A 12-year-old boy with an intramural hydatid cyst of the heart is presented. In hydatid disease the incidence of cardiac cyst localization is less than 2%. The cyst was successfully excised by open heart surgery.
Coronary arterial stenoses impose a constraint on the delivery of cold cardioplegic solutions conventionally perfused via the aortic root, resulting in uneven myocardial cooling and protection. Therefore the hearts undergoing coronary bypass operations show impaired cooling of the post-occlusive myocardial regions, and temperature gradients among different myocardial fields are registered after cold cardioplegic perfusion. We applied retrograde coronary sinus perfusion of cold cardioplegic solution in canine hearts with occluded multiple left coronary arterial branches to overcome the above-mentioned drawbacks, and a uniform left ventricular cooling was demonstrated by this technique.
Routine use of open mitral commissurotomy in all cases of rheumatic mistral stenosis is the recommended treatment of choice in recent years. Effective division of the subvalvular apparatus (chordae tendineae and papillary muscles) can be accomplished easily during open commissurotomy and therefore recurrences after the open approach is less than the recurrences after closed commissurotomy. These subvalvular elements can not be freed easily during closed mitral commissurotomy. Low mortality rates after open approach suggests that this operation can be performed safely in cases of MS. Open approach has several advantages versus closed commissurotomy. We believe that closed commissurotomy should be replaced by open commissurotomy in all cases of MS.
Fontan operation and its modifications are used for the physiological correction of complex congenital heart malformations with functionally single ventricle. Atrial natriuretic peptide (ANP), a physiological diuretic and vasodilator that--together with the effects of cardiopulmonary bypass--plays an important role in the augmentation of capillary permeability in Fontan patients. The rise in right atrial pressure and wall stress is an important stimulus for the release of ANP. ANP levels were measured before and early after surgery in Fontan group (n = 20) and control group (n = 20, patients with simple cardiac defects) to study its influence on and association with mean right atrial pressure, pulmonary vascular resistance (PVR), systemic vascular resistance, amount of drainage during early and late postoperative period, duration of intensive care unit and hospital stay, and need for colloid supplement. Early postoperative ANP values showed a negative correlation with PVR (r = -0.55) and total drainage (r = -0.88). There was no significant change in ANP during surgery or in the postoperative period in control patients. Reduction of PVR and maintenance of efficient urine output are important in the management of Fontan circulation. We conclude that high levels of ANP measured early after Fontan operation can be used as a marker for the successful establishment of Fontan circulation in patients with complex congenital heart defects.
In the mixed types of total anomalous pulmonary venous connection, pulmonary veins frequently show an opening at the supracardiac and cardiac level. Rarely, some other combinations of mixed type cases have been reported in the literature. In the present case the right and left pulmonary veins formed two distinct venous chambers and showed supracardiac and infracardiac openings. Anastomosis of each of these common venous chambers was performed to the left atrium, separate from each other, by extracardiac approach. The patient had no hemodynamic problems in the postoperative period and showed no pulmonary venous obstruction in a control angiography performed after 9 months. He has not needed medication and has shown no limitation of activity during a follow-up of 6 years.
Aneurysms of the left atrium or its appendage are uncommon. Some occur with an intact pericardium and others are associated with a pericardial defect. The majority of patients are asymptomatic, but dysrhythmias and systemic embolism may occur. The condition should be suspected after chest radiography but can only be confirmed by angiocardiography. Resection is advised with cardiopulmonary bypass standing by. A patient with an intrapericardial aneurysm of the appendage correctly diagnosed by angiocardiography and successfully treated by simple excision is described.