Cardiac hemangioma of the left atrial appendag: a case report and discussion.

Cardiac hemangioma is an extremely rare, benign vascular tumor of the heart. In contrast to myxoma, hemangioma rarely involves left atrial tissue in adults and little information about the tumor is available. We encountered a 65-year-old woman with a left atrial hemangioma arising in the appendage and growing like an extracardiac mass. The tumor was removed from the left atrium with all the left appendage under cardiopulmonary bypass. Histopathological examination revealed that it was a cavernous-type hemangioma. Among the five described cases, this case was the only one in which the tumor arose from the appendage and grew into the pericardial cavity with resultant paroxystic atrial fibrillation.

[Inflammatory and fibrinolytic activation after coronary artery bypass with extracorporeal circulation]. / Caratterizzazione dell'attivazione infiammatoria e fibrinolitica dopo intervento di bypass aortocoronarico in circolazione extracorporea.

BACKGROUND: The aim of this study was to determine the course of the main inflammatory and fibrinolytic markers in patients undergoing primary elective coronary artery bypass graft with extracorporeal circulation. METHODS: One hundred and thirteen patients (105 males, 8 females) undergoing primary isolated coronary artery bypass with normo- (37 degrees C) or hypothermic (26 degrees C) systemic perfusion were prospectively studied. The clinical course of the patients was recorded and inflammatory and fibrinolytic markers (C-reactive protein, fibrinogen, interleukin-6, plasminogen activator inhibitor-1, prothrombin time, activated partial thromboplastin time, platelets and white blood cell counts) were determined before surgery, 24, 48 and 72 hours thereafter, and at hospital discharge. RESULTS: Two patients died (mortality 1.7%) and 6 had a major complication (event free survival > 94%). Interleukin-6, lymphocyte, neutrophil and monocyte levels increased after surgery but returned to normal at hospital discharge. C-reactive protein levels increased after 24 hours and remained high at hospital discharge. Plasminogen activator inhibitor-1, prothrombin time, and activated partial thromboplastin time increased from few hours postoperatively and returned to normal before discharge. Platelets decreased immediately after surgery and normalized only at hospital discharge. Fibrinogen decreased in the first 24 postoperative hours, raised later and remained elevated at hospital discharge. CONCLUSIONS: Cardiopulmonary bypass activates inflammatory response and hemostatic/fibrinolytic balance in patients undergoing primary isolated coronary artery bypass.

Echocardiographic assessment of mitral valve morphology and performance after triangular resection of the prolapsing posterior leaflet for degenerative myxomatous disease.

The gold standard for the surgical treatment of prolapse of the posterior leaflet of the mitral valve (MV) for degenerative myxomatous disease has been represented by the quadrangular resection of the leaflet, according to the Carpentier technique. Since 2006 we performed a triangular resection of the prolapsing leaflet in 20 patients with myxomatous mitral regurgitation (MR). Seventeen patients (85%) underwent the triangular resection of P2; one patient (5%) had a triple scallops triangular resection (P1, P2, P3) and two (10%) a double scallops (P2, P3) resection. In this study, we report the immediate and mid-term clinical and echocardiographic results of a cohort of 20 patients, who underwent this technique. Thirty-day mortality was 0. Acute renal failure occurred in three patients (15%) and they resolved with conservative management. One patient (5%) required re-exploration for bleeding. At the mean follow-up of 13.1+/-4.2 months survival was 95%; one patient died of lymphoma during the follow-up time. All the cases were in New York Heart Association (NYHA) class I. Nineteen survivors underwent transthoracic echocardiography (TTE) (5), or transesophageal echocardiography (TEE) (13), performed by two skilled cardiologists. All patients showed no or trivial MV regurgitation. We believe that triangular resection of posterior MV leaflet (PMVL) provides excellent mid-term results providing the surgeon with a reliable and reproducible surgical option for myxomatous degenerative MV regurgitation.

Multiple triangular resection: a reliable technique for correction of multiple prolapse of the mitral valve.

Quadrangular resection of the posterior leaflet of the mitral valve is a well-established technique for the treatment of mitral regurgitation from prolapse of P2. Recently, Suri described triangular resection of the prolapsing scallop, a technique that, avoiding the plication of the annulus corresponding to the resected leaflet, maintains the geometry of the mitral annulus, allowing a more physiologic function of the mitral valve. In this paper, we report multiple triangular resection for the treatment of multiple prolapse of the posterior leaflet.