A case of severe, chronic hypothermia (bodytemperature 21.4"C) was successfully treated by means of extracorporeal circulation containing heat-exchanger and oxygenator. Thoracotomy was avoided. As far as we know, this is the first patient to survive such a low temperature without any residual disability. Scand Cardiovasc J Downloaded from informahealthcare.com by University of Otago on 12/26/14 For personal use only. Scand Cardiovasc J Downloaded from informahealthcare.com by University of Otago on 12/26/14 For personal use only.

Johansson, L., Kugelberg, J. & Thulin, L. Myxofibrosarcoma in the left atrium originally presented as a cardiac myxoma with chondroid differentiation. APMIS 97: 833-838. 1989.Malignant cardiac tumours located on heart valves are very rare. We report on a myxofibrosarcoma originally presented as a cardiac myxoma (CM), partly with chondroid differentiation, located on the posterior leaflet of the mitral valve. The tumor recurred twice, the first time disguised as a CM with only minor components of myxofibrosarcoma, and finally metastazised as a myxofibrosarcoma. Patient survival (40 months from first surgery) was surprisingly long and this may well reflect both the effectiveness of the combined radiation and cytostatic treatment and the histopathological features of the tumor.

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Late cardiac tamponade is a rare but serious complication following open-heart surgery. It occurred in 9 (0.8%) of 1 094 consecutive patients 6 to 13 (median 8) days after operation. Six patients had undergone valve replacement and three coronary bypass surgery. All were on anticoagulant medication postoperatively (median TT index 7%). Early symptoms of cardiac tamponade were nausea and general malaise (present in all 9 cases), whereas classical signs of tamponade such as arterial hypotension and distended neck veins appeared late. The cardiac silhouette was radiographically enlarged in all cases, but this finding was seldom diagnostic. Computed tomography gave the surest diagnosis and permitted quantitative assessment of the fluid in the pericardium. Pericardial needle puncture was effective in temporarily relieving the tamponade, but insertion of a tube by the subxiphoid approach gave definitive drainage.

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