Objective: Cardiac myxoma usually presents during early adulthood. There is generally a tendency for prompt surgical resection. However, advanced age of patients presenting with this disease may increase the operative risk due to other cardiac and non-cardiac problems. Therefore, we evaluated elderly patients who underwent surgery for myxoma to review the management of treatment.
Methods:Between September 1985 and March 2012, a total of 17 consecutive patients over 65 years of age (5 male, 12 female; mean age: 69.3±3.5 years) who had undergone surgical resection for cardiac myxoma were analyzed retrospectively. Echocardiography had been performed in all patients to diagnose the myxoma and evaluate other cardiac pathologies. Coronary angiography had been performed in all patients except in two cases who underwent emergency surgery.Results: Thirteen patients (76.4%) survived the operation. Two patients who underwent emergency operation died early and four patients died during the follow-up time. Concomitant procedures included coronary artery bypass grafting in two, radiofrequency ablation in one, mitral valve reconstruction in one and femoral embolectomy in one patient.
Conclusions:In an era of aging population, myxoma tends to be diagnosed more frequently in elderly and high-risk patients. Complete preoperative assessment of these patients is a more appropriate approach in stable patients than the traditional emergency surgery applied to all cases.Keywords: Coronary angiography, echocardiography, myxoma, older age
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İleri yaş hastalarda kardiyak miksomanın cerrahi tedavisiAmaç: Kardiyak miksoma genellikle erken erişkinlikte ortaya çıkar ve tanı sonrası hızlı bir şekilde cerrahi rezeksiyon yapılmaya eğilim vardır. Bununla beraber, daha ileri yaşlarda bu hastalığa maruz kalan hastalarda, cerrahi risk eşlik eden diğer kardiyak ve non-kardiyak rahatsızlıklardan dolayı daha yüksek olabilir.Bu nedenle, kardiyak miksoma nedeniyle cerrahi rezeksiyon yapılan yaşlı hastalarımızı, tedavi yönetimle-rini gözden geçirmek için değerlendirdik.Yöntemler: Eylül 1985-Mart 2012 arasında kardiyak miksoma nedeniyle ameliyat edilen 65 yaş üzerindeki ardışık 17 hasta (5 erkek, 12 kadın; ortalama yaş, 69.3±3.5 yıl) retrospektif olarak analiz edildi. Tüm hastalara miksoma tanısı ve diğer kardiyak defektlerin saptanması için ekokardiyografi yapıldı. Acil olarak opere edilen iki hasta dışında tüm hastalara koroner anjiyografi yapıldı. En çok gözlenen semptom dispneydi (%70.5), atriyal fibrilasyon 5 hastada gözlendi (%29.4). Sistemik embolizasyon 7 hastada vardı (%41.1). Tüm tümörler sol atriyumdan köken almışlardı.
Bulgular:Operasyon sonrası hayatta kalan hasta sayısı 13 (%76.4) idi. Acil olarak operasyona alınan iki hasta da erken dönemde kaybedildi. Takip esnasında 4 hasta kaybedildi. Eş zamanlı olarak iki hastaya koroner arter baypas cerrahisi, 1 hastaya radyofrekans ablasyon, 1 hastaya mitral kapak onarımı ve 1 hastaya da femoral embolektomi yapıldı.Sonuç: Yaşlanan toplumda, miksomanın daha yaşlı ve yüksek riskli hastalarda ...
The treatment of the massive pulmonary embolism concomitant hemodynamic instability in pregnancy is difficult and controversial and carries a high risk for both the baby and the mother. The catheter-directed thrombectomy with or without extracorporeal membrane oxygenation support may be a suitable management strategy in suitable cases but pregnancy-related complications may follow the treatment of pulmonary embolism and atypical hemolytic uremic syndrome should be considered in the differential diagnosis. We present a case of a 32-year-old patient who had a pulmonary embolism with shock in the 8th week of pregnancy complicated by atypical hemolytic uremic syndrome.
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