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Objective: Risk factors of abdominal complications after cardiac surgery are largely unknown. We undertook this study to determine different types of abdominal complications after cardiac surgery and to identify patients at risk., Patients and Methods: 3312 adult patients were operated between Jan. 91 and Oct. 95 (2352 males, 960 females, 62.6 +/- 0.18y). We included all patients who suffered from abdominal complications within 30 days postoperatively., Results: Abdominal complications are rare after cardiac surgery using cardiopulmonary bypass (CPB) (1.4%), but they are associated with high mortality (14.5%) in our department. Abdominal complications like paralytic ileus (43.8%), erosive gastritis (22.9%) and gastrointestinal bleeding (18.8%) are more often, compared with acute cholecystitis (14.5%), acute pancreatitis (8.3%) and intestinal ischemia (19.5%). Patients with intestinal ischemia are at high risk and do have a high mortality (83%). Abdominal complications can be found more often in connection with prolonged myocardial ischemia and valve replacement or combined operations. Prediction of complications on the basis of anamnestic data alone was not possible., Conclusion: Abdominal complications after cardiac surgery, especially intestinal ischaemia, are life-threatening. Prediction of abdominal complications is impossible. We have to concentrate on an early diagnosis and therapeutic intervention to lower mortality. A close cooperation between cardiac and general surgeons is mandatory for a successful treatment of life-threatening abdominal complications such as intestinal ischemia.

Type and frequency of abdominal complications after open heart surgery are described. Out of 3,312 patients, 48 patients (1.4%) developed early postoperative abdominal complications with a mortality rate of 14.5%. Paralytic ileus, erosive gastritis and gastrointestinal hemorrhage were the most frequent complications, whilst intestinal ischemia, acute cholecystitis and acute pancreatitis were less frequently observed. The comparison of the frequency of abdominal complications in cardiac surgery patients with the same complications in other operated patients showed no significant difference (hi-square test), with the exception of COLD which was more frequent in the group with abdominal complications. No association was found between perioperative treatment with aprotinine and the development of abdominal complications.

History and Clinical Findings: A 32-year-old man of Albanian descent had for ten years been complaining of pain over the apex of the heart with gradually increasing dyspnoea. He was hospitalised because of an acute duodenal ulcer., Investigations: Clinical and biochemical examinations were within normal limits. Computed tomography and magnetic resonance imaging revealed a myocardial tumour in the right ventricle, 4 x 3 x 3 cm., Treatment and Course: A primary myocardial tumour of unknown malignancy was suspected, but at surgery it was found to be an echinococcal cyst, which was resected. Echinococcal antigen titre, first measured postoperatively, was positive (ELISA and IHA tests). Albendazole was administered (50 mg/kg daily) to prevent recurrence. The patient was still symptom-free two years postoperatively., Conclusion: Echinococcal cyst should be considered in the differential diagnosis of cardiac tumour. If untreated the condition may be fatal. Resection under cardiopulmonary bypass with cardioplegia, as in this patient, carries a low risk and is therefore the treatment of choice.