RESUMO
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.
Assuntos
Átrios do Coração/patologia , Neoplasias Cardíacas/patologia , Hemangioma/patologia , Neoplasias Vasculares/patologia , Idoso , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Humanos , Ultrassonografia , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/cirurgiaRESUMO
BACKGROUND AND AIM OF THE STUDY: Clinical and echocardiographic results were investigated to evaluate mitral valve repair in patients undergoing coronary artery bypass grafting (CABG) for ischemic cardiomyopathy (ICM) with moderately severe mitral regurgitation (MR). METHODS: A total of 78 patients (21 women, 57 men; mean age 69.5 +/- 7.8 years) with ischemic mitral regurgitation underwent mitral valve repair and CABG. The mean left ventricular ejection fraction (LVEF) was 42.4 +/- 12.4%. Among the patients, 19 (24.4%) had preoperative congestive heart failure (CHF). This surgery constituted a second such operation in five patients (6.4%). The MR was grade 3+ in 28 patients (35.9%) and 4+ in 50 (64.1%). The mean number of grafts was 3.6 per patient. RESULTS: Hospital mortality was 11.5% (n = 9). Risk factors for early mortality were preoperative NYHA class > or = III (p = 0.014), preoperative heart failure (p <0.001) and reoperation (p = 0.002). The five-year survival was 82.6 +/- 5.9%, and freedom from grade > or =2+ MR was 93.1 +/- 4.1%. Postoperatively, 66 patients (89.6%) were in NYHA class I and seven (9.4%) in class II, demonstrating a statistically significant improvement (p = 0.03). Late echocardiography showed a significant improvement in LVEF (from 42.4 +/- 12.4% to 51.7 +/- 10.9%; p = 0.01) and a reduction in pulmonary artery pressure (from 37.6 +/- 11.9 mmHg to 29.3 +/- 7.4 mmHg; p = 0.004). CONCLUSION: It is concluded that in patients with ICM, mitral valve repair combined with CABG provides a dramatic improvement in ejection fraction and in CHF, with excellent long-term survival, even in patients with a low LVEF.
Assuntos
Cardiomiopatias/cirurgia , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatias/complicações , Doença da Artéria Coronariana/complicações , Ecocardiografia Doppler , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
De Paulis and associated introduced a new aortic root conduit for valve-sparing operation. The use of this prosthesis for David I (reimplantation) procedure occasionally may be problematic when the top of the commissures, do not match the new sinotubular junction of the graft. We propose a simple method that allows to create a new sinotubular junction at the desired level in the skirt portion of the Valsalva prosthesis.
Assuntos
Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Síndrome de Marfan/cirurgia , Seio Aórtico/cirurgia , Aorta/patologia , Aneurisma Aórtico/patologia , Prótese Vascular , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Síndrome de Marfan/patologia , Pessoa de Meia-Idade , Polietilenotereftalatos , Desenho de Prótese , Reimplante/métodos , Seio Aórtico/patologia , Técnicas de SuturaRESUMO
Aortic arch replacement extended to the ascending and/or descending thoracic aorta with a single vascular graft may cause kinking of the prosthesis. We propose an artifact to obtain a curved prosthesis from a straight one for total aortic arch replacement without the risk of kinking.
Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Aterosclerose/cirurgia , Prótese Vascular , Idoso , Aneurisma da Aorta Torácica/complicações , Doenças da Aorta/complicações , Doenças da Aorta/cirurgia , Aterosclerose/complicações , Humanos , Masculino , Desenho de PróteseRESUMO
Redo sternotomy is a challenging surgical procedure performed with increasing frequency; catastrophic hemorrhage is a rare but highly lethal complication. We report our experience in treating this complication in 3 cases of 307 reoperations and propose a simple method to control catastrophic hemorrhage during sternal reentry.
Assuntos
Hemostasia Cirúrgica/métodos , Toracotomia/efeitos adversos , Idoso , Perda Sanguínea Cirúrgica , Feminino , Humanos , Masculino , Reoperação/efeitos adversosRESUMO
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.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Prolapso da Valva Mitral/cirurgia , HumanosRESUMO
A 44-year-old woman with a history of transient ischemic attack underwent closure of atrial septal defect with a 26 mm Amplatzer device. The device was released without residual shunt or impingement on intracardiac structures. Within seconds, the transesophageal echocardiography showed the initial dislodgement of the device from the atrial septum and its consequent slipping back into the right atrium close to the tricuspid valve. Soon after the device disappeared from the right atrium and it could be founded into the right ventricle under the tricuspid valve. The patient was transferred in the operating room for an emergency operation. The device could not be found in the right ventricle because its downstream migration. The Amplatzer septal occluder was identified by palpation into the pulmonary artery trunk: it was retrieved from the right ventricle through the pulmonary valve and the atrial septal defect was closed by running suture.
Assuntos
Migração de Corpo Estranho/cirurgia , Comunicação Interatrial/cirurgia , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Adulto , Ecocardiografia Transesofagiana , Falha de Equipamento , Feminino , Comunicação Interatrial/diagnóstico por imagem , Humanos , Embolia Pulmonar/diagnóstico por imagemRESUMO
Renal carcinoma extending into the inferior vena cava can be excised with a good early-term and long-term prognosis. Cardiopulmonary bypass and deep hypothermic circulatory arrest are used to resect intracardiac extension of the tumor. We propose antegrade selective cerebral and cardiac perfusion associated with systemic circulatory arrest to protect the brain and the abdominal viscera while obtaining a bloodless surgical field for tumor thrombus removal.