.

The authors present three patients who had either coronary artery disease or severe aortic stenosis or both along with congenital coarction of the aorta. The use of a heterotopic bypass (Dacron tube implanted between the ascending and descending aorta) allowed the surgeons to correct the coarction through a median sternotomy and perform the coronary artery bypass grafting and valve replacement at the same time. The authors are convinced that the scarcely mentioned heterotopic bypassing of the coarcted aorta should be added to the armamentarium of the surgeons who operate on patients with coarctation or recoarctation of the aorta in adulthood or with coarctation that is associated with cardiac lesions.

Surgical treatment of cardiac myxomas: a 20-year follow-up.

Clinical experience in the diagnosis and management of 50 cases of cardiac myxoma seen over a 20-year period from 1974 to 1994 has been reviewed. There were 17 men and 33 women of mean age 55.2 (range 16-81) years. Echocardiography confirmed the diagnosis in all patients. The location of myxomas was as follows: left atrial alone in 42 patients, right atrial alone in three, right ventricular alone in one, left atrial+right atrial in two, left atrial+right atrial+right ventricular in one, and left atrial+left ventricular in one. Nineteen patients were operated on within 48 hours of the diagnosis. All tumours were successfully removed with the aid of cardiopulmonary bypass. The hospital mortality rate was 10%. Excision of the tumour resulted in marked symptomatic improvement. There was one late death. The current survivors are symptom-free at a mean follow-up of 76.4 (range 1-241) months. Echocardiographic studies were performed in all survivors and no recurrences have been observed. It is concluded that excision of cardiac myxomas is curative and long-term survival is excellent. Radical tumour excision may prevent recurrences.

[Long-term results of surgical treatment of cardiac myxomas]. / A cardialis myxomák sebészi kezelésének késöi eredményei.

We have reviewed our clinical experience in the diagnosis and management of 50 cases of cardiac myxoma seen over a 20 year period, 1974 to 1994. There were 17 males and 33 females, their ages ranged from 16 to 81 years (mean 55.2 years). Echocardiography confirmed the diagnosis in all patients. The location of myxomas was as follows: left atrial alone in 42 patients, right atrial alone in 3, right ventricular alone in 1, left + right atrial in 2, left + right atrial + right ventricular in 1, and left atrial eft ventricular in 1. Nineteen patients were operated on within 48 hours following the diagnosis. All tumors were successfully removed with the aid of cardiopulmonary bypass. The hospital mortality rate was 10%. Excision of the tumor resulted in marked symptomatic improvement. There was one late death. The current survivors are asymptomatic at a mean follow-up of 76,4 months (range 1-241 months). Echocardiographic studies were performed in all survivors and no recurrences have been observed. We conclude that excision of cardiac myxomas is curative and long-term survival is excellent. Radical tumor excision may prevent recurrence.

The use of an internal mammary artery for creating a systemic-to-pulmonary artery shunt.

We report on two patients who had systemic-to-pulmonary artery shunts created by the use of the internal mammary artery (IMA). The first patients was operated on more then 30 years ago (the case has never been published) and the second one move recently. We give a brief summary of the ten cases of the same operation published so far, and emphasize the usefulness of the IMA that stays open despite the initially poor run-off and is capable of supplying increasing amounts of blood to the growing pulmonary arteries.

[Echocardiographic diagnosis of intermittent failure of a mitral valve prosthesis]. / Intermittáló mitralis mübillentyü "beragadás" echocardiographiás diagnózisa.

Three cases are reported who had intermittent diastolic jamming of a mitral tilting disc valve. The clinical presentation of this unfrequent but catastrophic early postoperative complication was different in all cases: the first patient presented with heart failure, the third patient had loss of consciousness with enuresis and the second patient was asymptomatic at the time of the diagnosis. Electromechanical dissociation was first suspected by clinical examination in 2 cases but it was confirmed in all 3 cases by 2 dimensional and Doppler echocardiography. Transesophageal echocardiography did not provide any additional information. Besides opening failure of the valve Doppler echocardiography also demonstrated incomplete or delayed opening in the asymptomatic period. Survival is dependent on correct diagnosis and urgent surgical treatment of this type of prosthetic valve dysfunction.

Accessory mitral valve tissue causing left ventricular outflow tract obstruction.

Among the various causes of left ventricular outflow tract obstruction accessory mitral valve tissue is the least common. To the best of our knowledge there have been only five such cases reported to date. The aim of presenting two more cases and reviewing the literature is to bring attention to this rare anomaly as it is easy to treat provided it has been diagnosed preoperatively or recognised at surgery.