Cardiac myxoma is the most common benign tumor of the heart. It presents with a variety of clinical signs and symptomatology making diagnosis frequently quite a challenge. We review our experience with 41 patients who underwent surgical intervention for cardiac myxoma between 1994 and 2011. All patients' preoperative, intraoperative and postoperative characteristics were recorded. They all had a standard sternotomy and cardiopulmonary bypass with cardioplegic cardiac arrest and were followed up with clinical examination and echocardiography. The surgical goal was to remove not only the tumor but the whole area of attachment to prevent recurrence. Biatrial approach facilitated the complete excision of the tumor. Surgical excision of cardiac myxoma carries a low-operative risk and gives excellent short- and long-term results.
We are reporting the successful surgical treatment of a 23-year-old female with a giant right coronary artery to coronary sinus fistula. This woman had complaints of chest pain and dyspnea on exertion for few months. Transthoracic echocardiography (TTE) showed a large tortuous right coronary artery and a dilated coronary sinus. Preoperative multi-detector computed tomography (MDCT) coronary angiography and cardiac catheterization confirmed the diagnosis of a right coronary artery to coronary sinus fistula. The patient underwent surgical closure of the fistula and division of the communication between the right coronary artery and the coronary sinus with the use of cardiopulmonary bypass. The patient was discharged home on postoperative day 5 and at one-year follow-up is symptom-free.
Ascending aorta and proximal aortic arch replacement with brief duration of deep hypothermic circulatory arrest combined with retrograde cerebral perfusion is a safe method with acceptable short- and long-tem results.
Myxoma is the most common primary cardiac tumor and is usually located in the left atrium. Clinical manifestation relies in large part on the size, location, and architecture of the tumor. There are many reports in the literature of cardiac myxomas causing syncope, embolism, even myocardial infarction. We present a rare case of a patient who underwent urgent surgical resection of a large left atrial myxoma mimicking mitral stenosis. The postoperative course of the patient was uncomplicated. One year after surgery, the patient is asymptomatic and disease-free.
Surgical reconstruction of the LMCA is a safe and effective treatment for left main stenosis. Re-institution of normal blood flow through the left main coronary artery possibly confers advantages over bypass surgery.
Patient: Male, 74
Final Diagnosis: Heparin-induced thrombocytopenia (HIT)
Symptoms: Chest discomfort
Medication: Heparin
Clinical Procedure: Angioplasty and bypass surgery
Specialty: Cardiology
Objective:
Adverse events of drug therapy
Background:
Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin therapy, characterized by thrombocytopenia and high risk for venous and arterial thrombosis.
Case Report:
We report an unusual case of acute stent thrombosis secondary to delayed HIT. A 74-year-old man with non-ST-segment elevation myocardial infarction had a coronary angiography which revealed 2-vessel disease. A bolus of unfractionated heparin (UFH) was administered at admission and he received fondaparinux during his hospitalization. We performed elective percutaneous coronary intervention (PCI) with stents to LAD and LCx. Two hours after PCI, the patient developed acute pulmonary edema, and repeat angiography revealed an occlusive thrombus in the ostial LAD and the LCx. A turbidimetric assay for the rapid detection of plasma anti-PF4/heparin antibodies was negative. After repeated unsuccessful attempts of balloon angioplasty and continuous thrombosis, the patient was transferred for emergency surgical revascularisation and was treated with additional UFH followed by enoxaparin. Platelets decreased gradually to 38 k/μl 7 days after surgery, at which time enoxaparin was replaced with fondaparinux. The subsequent HIT test results were positive.
Conclusions:
HIT should be considered in patients with multiple recent exposures to anticoagulants, independent of the platelet count, if there are signs and symptoms of thrombosis.
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