Search

Primary spindle cell sarcoma of the heart is a rare malignant tumor of the heart. A 65-year-old woman was admitted under our care with complaints of shortness of breath. Echocardiogram showed pedunculated mass in the left atrium. Cardiac magnetic resonance imaging done elsewhere had confirmed a left atrial tumor. No further investigations were considered with a diagnosis of left atrial myxoma. She underwent total excision of the tumor: mitral valve involvement necessitated a repair all of which was done under cardiopulmonary bypass. Histopathology showed a primary spindle cell sarcoma. In view of histology, chemotherapy was planned and initiated. A month after surgery, she presented again with a recurrence.

BACKGROUND: We previously reported that there was no significant difference at 30 days or at 1 year in the rate of the composite outcome of death, stroke, myocardial infarction, or renal failure between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). We now report the results at 5 years (the end of the trial). METHODS: A total of 4752 patients (from 19 countries) who had coronary artery disease were randomly assigned to undergo off-pump or on-pump CABG. For this report, we analyzed a composite outcome of death, stroke, myocardial infarction, renal failure, or repeat coronary revascularization (either CABG or percutaneous coronary intervention). The mean follow-up period was 4.8 years. RESULTS: There were no significant differences between the off-pump group and the on-pump group in the rate of the composite outcome (23.1% and 23.6%, respectively; hazard ratio with off-pump CABG, 0.98; 95% confidence interval [CI], 0.87 to 1.10; P=0.72) or in the rates of the components of the outcome, including repeat coronary revascularization, which was performed in 2.8% of the patients in the off-pump group and in 2.3% of the patients in the on-pump group (hazard ratio, 1.21; 95% CI, 0.85 to 1.73; P=0.29). The secondary outcome for the overall period of the trial - the mean cost in U.S. dollars per patient - also did not differ significantly between the off-pump group and the on-pump group ($15,107 and $14,992, respectively; between-group difference, $115; 95% CI, -$697 to $927). There were no significant between-group differences in quality-of-life measures. CONCLUSIONS: In our trial, the rate of the composite outcome of death, stroke, myocardial infarction, renal failure, or repeat revascularization at 5 years of follow-up was similar among patients who underwent off-pump CABG and those who underwent on-pump CABG. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294 .).

Patients with infrarenal abdominal aortic aneurysm with unfavorable anatomy for endovascular aneurysm repair have to undergo open surgical repair. Open surgery has its own morbidity in terms of proximal clamping and declamping, bleeding and prolonged hospital stay and mortality. We present two such patients with juxtarenal abdominal aortic aneurysm who underwent open surgical repair. The proximal aortic control during open surgical repair of the aneurysm was achieved by endoaortic balloon occlusion technique.

The TTK Chitra prosthetic Heart Valve (CHV) is the first heart valve manufactured in India and has been in use since 1992. This study was aimed to document the ten year outcome of patients who underwent valve replacement with CHV. All patients who underwent valve replacement with the CHV (n = 65) between January 1992 and December 1995 in our institution were included. Postal communication was sent to review them. Forty three patients responded. Follow up included clinical evaluation, PT/INR estimation and echocardiography evaluation. The age ranged from 8 to 62 yrs. The male to female ratio was 1.6:1. Of 65 patients, 58.5% (38 patients) underwent mitral valve replacement, 29.3% (19 patients) underwent aortic valve replacement and 12.3% (8 patients) underwent double valve replacement. There was no hospital mortality. The long-term mortality rate was 20.9% (9 patients). Two patients (4.6%) had valve thrombosis, 2 patients (4.6%) had prosthetic valve endocarditis, 1 patient (2.3%) had myocardial infarction and 1 patient (2.3%) had low cardiac output secondary to severe left ventricular dysfunction. The cause of death in the remaining 3 patients (6.9%) could not be ascertained. No structural complications were noted in this group of patients. CHV has good haemodynamics with no structural failure and acceptable thromboembolic levels. The valve is cost effective, easily available and user friendly. The valve consequently is the valve of choice in a large number of centres dealing with rheumatic heart disease in the lower socio-economic strata of society.

Primary cardiac tumors are rare with an incidence of 0.0013 and 0.03% in collected autopsy series. 75% of primary cardiac tumors are benign. In adults 50% of benign cardiac tumors are myxomas. This report summarizes our 22 year experience with cardiac myxomas. Aim of our study was to analyse the presentation of myxoma and review the short and long term outcome after myxoma excision. During the years 1986 to 2007, 32 patients were operated for myxoma.13 male (40.7%) and 19 female (59.3%) within an age range of 16 to 72 years, underwent surgical excision of primary or recurrent intra cardiac tumors. Seven patients (21.87%) presented with obstructive symptoms and 12 patients (37.55%) with embolic manifestations. In the embolic group, five patients (41.6%) had peripheral artery embolism and six (50%) had a cerebrovascular event and one presented with Left Pulmonary Artery embolism (8.33%). Twenty two patients (72.2%) had left atrial myxoma, eight patients (22.2%) had right atrial myxomas and two patients (5.5%) had biatrial myxomas. Two of the left atrial myxomas (6.25%) were recurrent lesion. The Surgical management was complete wide excision on Cardio pulmonary bypass. There were no early deaths. Twenty seven patients are on regular follow-up in class I symptoms with no documented recurrences. Obstructive symptoms is the common mode of presentation followed by embolic manifestation. Trans-thoracic echocardiography, supplemented by trans esophageal echocardiography when necessary forms the mainstay of diagnosis. Surgical excision of atrial myxoma gives excellent short term and long term results.

Solitary fibrous tumors are rare mesenchymal tumors accounting for

Primary osteosarcoma arising from the ribs is very rare. An unusual case of a primary chondroblastic osteosarcoma of the rib in a 30-year-old woman is described here. The patient underwent wide excision of the tumor along with the involved rib, followed by chemotherapy. Although clinically unsuspected in this unusual site, pathology confirmed a completely resected chondroblastic osteosarcoma.

Background The Chitra TTK heart valve has been in use at G.K.N.M. Hospital, Coimbatore, as the valve of choice. Initially this valve was used as part of a multi-centric trial and later it was the valve of choice in our institution.

Idiopathic pulmonary artery aneurysms are rare and need a multidisciplinary approach to diagnosis and treatment. Surgery is the treatment of choice, especially when the aneurysms are large and when they are associated with pulmonary regurgitation. This report highlights a case in which successful surgical repair preserved the native pulmonary valve after pulmonary artery reconstruction.

Received 18/12/06; Review Completed 01/06/07; Accepted 29/06/07. Ms. S, an 18-year-old, underwent a ventricular septal defect closure, infundibular resection and an aortic valve replacement using a 9A Starr Edwards Ball valve prosthesis model number 1260 in 1987. She subsequently married, had two children and was lost to follow up. She presented to us in January 2005 with a history of fevers, rigors and chills following dental extraction. Based on an echocardiogram at an outside institution, her aortic valve had vegetations and a diagnosis of prosthetic valve endocarditis was made1. An our institution, an x-ray taken revealed a mobile prosthetic valve (Fig. 1). She became haemodynamically unstable and sustained cardiac arrest. After resuscitation, she was taken to the operating room for redo surgery with femoral bypass with external cardiac massage. Sternal entry was uneventful. Aorta was clamped and with a low aortotomy antegrade blood cardioplegia was given. The aortic prosthesis had completely dehisced from the annulus, and was just held together at one point2. This was explanted along with the vegetations. The abscess cavities in the aortic root were debrided. A pericardial patch was used to reconstruct the root between the left coronary cusp and the non-coronary cusp and between the left and right cusp. The aortic valve was replaced with a 25 mm Medtronic Hall valve prosthesis using pledgeted-interrupted sutured. She was slowly weaned off cardio pulmonary bypass (CPB). Recovery was delayed due to preoperative cardiac arrest. A tracheostomy was performed for prolonged ventilation. Eventually she recovered without residual deficit and was discharged. She reported for follow up in June 2006 with normal prosthetic valve function and had minimal neurological deficit with foot drop. An interesting aspect to this case is the distinctive appearance of a mobile dehisced valve noted on chest x-ray. Early recognition of this complication necessitates emergency life saving surgery.

Background The purpose of this study is to examine our experience with aortic root replacement using composite valve grafts in patients with proximal aortic disease.